Conventional therapies for depression

Electroconvulsive therapy (ECT)

Electroconvulsive therapy, or shock therapy, is enjoying somewhat of a comeback after falling into disrepute in the 1970s. Every year in Britain, 20,000 people are on the receiving end of 100,000 treatments—that is, at least five shock treatments apiece. In the US, 100,000 patients are subjected to more than half a million treatments a year. But perhaps the most astonishing of all these statistics is the number of cases of shock therapy that are still administered involuntarily. In the UK, some 3000 patients—or a sixth of all those treated with ECT—still receive the treatment against their will.

It is primarily used to treat severe depression. It involves the passage of electricity through the human brain. In bilateral ECT, electrodes are placed on the patient’s temples. With unilateral ECT, the electrodes are placed over the front and back of one side of the head. The applied voltage can be anywhere from 70 to 170, and the current from 500 to 100 milliamperes—the power consumed by a 100-watt bulb flashed for one-half to one second. The result is similar to a grand mal epileptic seizure, and that is its purpose.

It is believed that the induced seizure causes chemical changes to the brain that normalize moods and alter pain perception. But since nobody really fully understands how ECT works, its efficacy has been likened to kicking a malfunctioning TV set. If you do it long enough and hard enough, you may just produce the desired result.

Overall, ECT appears to have immediate, though temporary, beneficial effects where depression is characterized by psychotic features, or an individual has lost the will to live, doesn’t sleep and is refusing food.

ECT emphatically doesn’t work for Parkinson’s disease, Alzheimer’s disease, violent behaviour, obsessive–compulsive disorders and depressed individuals who do not respond to drug treatment. ECT should not be used for cases of mania, schizophrenia, epilepsy, autism or dementia.

While the medical profession believes ECT is a ‘life-saving option’, there is no evidence for this. Although we know it can kill, there are few figures to show how often it does. Risk of death from ECT is underreported all over the world. In the UK, there is no audit of ECT use. In the US, no national records are kept (except in the state of Texas), so it is impossible to quote accurate figures.

While psychiatrists constantly reassure us that patients are happy with the results of ECT, surveys of users suggest that many recipients are deeply divided. In a 1993 survey by MIND, the UK’s leading mental health charity, 43 per cent of patients said they found ECT helpful, 37 per cent said it was unhelpful and 20 per cent said it made no difference. In plain language, this means that more than half of those treated found ECT did not help their condition or made it worse. A survey by the United Kingdom Advocacy Network (UKAN) two years later was even more revealing since less than a third of respondents found ECT helpful. Two-thirds regarded their experience as unhelpful, and half of those believed themselves to be damaged by the procedure.

Psychotherapy

So-called ‘talking cures’ are probably the oldest form of modern treatment for depression. Begun by Sigmund Freud in the 19th century, and later adapted by Carl Jung and others, psychotherapy is characterized by in-depth assessment of the patient’s problem, usually provided by extensive interviews with the patient himself. The psychotherapist usually confines himself to a listening mode, encouraging the patient simply to talk—frequently about childhood and family relationships.

The theory is that talking through the ‘root of the problem’ may help to resolve it. Frequently, however, the therapist will try to analyse the patient’s difficulties, often according to a theoretical construct of unconscious human behaviour. The theories may well differ even within one school of therapy.

Today, given the plethora of different psychoanalytical theories, modern psychotherapists often need to rely on a blend of theories, according to personal preference and experience. Most psychotherapy tends to be a long drawn-out affair, continuing over as many as two or more years and involving literally hundreds of separate sessions.

For half a century, no studies were done to assess psychotherapy’s effectiveness. It was only the ‘heretical’ psychologist Hans Eysenck who, in the 1950s, dared to question the orthodoxy by seeking out clinical evidence for psychotherapy. He compared the outcome reports of 24 studies of ‘talking-cure’ treatments with two control studies involving patients who had received no treatment whatsoever.

Eysenck found that two-thirds of the patients improved substantially within two years, whether they had been treated or not. Looking closely at the figures, he concluded that psychotherapy was not only completely useless, but that it was also marginally harmful.

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