A charged debate: ECT versus Deep Brain Stimulation (Part One)

This morning I’ve been on a complex and fascinating odyssey – inside the brain.

It all started with Deep Brain Stimulation (DBS) and how it compares to Electroconvulsive Therapy (ECT), commonly known as “Shock Treatment.”

That was my assignment – based on a story posted on Healthzone.ca and in print earlier this week by Star Health Writer Megan Ogilvie. It covered a tiny Toronto Western Hospital trial of 20-patients with intractable depression who underwent DBS.

DBS was originally developed to treat Parkinson's Disease. It's a relatively new and highly invasive treatment involving surgically inserting a pacemaker-like battery into the chest that pumps electrical currents through electrodes that have been drilled deep into the brain.

Somehow, no one knows exactly how or why, these currents rejig the brain’s chemistry and alleviate severe depression – the deep, dark, deadening depression that necessitates hospitalization and doesn’t respond to any other treatments — drugs and ECT. It's not that common.

A year after surgery, 7 of the 20 patients in this trial were still symptom-free. Others, reported significant improvements.

Okay. Let’s rewind a little bit, and talk about ECT - Electroconvulsive Therapy. Shock Therapy.

ECT has been around for decades, since the 1930s. It’s still used today, because it works.

However, today’s ECT is not the same as the original ECT of the 1930s in Germany Italy (corrected August 5), where it was invented.

Like a 1908 Model ‘T’ Ford and a 2008 Shelby GT500 – both are automobiles. Both Fords. Both transport you from Point A to Point B. But the resemblance pretty well ends there.

So it is with ECT.

Today, ECT is more streamlined, sensitive and safer than its earlier predecessors. It delivers a less bumpy ride. It’s administered with more care and compassion for the patient and the risks are minimized.

But it still does the basically the same thing. It causes a mild convulsion in the brain which somehow helps ease depression and mania or psychosis. Faster, more efficiently, and with fewer side effects than medication.

It’s not DBS, but it’s often tried before DBS is even considered. If ECT doesn’t work – and many treatments are usually administered first – if medications don’t work, then other options are considered. One of them, the newest, may be DBS, which is still undergoing trials.

Before we go any further, let’s take a little detour to Hollywood.

Psychiatry has always held a fascination for movie makers, though rarely is it accurately or fairly portrayed.

That’s certainly the tragic case with ECT because Hollywood has strongly influenced the public perception of a treatment that for many years has proven its effectiveness.

Think Milos Forman’s 1975 film adaptation of Ken Kesey’s 1962 novel One Flew Over The Cuckoo’s Nest.

ECT is laced with intense often irrational emotion. Milos Forman’s film stoked that fear, especially as protagonist Patrick McMurphy (Nicholson) has a barbarically administered ECT treatment, which doesn’t faze him. In the end, however, his irrepressible spirit is permanently suppressed with a frontal lobotomy.

In the minds of the 1975 movie-going public (and to this day), this legendary, Oscar-award winning film and it’s portrayal of ECT and that lobotomy, I would bet my life, remain irreversibly confused and have became one and the same.

One Flew Over The Cuckoo’s Nest ignited such a powerful and pervasive surge of anti-ECT sentiment that people ever since, who may have benefitted from ECT, are petrified and often refuse to have it, though it saves lives, helps people regain their healthy lives and prevents suicide.

I’m not saying people haven’t suffered from ECT. They have. Those incidences are not recent.

In the mid-1960s and 1970s, I had about five or six courses of ECT – one course can be six to 12 treatments – at the Clarke Institute of Psychiatry, when the anti-psychotics of the day – Haldol and Chlorpromazine – didn’t work for me. Nothing was working for me.

I was severely “catatonic” or “manic” or “psychotic” — take your pick. They’re all forms of psychosis — and believe me, I was psychotic. I remember.

I’ll never forget being wheeled on a gurney into a bright, white, sterile room. Very antiseptic smelling, like a small operating room. I was hooked up to an IV and something was put into my mouth to prevent me from biting my tongue. I was anaesthetized. Out like a light.

Then I remember waking up with a mild headache which lasted about 10 minutes.

ECT helped me, when nothing else did. I did not have any side effects. If there was memory loss, I have no idea what I’ve forgotten. I seem to manage fine as a reporter where memory is a crucial tool.

Stay tuned for Part Two.

Comments

[Deep Brain Stimulation]

There are several different areas that DBS implants can be placed in order to improve mood. See the link for more information about these areas. I think deep brain stimulation will be limited in use because it requires a person to undergo risky brain surgery. Transcranial magnetic stimulation is a method of non-invasively stimulating brain areas without the need for surgery.