Shock therapy: New twist on an old treatment

One in 10 adults suffers from some type of depression. Medications and psychotherapy are common treatments, but for many, they just do not work. Now, a treatment considered barbaric decades ago is making a big comeback.

The past six years have been anything but easy for Jim and Amy Adkins. Jim suffers from severe depression that started when his dad committed suicide.

"I attempted suicide twice. I was just at the end of my rope,” says Jim.

Drugs and therapy did not work, so Jim’s doctor told him about shock therapy, now known as ECT. Duke psychiatrist Richard Weiner says ECT has been used since the 1930s but Hollywood gave it a bad rap.

He says, "For a lot of the public, what they know about ECT is what they saw on One Flew over the Cuckoo's Nest.”

Now, Jim is on his thirteenth treatment. Doctors first give him general anesthesia and a muscle relaxer. Once Jim is asleep, doctors deliver a quick electrical current that causes a seizure in the brain. The seizure produces chemical changes in the brain that reduce the depressive symptoms.

Dr. Weiner explains, "The same kind of neurotransmitter changes that occur with antidepressants also occur with ECT. It's just that ECT does it more powerfully."

There is no pain and studies show for those who are good candidates, ECT works between 80 and 90 percent of the time. But there are risks including headache, muscle pain, nausea and temporary memory problems. Still, Jim is happy he gave it a try. Since starting ECT, he has not had any thoughts of suicide.

Jim says, "Now, there's hope. I see a future."

The number of patients using ECT has tripled since the 1980's. Most patients will need follow-up treatments or other drug therapies after ECT. The shock therapy is mainly used for patients with severe, debilitating depression.


BACKGROUND: Depression is a medical illness that involves the brain. It affects more than 20 million Americans. Symptoms can include sadness, loss of interest or pleasure, changes in weight, difficulty sleeping or sleeping too much, a loss of energy, feelings of worthlessness, and thoughts of death or suicide. Researchers believe there are a variety of causes including genetic, environmental, psychological and biochemical factors. Depression usually starts between ages 15 and 30 and is much more common in women. Typical treatments include antidepressant drugs and talk therapy.
(SOURCE: National Institute of Mental Health)

WHAT IS ECT? Electroconvulsive therapy (ECT) is used to treat severe depression. It involves using electricity to induce a seizure. Doctors believe the seizure in the brain produces a host of chemical and physiologic changes in the brain. When ECT was first introduced in the 1940s, it was performed without anesthesia. The treatments were often portrayed as painful and punitive in movie scenes. "The treatments don't look anything like they used to look," Richard Weiner, M.D., Professor of Psychiatry, Medical Director of the Duke ECT Program, told Ivanhoe. "The type of electricity that we use now is very different from the type of electricity that used to be used. What we use now is actually modeled after the type of electricity that the brain itself uses." Today, patients also receive muscle relaxers prior to having the procedure, and they are put under general anesthesia. About 100,000 people undergo ECT treatments each year. It is recommended for those with severe depression who fail to respond to other therapies such as medications and psychotherapy.
(SOURCE:, Ivanhoe interview with Dr. Weiner)

HOW SUCCESSFUL IS IT? Several studies show ECT therapy works between 80 percent and 90 percent of the time for those who are good candidates. "The results can be extraordinarily dramatic," Dr. Weiner said.

RISKS: There are risks and side effects of ECT therapy. These include headache, muscle pain, nausea, and memory problems. Many patients who undergo ECT treatments continue taking their antidepressant medications, which also pose side effects. "Any treatment has risks and not treating also has risks," Dr. Weiner said. While there has been some concern about ECT causing permanent changes in the brain, Dr. Weiner says: "What's been found is ECT doesn't cause any pathological, structural changes in the brain. Interestingly, what has been found is depression itself causes pathological changes in certain parts of the brain, so in a sense, ECT may end up being better for their [patients'] brain rather than bad for their brain."
(SOURCE: Ivanhoe interview with Dr. Weiner)

For more information, please contact:

Sarah Avery
Senior Media Relations Specialist
Duke Medicine News and Communications
(919) 660-1306

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