Electroconvulsive therapy 44093 225542477 2008-07-14T06:12:18Z Jimfbleak 7872 genuine error '''Electroconvulsive therapy''' ('''ECT'''), also known as '''electroshock''', is a controversial [[psychiatry|psychiatric]] treatment in which [[seizure]]s are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe [[clinical depression|major depression]] which has not responded to other treatment, and is also used in the treatment of [[mania]] (often in [[bipolar disorder]]), [[catatonia]], [[schizophrenia]] and other disorders. It was first introduced in the 1930s<ref>Psychology Frontiers and Applications - Second Canadian Edition (Passer, Smith, Atkinson, Mitchell, Muir)</ref> and gained widespread use as a form of treatment in the 1940s and 50s; today, an estimated 1 million people worldwide receive ECT every year,<ref>{{cite web | title=Electroconvulsive therapy discussion hosted at the MGH | url=http://www.massgeneral.org/pubaffairs/Issues2006/101306ect.htm | accessdate=2007-06-05}}</ref> usually in a course of 6-12 treatments administered 2 or 3 times a week. Electroconvulsive therapy can differ in its application in three ways; electrode placement, length of time that the stimulus is given, and the property of the stimulus. The variance of these three forms of application have significant differences in both adverse side effects and positive outcomes. In a study, ECT was shown clinically to be the most effective treatment for severe depression, and to result in improved [[quality of life]] in both short- and long-term.<ref>McCall WV, Prudic J, Olfson M, Sackeim H. Health-related quality of life following ECT in a large community sample. J Affect Disord. 2006 Feb;90(2-3):269-74. PMID 16412519</ref> After treatment, drug therapy can be continued, and some patients receive continuation/maintenance ECT. Supposed beneficial and detrimental effects include those listed later in this article. The [[American Psychiatric Association]] and the [[National Institute for Health and Clinical Excellence]] have concluded that the procedure does not cause brain damage.<ref name=brain>{{cite web | url = http://www.psych.org/research/apire/training_fund/clin_res/index.cfm | author = American Psychiatric Association | title=Electroconvulsive Therapy (ECT) | accessdate=2007-12-29}}</ref><ref name=brain2> {{cite web | url=http://www.nice.org.uk/guidance/index.jsp?action=download&o=32597 | title=TA59 Electroconvulsive therapy (ECT): Guidance | author=[[NICE]] | pages=p.13 | accessdate=2007-12-29}} </ref> Certain types of ECT have been shown to cause persistent memory loss,<ref name="sackeim cognitive"/> whereas [[confusion]] usually clears within hours of treatment{{Fact|date=April 2008}}. Informed consent is a standard of modern electroconvulsive therapy<ref>http://www.ncsl.org/programs/health/shn/2007/sn499c.htm</ref>. Involuntary treatment is uncommon in countries that follow contemporary standards and is typically only used when the use of ECT is considered potentially life saving.<ref name="surgeon">[http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec3_1.html Mental Health: A Report of the Surgeon General - Chapter 4]. Retrieved [[2007-12-29]].</ref> ==Indications== ECT is used predominantly as a treatment for severe depression. It is generally reserved for use as a second-line treatment for patients who have not responded to drugs. The first-line use of treatment is for situations where immediate clinical intervention is needed or alternative treatments are not advisable. About seventy percent of ECT patients are women.<ref name="Rudorfer"/>This is largely, but not entirely, due to the fact that women are more likely to receive treatment for depression.<ref name="Rudorfer"/><ref name="Reid"/> Older and more affluent patients are also more likely to receive ECT. The use of ECT treatment is "markedly reduced for ethnic minorities."<ref>{{cite journal |author=Euba R, Saiz A |title=A comparison of the ethnic distribution in the depressed inpatient population and in the electroconvulsive therapy clinic |journal=J ECT |volume=22 |issue=4 |pages=235–6 |year=2006 |pmid=17143151 |doi=10.1097/01.yct.0000235928.39279.52}}</ref><ref name="Reid"/> ECT is also sometimes used in the treatment of other disorders, for example, [[schizophrenia]], [[mania]], especially in [[bipolar disorder]] and [[catatonia]].<ref name="Rudorfer"/> In the US the Surgeon General's report on mental health summarised current psychiatric opinion about the effectiveness of ECT. It stated that both clinical experience and controlled trials had determined ECT to be effective (with an average 60 to 70 percent response rate) in the treatment of severe depression, some acute [[psychotic]] states, and [[mania]]. Its effectiveness had not been demonstrated in [[dysthymia]], [[substance abuse]], [[anxiety]], or [[personality disorder]]. The report stated that ECT does not have a long-term protective effect against suicide and should be regarded as a short-term treatment for an acute episode of illness, to be followed by continuation therapy in the form of drug treatment or further ECT at weekly to monthly intervals.<ref name="SG">Surgeon General (1999). [http://www.surgeongeneral.gov/library/mentalhealth/home.html ''Mental Health: A Report of the Surgeon General''], chapter 4.</ref> A large multicentre clinical follow-up study of ECT patients in New York found response rates of 30-47 percent (depending on criteria), with 64 percent of those relapsing within six months.<ref>{{cite journal |author=Prudic J, Olfson M, Marcus SC, Fuller RB, Sackeim HA |title=Effectiveness of electroconvulsive therapy in community settings |journal=Biol. Psychiatry |volume=55 |issue=3 |pages=301–12 |year=2004 |pmid=14744473| doi = 10.1016/j.biopsych.2003.09.015 <!--Retrieved from CrossRef by DOI bot-->}}</ref> A survey of New York psychiatrists found that they thought that 85 percent of their patients benefited from ECT.<ref name="Prudic 01"/> In the UK in 2003 the UK ECT Review Group, led by Professor Geddes of Oxford University, reviewed the evidence and concluded that ECT had been shown to be an effective short-term treatment for depression (as measured by [[symptom rating scales]]) in physically healthy adults, and that it was probably more effective than drug treatment. Bilateral ECT was more effective than unilateral, and high-dose was more effective than low-dose. Their conclusions were qualified: most of the trials were old and conducted on small numbers of patients; some groups (for example, elderly people, women with [[postpartum depression]] and people with treatment-resistant depression) were under-represented in the trials even though ECT is believed to be especially effective for them.<ref> The UK ECT Review Group (2003). [http://md1.csa.com/partners/viewrecord.php?requester=gs&collection=ENV&recid=5750307&q=%22Efficacy+and+safety+of+electroconvulsive+therapy+in+depressive+disorders%22&uid=791573526&setcookie=yes "Efficacy and safety of electroconvulsive therapy in depressive disorders: a systemic review and meta-analysis"]. ''Lancet'' '''361''':799-808.</ref> ==Administration== Once the decision has been made for a patient to have ECT there is usually a pretreatment evaluation that determines what factors will allow for maximum benefits and minimize risk. Informed consent is also sought before treatment. Patients are informed about the risks and benefits of the procedure. Patients are also made aware of risks and benefits of other treatments and of not having the procedure done at all. Depending on the jurisdiction the need for further inputs from other medical professionals or legal professionals may be required. ECT is usually given on an in-patient basis, although it may also be given on an out-patient basis. Prior to treatment a patient is given a short-acting anesthetic such as [[methohexital]], [[propofol]], [[etomidate]] and [[thiopental]],<ref name="Rudorfer">Rudorfer, MV, Henry, ME, Sackeim, HA (2003). [http://media.wiley.com/assets/138/93/UK_Tasman_Chap92.pdf "Electroconvulsive therapy"]. In A Tasman, J Kay, JA Lieberman (eds) ''Psychiatry, Second Edition''. Chichester: John Wiley & Sons Ltd, 1865-1901.</ref> a muscle relaxant such as [[suxamethonium]] (succinylcholine), and occasionally [[atropine]] to inhibit salivation. [[Electrode]]s are usually placed one on either side of the patient's head. This is known as bilateral ECT. Less frequently both electrodes are placed on one side of the head. This is known as unilateral ECT. In bifrontal ECT, an uncommon variation, the electrode position is somewhere between bilateral and unilateral. Unilateral is thought to cause fewer cognitive effects than bilateral but is considered less effective.<ref name="Rudorfer"/> In the USA most patients receive bilateral ECT.<ref name="Prudic 01">Prudic, J, Olfson, M, Sackeim, HA (2001). "Electroconvulsive therapy practices in the community." ''Psychological Medicine'' '''31''': 929-934. PMID 11459391.</ref> In the UK almost all patients receive bilateral ECT.<ref name="Duffett">{{cite journal |author=Duffett R, Lelliott P |title=Auditing electroconvulsive therapy. The third cycle |journal=Br J Psychiatry |volume=172 |issue= |pages=401–5 |year=1998 |pmid=9747401 |doi=}}</ref> The electrodes deliver an electrical stimulus. The stimulus levels recommended for ECT are in excess of an individual's seizure threshold: about one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT.<ref name="Rudorfer"/> Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more severe [[mental function|cognitive impairment]] without additional therapeutic gains.<ref name="Lock"/> Seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex.<ref name="Prudic 01"/> Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold. ===ECT machines=== Most modern ECT machines deliver a brief-pulse current, which is thought to cause fewer cognitive effects than the sine-wave currents which were originally used in ECT.<ref name="Rudorfer"/> A small minority of psychiatrists in the USA still use sine-wave stimuli.<ref name="Prudic 01"/> Sine-wave is no longer used in the UK.<ref name="Duffett"/> Typically, the electrical stimulus used in ECT is about 800 milliamps, and the current flows for between one and 6 seconds.<ref name="Lock">Lock, T (1995). "Stimulus dosing". In C Freeman (ed.) ''The ECT Handbook''. London: Royal College of Psychiatrists, 72-87.</ref> In the USA, ECT machines are manufactured by two companies, Somatics, which is owned by psychiatrists Richard Abrams and Conrad Swartz, and MECTA. The [[Food and Drug Administration]] has classified the devices used to administer ECT as [[Medical devices#Class III: General Controls and Premarket Approval|Class III medical devices]].<!-- --><ref>Federal Register (1979), p. 51776</ref> Class III is the highest-risk class of medical devices. In the UK the market for ECT machines was long monopolised by Ectron Ltd, although in recent years some hospitals have started using American machines. Ectron Ltd was set up by psychiatrist Robert Russell, who together with a colleague from the Three Counties Asylum, Bedfordshire, invented the Page-Russell technique of intensive ECT. "Since the mid-1980s, [[Harold A. Sackeim]] worked as a consultant to the ECT device manufacturer Mecta Corp{{Fact|date=June 2008}}. He never revealed his financial interest in ECT to the [[National Institute of Mental Health]]{{Fact|date=June 2008}}, as required by federal law{{Fact|date=June 2008}}, and, until 2002, did not reveal it to New York officials as required by state law{{Fact|date=June 2008}}. ''Neuropsychopharmacology'' has endured negative publicity over its failure to disclose financial conflicts of journal authors{{Fact|date=June 2008}}, resulting in the editor's resignation and a promise to disclose such conflicts in the future{{Fact|date=June 2008}}; yet there is no disclosure of Sackeim's long-term relationship with Mecta, nor did Sackeim disclose his financial conflict when his NIMH grant was renewed to 2009 at approximately $500,000 per year"{{Fact|date=June 2008}}. In a video of legal proceedings in 2004, Harold Sackeim says that, in exchange for consulting for Somatics Inc., he received honorarims from Somatics worth $1500.<ref name="Harold Sackeim tells NY Assemblyman he discarded responses">Author: ectorg. Web page: “Harold Sackeim tells NY Assemblyman he discarded responses.” Web site: “YouTube.” Date: July 31, 2006. Institution: YouTube, LLC . Date of access: June 6, 2008. Web address: http://www.youtube.com/watch?v=FiQCYqjalSA.</ref> In the same video, Sackeim says he disagrees with president of Somatics Richard Abrams, because 'he tends to...umm...be overly...uh...dismissive of the types of side effects ECT can have'. In another video of the proceedings, Sackeim admits that he charged Mecta $10,875, at a rate of $500 per hour, and made a deal to be a witness in defense of Mecta at trial.<ref name="Mecta money">Author: ectorg. Web page: “Mecta money.” Web site: “YouTube.” Date: July 31, 2006. Institution: YouTube, LLC . Date of access: June 6, 2008. Web address: http://www.youtube.com/watch?v=ZubwVyFmU84.</ref> ===Variations in international practice=== There is wide variation in ECT use between different countries, different hospitals, and different psychiatrists.<ref name="Rudorfer"/> International practice varies considerably from widespread use of the therapy in many western countries to a small minority of countries that do not use ECT at all, such as Slovenia.<ref>See the [http://e-uprava.gov.si/e-uprava/en/faqKategorijaVprasanje.euprava?faq.id=74&faq.vprasanje.id=328 Slovenian government website] for information about ECT in Slovenia.</ref> Guidelines on the use of ECT are stringent in the USA and the UK. Modern standards are not always followed throughout the world and not all countries that use ECT have written technical standards. The use of both anesthesia and muscle relaxants is universally recommended in the administration of ECT. If anesthesia and muscle relaxants are not used the procedure is called unmodified ECT. In a minority of countries such as Japan,<ref>{{cite journal |author=Motohashi N, Awata S, Higuchi T |title=A questionnaire survey of ECT practice in university hospitals and national hospitals in Japan |journal=J ECT |volume=20 |issue=1 |pages=21–3 |year=2004 |pmid=15087992 |doi=}}</ref> India,<ref>{{cite journal |author=Chanpattana W, Kunigiri G, Kramer BA, Gangadhar BN |title=Survey of the practice of electroconvulsive therapy in teaching hospitals in India |journal=J ECT |volume=21 |issue=2 |pages=100–4 |year=2005 |pmid=15905751 |doi=}}</ref> and Nigeria,<ref>{{cite journal |author=Ikeji OC, Ohaeri JU, Osahon RO, Agidee RO |title=[http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=10734527&cmd=showdetailview&indexed=google Naturalistic comparative study of outcome and cognitive effects of unmodified electro-convulsive therapy in schizophrenia, mania and severe depression in Nigeria] |journal=East Afr Med J |volume=76 |issue=11 |pages=644–50 |year=1999 |pmid=10734527 |doi=}}</ref> ECT may be used without anesthesia. WHO has called for a world wide ban on unmodified ECT and the topic is currently being debated in countries like India. The practice has been recently abolished in Turkey's largest psychiatric hospital.<ref>{{cite web |url=http://v1.dpi.org/lang-en/resources/topics_detail?page=557 |title=Abusive practice of "unmodified" electroshock treatment abolished at main psychiatric facility of Turkey |accessdate=2008-03-25 |publisher=[[Disabled Peoples' International]]}}</ref> A major difficulty for developing countries in eliminating unmodified ECT is a lack of trained anesthetists available to administer the procedure.<ref> {{cite web |url=http://www.expresshealthcaremgmt.com/20030531/medethics.shtml |title=Psychiatrists plead against ban of direct electro convulsive therapy |last=Dutta |first=Rita |date=2003 |accessdate=2007-12-31 |publisher=Indian Express Group of Newspapers }} </ref> A small minority of countries never seek consent before administering ECT. This significantly uneven application of ECT around the world continues to make ECT a controversial procedure. In the USA, a survey of psychiatric practice in the late 1980s found that an estimated 100,000 people received ECT annually, with wide variation between metropolitan statistical areas.<!-- --><ref name="Hermann 95">{{cite journal | author=Hermann R, Dorwart R, Hoover C, Brody J | title=Variation in ECT use in the United States. | journal=Am J Psychiatry | volume=152 | issue=6 | pages=869–75 | year=1995 | pmid=7755116}}</ref> Accurate statistics about the frequency, context and circumstances of ECT in the United States are difficult to obtain because only a few states have reporting laws that require the treating facility to supply state authorities with this information.<ref> {{cite news | first = Dennis | last = Cauchon | title = [http://www.harborside.com/~equinox/ect1.htm Patients often aren't informed of full danger] | publisher = USA Today | date = 1995-12-06 | language = English }}</ref> One state which does report such data is Texas, where in the mid-1990s ECT was used in about one third of psychiatric facilities and given to about 1,650 people annually.<ref name="Reid"> Reid, WH ''et al.'' (1998). "ECT in Texas: 19 months of mandatory reporting." ''Journal of Clinical Psychiatry'' '''59''': 8-13. PMID 9491059.</ref> Usage of ECT has since declined slightly; in 2000-01 ECT was given to about 1,500 people aged from 16 to 97 (in Texas it is illegal to give ECT to anyone under sixteen).<ref>Texas Department of State (2002) [http://www.dshs.state.tx.us/mhquality/ECT_Complete_Report_FY01.pdf Electroconvulsive therapy reports].</ref> ECT is more commonly used in private psychiatric hospitals than in public hospitals and minority patients are underrepresented in the ECT statistics.<ref name="Rudorfer"/> In the United States ECT is usually given three times a week; in the UK it is usually given twice a week.<ref name="Rudorfer"/> Occasionally it is given on a daily basis.<ref name="Rudorfer"/> A course usually consists of 6-12 treatments, but may be more or fewer. Following a course of ECT some patients may be given continuation or maintenance ECT with further treatments at weekly, fortnightly or monthly intervals.<ref name="Rudorfer"/> A few psychiatrists in the USA use multiple-monitored ECT (MMECT) where patients receive more than one treatment per anesthetic.<ref name="Rudorfer"/> In the United Kingdom in 1980, an estimated 50,000 people received ECT annually, with use declining steadily since then<ref name="Pippard">Pippard, J and Ellam, L (1981). ''Electroconvulsive treatment in Great Britain, 1980''. London: Gaskell.</ref><!--Is this the same as the Lancet article which I have added here? Can anyone confirm?--><ref>{{cite journal |author=Pippard J, Ellam L |title=Electroconvulsion treatment in Great Britain 1980 |journal=Lancet |volume=2 |issue=8256 |pages=1160–1 |year=1981 |pmid=6118592 |doi=}}</ref> to about 12,000 per annum. It is still used in nearly all psychiatric hospitals, with a survey of ECT use from 2002 finding that 71 percent of patients were women and 46 percent were over 65 years of age. Eighty-one percent had a diagnosis of mood disorder; schizophrenia was the next most common diagnosis. Sixteen percent were treated without their consent.<ref>[http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_4083142 Electro convulsive therapy: survey covering the period from January 2002 to March 2002], ''[http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/Statisticalhealthcare/DH_4000216 Statistical Bulletin 2003/08]''. Department of Health.</ref> In 2003 the [[National Institute for Clinical Excellence]], a government body which was set up to standardize treatment throughout the National Health Service, issued guidance on the use of ECT. Its use was recommended "only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode".<ref name="nice intro"> NICE 2003. [http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11494 Electroconvulsive therapy (ECT)]. Retrieved on [[2007-12-29]]. </ref> The guidance got a mixed reception. It was welcomed by an editorial in the British Medical Journal<ref>Carney, S & Geddes, J (2003). [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1126234 "Electroconvulsive therapy: recent recommendations are likely to improve standards and uniformity of use"]. ''British Medical Journal'' '''326''': 1343-4.</ref> but the Royal College of Psychiatrists launched an unsuccessful appeal.<ref>NICE (2003). [http://www.nice.org.uk/page.aspx?o=62452 Appraisal of electroconvulsive therapy: decision of the appeal panel]. London: NICE.</ref> The NICE guidance, as the British Medical Journal editorial points out, is only a policy statement and psychiatrists may deviate from it if they see fit. Adherence to standards has not been universal in the past. A survey of ECT use in 1980 found that more than half of ECT clinics failed to meet minimum standards set by the Royal College of Psychiatrists, with a later survey in 1998 finding that minimum standards were largely adhered to, but that two-thirds of clinics still fell short of current guidelines, particularly in the training and supervision of junior doctors involved in the procedure.<ref>Duffett, R and Lelliot, P (1998). [http://bjp.rcpsych.org/cgi/content/abstract/172/5/401 "Auditing electroconvulsive therapy: the third cycle"]. ''[[British Journal of Psychiatry]]'' '''172''':401-405.</ref> A voluntary accreditation scheme, ECTAS, was set up in 2004 by the Royal College, but as of 2006 only a minority of ECT clinics in England, Wales, Northern Ireland and the Irish Republic have signed up.<ref>Royal College of Psychiatrists (2006). [http://www.rcpsych.ac.uk/crtu/centreforqualityimprovement/electroconvulsivetherapy.aspx ECTAS newsletter] issue 5.</ref> Sarah Hall reports, "ECT has been dogged by conflict between psychiatrists who swear by it, and some patients and families of patients who say that their lives have been ruined by it. It is controversial in some European countries such as Holland and Italy, where its use is severely restricted".<ref name="Sarah Hall">Author: Sarah Hall. Web page: “Rise in electric shock therapy in county.” Web site: "Norwich Evening News 24.” Date: June 4, 2008. Institution: Archant Regional. Date of access: June 4, 2008. Web address: http://www.eveningnews24.co.uk/search/story.aspx?brand=ENOnline&category=News&itemid=NOED03%20Jun%202008%2012:55:17:717&tBrand=ENOnline&tCategory=search.</ref> ==Adverse effects== The physical risks of ECT are similar to those of brief [[general anesthesia]]; the United States' Surgeon General's report says that there are "no absolute health [[contraindications]]" to its use.<ref name="SG"/> Immediately following treatment the most common adverse effects are confusion and memory loss. The state of confusion usually disappears after an hour. ===Effects on cognition and memory=== It is the effects of ECT on long-term memory that give rise to much of the concern surrounding its use.<ref name="Lisanby 2000"/>The acute effects of ECT include [[amnesia]], both retrograde (for events occurring before the treatment) and anterograde (for events occurring after the treatment).<ref name="Benbow"> Benbow, SM (2004) "Adverse effects of ECT". In AIF Scott (ed.) [http://www.rcpsych.ac.uk/publications/collegereports/cr/cr128.aspx ''The ECT Handbook, second edition.''] London: The Royal College of Psychiatrists, pp.170-174. </ref> Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with sine-wave rather than brief-pulse currents. The vast majority of modern treatment uses brief pulse currents.<ref name="Benbow"/> [[Retrograde amnesia]] is most marked for events occurring in the weeks or months before treatment, with one study showing that although some people lose memories from years prior to treatment, recovery of such memories was "virtually complete" by seven months post-treatment, with the only enduring loss being of memories in the weeks prior to the treatment.<ref name="Squire">Squire, L (1981). "Retrograde amnesia and bilateral electroconvulsive therapy:long-term follow up". ''Archives of General Psychiatry'' '''38''':89-95. PMID 7458573 </ref> Later research by the same author suggested memory of events in the months prior to treatment might be lost, as well as suggesting that self-report of memory loss was in fact a problem before treatment which patients associated with it.<ref>Squire LR, Slater PC. Electroconvulsive therapy and complaints of memory dysfunction: a prospective three-year follow-up study. Br J Psychiatry. 1983 Jan;142:1-8. PMID 6831121</ref> Further reviews have supported the idea that reports of memory loss are due to somatoform disorders and not to brain damage.<ref>Fink M. Complaints of loss of personal memories after electroconvulsive therapy: evidence of a somatoform disorder? Psychosomatics. 2007 Jul-Aug;48(4):290-3. PMID 17600164</ref> [[Anterograde amnesia|Anterograde memory loss]] is usually limited to the time of treatment itself or shortly afterwards. In the weeks and months following ECT these memory problems gradually improve, but some people have persistent losses, especially with bilateral ECT.<ref name="Rudorfer"/><ref name="Benbow"/> One review of patient self-reporting found that between 29 percent and 55 percent (depending on the study) of people who had undergone ECT reported persistent memory loss.<ref name="bmj rose"> Rose, D ''et al''. (2003). [http://www.bmj.com/cgi/content/full/326/7403/1363 "Patients' perspectives on electroconvulsive therapy: systematic review"]. ''"British Medical Journal'' '''326''':1363-1365.</ref> In 2000 American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with persistent impairment for memory of public events" as compared to RUL ECT.<ref name="Lisanby 2000"> Lisanby, SH (2000). [http://archpsyc.ama-assn.org/cgi/content/abstract/57/6/581 "The effects of electroconvulsive therapy on memory of autobiographical and public events"]. ''Archives of General Psychiatry'' '''57''':581-90. PMID 10839336.</ref> A large study (250 subjects), published January 2007 by Harold Sackeim and colleagues found that some forms (namely bilateral application and sine wave currents) of ECT "routine[ly]" causes "adverse cognitive effects," including cognitive dysfunction and memory loss, that can persist for an extended period.<!-- --><ref name="sackeim cognitive">Sackeim, HA ''et al.'' (2007). [http://www.nature.com/npp/journal/v32/n1/pdf/1301180a.pdf "The Cognitive Effects of Electroconvulsive Therapy in Community Settings."] ''Neuropsychopharmacology'' '''32'''(1):244-254. PMID 16936712.</ref> Formal neuropsychological testing has documented permanent neuropsychological deficits in patients who receive certain types of ECT treatment,<!-- --><ref>FDA, Docket #82P-0316</ref><ref>See for example, Andre, L (2001). Testimony at the public hearing of the NY State (US) Assembly Standing Committee on Mental Health on electroconvulsive therapy; Donahue, A (12 March 1999). Testimony at the public hearing of the Vermont (US) Health and Welfare Committee on electroconvulsive therapy.</ref> A recent article by a neuropsychologist and a psychiatrist in Dublin suggests that ECT patients who experience cognitive problems following ECT should be offered some form of cognitive rehabilitation. The authors say that the failure to attempt to rehabilitate patients may be partly responsible for the negative public image of ECT.<ref>Mangaoang, MA and Lacey, JV (2007). "Cognitive rehabilitation: assessment and treatment of persistent memory impairments following ECT". ''Advances in Psychiatry'' '''13''': 90-100.</ref> A study published in 2004 in the "Journal of Mental Health" reported that 35 to 42% of patients said ECT resulted in loss of intelligence.<ref name="Eliciting users’ views of ECT in two mental health trusts with a user-designed questionnaire">Philpot M, Collins C, Trivedi P, Treloar A, Gallacher S, Rose D: Eliciting users’ views of ECT in two mental health trusts with a user-designed questionnaire. Journal of Mental Health 13(4): 403-413, 2004</ref> The study also reported, "There is no overlap between clinical and consumer studies on the question of benefit." ===Effects on brain structure=== A number of national mental health institutions have concluded that there is no evidence that ECT causes structural brain damage<ref name=brain/><ref name=brain2/>. A report by the United States Surgeon General states, "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals".<ref name="surgeon"/> All of the recent scientific reviews on this topic which reviewed the body of ECT research using autopsies, brain imaging, and animal studies of electroconvulsive therapy, have also concluded that there is no evidence that ECT causes brain damage.<ref name="Rudorfer"/><ref>{{cite journal |author=Devanand DP, Dwork AJ, Hutchinson ER, Bolwig TG, Sackeim HA |title=Does ECT alter brain structure? |journal=Am J Psychiatry |volume=151 |issue=7 |pages=957–70 |year=1994 |pmid=8010381 |doi=}}</ref> Current research is examining the possibility that, "...rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness"<ref>[http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=1028 Primary Psychiatry: In Session with Charles H. Kellner, MD: Current Developments in Electroconvulsive Therapy<!-- Bot generated title -->]</ref> ===Effects in pregnancy=== ECT is generally accepted to be relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments<ref>Miller LJ. Use of electroconvulsive therapy during pregnancy. Hosp Community Psychiatry. 1994 May;45(5):444-50. PMID 8045538</ref><ref>Walker R, Swartz CM. Electroconvulsive therapy during high-risk pregnancy. Gen Hosp Psychiatry. 1994 Sep;16(5):348-53. PMID 7995506</ref><ref>Ferrill MJ, Kehoe WA, Jacisin JJ. ECT During Pregnancy: Physiologic and Pharmacologic Considerations. Convuls Ther. 1992;8(3):186-200. PMID 11941169</ref>. Much of the medical literature is composed of case studies of single or twin pregnancies, and although some have reported serious complications<ref>e.g. PMID 10668602 (death) (French), PMID 10074880 (premature labour), PMID 9871846 (spontaneous abortion)</ref><ref>Pinette MG, Santarpio C, Wax JR, Blackstone J. Electroconvulsive therapy in pregnancy. Obstet Gynecol. 2007 Aug;110(2 Pt 2):465-6. PMID 17666629</ref>, the majority have found ECT to be safe<ref>e.g. PMID 14560648, PMID 17804997, PMID 11593722, PMID 10614034 (two patients), PMID 8198651 (twins), PMID 11941159 (twins), PMID 2246991</ref>. ==Mechanism of action== The aim of ECT is to induce a therapeutic clonic [[seizure]] (a seizure where the person loses consciousness and has convulsions) lasting for at least 15 seconds. Although a large amount of research has been carried out, the exact mechanism of action of ECT remains elusive. The main reasons for this are the difficulty of isolating the therapeutic effect from the plethora of effects that accompany the anesthetic, electric shock and seizure; the differences between the brains of humans and those of other animals; and the lack of satisfactory animal models of mental illness.<ref name="Rudorfer">Rudorfer, MV, Henry, ME, Sackeim, HA (2003). [http://media.wiley.com/assets/138/93/UK_Tasman_Chap92.pdf "Electroconvulsive therapy"]. In A Tasman, J Kay, JA Lieberman (eds) ''Psychiatry, Second Edition''. Chichester: John Wiley & Sons Ltd, 1865-1901.</ref> Electroconvulsive Therapy (ECT) increases serum [[brain-derived neurotrophic factor]] (BDNF) in drug resistant depressed patients.<ref>{{cite journal |author=Bocchio-Chiavetto L, Zanardini R, Bortolomasi M, ''et al'' |title=[http://air.unimi.it/handle/2434/24111 Electroconvulsive Therapy (ECT) increases serum Brain Derived Neurotrophic Factor (BDNF) in drug resistant depressed patients] |journal=Eur Neuropsychopharmacol |volume=16 |issue=8 |pages=620–4 |year=2006 |pmid=16757154 |doi=10.1016/j.euroneuro.2006.04.010}}</ref> ==Legal status== ===Informed consent=== It is widely acknowledged internationally that written [[informed consent]] is as important in ECT as other medical treatments. The [[World Health Organization]], in its 2005 publication "Human Rights and Legislation WHO Resource Book on Mental Health," specifically states, "ECT should be administered only after obtaining informed consent."<ref>World Health Organisation (2005). [http://www.who.int/mental_health/policy/resource_book_MHLeg.pdf ''WHO Resource Book on Mental Health, Human Rights and Legislation'']. Geneva, 64.</ref> In the US, this doctrine places a legal obligation on a doctor to make a patient aware of: the reason for treatment, the risks and benefits of a proposed treatment, the risks and benefits of alternative treatment, and the risks and benefits of receiving no treatment. The patient is then given the opportunity to accept or reject the treatment. The form states how many treatments are recommended and also makes the patient aware that the treatment may be revoked at anytime during a course of ECT.<ref name="SG"/> The Surgeon General's report on mental health said that patients should be warned that the benefits of ECT are short-lived without active continuation treatment in the form of drugs or further ECT and that there may be some risk of permanent severe memory loss after ECT.<ref name="SG"/> The report advised psychiatrists to involve patients in discussion, possibly with the aid of leaflets or videos, both before and during a course of ECT. To demonstrate what would be required to fully satisfy the legal obligation for 'informed consent', one psychiatrist, working for an antipsychiatry organisation, has formulated his own 'consent form'<ref>{{cite web|author=Johnson, R |date= |url=http://www.psychrights.org/Research/Digest/InformedConsent/DrJohnsonECTInformedConsent.pdf |title=An informed consent form for electroconvulsive therapy, draft 1. |publisher=PsychRights}}</ref> using the Texas Legislature as a model.<ref>Texas Legislature (2004). [http://www.capitol.state.tx.us/statutes/docs/HS/content/word/hs.007.00.000578.00.doc Health & safety code Chapter 578. Electroconvulsive and other therapies Sec.578.001].</ref> It should be noted that printed or videotaped materials regarding ECT might be commissioned by the manufacturers of the equipment used, and so the possibility of this information leaning towards [[confirmation bias]] should be considered. Some question the effects of drugs on the ability to give [[informed consent]]. In the UK in order for consent to be valid it requires an explanation in "broad terms" of the nature of the procedure and its likely effects.<ref>Jones, R (1996) ''Mental Health Act Manual, 5th edition.'' London: Sweet and Maxwell, page 225.</ref> One review from 2005 found that only about half of patients felt they were given sufficient information about ECT and its adverse effects,<ref>Rose, DS ''et al''. (2005)[http://bjp.rcpsych.org/cgi/content/abstract/186/1/54 "Information, consent and perceived co-ercion: patients' perspectives on electroconvulsive therapy"]. ''[[British Journal of Psychiatry]]'' '''186''':54-59.</ref> and another survey found that about fifty percent of psychiatrists and nurses agreed with them.<ref name="Lutchman"> Lutchman, RD ''et al''. (2001). [http://www.ingentaconnect.com/content/routledg/cjmh/2001/00000010/00000002/art00004 "Mental health professionals' attitudes towards and knowledge of electroconvulsive therapy."] ''Journal of Mental Health'' '''10'''(20):141-150.</ref> ===Involuntary ECT=== Procedures for involuntary ECT vary from country to country depending on local [[mental health law]]s. Legal proceedings are required in some countries, while in others ECT is seen as another form of treatment that may be given involuntarily as long as legal conditions are observed. In the USA, the Surgeon General's report on mental health requires a judicial proceeding, at which patients may be represented by legal counsel, prior to initiation of involuntary ECT, stating: "As a rule, the law requires that such petitions are granted only where the prompt institution of ECT is regarded as potentially lifesaving, as in the case of a person in grave danger because of lack of food or fluid intake caused by [[catatonia]]."<ref name="SG"/> In England and Wales the [[Mental Health Act 1983]] currently allows the use of ECT on detained patients (with and without [[capacity (law)|capacity]]) if the treatment is likely to alleviate or prevent deterioration in a condition and is authorized by a psychiatrist from the Mental Health Act Commission's panel. However, proposed amendments to the Mental Health Act (clause 30) will introduce a capacity-threshold for the imposition of ECT. This in effect will mean that ECT may not be given to a patient who has capactity to refuse to consent to it, irrespective of his or her detention under the Act (the treatment may still be given in an emergency under s62).<ref>The Mental Health Act 1983, Part 4, section 58.</ref> If the treating psychiatrist thinks the need for treatment is urgent they may start a course of ECT before authorization.<ref>The Mental Health Act 1983, Part 4, section 62.</ref> About 2,000 people a year in England and Wales are treated without their consent under the Mental Health Act,<ref>The Mental Health Act Commission (2005) ''In Place of Fear? eleventh biennial report, 2003-2005'', 236. The Stationery Office.</ref> with a small number of informal patients treated in this way under common law. In Scotland the Mental Health (Care and Treatment) (Scotland) Act 2003 gives patients with capacity the right to refuse ECT.<ref>The Mental Health (Care and Treatment) (Scotland) Act 2003, Part 16, sections 237-239.</ref> A study published in 2005 in the "British Journal of Psychiatry" described patients' perspectives of electroshock. The study stated, “About half (45-55%) of patients reported they were given an adequate explanation of ECT, implying a similar percentage felt they were not.”<ref name="Information, consent and perceived coercion">Rose D, Wykes T, Bindman J, Fleischmann P: Information, consent and perceived coercion: patients’ perspectives on electroconvulsive therapy. British Journal of Psychiatry 186: 54-59, 2005.</ref> The study also said, “Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form. [deletion] The proportion who feel they did not freely choose the treatment has actually increased over time. The same themes arise whether the patient had received treatment a year ago or 30 years ago. [deletion] Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.” Duress in involuntary ECT makes reports about its effects, by patients while under duress, uncertain in their validity. Megara Sanderson, Events & Culture Editor of newspaper "The Flying Horse" reports, "Some speculate that patients may pretend that they are cured of their mental illness so that they no longer have to endure the electro-convulsive treatment."<ref name="Megara Sanderson in digital copy">Author: Megara Sanderson. Web page: “A Shocking Experience.” Web site: “The Flying Horse.” Date: April 14, 2008. Institution: Middlesex Community College. Date of access: May 2, 2008. Web address: http://theflyinghorse.net/wp/?p=101.</ref><ref name="Megara Sanderson in hardcopy">Author: Megara Sanderson. Article: “A Shocking Experience.” Periodical: “The Flying Horse.” Volume: 2. Issue: 4. Date: May 2008. Institution: Middlesex Community College.</ref> Involuntary electroshock contravenes the principle of autonomy in [[medical ethics]]. The maxim of autonomy is "Voluntas aegroti suprema lex." This rule states that the will of the patient is supreme. It implies that a patient has the right to refuse a medical treatment, such as ECT. ===History=== As early as the 16th century, agents to produce seizures were used to treat psychiatric conditions. In 1785 the therapeutic use of seizure induction was documented in the London Medical Journal.<ref name="Rudorfer">Rudorfer, MV, Henry, ME, Sackeim, HA (2003). [http://media.wiley.com/assets/138/93/UK_Tasman_Chap92.pdf "Electroconvulsive therapy"]. In A Tasman, J Kay, JA Lieberman (eds) ''Psychiatry, Second Edition''. Chichester: John Wiley & Sons Ltd, 1865-1901.</ref> Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist [[Ladislas J. Meduna]] who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures with first [[camphor]] and then [[metrazol]] (cardiazol). Within three years metrazol convulsive therapy was being used worldwide.<ref name="Fink-history">Fink, M (1984). "The origins of convulsive therapy". ''American Journal of Psychiatry'' '''141''':1034-41.</ref> In 1937, the first international meeting on convulsive therapy was held in Switzerland by the Swiss psychiatrist Muller. The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide.<ref name="Fink-history">Fink, M (1984). "The origins of convulsive therapy". ''American Journal of Psychiatry'' '''141''':1034-41.</ref> Italian Professor of neuropsychiatry [[Ugo Cerletti]], who had been using electric shocks to produce seizures in animal experiments, and his colleague Lucio Bini developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1937, experimented for the first time on a person. ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient.<ref>Cerletti, U (1956). "Electroshock therapy". In AM Sackler ''et al''. (eds) ''The Great Physiodynamic Therapies in Psychiatry: an historical appraisal.'' New York: Hoeber-Harper, 91-120.</ref> Cerletti and Bini were nominated for a [[Nobel Prize]] but didn't get one. By 1940, the procedure was introduced to both England and the US. Through the 40's and 50's the use of ECT became widespread. ECT is the only form of [[shock treatment]] still performed by modern medicine. In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse. It took many years for brief-pulse equipment to be widely adopted<ref name="Kiloh">Kiloh, LG, Smith, JS, Johnson, GF (1988). ''Physical Treatments in Psychiatry''. Melbourne: Blackwell Scientific Publications, 190-208. ISBN 0-86793-112-4</ref> Unilateral ECT has never been popular with psychiatrists and is still only given to a minority of ECT patients.<ref name="Rudorfer"/> In the 1940s and early 1950s ECT was usually given in "unmodified" form, without muscle relaxants, and the seizure resulted in a full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s psychiatrists began to experiment with [[curare]], the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of [[suxamethonium]] (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. A short-acting anesthetic was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants.<ref name="Kiloh"/> The steady growth of antidepressant use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 50's to the 70's. The Surgeon General stated there were problems with electroshock therapy in the initial years before anesthesia was routinely given and, ''these now antiquated practices contributed to the negative portrayal of ECT in the popular media.''<ref name="erica goode"> {{cite web |url=http://query.nytimes.com/gst/fullpage.html?sec=health&res=9805E1DD1431F935A35753C1A96F958260 |title=Federal Report Praising Electroshock Stirs Uproar |last=Goode |first=Erica |publisher=[[New York Times]] |date=[[1999-10-06]] |accessdate=2008-01-01 }} </ref> The New York Times described the public's negative perception of ECT as being caused mainly by one movie,"For Big Nurse in ''One Flew Over the Cuckoo's Nest,'' it was a tool of terror, and in the public mind ''shock therapy'' has retained the tarnished image given it by Ken Kesey's novel: dangerous, inhumane and overused".<ref> {{cite web |url=http://query.nytimes.com/gst/fullpage.html?sec=health&res=9C0CE0D81F3EF931A3575BC0A966958260 |title=The Quiet Comeback of Electroshock Therapy |last=Goleman |first=Daniel |date=[[1990-08-02]] |accessdate=2008-01-01 |publisher=[[New York Times]] }} </ref> In 1976 Dr. Blatchley demonstrated the effectiveness of his constant current, brief pulse device ECT. This device eventually largely replaced earlier devices because of the reduction in cognitive side effects, although some ECT clinics in the US still use sine-wave devices.<ref name="Prudic 01"/> The 1970s saw the publication of the first American Psychiatric Association task force report on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). The report endorsed the use of ECT in the treatment of depression. The decade also saw criticism of ECT.<ref>See Friedberg, J (1977). "Shock treatment, brain damage, and memory loss: a neurological perspective". ''American Journal of Psychiatry'' '''134''':1010-1014; and Breggin, PR (1979) ''Electroshock: its brain-disabling effects''. New York: Springer</ref> Specifically critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT. The use of ECT declined until the 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression".<ref name="erica goode"/> In 1985 the [[National Institute of Mental Health]] and [[National Institutes of Health]] convened a consensus development conference on ECT and concluded that, whilst ECT was the most controversial treatment in psychiatry and had significant side-effects, it had been shown to be effective for a narrow range of severe psychiatric disorders.<ref>Blaine, JD and Clark, SM (1986). "Report of the NIMH-NIH consensus development conference on Electroconvulsive therapy". ''Psychopharmacology Bulletin'' '''22'''(2): 445-452.</ref></blockquote> Due to the backlash noted previously, national institutions reviewed past practices and set new standards. In 1978 The American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances. The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented. Finally in 2001 the American Psychiatric Association released its latest task force report. This report emphasizes the importance of informed consent, and the expanded role that the procedure has in modern medicine. ==Role in mass media== ===ECT=== ====Fictional and semi-fictional depictions==== {{main|Fictional and semi-fictional depictions of ECT}} Electroconvulsive therapy has been depicted in several fictional and semi-fictional films, books, and songs, such as in "Requiem for a Dream" and "One Flew Over the Cuckoos Nest". ====Personal depictions==== Positive effects of ECT have been reported by several noteworthy individuals. [[Katharine D. Dukakis|Kitty Dukakis]], wife of politician [[Michael Dukakis]], reports in a ''[[Newsweek]]'' article mostly positive effects from electroconvulsive therapy, and regards memory loss as an acceptable price to pay for relief from depression. {{quote|[For me,] the memory issues are real but manageable. Things I lose generally come back. Other memories I prefer to lose, including those about the depression I was suffering. But there are some memories—of meetings I have attended, people's homes I have visited—that I don't want to lose but I can't help it. They generally involve things I did two weeks before and two weeks after ECT. Often they are just wiped out....I have learned ways to partly compensate for whatever loss I still experience. I call my sister Jinny, Michael and my kids, asking what my niece Betsy's phone number is, what we did yesterday and what we are planning to do tomorrow. I apologize prior to asking. I wonder when they are going to run out of patience with "Kitty being Kitty." I hate losing memories, which means losing control over my past and my mind, but the control ECT gives me over my disabling depression is worth this relatively minor cost. It just is.|<ref name="dukakis newsweek">Dukakis, K and Tye, L (2006), excerpt from [http://www.newsweek.com/id/45609/page/1 'I Feel Good, I Feel Alive']. ''Newsweek'' September 18:62-63.</ref>}} American psychotherapist [[Martha Manning]]'s autobiographical ''[[Undercurrents (autobiography)|Undercurrents]]''<ref>{{cite book | last = Manning | first = Martha | title = Undercurrents: A Therapist's Reckoning with Her Own Depression | publisher = Harper San Francisco | date = March 1996 | id = ISBN 978-0062511843}}</ref> acknowledges the downside of treatment: "I felt like I'd been hit by a truck for a while, but that was, comparatively speaking, not so bad," as well as the upside: "Afterwards, I thought, do regular people feel this way all the time? It's like you've not been in on a great joke for the whole of your life." In his autobiographical book ''Electroboy'', American writer [[Andy Behrman]] describes undergoing ECT as a treatment for bipolar disorder while under house-arrest: "I wake up thirty minutes later and think I am in a hotel in Acapulco. My head feels as if I have just downed a frozen margarita too quickly. My jaws and limbs ache. But I am elated."<ref>{{cite book | last = Behrman | first = Andy | title = Electroboy: A Memoir of Mania | publisher = Random House | date = February 2003| id = ISBN 978-0812967081}}</ref> Curtis Hartmann, a lawyer in western Massachusetts, stated: "ECT, a treatment of last resort for severe, debilitating depression, is all that has ever worked for me. I awaken about 20 minutes later, and although I am still groggy with anesthesia, much of the hellish depression is gone. It is a disease that for me, literally steals me from myself—a disease that executes me and then forces me to stand and look down at my corpse. Thankfully, ECT has kept my monster at bay, my hope intact".<ref>http://psychservices.psychiatryonline.org/cgi/content/full/53/4/413</ref> ====Negative personal depictions==== Negative effects of ECT have been reported by noteworthy individuals. [[Ernest Hemingway]], American author, committed suicide shortly after ECT treatment at the Menninger Clinic in 1961. He is reported to have said to his biographer, "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient...."<ref>[[A. E. Hotchner]], ''Papa Hemingway: A Personal Memoir'', ISBN 0786705922; pg 280</ref> In 2005, "Peggy S. Salters, 60, sued Palmetto Baptist Medical Center in Columbia, as well as the three doctors responsible for her care. As the result of an intensive course of outpatient ECT in 2000, she lost all memories of the past 30 years of her life, including all memories of her husband of three decades, now deceased, and the births of her three children. Ms. Salters held a Masters of Science in nursing and had a long career as a psychiatric nurse, but lost her knowledge of nursing skills and was unable to return to work after ECT."{{Fact|date=June 2008}} The jury awarded Salters $635,177 in compensation for her inability to work. Registered nurse Barbara C. Cody reports in a letter to the ''[[Washington Post]]'' that her life was forever changed by 13 outpatient ECTs she received in 1983. "Shock 'therapy' totally and permanently disabled me. EEGs [electroencephalograms] verify the extensive damage shock did to my brain. Fifteen to 20 years of my life were simply erased; only small bits and pieces have returned. I was also left with short-term memory impairment and serious cognitive deficits. [deletion] Shock "therapy" took my past, my college education, my musical abilities, even the knowledge that my children were, in fact, my children. I call ECT a rape of the soul."<ref>{{cite web|last=Cody|first=Barbara|title=Letter|accessdate=2006-09-23 |url=http://www.healthyplace.com/Communities/Depression/ect/media/postltrs.html |year=Approximately between 1995-2006|publisher=HealthyPlace.com}}</ref> In 2007, a judge canceled a two year old court order that allowed the involuntary electroshock of Simone D., a psychiatric patient at [[Creedmoor Psychiatric Center]] in the state of New York<ref name="Another victory against forced electroshock">Author: MindFreedom International. Web page: “Another victory against forced electroshock. Simone D. wins!” Web site: “MindFreedom International.” Date: August 28, 2007. Institution: MindFreedom International. Date of access: April 18, 2008. Web address: http://www.mindfreedom.org/campaign/kb/mental-health-abuse/electroshock/simone-d.</ref>. Although Simone spoke only Spanish, she rarely received access to staff fluent in her language<ref name="Another victory against forced electroshock">Author: MindFreedom International. Web page: “Another victory against forced electroshock. Simone D. wins!” Web site: “MindFreedom International.” Date: August 28, 2007. Institution: MindFreedom International. Date of access: April 18, 2008. Web address: http://www.mindfreedom.org/campaign/kb/mental-health-abuse/electroshock/simone-d.</ref><ref name="Lauren Tenney">Author: Lauren Tenney. Web page: “Testimony from Lauren Tenney, Member of FUTURE Views and the Mental Patients Liberation Alliance.” Web site: “New York State Office of Mental Health.” Date: October 5, 2007. Institution: New York State Office of Mental Health. Date of access: April 18, 2008. Web address: http://www.omh.state.ny.us/omhweb/statewideplan/2006/testimony/507/nyc/tenney.html.</ref>. Simone previously had 200 electroshocks<ref name="Another victory against forced electroshock">Author: MindFreedom International. Web page: “Another victory against forced electroshock. Simone D. wins!” Web site: “MindFreedom International.” Date: August 28, 2007. Institution: MindFreedom International. Date of access: April 18, 2008. Web address: http://www.mindfreedom.org/campaign/kb/mental-health-abuse/electroshock/simone-d.</ref><ref name="Lauren Tenney">Author: Lauren Tenney. Web page: “Testimony from Lauren Tenney, Member of FUTURE Views and the Mental Patients Liberation Alliance.” Web site: “New York State Office of Mental Health.” Date: October 5, 2007. Institution: New York State Office of Mental Health. Date of access: April 18, 2008. Web address: http://www.omh.state.ny.us/omhweb/statewideplan/2006/testimony/507/nyc/tenney.html.</ref>. However, she communicated that she did not want more electroshock<ref name="Another victory against forced electroshock">Author: MindFreedom International. Web page: “Another victory against forced electroshock. Simone D. wins!” Web site: “MindFreedom International.” Date: August 28, 2007. Institution: MindFreedom International. Date of access: April 18, 2008. Web address: http://www.mindfreedom.org/campaign/kb/mental-health-abuse/electroshock/simone-d.</ref><ref name="Lauren Tenney">Author: Lauren Tenney. Web page: “Testimony from Lauren Tenney, Member of FUTURE Views and the Mental Patients Liberation Alliance.” Web site: “New York State Office of Mental Health.” Date: October 5, 2007. Institution: New York State Office of Mental Health. Date of access: April 18, 2008. Web address: http://www.omh.state.ny.us/omhweb/statewideplan/2006/testimony/507/nyc/tenney.html.</ref>. Simone stated, "Electroshock causes more pain. I suffer more from shock treatment!<ref name="Another victory against forced electroshock"/>" In 2008, David Tarloff, a psychiatric patient who had received electroshock, assaulted two therapists in the city of New York. Tarloff injured one therapist and murdered the other. One of the therapists was Kent Shinbach, a psychiatrist who had an interest in electroconvulsive therapy. "It is not clear whether Dr. Shinbach played any role in Mr. Tarloff's shock therapy"<ref>http://www.nysun.com/new-york/shock-therapy-emerges-as-detail-in-therapists/71616/ </ref>. However, Tarloff told investigators that Shinbach had given Tarloff psychiatric treatment at a psychiatric facility initially in 1991<ref name="Christopher Faherty">{{cite web |author=Christopher Faherty |url=http://www.nysun.com/news/new-york/suspected-killer-didnt-mean-hurt-anyone |title=Suspected Killer 'Didn't Mean To Hurt Anyone' | The New York Sun |accessdate=2008-04-13 |date=2008-04-02|format= |work=}}</ref>. In an interview with "[[Houston Chronicle]]"in 1996, [[Melissa Holliday]], a former extra on "Baywatch" and model for "Playboy" stated the ECT she received in 1995, "ruined her life". She went on to state, "I've been through a rape, and electroshock therapy is worse. If you haven't gone through it, I can't explain it"<ref>http://www.healthyplace.com/Communities/Depression/ect/news/woman.asp</ref> Liz Spikol the senior contributing editor of [[Philadelphia Weekly]], wrote of her ECT in 1996, "Not only was the ECT ineffective, it was incredibly damaging to my cognitive functioning and memory. But sometimes it's hard to be sure of yourself when everyone "credible"—scientists, ECT docs, researchers—are telling you that your reality isn't real. How many times have I been told my memory loss wasn't due to ECT but to depression? How many times have I been told that, like a lot of other consumers, I must be perceiving this incorrectly? How many times have people told me that my feelings of trauma related to the ECT are misplaced and unusual? It's as if I was raped and people kept telling me not to be upset—that it wasn't that bad."<ref>http://trouble.philadelphiaweekly.com/archives/2006/12/funday_ect_stud.html.</ref> === Famous people who have undergone ECT === {{Cleanup-laundry|date=June 2008}} *[[Antonin Artaud]], French playwright<ref>{{cite book | last = Barber | first = Stephen | title = The Screaming Body: Antonin Artaud - Film Projects, Drawings and Sound Recordings | publisher = Creation Books | date = February 2005 | id = ISBN 978-1840680911}}</ref> *[[Kitty Dukakis]], wife of former Massachusetts governor and 1988 Democratic presidential nominee Michael Dukakis and author of ''Shock'',<ref>{{cite book | last = Dukakis | first = Kitty | coauthors = Tye, Larry | title = Shock: The Healing Power of Electroconvulsive Therapy | publisher = Avery | date = September 2006 | id = ISBN 978-1583332658}}</ref> a book chronicling her experiences with ECT.<ref name="dukakis newsweek"/> *[[Thomas Eagleton]], US senator and vice presidential candidate<ref>{{cite web |url=http://www.guardian.co.uk/politics/2008/mar/29/uselections2008.usa |title=The White House losers | publisher=[[The Guardian]] | date=2008-03-29 |accessdate=2008-03-29 |work=}}</ref> *[[Roky Erickson]], American singer, songwriter, harmonica player and guitarist.<ref> [http://www.dallasobserver.com/2007-03-01/music/roky-erickson/ Dallas - Music - Roky Erickson]</ref> *[[Janet Frame]], New Zealand writer and poet.<ref>Frame, J. ''An Angel at My Table'', London, Virago, 2008 (autobiography)</ref> *[[Romulus, My Father|Romulus Gaita]], father of philosopher [[Raimond Gaita]] *[[Judy Garland]], actress<ref name="Harming Artists">Author: Citizens Commission on Human Rights. Web page: “Harming Artists: Psychiatry Ruins Creativity.” Web site: “Psychiatric Abuse.” Date: 2004. Institution: Citizens Commission on Human Rights. Date of access: May 28, 2008. Web address: http://www.psychiatric-abuse.org.uk/Harming%20Artists.pdf.</ref> *[[Harold Gimblett]], British cricketer. "Rita [his wife] came to see me and couldn't believe the difference. I had some colour back in my cheeks..."<ref>{{cite web | title=Tale of a tormented genius | url=http://content-www.cricinfo.com/england/content/story/129485.html | accessdate=2007-06-12 }}</ref> *[[Peter Green (musician)|Peter Green]], English blues guitarist, founding member of Fleetwood Mac<ref>[http://www.fmlegacy.com/Bios/biopeter.html Peter Green Biography]</ref> *[[David Helfgott]], Australian Pianist.<ref>[http://www.denisdutton.com/helfgott.htm Denis Dutton on David Helfgott]</ref> *[[Marya Hornbacher]], American writer. <ref>Hornbacher, Marya. ''Madness: A Bipolar Life'', New York, 2008 (autobiography)</ref> *[[Michael Moriarty]], American actor.<ref> [http://www.mmuuuhp.com/demons050720.htm Moriarty tames his demons]</ref> *[[Sherwin B. Nuland]], American surgeon and writer<ref>Sherwin Nuland (2001) [http://www.ted.com/index.php/talks/view/id/189 My history of electroshock therapy], TED lecture</ref> *[[Sylvia Plath]], American writer and poet.<ref>[http://www.sylviaplath.de Sylvia Plath Homepage]</ref> *[[Lou Reed]], The Velvet Underground<ref>[http://www.electroboy.com/electroshock-therapy.shtml Electroshock Therapy Treatment - ECT and how it works]</ref> *[[Yves Saint-Laurent (designer)|Yves Saint-Laurent]], French fashion designer.<ref>[http://www.thebiographychannel.co.uk/biography_story/931:1087/1/Yves_Saint_Laurent.htm The Biography Channel - Yves Saint Laurent Biography]</ref> *[[Townes van Zandt]], American country singer-songwriter.<ref>See the biographical film, ''[[Be Here to Love Me]]''.</ref> *[[Vivien Leigh]], English Actress and second wife of Laurence Olivier ==See also== * [[DSM-IV Codes]] * [[Harold A. Sackeim]] ==References== <!--See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for an explanation of how to generate footnotes using the <ref(erences/)> tags--> {{reflist|2}} == External links == * [http://www.psych.org/research/apire/training_fund/clin_res/index.cfm American Psychiatric Association on ECT] - brief article from the [[American Psychiatric Association]]. * [http://www.mind.org.uk/Information/Booklets/Making+sense/ECT.htm MIND on ECT] - information on ECT from MIND (leading mental health charity in England and Wales). * [http://www.psychiatrictimes.com/display/article/10168/48111 About to have ECT? ...] - Psychiatric Times article on the portrayal of ECT by Hollywood * [http://www.ted.com/index.php/talks/view/id/189 TED talk on ECT] - 30-year-practicing surgeon and successful writer [[Sherwin B. Nuland]] on the history of ECT and his personal experience with it. {{Psychiatry}} [[Category:Psychiatric treatments]] [[Category:Human rights abuses]] [[Category:Mind control]] [[Category:History of mental health]] [[cs:Elektrokonvulzivní terapie]] [[da:ECT]] [[de:Elektrokrampftherapie]] [[et:Elekterkrampravi]] [[es:Terapia electroconvulsiva]] [[fr:Sismothérapie]] [[it:Terapia elettroconvulsivante]] [[he:נזעי חשמל]] [[ku:Elektrokompûlsîv terapî]] [[hu:Elektrosokk-terápia]] [[nl:Elektroconvulsietherapie]] [[ja:電気けいれん療法]] [[no:Elektrokonvulsiv terapi]] [[pl:Terapia elektrowstrząsowa]] [[pt:Eletroconvulsoterapia]] [[sr:Електрошок терапија]] [[fi:Sähköhoito]] [[sv:ECT]] [[zh:電痙攣療法]]