In praise of 'electroshock'

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What does it feel like to be profoundly depressed?

"Sometimes you feel like your head is going to explode," Richard Braudo explains. "There were times I was so depressed, I was comatose. You can reach the point where you don't want to live - the pain is too much."

Mr. Braudo knows. His diagnosis: treatment-resistant bipolar affective disorder.

The Toronto lawyer and management consultant has survived 30 bouts of severe depression, each lasting many months, not to mention a couple of suicide attempts.

But, at the age of 55, he has finally achieved "stable wellness."

Mr. Braudo credits electroconvulsive therapy for his recovery. He has undergone 10 courses of ECT since 1991, the last about 18 months ago - the longest period, by far, in his adult life that he has gone without a bout of depression.

He has chosen to tell his story to help counter the negative public image of ECT as barbaric and painful and to underscore that prescription drugs are not the be-all and end-all for people with psychiatric illnesses.

"I've been on dozens and dozens of drug combinations and they never did anything but aggravate my condition," Mr. Braudo says.

In fact, while antidepressants would sometimes lift him out of depression, they could also propel him into a state of hypermania that was almost as destructive.

It was not until he tried ECT that he was able to break that vicious cycle. (Mr. Braudo stresses, though, that recovery is a lot of work: Aside from ECT, he undergoes cognitive behaviour therapy, psychiatric care and treatment by a naturopathic doctor.)

Murray Enns, a professor in the department of psychiatry at the University of Manitoba in Winnipeg, says ECT's bad rap comes principally from a memorable scene in a Hollywood movie. "The One Flew Over the Cuckoo's Nest portrayal of people thrashing about while being shocked just doesn't happen," he says.

In fact, the term shock therapy is a misnomer. ECT is a procedure in which an electrical current is briefly sent through the brain through electrodes placed on the scalp. The electrical stimulation, which lasts a few seconds, is just a means to an end: It produces a seizure, which, in turn, alters brain chemicals, similar to what medications do.

ECT dates to 1938, when Italian researchers noted that people who suffered seizures saw their depression lift, and they tried to reproduce the seizures with electrical stimulus. At the time, the only other treatments for severe depression were frontal lobotomy and insulin-shock therapy - injecting a patient with insulin to provoke convulsions and a temporary coma.

In the 1950s, the first prescription antidepressants were developed and ECT began to fall out of favour. Now, it is used only for the treatment of those who are severely depressed who do not respond to medication, particularly if the patient is suicidal.

But there are still vocal opponents.

"Electroshock should be banned outright," says Bonnie Burstow, a Toronto psychotherapist. "It's not a legitimate medical treatment. It's barbaric."

She says a careful reading of medical literature will show that ECT is no more effective for treating depression and preventing suicide than a placebo, but it causes great harm.

The principal side effect of ECT is memory loss. While most researchers say the memory loss is short-term and temporary - and note that severe depression itself is associated with memory loss - Dr. Burstow says the brain damage caused by ECT is far more extensive. "I've seen people who've had their lives erased," she says. "The most common effect is eight to nine years of memory loss. That's not minor."

Dr. Burstow also notes that two to three times more women than men undergo ECT, a situation she described as "psychiatric rape."

Lakshmi Yatham, a professor of psychiatry at the University of British Columbia in Vancouver, says the claims of anti-ECT activists are outrageous and simply not supported by scientific evidence.

For example, women are more likely to receive ECT because they suffer depression in much higher numbers than men.

"There is no doubt this treatment is effective. It saves lives," Dr. Yatham says.

If anything, he says, the treatment is underused, in large part because of the misconceptions that persist. "This is the only treatment we stop after it works," Dr. Yatham notes.

Increasingly, however, practitioners are offering maintenance ECT to prevent the recurrence of depression.

Still, the procedure is offered to only a tiny percentage of those who suffer severe depression - even among those who are admitted to hospital for care, only about 5 per cent get ECT.

Mr. Braudo thinks that the critics are a "fringe element.

"Before you talk about what it feels like to have ECT, you have to understand what it feels like to be in a major depression," he says. "My choices were down to suicide or ECT. I made the right choice and, as a result, I've learned to live and thrive."

André Picard is The Globe and Mail's public health reporter.