Restart your brain with electroconvulsive therapy?

The gold-standard for depression

Feeling depressed? How would you like to restart your brain? Maybe that’s the solution to all your problems.

According to the NIMH (National Institutes of Mental Health), around 21 million adults in the United States alone had a period of Major Depressive Disorder (MDD) in 2021. Anywhere between 30 and 60 percent of people with MDD are considered “treatment-resistant”—that is to say, antidepressants and therapy don’t relieve their symptoms. But, each year, only one hundred thousand of them opt for “brain stimulation therapy,” as the NIMH describes electroconvulsive therapy (ECT), when the pills don’t work. This is despite the fact that within the psychiatric community ECT is commonly referred to as the “gold standard” for so-called treatment-resistant mood disorders.

The NIMH states that ECT is usually only used if other treatments have been tried and have failed, and if a person’s situation is potentially life-threatening:

ECT is usually considered only if a person’s illness has not improved after trying other treatments like medication or psychotherapy. To be eligible for ECT, a person must have severe, treatment-resistant depression or require a rapid response due to life-threatening circumstances, such as being unable to move or respond to the outside world (e.g., is catatonic), being suicidal, or being malnourished.

What is ECT?

Electroconvulsive therapy originated in Italy in 1934, where two researchers decided to test an idea they had on a man who was found wandering around and incoherent. They took him to their clinic and (without telling him what they were about to do) subjected him to a strong electric current. When he screamed: “Don’t do it again! It will kill me!” they interpreted this as a measure of success, as the man had uttered an intelligible statement. They proceeded to shock him another dozen-or-so times over the coming days and weeks, and eventually he returned home to his family and his job.

A few months later he was once again rambling and incoherent, but:

While the patient eventually relapsed, this was a win for science—Cerletti and Bini, who were later nominated for a Nobel Prize ... [had] demonstrated that seizures could be safely induced with electricity and relieve serious symptoms.

How does it work?

Since then, almost a hundred years have passed but scientists still don’t know exactly what ECT does to the brain. According to the Mayo Clinic,

No one knows for certain how ECT helps treat severe depression and other mental illnesses.

What they do say is that it changes the brain, as one might expect:

What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses. That's why ECT is most effective in people who receive a full course of multiple treatments [emphases added].

Advances!

Nonetheless, today’s ECT practitioners reassure potential clients that the procedure is vastly different from what it looked like decades ago. The main difference is that you don’t feel what is being done to you.

Today, the person undergoing electric shock will first have an IV line inserted, via which both a muscle relaxant and general anesthesia are administered. Then, electrode pads are placed on the person’s head, sometimes on one side, sometimes both.

There are three main ways to position the electrodes; bilateral, right unilateral, and bifrontal. Although much is known today about the various regions of the brain, there is apparently no attempt to place the electrodes in any particular localized region. This is because the desired effect is a grand mal seizure (ECT activates over 90 percent of the brain), not a specific action within the brain. That said, the bilateral placement is considered the most effective, although it is also associated with the most memory impairment.

The current administered varies from clinic to clinic, but is certainly much higher than the brain is used to dealing with; according to one source, it is over two thousand times greater than the amount of electricity normally flowing thru the brain:

... one ECT session assaults the brain with 2,300 times more electricity than it needs to function…

Proponents claim that because the electric current is administered in short pulses, it is less harmful than the older, cruder way of delivering an electric shock in sine waves. However, there are no studies that conclusively prove this—and in any case, sine wave therapy is still in use.

Efficacy

Much of the scientific literature referring to ECT cites success rates of over 70 percent. The studies such statistics are based on, however, are of exceptionally low quality and most have only a few dozen people enrolled. Most date to the 1980s or earlier.

In contrast, a more recent study from 2023 concluded that people in the ECT group were much more likely to commit suicide than those in the control group:

Compared to the reference individuals, patients having received ECT had a substantially elevated suicide rate…

Side-effects

Memory impairment is one of the most common side effects of ECT. According to the Mayo Clinic, memory loss following ECT is “usually” temporary:

Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years ... For most people, these memory problems usually improve within a couple of months after treatment ends.

Other side-effects include confusion, “which can last from a few minutes to a few hours ... Rarely, confusion may last several days or longer...”

Occasionally, ECT may result in death, as it did for one patient in England, whose story can only be found in the internet archive. Elsie Tindle, who was hospitalized involuntarily as a danger to herself, was subjected to ECT because she refused to eat or take medication and would rip out her IV line. Following the third treatment, she went into a permanent epileptic seizure and died. Such a result is considered rare, according to physicians, occurring in “only” one in eighty thousand instances.

Relapse

Relapse—the return of “severe major depression”—after ECT is extremely common. Over half of those who undergo ECT relapse within a year, most within the first six months after treatment. Interestingly, this approximately parallels the time frame within which memory loss is allegedly reversed, so much so that it was once believed within the psychiatric community that the primary therapeutic effect of ECT was destruction of the memory and with it, knowledge of all the factors that had been distressing the patient.

So, the Mayo Clinic concedes that:

Even after your symptoms improve, you'll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, or psychological counseling (psychotherapy).

Dissatisfied

Following a lawsuit, Somatics, LLC, a prominent manufacturer of ECT devices, published a disclosure admitting that ECT can cause permanent brain damage:

ECT may result in anterograde or retrograde amnesia. Such post-treatment typically dissipates over time, however, incomplete recovery is possible. In rare cases, patients may experience permanent memory loss or permanent brain damage.

Many survivors would agree:

I’m missing between eight and fifteen years of memory and skills ... I’m a trained classical pianist, but I don’t have that kind of ability any longer ... People come up to me and I don’t know who they are, even though they tell me about things we’ve done [together] ... Mostly what I had was modified shock and it was seen as effective. By ‘effective’ I know that it means that they diminish the person. They certainly diminished me ... I work as a payroll clerk...

Erika Civils wrote an article entitled: “How ECT Fried My Brain” in which she writes:

I dropped out of CSU in 2013, and having tried over 20 different antidepressants and mood stabilizers since 2011, ECT was recommended to me. I was told that only temporary, minor memory loss was possible, in rare cases, before starting ECT in 2013.

The best way to sum up extreme ECT memory loss is it’s like having Alzheimer’s, and being fully cognizant of it. What that does in effect is take away who you are as a person: your self-identity.

To those who don’t understand this, who you are, your entire sense of self, ARE YOUR MEMORIES. The way you connect with others through stories, jokes, shared memories, is gone. Socialization skills, along with countless other aspects of life, have to be relearned.

Shirley Johnston described to Dr. Bonnie Burstow how entire periods of her past, including significant events, have effectively disappeared:

The damage done to my brain ... is still evident ... The memory loss is especially painful, since I could not remember a lot of times while the children were growing up ... I feel so alien because of this damage ... Finally, when the anxiety got so bad, I would completely avoid people.

Another unnamed survivor quoted by Dr. Burstow described “the feeling of being led to the slaughter on treatment mornings.”

Sue, another survivor quoted by Dr. Burstow, was “treated” with ECT against her will, and noted: 

All the therapy in the world is not going to erase the scars of being dragged into a room, having a band on your head, and having your brains fried. People say there’s no torture [today]. That’s pure BS. There is torture being paid for by the Ministry of Health.