Does electroconvulsive therapy cause brain damage?

Abstract

Although the use of ECT has declined dramatically from its inception, this decrease has recently shown signs of leveling out because of ECT's powerful therapeutic effect in severely ill depressed individuals who either do not respond to pharmacologic alternatives or are too ill to tolerate a relatively lengthy drug trial. Notwithstanding its therapeutic benefits, ECT has also remained a controversial treatment modality, particularly in the eye of the public. Given the unsavory qualities associated with the word “electroconvulsive,” claims of possible, probable, or even certain brain damage with ECT have easily found listeners. A careful, nonselective assessment of data covering the areas of pathology, radiology, electrophysiology, biochemistry, and neuropsychology leads both to certain conclusions and to certain unanswered questions. ECT is not the devastating purveyor of wholesale brain damage that some of its detractors claim. For the typical individual receiving ECT, no detectable correlates of irreversible brain damage appear to occur. Still, there remains the possibility that either subtle, objectively undetectable persistent deficits, particularly in the area of autobiographic memory function, occur, or that a rarely occurring syndrome of more pervasive persistent deficits related to ECT use may be present. Clearly, more research directed toward answering these questions needs to be carried out so that the role of ECT can be more rigorously defined. While such research is pending, however, we cannot expect that the conditions that predispose to clinical referrals for ECT will disappear. Given the misery, anguish, and risk of death by suicide, starvation, or debilitation associated with severe depressive illness, for example, it still appears that ECT, at least for the present, must continue to be available.

Isoflurane Narcotherapy in Depressive Patients Refractory to Conventional Antidepressant Drug Treatment

“…Thus, according to the hypothesis to be tested in this study, ECT would be therapeutic only because of its inherent induction of an electrocerebral disactivation (monitored in the EEG as 'flat line'), whereas the electri cally induced seizure per se [ 12] or the acute organic brain syndrome [13,14] (a consequence of the seizure) are unnecessary side effects [15,16] of ECT, which have nothing to do with the therapeutic efficacy of ECT.…”

Using thiamine to reduce post‐ECT confusion

“…Over the years, attempts have been made to minimize the severity of post-ECT confusion by focussing on a variety of methodological factors within the clinician's control, such as electrode placement, stimulus waveform, stimulus dose, intervals between treatments and treatment number (Strain et al, 1968;Bidder et al, 1970;Weiner, 1984;Sackeim et al, 1986;Weiner et al, 1986;Sackeim et al, 1993). Though such strategies have produced some modest bene®t, further progress in this area most likely depends on a greater understanding of the underlying pathophysiological mechanisms.…”

Shock therapy: a history of electroconvulsive treatment in mental illness

“…His task force cited three studies in arguing that memory was not persistently impaired by ECT. Weiner himself had been critical of one of those studies in a 1984 paper (Weiner, 1984) and Weiner's own 1986 study found "provocative evidence for what amounts to objective personal memory losses lasting at least six months with BL [bilateral] but not with UL[unilateral] ECT …" (Weiner, 1986, p. 321). The results, said Weiner, suggested that the cause of the memory loss was "organic rather than functional" (Weiner, 1986, p. 321).…”