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ECT for depression – not so shocking

I grew up in the era of One Flew Over the Cuckoo’s Nest, the film that portrays electroshock therapy as a form of torture practiced by caregivers who resemble sadistic prison guards. But lately, I have come to see this treatment in a whole new light, thanks to a physician I met whose life was literally saved by the procedure.

The physician/patient (whom I’ll call Henry) is a Bay Area ophthalmologist in his 50s who came to the brink of suicide, one day finding himself at the edge of the Golden Gate Bridge. He would have jumped, were it not for a police officer who approached him with a gentle offer of help. He thought then of his children and how much it would have harmed them if he took this fatal step.

Henry was hospitalized in the locked psych ward at Stanford, seemingly beyond hope. Despair was his constant companion, despite access to myriad drug treatments. Then he met Brent Solvason, MD, a Stanford psychiatrist who specializes in electroconvulsive therapy, as the procedure is officially known. Solvason said he found ECT strange when he first began using it nearly a decade ago, but he ultimately discovered that it was clearly the quickest and most effective route to relieving major depression. I read some of the medical literature on ECT and found this to be the generally accepted view on ECT in the psychiatric community. Still, many psychiatrists are loathe to offer the procedure to patients because of the lingering stigma from the early days, when ECT was often performed without anesthesia and sometimes against the patient’s will (as portrayed in Cuckoo’s Nest).

I spent several hours with Henry as he told me the remarkable story of his recovery, bit by bit, from the suffocating fog of depression. He was very open about his feelings, a sensitive man who seemed very much in control of his life today; I found it hard to imagine that this affable, soft-spoken fellow was at one time ready to give up on life.

I also had the privilege of seeing ECT administered to several patients. I found it fairly benign, far from the scary procedure most would probably envision. The patients had small pads applied to their temples for delivering a low level of electricity, less than that used to power a light bulb. The current was delivered in a brief pulse, and the only evidence of the resulting seizure was a partly clenched fist or a tightening of the face muscles. The patients, given a short-acting anesthetic, woke up minutes later. They were a bit foggy at first, then slowly returned to full consciousness.

Henry experienced one of the common side-effects of ECT - memory loss - though in his case, the impact was severe. He lost all memory of what it was like to practice medicine and never imagined he’d ever return to the profession. How he was able to slowly regain his skills and recover from a profound depression proved to be fascinating tale.

You can read more about Henry in the latest issue of Stanford Medicine magazine.

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