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Electroconvulsive Therapy: A Second Opinion
Note: The information on this
website is not a substitute for
diagnosis and treatment by a qualified, licensed professional.
o Lengths of hospital stay for patients receiving ECT were generally longer than for other depression hospitalizations, both for first ECT and later ECT series.
Epidemiologic considerations in electroconvulsive therapy. Babigian HM, Guttmacher LB. Arch Gen Psychiatry 1984 Mar;41(3):246-53
o "As a neurologist and electroencephalographer, I have seen many patients after ECT, and I have no doubt that ECT produces effects identical to those of a head injury. After multiple sessions of ECT, a patient has symptoms idenctical to those of a retired, punch-drunk boxer...After a few sessions of ECT the symptoms are those of moderate cerebral contusion, and further enthusiastic use of ECT may result in the patient functioning at a subhuman level. Electroconvulsive therapy in effect may be defined as a controlled type of brain damage produced by electrical means."
Sydney Samant, M.D. Clinical Psychiatry News. March 1983.
o "Given that the average ECT procedure induces a level of electricity that is approximately 2 1/2 times greater than that required to induce a convulsion, the term ECT is really a euphemistic misnomer. It is not a "convulsive therapy." Rather, it is systematic brain damage, and the damage is the effect; the more current, the more brain damage."
John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79.
oEarly animal studies provided unequivocal evidence of brain damage, and indeed it was openly admitted by psychiatrists that this was the mechanism of improvement, and that the patient, "secures his readaptation to normal life at the expense of a permanent lowering of functional efficiency".
L. Johnstone, Is the use of ECT a non-issue for psychologists, in: Clinical Psychology Forum, August 1992, pp. 30-31. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press
o Numerous studies, whose results are not reported in the official journals, confirmed widespread and often permanent impairment in a range of cognitive abilities, even after standard length courses of ECT ...
Ibid.
o An appalling abuse is going on in our midst: thousands of people a year are having brain damage inflicted on them in the name of "treatment".
Ibid.
S. Sament, In favor of wider ECT ban, Clinical Psychiatry News (March 1983), 11.
o "The studies by Hartelius, by Ferraro et al., and by Alpers and Hughes were definitive. They demonstrated that ECT causes brain damage in monkeys, dogs, and cats, including hemorrhages and cell death. The "controversy" should have ended with these studies, as well as with a number of confirmations from other animal investigations in the 1940s and 1950s. Instead, the research stopped, and the coverup began."
Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing B.J. Alpers, The brain changes associated with electrical shock treatment, Lancet 66 (1946), 363-369; A. Ferraro, I. Roizin and M. Helfand, Morphologic changes in the brains of monkeys following convulsions electrically induced, Journal of Neuropathology and Experimental Neurology 5 (1946), 285-308; A. Ferraro and L. Roizin, Cerebral morphologic changes in monkeys subjected to a large number of electrically induced convulsions (32-100), American Journal of Psychiatry 106(1949), 278-284.
o "ECT is closed-head electrical injury, typically producing a delirium with global mental dysfunction (an acute organic brain syndrome). Significant irreversible effects from ECT are demonstrated by many studies, including: (1) Inventories of autobiographic and current events memories before and after ECT; (2) Retrospective subjective observations on memory; (3) Autopsy studies of animals and some of humans. ECT causes severe and irreversible brain neuropathology, including cell death."
Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press
o A patient recovering consciousness from ECT might understandably exhibit multiform abnormalities of all aspects of thinking, feeling, and behaving, including disturbed memory, impaired comprehension, automatic movements, a dazed facial expression, and motor restlessness.
R. Abrams, Electroconvulsive Therapy, 3rd edn, Oxford University Press, New York, 1997. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.
o "An organic psychosis may occur with few treatments. The syndrome may include disorientation, amnesia, agnosia, confabulation, aphasia, apraxia, and delirium, the latter being seen principally as the postseizure emergence of delirium."
M. Fink, Convulsive Therapy: Theory and Practice, Raven Press, New York, 1979. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.
o "ECT can acutely disrupt not only memory but 'perceptual, language and other cognitive functions', especially if the stimulus intensity is relatively high.
Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing M. Fink, Reconsidering ECT in adolescents, Psychiatric Times (January 1995), 18.
o "From the very beginning - based on animal studies, human autopsies, and clinical observation - ECT was known to cause brain damage. In fact, the brain damage was considered the principal element of the therapeutic impact. Later, with increasing concern about ECT's bad image, advocates began to deny these well-established observations."
Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.
o "Some human and animal autopsies reveal permanent brain pathology. Some patients have persisting spontaneous seizures after having received ECT. Patients having received many ECTs score lower than control patients on psychological tests of organicity, even when degree of psychosis is controlled for."
D.I. Templer and D.M. Veleber, Can ECT permanently harm the brain?, Clinical Neuropsychology 4(2) (1982), 62-66. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.
o "The question whether or not irreversible damage to the nerve cells may occur in association with ECT must therefore be answered in the affirmative."
Hans Hartelious.
o"Over twenty years ago Cotman reported in Science that ECT disrupts (protective) protein production by brain cells. More recent studies show that electric shocks to the brain also causes an increase the production of inflammatory proteins inside brain cells."
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Cotman, et al. Electroshock effects on brain protein synthesis. Science 1971;178:454-456. Marcheselli, et al. Sustained induction of prostaglandin endoperoxidase synthase-2 by seizures in hippocampus J Biol Chem 1996; 271:24794-24799.
o "C. Edward Coffey, MD, a leading proponent of ECT, conducted a study at Duke University Medical Center and the Durham VA Hospital which looked at the brain scans (by MRI) of patients before and after ECT. Out of 35 patients studied, 8 had changes on MRI after shock. That's 22%, or greater than one in 5, with anatomic brain effects. Among those with the brain changes, one patient suffered a stroke and two had new abnormal neurologic signs on exam within 6 months of the ECT."
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Coffey, et al. Brain Anatomic Effects of ECT ŒArch Gen Psych1 1991;48:1013-1021.
o "Weinberger looked at the effects of ECT on the brains of schizophrenics by comparing brain CT scans of those who had ECT with schizophrenics who never received shock. He documented that cerebral atrophy (brain shrinkage) was significantly more common in those who had been shocked."
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Weinberger, et al. Structural abnormalities in the cerebral cortex of chronic schizophrenic patients. Arch Gen Psych 1979;36:935-939.
o "Another CT scan study done by Calloway looking at a similar group confirmed that frontal lobe atrophy (brain shrinking) was significantly more common in ECT recipients."
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Calloway, et al. ECT and cerebral atrophy: a CT study. Acta Psych Scand 1981;64:442-445.
o "Andreasen used MRI scans to demonstrate a strong correlation between the number of previous ECT treatments to enlarged ventricles (loss of brain tissue). Andreasen, et al. MRI of the Brain in Schizophrenia Arch Gen Psych 1990;47:35-41.
o "A study in England compared the brain CT scans of 101 depressed patients who had received ECT to 52 normal volunteers. They found a significant relationship between treatment with ECT and brain atrophy. In fact ECT recipients were twice as likely to have a measurable loss of brain tissue in the front area of the brain and a tripling of the incidence of a loss of brain tissue in the back of the brain. Most significantly, the brain abnormalities correlated only with ECT, and not with age, alcohol use, gender, family history of mental illness, age at the time of psychiatric diagnosis, or severity of mental illness."
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Dolan, RJ, et al. The cerebral appearance in depressed subjects Psychol Med 1986;16:775-779.
o "An animal study sought to discover whether giving supplementary oxygen during shock would prevent brain damage; they also gave vitamin E to lessen the effects of damaging 'free radical' molecules that get released during a shock seizure. They found no difference in the brain damaging effects of ECT-induced seizures by giving oxygen and vitamin E. These findings disprove the claim that modern ECT methods (complete with anesthesia and oxygen) are any less damaging to the brain than uncontrolled seizures."
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Manoel, et al. Brain damage following repeated electroshock in cats and rats Rev Rom Neurol Psych 1986;24:59-64.
Brain Damage and Memory Loss from ECT
Dr. Peter Sterling, Ph.D., Associate Professor of Neurobiology at the University of Pennsylvania, made the following overall conclusions based on a thorough review of all the scientific literature on ECT when he testified before the Standing Committee on Mental Health of the Assembly of the State of New York in 1978:
"1.Convulsions caused by electrical shocks to the brain are accompanied by alterations within the brain. Many of the brain's natural protections are broken down. Mentioned in particular are the massive rise in blood pressure, the breakdown of cerebral auto regulation of blood flow, and the breakdown of the blood-brain barrier.
"2.Such changes can lead to alterations in brain chemistry and physiology. The change most easily measured in humans is the alteration of the EEG toward a form that is commonly recognized as pathological.
"3. Such changes are also associated in many studies with gross pathology such as brain swelling (edema) and particularly brain hemorrhages which lead to the irreversible death of neurons.
"4. Such changes are also associated with persisting, probably permanent amnesias for life events and experiences.
"5. Such amnesias may only be detected when patients are questioned in detail about their life histories before and following the administration of shocks.
"6. At all levels, from changes in blood pressure to losses in memory, there is extreme variability. Losses can, however, be catastrophic after only a few shocks. In general, the younger and healthier the animal or person, the less permanent damage may result.
"7. Such losses of memory can and do occur without any necessary changes in overall intelligence as measured by a psychological test and without any other detectable neurological abnormalities. This finding is common not only with ECT but in brain damage accompanying other kinds of insult such as trauma or toxicity."
Brain Damage and Memory Loss from ECT: Testimony Prepared for the Standing Committee on Mental Health of the Assembly of the State of New York. October 5, 1978. Dr. Peter Sterling, Ph.D. Associate Professor of Neurobiology, Department of Anatomy, School of Medicine, University of Pennsylvania
o "The electricity passing through the brain causes massive, simultaneous excitation of vast numbers of neurons. The inhibitory mechanisms that normally hold neurons in check…are overwhelmed by the excitation. As the excitation builds and swamps the inhibitory mechanisms, it spreads throughout the brain. When the excitation reaches the motoneurons of all the body's muscles, there is massive, convulsive muscular contraction. The muscles contract so powerfully that tendons may be torn from the bones, the bones themselves may be broken, teeth chipped and broken, and so on. The massive requirements for oxygen and the interruption of breathing caused by the convulsion often causes anoxia…. This overall response resembles the "grand mal" seizure that occurs in epilepsy."
Ibid.
o Accompanying the convulsion, there is a tremendous rise in blood pressure: changes in arterial pressure from 80mm Hg to 220mm Hg, or almost 200%, have been recorded.
Brain Damage and Memory Loss from ECT: Testimony Prepared for the Standing Committee on Mental Health of the Assembly of the State of New York. October 5, 1978. Dr. Peter Sterling, Ph.D. Associate Professor of Neurobiology, Department of Anatomy, School of Medicine, University of Pennsylvania citing Plum, F., Posner, J.B. & Troy, B.: Cerebral metabolic and circulatory responses to induced convulsions in animals. Arch. Neurol. 18:1-13, 1968.
o "With the onset of the seizure, cerebral blood flow rises dramatically -- as much as 400%. Cerebral oxygen consumption also rises as much as 400%. In accomplishing such massive increases in blood flow, the automatic mechanisms that normally regulate cerebral blood flow are overwhelmed….These changes accompanying ECT are not modified by the administration of anesthetic, paralytic drugs or oxygen.
Ibid; citing Plum, F., Posner, J.B. & Troy, B.: Cerebral metabolic and circulatory responses to induced convulsions in animals. Arch. Neurol. 18:1-13, 1968 and Posner, J.B., Plum, F. & Van Poznak, A.: Cerebral metabolism during electrically induced seizures in man. Arch. Neurol. 20:388-395, 1969.
o "The extremely high cerebral blood pressure and the breakdown in auto regulation of cerebral blood flow during the seizure frequently ruptures small, and occasionally large, vessels in the brain." Madow (1956) reviewed 42 cases of autopsy assembled from 26 published reports on patients who had recently received ECT. Twenty-five (60%) had either petechial hemorrhages or large infarcts. About three-quarter of these patients were over forty, but the frequency of hemorrhage in the group under forty was the same as for the older group."
Ibid; citing Madow, L.: Brain changes in electroshock therapy. Am. J. Psychiat. 113:337-347, 1956.
o "There seems every reason to suspect…that subarachnoid or intracerebral bleeding accompanies ECT about half the time. This is supported by numerous studies in animals autopsied after being subjected to ECT. For example, Alpers and Hughes (1942) found bleeding in 23/30 cats (77%); Heilbrunn(1943) found petechial or larger hemorrhages in all of the rats that convulsed in his experiments to ECT; Heilbrunn and Weil (1942) made similar findings in 17/21 (81%) rabbits. Wherever bleeding occurs in the brain, neurons lose their supply of oxygen and nutrients -- and die."
Ibid; citing Alpers, B.J. and Hughes, J.: Changes in the brain after electrically induced convulsions in cats. Arch. Neurol. & Psychiat. 47:385, 1942; Heilbrunn, C.: Prevention of hemorrhages in the brain in experimental electric shock. Arch. Neurol. & Psychiat. 50:450, 1943; and Heilbrunn, G. and Weil, A.: Pathologic changes in the central nervous system in experimental electric shock. Arch. Neurol. & Psychiat. 47:918, 1942.
o The electrical shock causes damage to the blood-brain barrier. This has been shown experimentally in animals, and there is every reason to believe that it happens in humans as well. Whatever the cause, the loss of this protective barrier exposes the brain tissue to components of the blood from. it is normally protected."
Ibid; citing Aird, R.B., Strait, L., Pace, J.W., Hrenoff, M.K., and Bowditch, S.C.: Current pathway and neurophysiologic effects of electrically induced convulsions. J. Nerv. & Ment. Dis. 123:505-512, 1956; Angel, C., Hartman, A.M., Burkett, J.L. and Roberts, A. J.: Effects of electroshock and trypan red on the blood-brain barrier and response retention in the rat. J. Nerv. & Ment. Dis. 140:405-411, 1965; Lee, J.C. and Olszewski,J.: Increased cerebriovascular permeability after repeated electroshock. Neurol. 11:515-519, 1961.
o "The combination of raised cerebral blood pressure and ruptured blood-brain barrier often causes another problem, cerebral edema….As the pressure inside the skull rises from the swelling, capillaries are closed. Their linings are damaged by anoxia making them even more leaky. This leads to more edema and damage."
Ibid; citing Fishman, R.A.: Brain Edema. N. .Engl. J... Med. 293, 14: 706-711, 1975; Klatzo, I. and Seitleberger, F.: Brain Edema. Springer-Verlag, N.Y., Inc., 1967.
o "Edema has been noted in the human retina, an easily visible part of the brain, as a consequence of shock."
Ibid; citing Winnick, H.Z., Landau, l.L., AssaIl, J. & Tomim, B.:"Microvascular changes during insulin-coma treatment" in Rinkel, M.: Biological Treatment of Mental Illness. L. C. Page & Co., N.Y. 1966.
o "Even if the brain receives enough oxygen during a seizure, the brain may exhaust its sources of nutrients and be irreversibly damaged. It means that the abolition of electrical activity and the coma that sometimes follows a seizure can occur even though adequate oxygen is supplied."
Ibid; citing Posner et al.
o "There are changes in a host of brain chemicals as the result of ECT. Synthesis of protein and RNA are inhibited within five minutes of ECS, with the decrease persisting for a number of hours. The levels of neural transmitters (acetylcholine, norepinephrine, serotonin) and their related enzymes also change."
Ibid; citing Essman, W.B.: Neurochemistry of Cerebral Electroshock. Spectrum Publication, Inc., Flushing, N. Y.,Wiley 1973.
o "Following ECT, there is a marked rise-in cerebral levels of arachidonic acid. This compound has been shown to cause aggregation of blood platelets when injected into the cerebral blood supply, resulting in small "strokes" throughout the brain. Conceivably the rise in arachidonic acid associated with ECT could be a source of brain damage."
Ibid; citing Essman; Bazan, N.G.: Biochem-Biophys. Acta. 218:1-10, 1970; J. Neurochem. 18:1379 1385, 1971; and Furlow, T.W.,Jr. & Bass, N.H.: Stroke in rats produced by carotid injection of sodium arachidonate. Science 187:658-660, 1975.
Changes in the electroencephalogram (E.E.G.)
o "The EEG changes markedly during and following ECT….of 42 patients with normal EEGs before ECT, half (21) had abnormal EEGs following treatment. One-third of these abnormalities were severe "cerebral dysrhythmias". The EEG patterns resembled those commonly seen in epileptic patients in the periods between epileptic seizures."
Ibid; citing Mosovich, A.,& Katzenelbogen, S.: Electroshock therapy, clinical and electroencephalographic studies. J. Nerv. & Ment. Dis. 107: 517-30, 1948.
o "The frequency of damage increased with increasing number of shocks:. after 16-42 shocks, half the patients showed cerebral dysrhythmia... These changes were often extremely long lasting. Thus, 68/82 patients showed the dysrhythmia the day following ECS, and 20 patients still had the pattern 10 months later. For all anyone knows, the changes were permanent."
Ibid.
o "These findings have been confirmed in modern studies using anesthesia, oxygen, and muscle paralysis."
Ibid; citing Abrams, R., Fink, M., Dornbush, R. L., Feldstein, S., Volavka, J. and Roubicek, J.: Unilateral and bilateral electroconvulsive therapy: Effects on depression, memory, and the electroencephalogram. Arch. Gen. Psychiat. 27:88-91, 1972; and Volavka, J., Feldstein, S., & Abrams, R.: EEG and clinical change after bilateral and unilateral electroconvulsive therapy. EEG Clin. Neurophysiol. 32:631-639, 1972.