Dr. Oz Show – The Shock That Could Save Your Life – Electroshock Therapy for Depression
As many people know the Dr. Oz show, did 30 minutes today on electroshock therapy. I’m going to talk a little about the Dr. Oz show’s representation of electroshock therapy and add a few additional facts.
First off, the Dr. Oz show is a source of entertainment, like anything else on TV, so he added drama that wasn’t particularly necessary. That is the way of the show, and TV, however. Specifically, the show started off with scenes of electroshock therapy being given pre-1950 which is when you see people having convulsions in the bad old days before people were anesthetized during treatments. This is not the best way to start a show that is supposed to educate about current treatment, but he does balance this later on.
The Good About the Dr. Oz Show
I was impressed really. They did do a lot of things right and they did share a lot of facts about electroshock therapy, now known as electroconvulsive therapy (ECT). What the Dr. Oz show did right:
- Represented the modern procedure accurately and even showed the procedure being performed
- Mentioned repetitive transcranial magnetic stimulation (rTMS) as an alternative therapy (rTMS uses magnetic waves rather than electricity)
- Stated that almost all insurance companies cover ECT (to the best of my knowledge this is true)
- Spoke that it should be used judiciously
- Placed it in a reasonable historical context
- Tried to reduce stigma and fear and increase awareness around the procedure
- Mentioned memory loss (twice) as a side effect
The Bad about the Dr. Oz Show on Electroconvulsive Therapy (ECT)
As with all things in life, nothing is perfect. Some things you should know that weren’t altogether accurate about the show:
- Only talked about right unilateral brief-pulse ECT – while this is considered the most modern form of ECT it is not the only type. Before getting ECT you need to know what type you are getting in order to accurately judge the risks.
- Stated that ECT “reset the chemical messengers / receptors” in the brain – the truth is we don’t know exactly how ECT works, we only know that it does. It’s likely it works in multiple ways but “resetting chemical messengers / receptors” is mostly just a simplified concept and not medically accurate or at the very least, not medically complete.
- Didn’t mention the other side effects of ECT – while memory loss is generally considered the most concerning, other side effects are also possible.
Altogether, I thought it was a good show, and if a tad flamboyant, represented ECT well but there are other things you should be aware of.
Pros and Cons of Electroconvulsive Therapy (ECT)
I’m a bit of an expert on ECT. Not only have I undergone it but I’m about three-quarters the way through of writing a book on it, so I’ve researched this area quite a bit. And while I can’t summarize a book on ECT for you in a few bullet points, here are some other things I think you should know about ECT.
Pros of Electroconvulsive Therapy (ECT)
- ECT can be fast and effective. It can work after one treatment although you’ll likely have to have between 9-12 in your first series.
- ECT works on more than 80% of people with major depression.
- ECT is mostly used for major depression and bipolar disorder and is rarely used for schizophrenia any more.
- You don’t remember having ECT as you are under a general anesthetic.
- No treatment has ever been shown more effective for depression than ECT.
Cons of Electroconvulsive Therapy (ECT)
- ECT can cause memory loss. The evidence suggests that this memory loss is specifically for the time period around the treatment but a few people have claimed greater losses of memory. – This varies with type of ECT performed.*
- Cognitive impairment – ECT typically causes cognitive impairment for the time around the treatment and it is not permanent. Six months after treatment cognitive skills have been shown to be improved, overall, after ECT. – However, this is not necessarily true for bilateral or sine wave ECT.*
- Typical side effects also include jaw and muscle pain but this is short-term.
- ECT antidepressant effects tend to be temporary so medication is needed to maintain those effects.
Overall Opinion of Electroconvulsive Therapy (ECT)
ECT is ten times less likely to kill you than childbirth and about 1000 times safer than untreated major depression (in terms of death). However, this doesn’t mean it’s for everyone. The cognitive side effects are real and of a real concern.
That being said, cognitive side effects tend to build up over time. In other words, you don’t get one treatment and then find that you have no memory. You have one treatment and likely no memory side effects; then you have two treatments and find a few side effects; and then three treatments, and a few more, and so on. Some people will go through a series and not lose any memory or find any cognitive deficits. Some people will. And you don’t know which group you’re going to fall into until you try ECT. But like I said, it’s gradual and you can stop an ECT series at any time.
ECT didn’t work for me. I did nine treatments. It was painful and I hated it. That being said, it’s a perfectly appropriate treatment for some people in some cases. I really believe it is something to be considered by people who:
- Need a fast antidepressant action
- Have failed multiple treatments
This doesn’t mean I think people should run out and get it, but it does mean I think it’s worth considering.
*Sine wave ECT is an older form of ECT that is much higher risk in terms of cognitive impairment and memory loss. Brief pulse and ultra-brief pulse ECT are now (arguably) the standard and pose much less risk. Similarly, bilateral electrode placement (one electrode over each temple) is more risky than unilateral placement. It’s important to understand the differences in these risks if you’re considering treatment. For a scientific take on this, see The Cognitive Effects of Electroconvulsive Therapy in Community Settings.
22 Responses to “Dr. Oz Show – The Shock That Could Save Your Life – Electroshock Therapy for Depression”
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Dear Tracy,
Do you have a publisher for your book? If not, we should talk. You can e-mail me offline at the address I provided.
All best,
Ian
I had ect in Sept. of 2011; I had 12 bilateral sessions which did not work. I fell into a deeper depression after the sessions to the point of suicide. I was put back on prozac which was the very first antidepressant that I had back in 1993 while going thru menopause and subsequent hospitalization for two weeks due to suicidal thoughts. I couldn’t wait for the prozac to kick in, was in bed or on the floor crying most of the time due to the emotional pain. My doctor decided to put me on viibryd (a new antidepressant) which brought me out of feeling suicidal, but had too may side-effects, mostly diarrhea which prevented me from even leaving the house, if only for a dental appointment. I slowly went off viibryd and am now on wellbutrin which I have previously taken with no side effects. I was a functional person (worked in family law as a paralegal for 10 yrs. and which I loved – now all that is gone). I am waiting for the wellbutrin to take effect but am so tired of the emotional merrygoround. I am treatment resistant and the doctor say If I don’t improve, he will hospitalize me, either in Jacksonville FL, or Maitland, FL. I don’t want to be hospitalized and hope I will soon start feeling better. I also tried TMS. but after two sessions my physcristrist died (he was only 49 yrs. old); and am now in a legal dispute to get some of my money back which I paid up front. This is the first time I have written to anyone about my ECT experiences because I don’t really want to thing about 2011 and what a painful year it was for me and my family.
Sincerely,
Lynn S. Lawrence,
Indialantic, FL
Hi Lynn,
I’m so sorry to hear of your experience. While ECT does have a very high efficacy rate, it is true that nothing will help everyone. It didn’t work for me either (although I didn’t have bilateral).
I’m not a medical professional and I’m not in a position to advise you on your treatment but will say that some people for whom antidepressants are ineffective find antipsychotics helpful. In your position, with everything you have tried, you might consider discussing that possibility with your doctor. There is also vagus nerve stimulation which is indicated for treatment-resistant depression.
I can’t say whether those would be right for you, just throwing them out there.
You will find something that works for you, don’t give up. It took a long time for me to find my first working medication, but I did, and you can too.
Good luck.
- Natasha Tracy
Dear Amy,
“It was a living nightmare for both of us (I was her full-time caregiver).”
I too have been a very, very long-time support person, health care advocate and caregiver to my spouse and I thank you for sharing from your similar perspective. I am extremely pleased and happy for both you and your Mom that you found a treatment option that has proven to be reasonably efficacious and beneficial for her needs without serious side-effects and for sharing your thoughts.
The point I wish to make clear it is fortunate that we have the choice of various treatment options although groups such as Mind Freedom or many of the participants to blog sites such as ECT.org were to have their druthers you would have not had ECT to choose from. Then again if one reads through many Internet blogs one will find advocates calling for the banning of almost each and every medication as well as alternative and/or adjunctive therapies because of unfortunate personal bad results and narrow mindedness in thinking.
These same individuals forget or simply disregard that others are benefiting from the very same treatments.
Warmly,
Herb
vnsdepression@gmail.com
http://www.vnstherapy-herb.blogspot.com
Dr. Estrada saved my mother’s life. From the age of 70-79, she was hospitalized roughly three times a year. She was suffering from catastrophic depression that manifested as intractable stomach pain accompanied by, at various points, auditory hallucinations, a belief that she had radiation poisoning, that she was being electrocuted by the outlets in her room, by the TV… the list goes on. There were countless suicide attempts and each time she was hospitalized, she’d be released two weeks later, meds in hand, as “cured.” It was a living nightmare for both of us (I was her full-time caregiver). In nine years, she went off her meds 43 times—and that’s with me trying to control the process! I myself have a doctorate in philosophy as well as in psychology, and am a relational self-psychologist in therapeutic practice as well as a practitioner of medical hypnosis. I consider shock treatment to be for extreme cases. No one took my mother’s depression with the full gravity it deserved, despite her history, until Dr. Estrada. And it must be remembered that, in this society, there is still a predilection to classify women past their mid-60s as hypochondriacs, or in need of attention, or as simply bored. We ran into this again and again. Older women being treated for depression are frequently infantilized. It took someone of Dr. Estrada’s diagnostic talents to see that she was a perfect candidate for shock treatment—and it worked! I got my wonderful mother back, and I got my own life back, too. The issue of temporary memory loss, particularly in the elderly when memory loss may already be present, is so insignificant when measured against the horrors of what psychotic depression really means, that I am “shocked” that anyone who has struggled with depression in their own life or with the depression of a loved one would seriously consider overlooking what is truly a miraculous treatment.
Hi Amy,
I’m glad to hear your mother experienced such success. Many people would agree with you that the small amount of memory loss is a small price to pay for the quality of life they experience after treatment.
That being said, there is always risk that the memory loss will be worse than average and I understand people not wanting to take that risk. I do agree though, it is worth careful consideration.
- Natasha Tracy
Hi Natasha.
I have only recently come accross your site and blog and think it’s great.
As I live in thre UKI did not see the show you mentioned but am glad to see that ECT is being discussed in an attemp to reduce the stigma around it.
I live with long term depression and have had ECT on more than one occasion. For me it worked well, yes there were side effects, I was a little disoriantated after each session and my memories of both hospitalizations when it was used is a bit fuzzy in places, but given the state I was in before I had the ECT, I still see that as an improvement.
I’m lucky in having a good relationship with my psychiatrist, we have discussed TMS, and I have decided that if I become that ill in the future then he will try that first before ECT and I have made an advanced directive to that effect as when I am that ill I am unable to make that descision.
Hi Natasha,
Fabulous review on the TV segment and the pros and cons of ECT.
Thanks for sharing your knowledge and research.
I’m an Aussie mental health advocate and love to hear both sides of the discussion.
Cheers,
Karen :)
Thanks Karen, appreciate it.
- Natasha Tracy
Natasha,
Nice review of the segment and discussion of ECT. I don’t know about it first-hand, but it was interesting how Dr. Oz said it, “reset the chemical messengers / receptors.” It looks like he’s thinking in terms of the chemical imbalance theory of mental illness. It seems to still be very pervasive.
Hi Meredith,
Thanks.
Yes, it struck me that he was thinking of the chemical imbalance theory. But it’s hard to know what to say to a general audience like he talks to. I’m a more technical kind of person but then, I don’t have to appeal to millions of viewers.
- Natasha Tracy
I had 16 shock treatments. The first two were unilateral. My doctor didn’t think they worked. He then moved to bilateral ECT and used 80 joules of electricity per treatment. This took 6 months. I came out of my depression. I had unexpected memory loss. I couldn’t remember how to cook my favorite dishes or drive to places I had been many times before. This ended in March of 2009. I used to read about a book a week, and I haven’t read a whole book since then, although I keep trying.
Strangely, I love to write and have been doing a great deal of it since undergoing ECT. After ECT I ended up on disability. I’m still on disability but am working part time. My income is less than half of what it used to be, but I am getting by. My 16 shock treatments cost about $20,000. Each treatment only took about 5 minutes. The doctors who perform ECT are probably making a killing. My insurance paid for it. I wish insurance would have paid for me to go on a 6 month tropical vacation instead. I’m sure that would have relieved my depression and I wouldn’t have to live with the side effects. I gave my consent for shock therapy, but I was so depressed at that point, that I wasn’t thinking clearly.
Hi Andrea,
Well if vacations cured depressions I’d be all for them but I can tell you I’ve had glorious vacations and they’ve done nothing for my bipolar depression.
I’m sorry you had such memory loss. I only had a little and that was troubling enough.
For the record, doctors do _not_ make a killing on ECT. The reason it costs so much is because it’s in a hospital and requires so much staff. Believe me, many doctors have gotten out of ECT because it isn’t worth the hassle.
Unfortunately, you experienced a common problem which is the fact that you were so depressed, you weren’t thinking clearly. That is common but what’s anyone to do in that case? Should the doctor not listen to you? Obviously _some_ treatment has to be done when you’re that depressed but if you can’t think clearly enough to pick it, who can? And how does someone know you’re not thinking clearly enough? It’s a very tough problem.
Just curious, when you doctor switched to bilateral ECT, did s/he explain the risks or did you care? (Feel free to answer or not.)
- Natasha Tracy
I don’t trust the psychiatrist who treated me. I was referred to him by another psychiatrist for ECT. He did explain the risks of bilateral ECT very briefly. I felt a lot of pressure to continue treatment both from him and from my family. It is very hard to stand up for yourself when you are depressed, unable to work, and being cared for by others. If you refuse a treatment, people think you don’t care about getting well. I can’t remember all of the details. My memory of the 6 months I received ECT is very hazy. I am not antipsychiatry, but I am pretty much anti ECT for me.
Hi Andrea,
I think it’s really hard to trust a doctor, especially one that is doing something so possibly risky as ECT. And like you said, you often get referred to someone – which is good as they are a specialist in ECT – but unfortunately it means you don’t have a rapport with them.
I can understand the pressure. Thankfully, I didn’t feel any and I stopped after 9 treatments because it wasn’t working. I could have switched to bilateral but I considered the risks too high and people, the doctor included, understood that decision. You’re right, it’s very hard to stand up for yourself when you’re sick. Most of us need strong advocates to do some of the work because we just aren’t able to ourselves. I recommend people go into ECT with a plan, ie, what you do or don’t want before you start so people know. You can change you mind, of course, but thinking about it ahead of time, I think, is a good idea.
I’m not sure I would do it again either. I completely understand being anti-ECT for you. That’s an entirely reasonable position for any given person. No treatment is right for everyone.
- Natasha Tracy
Hi Natasha,
Thanks for another blog well done by you.
More importantly as opposed to many of the Internet blogging sites I’ve come to read through the years is your ability to present a more balanced and unbiased perspective of controversial subject matter.
Bravo to you and your efforts to inform reasonably.
Warmly,
Herb
vnsdepression@gmail.com
http://www.vnstherapy-herb.blogspot.com
Thanks for the high compliment, Herb. I do try.
- Natasha Tracy
I wrote on ECT awhile back in anticipation of FDA Hearings http://www.huffingtonpost.com/dj-jaffe/fda-may-let-religion-and-_b_803051.html
Yes, of course the FDA didn’t decide much at all. They pretty much just stalled. But the data that came out of the meeting was really valuable.
- Natasha
And also I thought it was a preferred treatment for elderly who can’t tolerate strong meds. Yes? No? tx
You know more than me. I thought the 80% success rate he quoted was likely overstated, but don’t have research to back that up. Thoughts? I also thought that ECT was a preferred treatment for pregnant women who don’t want to ingest medications. Is that still true? Thanks.
Hi DJ Jaffee,
Success rate varies depending on what you’re treating, but the number really is near 80% in the treatment of depression according to the major literature review conducted by the FDA last year. Catatonia actually has an even higher success rate.
ECT is often preferred during pregnancy and in the elderly, you’re correct about that due to the difficulties in medicating those populations. I will say though, research on these populations is scarce.
- Natasha Tracy