In the News

As published in The Hartford Courant, November 9, 2004.

More Sensitive Electroshock

By Hilary Waldman

Until last year, Rosemarie Matthews was the very picture of a grandmother, baking pies, playing bingo and occasionally pumping a few quarters into the slots at Foxwoods.

A social magnet for her seven children and the swarm of grandchildren and great-grandchildren who filled her Windsor Locks home on weekends and holidays, Matthews never seemed to run out of loving energy.

But hidden within the confines of her kitchen, the storybook grandmother was spiraling into the grip of depression, masked by the cocktails she kept mixing to boost her spirits.

By the time she reached the bottom of her emotional abyss, Matthews was wasting away in a nursing home, unable to eat or sleep, her personality so distorted by depression that the once affable woman had alienated most of her nurses.

In the end, it took a treatment Matthews once associated with Frankenstein's monster to bring her home.

"I asked the doctor at the nursing home; I said we gotta do something for her," recalled Matthews' husband, Clifford, who by last summer feared his wife was dying. "They said we can put a tube in her stomach or give her electrical shock treatments."

Shock treatment. The very name conjures up images of psychiatry's sometimes-regrettable past.

But the treatment that has become almost synonymous with Jack Nicholson's leather-strapped body convulsing barbarously in the movie "One Flew Over the Cuckoo's Nest" remains one of the quickest and most effective depression remedies in psychiatry's toolbox.

"Again and again people say, 'I thought they didn't do that anymore,' " said Dr. Robert Ostroff, director of the Electroconvulsive Therapy Center at Yale-New Haven Hospital.

But since the 1930s, when two Italian mental health practitioners discovered a safe way to produce brain seizures using electrical shocks, psychiatrists and researchers have continued to refine and improve on the technique.

Indeed, since the 1980s, when medications in the Prozac family showed that altering brain chemistry can help people devastated by depression, electroconvulsive therapy has gained a stronger foothold in the psychiatric arsenal.

While anti-depressants work well for some people, they provide no benefit to as many as one-third of the patients who try them. Even when drugs work, they can take weeks to kick in - which can be too long for people whose despair is stirring suicidal feelings or destroying their bodies by rendering them unable to eat or sleep or even move their muscles.

"Every article [that criticizes shock treatment] fails to convey how sick these people really are," Ostroff said.

The idea that seizures can help calibrate brain chemistry can be traced back to the asylums of the early 20th century, where clinicians noticed that people who had multiple epileptic seizures showed improvement in their symptoms of depression.

Shocking the brain with electric currents similar to those used to illuminate a light bulb became a safer alternative to medications such as insulin or camphor, which made patients horribly sick at the same time that they induced a seizure.

In almost 70 years, the idea behind shock therapy has not changed. The method of delivery has.

Rosemarie Matthews had her first shock treatment at the UConn Health Center during the summer, after a friend of her son's told her how the therapy had rescued him from crippling depression.

Instead of being delivered in one gigantic jolt, gentler shock treatments are now given two to three times a week until the patient has completed eight to 14 sessions. Often, the patient starts treatment while in the hospital, but can easily continue as an outpatient.

Matthews knows she has had some memory loss, which electroshock opponents cite as its most devastating side effect.

Sitting at her kitchen table on a sparkling autumn day as her husband recounts her ordeal, Matthews appears amazed by some of the details. He remembers the day she was wheeled back to her room after the first shock treatment. She does not.

"She was always tense; her shoulders were up; her mouth was tight," Clifford Matthews recalled. After the treatment, she appeared more relaxed. "I said, 'Rose, I can see a difference already.' "

The treatment is done under general anesthesia, so it is natural that Matthews would not remember the shock. Patients also are given a muscle relaxant to spare them the discomfort of violent spasms that often accompany a grand mal seizure.

Matthews also is confused about her time in the hospital and the events leading up to her treatment. But while some shock opponents say the therapy robs patients of their pasts, Matthews says she has not lost track of her life before she became depressed.

"I'm happy that I'm not unhappy," said Matthews, 77, who added that she had never experienced any psychiatric problems in the past. A wiry woman in slacks and sneakers, she now keeps track of her many medical appointments by writing everything on a calendar.

"There must be a lot of people out there that need very badly what I'm getting, and they're not because they're scared," she said.

Doctors acknowledge that electroconvulsive therapy, as it is called today, has risks, not the least of which are the possible complications from general anesthesia. They also agree that some patients suffer more extensive memory loss than others.

That is why researchers across the country are looking for alternatives.

At Columbia University in New York and several other large medical centers, researchers are trying to find out whether magnets placed strategically on the brain can stimulate enough electrical activity to balance the chemistry without causing a seizure.

If multi-center clinical trials show positive results, the technique, called transcranial magnetic stimulation, could be ready for review by the FDA, said Sarah Hollingsworth Lisanby, director of the magnetic stimulation laboratory at Columbia.

If approved, Lisanby said, magnetic brain stimulation, which does not produce seizures and does not require anesthesia, could be a step patients could try before jumping to convulsive therapy.

Lisanby also is looking at the potential for using magnets to produce seizures that are targeted to a small area of the brain, away from the temporal lobe, which is responsible for memory.

"If magnetic therapy is successful," Lisanby said, "it could be the next phase of convulsive therapy."

One reason for continued interest in convulsive therapy is pressure from insurance companies to treat psychiatric patients quickly and discharge them from the hospital, said Dr. Michael Henry, director of electroconvulsive therapy at McLean Hospital, a private psychiatric hospital outside Boston, which is affiliated with Harvard.

In addition to the initial intensive dose, patients who do not respond to medications may also return to the hospital once a month or so for what are known as maintenance shock treatments.

Shock is also especially effective for elderly patients, such as Matthews, who cannot tolerate the side effects of medication. Such side effects can include blood pressure changes, dry mouth and constipation, said Joanna Fogg-Waberski, director of geriatric psychiatry and electroconvulsive therapy at The Institute of Living in Hartford.

While shock treatment remains a last resort for most people suffering from depression, patients do not have to be "at death's door" to be a candidate, Fogg-Waberski said.

The main criteria for considering shock treatment is major depression with psychotic symptoms such as hallucinations, hearing things, refusing to eat, refusing to drink, not getting out of bed or inability to sleep, she said.

"But," Fogg-Waberski added, "there are people in the middle who do not respond to anti-depressants or have terrible side effects" who might also benefit from shock.

Matthews went home from the nursing home three weeks ago and is continuing shock therapy every three weeks as an outpatient at the UConn Health Center. She is cooking again and has already joined her husband on a day trip to the casino.

Clifford Matthews said he's glad to have his wife back.

"I'm awful glad we did it," Clifford Matthews said. "I was ready to give up. I said, ' We're not going to get her home.' "