Medicine: Comeback for Shock Therapy?

Its unsavory reputation may be changing

The scene in which Actor Jack Nicholson receives an electric shock treatment in the 1975 film One Flew Over the Cuckoo's Nest reinforced the notion that shock therapy is a cruel and barbaric anachronism. Partially as a result of the movie, the popular image of electric shock, which had been steadily fading in the U.S., grew even dimmer. Now shock treatment is regaining popularity, defended by many psychiatrists as a safe, humane and often dramatically effective method for treating some forms of mental illness, particularly depression.

Electroconvulsive therapy (ECT) dates back to 1938, when Italian Psychiatrists Ugo Cerletti and Lucio Bini, searching for a treatment for schizophrenia, used electricity to induce convulsions in a disturbed patient. Afterward, his condition improved. In the ensuing years, ECT became a common treatment for severe psychotic illnesses, both in Europe and the U.S.

With the introduction of strikingly effective antipsychotic drugs such as chlorpromazine and imipramine in the 1950s, the popularity of shock treatment began to wane. The decline was hastened by growing worry about the safety and efficacy of ECT and by charges that it was being used excessively and indiscriminately in institutions that were little more than "shock mills." Between 1972 and 1977 in New York State, for example, use of ECT dropped by 38%. Across the nation, according to a 1978 report by the American Psychiatric Association, one-third of psychiatrists have reservations about the practice.

But dropping ECT apparently leaves a gap in the psychiatric arsenal. Neither psychotherapy nor medication seems to help 20% to 30% of people with extreme depression—those who suffer excessive weight loss, insomnia, loss of sex drive and energy, or threaten or attempt suicide. Other patients, for example, the elderly or those with heart conditions, cannot tolerate the medications. Drugs also tend to act more slowly and sometimes produce unpleasant side effects, notably tardive dyskinesia, uncontrollable facial and body contortions caused by lengthy use of antipsychotics. Says Dr. Stuart Yudofsky of the New York State Psychiatric Institute: "I'm not pushing the therapy. I don't work for the electric company.

But 80% of the depressions that do not respond to drugs do respond to convulsive therapy."

Proponents of ECT also point out that modern techniques are far removed from the horror of Cuckoo's Nest. Says Yudofsky, "The only way you physically know a seizure is taking place is that sometimes you see a finger wiggling slightly." The patient is injected with a short-acting anesthetic, then a muscle relaxant to prevent the sudden muscular contractions that in the past occasionally caused fractured bones or chipped teeth. An electrocardiogram is sometimes used to monitor the heart rhythm and oxygen is administered to prevent possible brain damage after the shock.