High-Powered Treatment

"My family and I were told it would cure the depression and it did not," says Lawrence, who's 46 and lives in Long Island, N.Y. "After holding out all this hope that it would be the final answer, it didn't happen. I was completely devastated. On top of that, I had memory loss, and on top of that, I had cognitive damage."

Lawrence runs a Web site called ect.org, which has a message board filled with hundreds of former ECT patients who call themselves "electroshock survivors." They say they've suffered brain damage as a result of ECT. But as no studies have established a link between ECT and long-term cognitive damage, evidence of long-term harm remains anecdotal.

But for most patients, ECT does provide near-immediate relief, say many psychiatrists. It tends to work best in people who've had a hard, fast fall into depression — people like Karen, a current patient of Melman's. (Because Karen is still going through treatments, she requested that her last name not be used.) Just one month after her first treatment in June, Karen, who is in her early 30s, returned to work part-time.

There were a few awkward exchanges in her first week back, Karen says, when she realized she had forgotten the names of certain co-workers. Her job as a communications liaison for a nonprofit in Seattle involves a lot of international travel, and after returning to work she had trouble recalling the details of some trips. ECT even erased an entire country from her memory — there are pictures of Karen on a trip to Ethiopia that she can't remember at all.

After 12 treatments, she says she's 90 percent better. "There's a little bit of gnawing anxiety … what if this happens again?"
 
Because ECT has a high relapse rate for depression, doctors prescribe psychotherapy or medications after the final ECT session. For skeptics of ECT like Breeding, the Texas psychologist, that proves that ECT is just a quick fix, and it doesn't work to relieve depression in the long run.

"Sometimes you need a quick fix," says Dr. Alan Gelenberg, a clinical professor of psychiatry at the University of Wisconsin-Madison. He points out that depression itself has a high relapse rate. And a 2001 Oxford University study found that depression returned in about 40 percent of patients who stopped taking an antidepressant. "But you do need to attend to long term issues in any way you can: medications, talk therapy or periodic readministrations of ECT."

Researchers like Dr. Sarah Lisanby, professor of clinical psychiatry at Columbia University, are working to find new, less traumatic therapies that rival ECT's efficacy for relieving depression.

Solving the mystery
But part of Lisanby's research is also devoted to uncovering how ECT works.

"Solving the mystery of how ECT works is going to be important for advancements in the field of psychiatry, because ECT has unparalleled efficacy," Lisanby says. "Understanding why ECT is so much more effective than medications could help the field develop more effective treatments – and safer treatments."

Because so much of ECT is still not understood, and because of its stigma, some psychiatrists treat ECT as a dire last resort. Instead of being considered a last option, Melman and other proponents of ECT wish that it was considered a next option.

"It can be considered much earlier than it is for most patients today," Melman says. "Patients suffer with depression either with no response or partial response (to antidepressants), and for years they limp along with terrible depression."