High-Powered Treatment

Breeding and other skeptics argue that ECT is nothing more than a quick fix: Once the treatments stop, the depression returns. And at least one study backs that claim: In 2001, Columbia University researchers found that without follow-up medications, depression returned in 84 percent of ECT patients within six months.

Most patients are given three treatments a week for a total of six to 12 sessions. After that, once the patient's mood has reached a plateau, the psychiatrist may stop the ECT sessions and prescribe an antidepressant. If someone hasn't responded well to antidepressants in the past, ECT won't do anything to change that. For those patients, a doctor may prescribe a different antidepressant from those that had failed before. Or those patients may need once-a-month follow-up treatments, called maintenance ECT, which can continue for years.

The American Psychiatric Association approves ECT as a "safe and effective" treatment for depression and other mental illnesses, such as schizophrenia and catatonia. Under the APA's guidelines, an anesthesiologist, a psychiatrist and a recovery nurse must be present during a treatment, and the treatment must be voluntary, unless the patient is unable to provide informed consent. It's not recommended for the very old, children or those with heart conditions. Insurance covers treatments for most patients.

Despite the APA's approval, for the general public, shock therapy still conjures images from "One Flew Over the Cuckoo's Nest" — it's Jack Nicholson being electrocuted, making terrible grimaces as his body convulses.

"Quite frankly, the stigma pushes people away from it, and it pushes some psychiatrists away from even recommending ECT," says Dr. William McDonald, an Emory University psychiatrist who reviews the APA's guidelines on electroconvulsive and electromagnetic therapies. "But most of the stigma related to ECT really is related to misconception."

Psychiatrists readily admit that in the early days, ECT absolutely was a cruel procedure. And because the treatment has lingered in the shadows of psychiatry for decades, many people still associate it with its sketchy past.

Convulsive therapy was introduced in the mid-1930s, when scientists discovered that by triggering a seizure, they were able to shock psychiatric patients back into a functioning state of mind. It was designed to be a treatment for curing schizophrenia, but doctors found it also seemed to benefit patients with depression, bipolar disorder and catatonia.

Convulsions strong enough to break bones
During the '40s and '50s, it was one of the only available methods for treating mental illness, so it was often overused. Even when doctors adhered to the standards of the day, it was a harrowing procedure: As patients were shocked with electricity, they were wide awake, feeling their bodies' convulsions, which were sometimes severe enough to break bones.

At its peak of popularity during the early 1960s, about 300,000 U.S. patients a year received shock therapy.

Treatments both then and now require about the same amount of electricity — somewhere between 3 and 100 joules depending on the patient. (For context, one joule is the amount of energy it takes to lift an apple three feet in the air; 100 joules is enough energy to power a desktop computer.) But in a modern ECT treatment, patients are under anesthesia during the entire process, asleep and unaware of the electrical currents charging through their brains. A muscle relaxant prevents their bodies from jerking around once the seizure is triggered; in fact, the patient hardly moves at all.

When Russell, 43, initially was considering ECT, he and his wife, Sue, did extensive research and had lengthy conversations with his doctor about the realities of the treatment. While he was desperate to find a way out of his depression, he was still terrified of shock therapy. "At first, I thought of Frankenstein," Bill Russell says. "I thought, 'That's drastic, that causes brain damage — there's no way I want to do that.'"