Jack Nicholson did for shock therapy what Jaws did for sharks: An expert argues that ECT is really more effective than antidepressants
Last updated at 10:01 PM on 9th July 2011
It’s the film scene that helped cement the view of electro-convulsive therapy (ECT) as a horribly brutal way to treat psychiatric patients.
A screaming, struggling Jack Nicholson is forced to have the treatment in the Oscar-winning adaptation of One Flew Over The Cuckoo’s Nest, made in 1975.
ECT was and still is seen by many as a throwback to an age when there were no drugs available to treat depression, and when radical surgery, even lobotomies, were mistakenly believed to be the only cure.
Current mythology: Jack Nicholson in One Flew Over The Cuckoo's Nest
Yet experts today are increasingly turning to the procedure, contending that using high-voltage bursts of electricity is usually safer, faster and more effective than most antidepressant drugs.
NICE, the Government’s health watchdog, has judged it suitable for use for those with severe depression, and every year about 12,000 Britons undergo the treatment, which was originally developed in the Thirties.
‘Films such as One Flew Over The Cuckoo’s Nest did for ECT what Jaws did for sharks – the depiction of the treatment in that film is completely over the top, with the patient being held down, writhing in pain, as he is electrocuted,’ says consultant psychiatrist Dr Susan Benbow, spokeswoman for The Royal College of Psychiatrists.
‘This is not what happens. For a start, during ECT the patient is anaesthetised and given a muscle relaxant – which has been the case since the Fifties – to ensure they feel no pain at all.
No one is ever forced to have ECT, and when antidepressant medication isn’t working, it can be life-saving.’
The procedure is thought to work by stimulating the release of mood-balancing chemicals.
‘The administering doctor holds electrodes to the patient’s temples,’ explains Dr Benbow, an expert in geriatric mental health.
'An electrical current is passed between the electrodes and induces a fit that lasts between 20 and 50 seconds. There is no big jolt – you hardly see any movement.
At one time, we didn’t understand how to tailor electrical doses to patients and people might have been given doses higher than needed. We now know that this increased the risk of side effects. Modern machines mean that doses can be more closely tailored to individuals.’
Complications are incredibly rare, but in some cases ECT can trigger heart problems such as an irregular heartbeat. Anyone in poor health will be assessed as to how any risks might outweigh the benefits.
‘Patients with severe depression are often immobile, catatonic and refuse to eat. In these cases, their illness is a far greater risk to their health than ECT could ever be,’ adds Dr Benbow.
When Jane Stephany’s 84-year-old mother Beatrice was given ECT last year, the family were deeply concerned as to whether they were right to give their consent. ‘I couldn’t bear the thought of her having electric currents shooting
through her brain,’ says Jane, 58, a former lawyer who lives in North London.
‘But my mother had no quality of life and, after trying endless types of medication that did nothing to help her, this seemed the only option left.’
Beatrice, who before her marriage worked in the publishing industry and was widowed in 1995 – began to feel unwell last May.
‘My mother had always been quite an anxious person but as she got older her anxiety seemed to get much worse,’ recalls Jane.
‘Over a few months, she became withdrawn, she could hardly speak and ate virtually nothing.’
In August, Jane contacted a psychiatrist and he admitted her to a private psychiatric hospital in North London.
‘She was diagnosed as having severe psychotic depression.
The consultant said it was one of the most severe cases he had seen,’ says Jane. ‘This was the point at which ECT was suggested.’ Beatrice was given six treatments over three weeks and, Jane says, by the time of her discharge she was virtually better and able to have three more treatments as an outpatient.
About two weeks after starting ECT in October, Jane noticed that Beatrice appeared to be improving. Jane says: ‘She had calmed down so much. Her body had been rigid and hunched up with anxiety before – yet now, gradually, she was relaxing and her speech had come back.
'It wasn’t long before she was looking like her old self, wanting to drive, see her friends, play bridge and do yoga, which she used to love.
‘The consultant at the hospital who had suggested ECT slowly withdrew her medication, leaving her on just the antidepressant mirtazapine.’
Dr Benbow warns there are side effects: ‘Some difficulties with short-term memory are probably present in everyone receiving ECT.
Most find this resolves a few weeks after the course finishes, but some say their memories never come back. It is not clear how much of this is due to ECT and how much is due to persisting symptoms of depression and treatment with anti-depression drugs.’
Jane knows how difficult it is for anyone to subject a loved one to this procedure.
‘It was an incredibly hard decision to have to make yet my mother is now back to her lovely old self. When someone is so ill, how can you deny them that chance?’
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I had about eight sessions of ECT and it isn't that bad from a patients perspective. The whole experience was neither cruel or barbaric for me. In my case it did the job in others it may not but the main thing is if I can put peoples minds at rest.It is nothing like the film.
- Dave Brittania, Louth, Lincolnshire, 10/7/2011 12:41
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