Shock therapy makes comeback but remains controversial

[Guest guest]

Kind of off topic but this is the Psychiatry's final solution if the drugs don't

work.

http://seattletimes.nwsource.com/html/health/2001844934_healthshock28.html

Shock therapy makes comeback but remains controversial

By Benedict Carey

Los Angeles Times

The electrical current throbs from one side of the skull to the other,

scrambling circuits along the way, inducing a brief seizure. When it's over and

the anesthesia wears off, patients often are subdued, confused, sometimes unsure

of where they are or why. Then, sometimes, the remarkable happens: Severely

depressed people feel better than they have in years.

Others are left distraught. They feel no better than before.

In recent years, electroconvulsive therapy, or ECT, has undergone a

transformation. With medication, the body no longer thrashes; the thrashing is

in the mind. Techniques are more precise, the brain better understood.

Exact numbers are not available on how many people get modern ECT, but estimates

have ranged from 30,000 to more than 50,000 a year since the early 1990s.

Scientific interest has surged, partly because drugs don't help many deeply

depressed people, particularly older adults. The government is funding some 20

ECT studies to test different techniques on behavior.

Researchers have studied the brains of shocked rodents to learn how bolts of

current alter the biology. And in June, a leading medical journal published the

results of a survey detailing what former ECT patients think about the

treatment.

Yet far from proving the effectiveness of ECT, the research only accentuates its

unknowns and shortcomings. Doctors still don't know exactly how the shocks

affect the brain, whether they cause permanent damage, or why they affect

depression. Though techniques and technology have improved, ECT itself appears

no more effective than it ever was.

When it comes to treating older people, doctors have no scientifically rigorous

evidence establishing ECT's safety or effectiveness, according to an exhaustive

review of the literature published last year. " Proponents have been saying it's

safe and effective, but their statements go beyond what we know for elderly

people, " said Bola, a researcher at the University of Southern California.

Slaughterhouse pigs

The reputation of shock therapy has alternately risen and fallen since 1938,

when Italian psychiatrist Ugo Cerletti decided to try shocking one of his

patients after watching slaughterhouse workers subdue pigs with bolts of current

to the brain.

Cerletti reported that the man improved after repeated shocks, and the idea

caught on among doctors desperate to help disturbed, often aggressive patients.

But use of ECT declined in the 1960s and '70s, with the introduction of new

psychiatric drugs.

That decline stopped in the 1980s, researchers say, because psychiatrists

refined their techniques and continued to report recoveries in severely

depressed people. By 1990, an American Psychiatric Association task-force report

concluded that the treatment was effective, " with 80 percent to 90 percent of

those treated showing improvement. " The association set guidelines for

treatment, specifying the amounts of electricity and placement of electrodes.

" You're talking about people who are desperate, who are often suicidal, " said

Harold Sackeim, chief of biological psychiatry at the New York State Psychiatric

Institute and a professor at Columbia and Cornell universities. " This is a

treatment that we know can help. "

Just buying time

Psychiatrists acknowledge that the mood-altering effect of ECT is usually

short-lived. Those who feel better after a series of shocks almost always plunge

back into depression within weeks or months.

" It must be thought of as a stopgap measure in life-threatening situations, "

said Dr. Schwartz, a research psychiatrist at the Neuropsychiatric

Institute at the University of California, Los Angeles. " All you're doing is

buying more time to get to a place where drugs, or cognitive therapy, can have

some effect. "

In an article in the March 14, 2001, Journal of the American Medical

Association, researchers at Columbia University in New York reported that a

combination of ECT and aggressive drug treatment successfully vanquished

depression in 14 of 23 people (61 percent) for at least six months. ECT alone

helped only four of 25 people in the study (16 percent).

But the researchers also reported that more than half of the 316 people

originally enrolled and given shock therapy dropped out of the study or were

excluded. Most of them didn't feel better after the shocks; others refused

further treatment; and some suffered complications.

The success rate is based only on the people who responded well to the shock and

had no adverse reactions or second thoughts. Without continual therapy of some

kind, the authors conclude, " almost universal relapse should be expected. "

Some psychiatrists believe the solution is more ECT. Continuation-ECT (C-ETC)

involves " maintenance " every few months. Some psychiatrists have been giving

C-ECT for years, and hundreds of people are already on this regimen, experts

estimate.

Yet there's no solid evidence that continually shocking a person is safe, and it

could cause damage, some doctors say.

New cells and 'mossy fibers'

In recent studies in rats, scientists have reported some of the first direct

evidence of biological changes from the treatments that might be related to

changes in behavior. They report that ECT accelerates production of new brain

cells in rats and spurs growth of neural connections called mossy fibers. Some

ECT doctors say new neurons are probably helpful and new nerve connections may

enhance brain function.

" These changes could help explain how it is that these severely depressed

patients recover, " said Dr. nby, who heads the American Psychiatric

Association's ECT Committee.

nby acknowledges, though, that doctors aren't sure whether the brain changes

are good or bad.

The studies purporting to show brain-cell proliferation from ECT may in fact be

showing evidence of cell damage, according to Nowakowski, a

neuroscientist at the Wood School of Medicine in New Jersey, who

pioneered the techniques used in the studies. " It's not clear ... whether

they're seeing proliferation or something else, " he said.

Nor is it clear what the growth of new neural connections means. Neuroscientists

say the brain's nerve networks are laid down over years, as the brain develops

and responds to stimuli. Chances that an instantaneous, shock-induced fiber

would make exactly the right connections to enhance function are extremely

remote.

Moreover, the mossy-fiber proliferation seen in shocked animals also turns up in

brains of people who have epilepsy or other seizure disorders. " There's a debate

over whether the epilepsy causes the fibers, or the fibers cause the epilepsy, "

Nowakowski said.

Lost memories

Some people who undergo ECT insist the shocks both relieved their illness and

improved their cognitive function. But over the years, the practice of ECT has

spawned a large and vocal group who say the shocks harmed them, mainly by

erasing memory.

" There are thousands of people out there who feel they weren't told the whole

story before getting the treatment, " said Juli Lawrence, who started the Web

site ect.org after shock treatments failed to lift her depression and killed

about two years of memory.

In the first major effort to learn from ECT patients, researchers in England

reviewed 35 studies involving more than 2,000 men and women who got ECT

treatment. Depending on the study, 30 percent to 80 percent reported lasting

memory loss. In one survey, a third of patients agreed that: " Electroconvulsive

therapy permanently wipes out large parts of memory. "

Those who saw ECT as ultimately helpful varied from about one-third, when

patients helped design or conduct surveys, to about three-fourths, when doctors

did.

" When you ask patients what they think, " said patient turned ECT critic

Andre, " you get a completely different story from the one psychiatrists are

telling. "

Dr. Loren Mosher, former director of schizophrenia research at the National

Institute of Mental Health and now a professor at the University of California,

San Diego, said the issue comes down to a " cost-benefit " analysis. " Does it make

sense to expose people to something which not only isn't very effective but also

has serious inherent danger? In my view, the cost to the person is greater than

the potential benefit. "

Jim - Norman

" Never look at the trombones, it only encourages them. "

Strauss

[Guest guest]

Kind of off topic but this is the Psychiatry's final solution if the drugs don't

work.

http://seattletimes.nwsource.com/html/health/2001844934_healthshock28.html

Shock therapy makes comeback but remains controversial

By Benedict Carey

Los Angeles Times

The electrical current throbs from one side of the skull to the other,

scrambling circuits along the way, inducing a brief seizure. When it's over and

the anesthesia wears off, patients often are subdued, confused, sometimes unsure

of where they are or why. Then, sometimes, the remarkable happens: Severely

depressed people feel better than they have in years.

Others are left distraught. They feel no better than before.

In recent years, electroconvulsive therapy, or ECT, has undergone a

transformation. With medication, the body no longer thrashes; the thrashing is

in the mind. Techniques are more precise, the brain better understood.

Exact numbers are not available on how many people get modern ECT, but estimates

have ranged from 30,000 to more than 50,000 a year since the early 1990s.

Scientific interest has surged, partly because drugs don't help many deeply

depressed people, particularly older adults. The government is funding some 20

ECT studies to test different techniques on behavior.

Researchers have studied the brains of shocked rodents to learn how bolts of

current alter the biology. And in June, a leading medical journal published the

results of a survey detailing what former ECT patients think about the

treatment.

Yet far from proving the effectiveness of ECT, the research only accentuates its

unknowns and shortcomings. Doctors still don't know exactly how the shocks

affect the brain, whether they cause permanent damage, or why they affect

depression. Though techniques and technology have improved, ECT itself appears

no more effective than it ever was.

When it comes to treating older people, doctors have no scientifically rigorous

evidence establishing ECT's safety or effectiveness, according to an exhaustive

review of the literature published last year. " Proponents have been saying it's

safe and effective, but their statements go beyond what we know for elderly

people, " said Bola, a researcher at the University of Southern California.

Slaughterhouse pigs

The reputation of shock therapy has alternately risen and fallen since 1938,

when Italian psychiatrist Ugo Cerletti decided to try shocking one of his

patients after watching slaughterhouse workers subdue pigs with bolts of current

to the brain.

Cerletti reported that the man improved after repeated shocks, and the idea

caught on among doctors desperate to help disturbed, often aggressive patients.

But use of ECT declined in the 1960s and '70s, with the introduction of new

psychiatric drugs.

That decline stopped in the 1980s, researchers say, because psychiatrists

refined their techniques and continued to report recoveries in severely

depressed people. By 1990, an American Psychiatric Association task-force report

concluded that the treatment was effective, " with 80 percent to 90 percent of

those treated showing improvement. " The association set guidelines for

treatment, specifying the amounts of electricity and placement of electrodes.

" You're talking about people who are desperate, who are often suicidal, " said

Harold Sackeim, chief of biological psychiatry at the New York State Psychiatric

Institute and a professor at Columbia and Cornell universities. " This is a

treatment that we know can help. "

Just buying time

Psychiatrists acknowledge that the mood-altering effect of ECT is usually

short-lived. Those who feel better after a series of shocks almost always plunge

back into depression within weeks or months.

" It must be thought of as a stopgap measure in life-threatening situations, "

said Dr. Schwartz, a research psychiatrist at the Neuropsychiatric

Institute at the University of California, Los Angeles. " All you're doing is

buying more time to get to a place where drugs, or cognitive therapy, can have

some effect. "

In an article in the March 14, 2001, Journal of the American Medical

Association, researchers at Columbia University in New York reported that a

combination of ECT and aggressive drug treatment successfully vanquished

depression in 14 of 23 people (61 percent) for at least six months. ECT alone

helped only four of 25 people in the study (16 percent).

But the researchers also reported that more than half of the 316 people

originally enrolled and given shock therapy dropped out of the study or were

excluded. Most of them didn't feel better after the shocks; others refused

further treatment; and some suffered complications.

The success rate is based only on the people who responded well to the shock and

had no adverse reactions or second thoughts. Without continual therapy of some

kind, the authors conclude, " almost universal relapse should be expected. "

Some psychiatrists believe the solution is more ECT. Continuation-ECT (C-ETC)

involves " maintenance " every few months. Some psychiatrists have been giving

C-ECT for years, and hundreds of people are already on this regimen, experts

estimate.

Yet there's no solid evidence that continually shocking a person is safe, and it

could cause damage, some doctors say.

New cells and 'mossy fibers'

In recent studies in rats, scientists have reported some of the first direct

evidence of biological changes from the treatments that might be related to

changes in behavior. They report that ECT accelerates production of new brain

cells in rats and spurs growth of neural connections called mossy fibers. Some

ECT doctors say new neurons are probably helpful and new nerve connections may

enhance brain function.

" These changes could help explain how it is that these severely depressed

patients recover, " said Dr. nby, who heads the American Psychiatric

Association's ECT Committee.

nby acknowledges, though, that doctors aren't sure whether the brain changes

are good or bad.

The studies purporting to show brain-cell proliferation from ECT may in fact be

showing evidence of cell damage, according to Nowakowski, a

neuroscientist at the Wood School of Medicine in New Jersey, who

pioneered the techniques used in the studies. " It's not clear ... whether

they're seeing proliferation or something else, " he said.

Nor is it clear what the growth of new neural connections means. Neuroscientists

say the brain's nerve networks are laid down over years, as the brain develops

and responds to stimuli. Chances that an instantaneous, shock-induced fiber

would make exactly the right connections to enhance function are extremely

remote.

Moreover, the mossy-fiber proliferation seen in shocked animals also turns up in

brains of people who have epilepsy or other seizure disorders. " There's a debate

over whether the epilepsy causes the fibers, or the fibers cause the epilepsy, "

Nowakowski said.

Lost memories

Some people who undergo ECT insist the shocks both relieved their illness and

improved their cognitive function. But over the years, the practice of ECT has

spawned a large and vocal group who say the shocks harmed them, mainly by

erasing memory.

" There are thousands of people out there who feel they weren't told the whole

story before getting the treatment, " said Juli Lawrence, who started the Web

site ect.org after shock treatments failed to lift her depression and killed

about two years of memory.

In the first major effort to learn from ECT patients, researchers in England

reviewed 35 studies involving more than 2,000 men and women who got ECT

treatment. Depending on the study, 30 percent to 80 percent reported lasting

memory loss. In one survey, a third of patients agreed that: " Electroconvulsive

therapy permanently wipes out large parts of memory. "

Those who saw ECT as ultimately helpful varied from about one-third, when

patients helped design or conduct surveys, to about three-fourths, when doctors

did.

" When you ask patients what they think, " said patient turned ECT critic

Andre, " you get a completely different story from the one psychiatrists are

telling. "

Dr. Loren Mosher, former director of schizophrenia research at the National

Institute of Mental Health and now a professor at the University of California,

San Diego, said the issue comes down to a " cost-benefit " analysis. " Does it make

sense to expose people to something which not only isn't very effective but also

has serious inherent danger? In my view, the cost to the person is greater than

the potential benefit. "

Jim - Norman

" Never look at the trombones, it only encourages them. "

Strauss

[Guest guest]

Kind of off topic but this is the Psychiatry's final solution if the drugs don't

work.

http://seattletimes.nwsource.com/html/health/2001844934_healthshock28.html

Shock therapy makes comeback but remains controversial

By Benedict Carey

Los Angeles Times

The electrical current throbs from one side of the skull to the other,

scrambling circuits along the way, inducing a brief seizure. When it's over and

the anesthesia wears off, patients often are subdued, confused, sometimes unsure

of where they are or why. Then, sometimes, the remarkable happens: Severely

depressed people feel better than they have in years.

Others are left distraught. They feel no better than before.

In recent years, electroconvulsive therapy, or ECT, has undergone a

transformation. With medication, the body no longer thrashes; the thrashing is

in the mind. Techniques are more precise, the brain better understood.

Exact numbers are not available on how many people get modern ECT, but estimates

have ranged from 30,000 to more than 50,000 a year since the early 1990s.

Scientific interest has surged, partly because drugs don't help many deeply

depressed people, particularly older adults. The government is funding some 20

ECT studies to test different techniques on behavior.

Researchers have studied the brains of shocked rodents to learn how bolts of

current alter the biology. And in June, a leading medical journal published the

results of a survey detailing what former ECT patients think about the

treatment.

Yet far from proving the effectiveness of ECT, the research only accentuates its

unknowns and shortcomings. Doctors still don't know exactly how the shocks

affect the brain, whether they cause permanent damage, or why they affect

depression. Though techniques and technology have improved, ECT itself appears

no more effective than it ever was.

When it comes to treating older people, doctors have no scientifically rigorous

evidence establishing ECT's safety or effectiveness, according to an exhaustive

review of the literature published last year. " Proponents have been saying it's

safe and effective, but their statements go beyond what we know for elderly

people, " said Bola, a researcher at the University of Southern California.

Slaughterhouse pigs

The reputation of shock therapy has alternately risen and fallen since 1938,

when Italian psychiatrist Ugo Cerletti decided to try shocking one of his

patients after watching slaughterhouse workers subdue pigs with bolts of current

to the brain.

Cerletti reported that the man improved after repeated shocks, and the idea

caught on among doctors desperate to help disturbed, often aggressive patients.

But use of ECT declined in the 1960s and '70s, with the introduction of new

psychiatric drugs.

That decline stopped in the 1980s, researchers say, because psychiatrists

refined their techniques and continued to report recoveries in severely

depressed people. By 1990, an American Psychiatric Association task-force report

concluded that the treatment was effective, " with 80 percent to 90 percent of

those treated showing improvement. " The association set guidelines for

treatment, specifying the amounts of electricity and placement of electrodes.

" You're talking about people who are desperate, who are often suicidal, " said

Harold Sackeim, chief of biological psychiatry at the New York State Psychiatric

Institute and a professor at Columbia and Cornell universities. " This is a

treatment that we know can help. "

Just buying time

Psychiatrists acknowledge that the mood-altering effect of ECT is usually

short-lived. Those who feel better after a series of shocks almost always plunge

back into depression within weeks or months.

" It must be thought of as a stopgap measure in life-threatening situations, "

said Dr. Schwartz, a research psychiatrist at the Neuropsychiatric

Institute at the University of California, Los Angeles. " All you're doing is

buying more time to get to a place where drugs, or cognitive therapy, can have

some effect. "

In an article in the March 14, 2001, Journal of the American Medical

Association, researchers at Columbia University in New York reported that a

combination of ECT and aggressive drug treatment successfully vanquished

depression in 14 of 23 people (61 percent) for at least six months. ECT alone

helped only four of 25 people in the study (16 percent).

But the researchers also reported that more than half of the 316 people

originally enrolled and given shock therapy dropped out of the study or were

excluded. Most of them didn't feel better after the shocks; others refused

further treatment; and some suffered complications.

The success rate is based only on the people who responded well to the shock and

had no adverse reactions or second thoughts. Without continual therapy of some

kind, the authors conclude, " almost universal relapse should be expected. "

Some psychiatrists believe the solution is more ECT. Continuation-ECT (C-ETC)

involves " maintenance " every few months. Some psychiatrists have been giving

C-ECT for years, and hundreds of people are already on this regimen, experts

estimate.

Yet there's no solid evidence that continually shocking a person is safe, and it

could cause damage, some doctors say.

New cells and 'mossy fibers'

In recent studies in rats, scientists have reported some of the first direct

evidence of biological changes from the treatments that might be related to

changes in behavior. They report that ECT accelerates production of new brain

cells in rats and spurs growth of neural connections called mossy fibers. Some

ECT doctors say new neurons are probably helpful and new nerve connections may

enhance brain function.

" These changes could help explain how it is that these severely depressed

patients recover, " said Dr. nby, who heads the American Psychiatric

Association's ECT Committee.

nby acknowledges, though, that doctors aren't sure whether the brain changes

are good or bad.

The studies purporting to show brain-cell proliferation from ECT may in fact be

showing evidence of cell damage, according to Nowakowski, a

neuroscientist at the Wood School of Medicine in New Jersey, who

pioneered the techniques used in the studies. " It's not clear ... whether

they're seeing proliferation or something else, " he said.

Nor is it clear what the growth of new neural connections means. Neuroscientists

say the brain's nerve networks are laid down over years, as the brain develops

and responds to stimuli. Chances that an instantaneous, shock-induced fiber

would make exactly the right connections to enhance function are extremely

remote.

Moreover, the mossy-fiber proliferation seen in shocked animals also turns up in

brains of people who have epilepsy or other seizure disorders. " There's a debate

over whether the epilepsy causes the fibers, or the fibers cause the epilepsy, "

Nowakowski said.

Lost memories

Some people who undergo ECT insist the shocks both relieved their illness and

improved their cognitive function. But over the years, the practice of ECT has

spawned a large and vocal group who say the shocks harmed them, mainly by

erasing memory.

" There are thousands of people out there who feel they weren't told the whole

story before getting the treatment, " said Juli Lawrence, who started the Web

site ect.org after shock treatments failed to lift her depression and killed

about two years of memory.

In the first major effort to learn from ECT patients, researchers in England

reviewed 35 studies involving more than 2,000 men and women who got ECT

treatment. Depending on the study, 30 percent to 80 percent reported lasting

memory loss. In one survey, a third of patients agreed that: " Electroconvulsive

therapy permanently wipes out large parts of memory. "

Those who saw ECT as ultimately helpful varied from about one-third, when

patients helped design or conduct surveys, to about three-fourths, when doctors

did.

" When you ask patients what they think, " said patient turned ECT critic

Andre, " you get a completely different story from the one psychiatrists are

telling. "

Dr. Loren Mosher, former director of schizophrenia research at the National

Institute of Mental Health and now a professor at the University of California,

San Diego, said the issue comes down to a " cost-benefit " analysis. " Does it make

sense to expose people to something which not only isn't very effective but also

has serious inherent danger? In my view, the cost to the person is greater than

the potential benefit. "

Jim - Norman

" Never look at the trombones, it only encourages them. "

Strauss

[Guest guest]

Kind of off topic but this is the Psychiatry's final solution if the drugs don't

work.

http://seattletimes.nwsource.com/html/health/2001844934_healthshock28.html

Shock therapy makes comeback but remains controversial

By Benedict Carey

Los Angeles Times

The electrical current throbs from one side of the skull to the other,

scrambling circuits along the way, inducing a brief seizure. When it's over and

the anesthesia wears off, patients often are subdued, confused, sometimes unsure

of where they are or why. Then, sometimes, the remarkable happens: Severely

depressed people feel better than they have in years.

Others are left distraught. They feel no better than before.

In recent years, electroconvulsive therapy, or ECT, has undergone a

transformation. With medication, the body no longer thrashes; the thrashing is

in the mind. Techniques are more precise, the brain better understood.

Exact numbers are not available on how many people get modern ECT, but estimates

have ranged from 30,000 to more than 50,000 a year since the early 1990s.

Scientific interest has surged, partly because drugs don't help many deeply

depressed people, particularly older adults. The government is funding some 20

ECT studies to test different techniques on behavior.

Researchers have studied the brains of shocked rodents to learn how bolts of

current alter the biology. And in June, a leading medical journal published the

results of a survey detailing what former ECT patients think about the

treatment.

Yet far from proving the effectiveness of ECT, the research only accentuates its

unknowns and shortcomings. Doctors still don't know exactly how the shocks

affect the brain, whether they cause permanent damage, or why they affect

depression. Though techniques and technology have improved, ECT itself appears

no more effective than it ever was.

When it comes to treating older people, doctors have no scientifically rigorous

evidence establishing ECT's safety or effectiveness, according to an exhaustive

review of the literature published last year. " Proponents have been saying it's

safe and effective, but their statements go beyond what we know for elderly

people, " said Bola, a researcher at the University of Southern California.

Slaughterhouse pigs

The reputation of shock therapy has alternately risen and fallen since 1938,

when Italian psychiatrist Ugo Cerletti decided to try shocking one of his

patients after watching slaughterhouse workers subdue pigs with bolts of current

to the brain.

Cerletti reported that the man improved after repeated shocks, and the idea

caught on among doctors desperate to help disturbed, often aggressive patients.

But use of ECT declined in the 1960s and '70s, with the introduction of new

psychiatric drugs.

That decline stopped in the 1980s, researchers say, because psychiatrists

refined their techniques and continued to report recoveries in severely

depressed people. By 1990, an American Psychiatric Association task-force report

concluded that the treatment was effective, " with 80 percent to 90 percent of

those treated showing improvement. " The association set guidelines for

treatment, specifying the amounts of electricity and placement of electrodes.

" You're talking about people who are desperate, who are often suicidal, " said

Harold Sackeim, chief of biological psychiatry at the New York State Psychiatric

Institute and a professor at Columbia and Cornell universities. " This is a

treatment that we know can help. "

Just buying time

Psychiatrists acknowledge that the mood-altering effect of ECT is usually

short-lived. Those who feel better after a series of shocks almost always plunge

back into depression within weeks or months.

" It must be thought of as a stopgap measure in life-threatening situations, "

said Dr. Schwartz, a research psychiatrist at the Neuropsychiatric

Institute at the University of California, Los Angeles. " All you're doing is

buying more time to get to a place where drugs, or cognitive therapy, can have

some effect. "

In an article in the March 14, 2001, Journal of the American Medical

Association, researchers at Columbia University in New York reported that a

combination of ECT and aggressive drug treatment successfully vanquished

depression in 14 of 23 people (61 percent) for at least six months. ECT alone

helped only four of 25 people in the study (16 percent).

But the researchers also reported that more than half of the 316 people

originally enrolled and given shock therapy dropped out of the study or were

excluded. Most of them didn't feel better after the shocks; others refused

further treatment; and some suffered complications.

The success rate is based only on the people who responded well to the shock and

had no adverse reactions or second thoughts. Without continual therapy of some

kind, the authors conclude, " almost universal relapse should be expected. "

Some psychiatrists believe the solution is more ECT. Continuation-ECT (C-ETC)

involves " maintenance " every few months. Some psychiatrists have been giving

C-ECT for years, and hundreds of people are already on this regimen, experts

estimate.

Yet there's no solid evidence that continually shocking a person is safe, and it

could cause damage, some doctors say.

New cells and 'mossy fibers'

In recent studies in rats, scientists have reported some of the first direct

evidence of biological changes from the treatments that might be related to

changes in behavior. They report that ECT accelerates production of new brain

cells in rats and spurs growth of neural connections called mossy fibers. Some

ECT doctors say new neurons are probably helpful and new nerve connections may

enhance brain function.

" These changes could help explain how it is that these severely depressed

patients recover, " said Dr. nby, who heads the American Psychiatric

Association's ECT Committee.

nby acknowledges, though, that doctors aren't sure whether the brain changes

are good or bad.

The studies purporting to show brain-cell proliferation from ECT may in fact be

showing evidence of cell damage, according to Nowakowski, a

neuroscientist at the Wood School of Medicine in New Jersey, who

pioneered the techniques used in the studies. " It's not clear ... whether

they're seeing proliferation or something else, " he said.

Nor is it clear what the growth of new neural connections means. Neuroscientists

say the brain's nerve networks are laid down over years, as the brain develops

and responds to stimuli. Chances that an instantaneous, shock-induced fiber

would make exactly the right connections to enhance function are extremely

remote.

Moreover, the mossy-fiber proliferation seen in shocked animals also turns up in

brains of people who have epilepsy or other seizure disorders. " There's a debate

over whether the epilepsy causes the fibers, or the fibers cause the epilepsy, "

Nowakowski said.

Lost memories

Some people who undergo ECT insist the shocks both relieved their illness and

improved their cognitive function. But over the years, the practice of ECT has

spawned a large and vocal group who say the shocks harmed them, mainly by

erasing memory.

" There are thousands of people out there who feel they weren't told the whole

story before getting the treatment, " said Juli Lawrence, who started the Web

site ect.org after shock treatments failed to lift her depression and killed

about two years of memory.

In the first major effort to learn from ECT patients, researchers in England

reviewed 35 studies involving more than 2,000 men and women who got ECT

treatment. Depending on the study, 30 percent to 80 percent reported lasting

memory loss. In one survey, a third of patients agreed that: " Electroconvulsive

therapy permanently wipes out large parts of memory. "

Those who saw ECT as ultimately helpful varied from about one-third, when

patients helped design or conduct surveys, to about three-fourths, when doctors

did.

" When you ask patients what they think, " said patient turned ECT critic

Andre, " you get a completely different story from the one psychiatrists are

telling. "

Dr. Loren Mosher, former director of schizophrenia research at the National

Institute of Mental Health and now a professor at the University of California,

San Diego, said the issue comes down to a " cost-benefit " analysis. " Does it make

sense to expose people to something which not only isn't very effective but also

has serious inherent danger? In my view, the cost to the person is greater than

the potential benefit. "

Jim - Norman

" Never look at the trombones, it only encourages them. "

Strauss