Why ECT Is Becoming a Preferred Depression Treatment
No longer a last-resort, ECT should be considered a first-line treatment
August 21, 2020
Brian Neville had a good life. A one-time bodybuilder, he was 43, a successful businessman in the tanning industry, with a home in Massachusetts and a vacation condo in Florida.
Then one morning in 2006 he woke up with the blues. It developed into a persistent darkness that just would not go away. After about six months, he sought treatment. He received prescription medications that he was assured would help counter a listless feeling that made even simple tasks like cleaning a room feel like climbing Mt. Everest while wearing nothing but his shoes.
Except that it didn’t.
Neville, now 54, realized what was troubling him was not what he calls “situation sadness,” a temporary state that can come from the loss of a job or a loved one.
“Everybody knows what it’s like to feel sad,” said Stephen J. Seiner, MD, medical director of the Electroconvulsive Therapy (ECT) Service at McLean Hospital. “And I think most people even know sadness to the point where it can temporarily incapacitate you.”
Depression Isn’t Just Feeling Sad
But depression goes far beyond mild anxiety or a passing dark moment. It is a physical illness, one the World Health Organization places as the leading cause of disability worldwide. An estimated 16 million American adults, or about 6.7% of the United States population age 18 and over, are diagnosed with major depressive disorder, according to the Anxiety and Depression Association of America.
Depression often accompanies other behavioral health diagnoses, including psychosis, bipolar disorder, or catatonia. It can often be triggered by everyday life stresses or changes. Left untreated, major depressive disorder triggers a cycle that can produce significant life changes, which may include the loss of the ability to work or function normally. It can lead to the deterioration of relationships and result in social isolation. The causes can be varied, including biological, environmental, and genetic factors.
355 million people are affected by depression, making it one of the most common disorders in the world
“There can be a biological predisposition, but there is often a trigger, and we just don’t always know what that trigger is,” explained Seiner. “Very often in patients who experience depression there may be a psychosocial stress that somehow sets off a cascade of neuronal connections in the brain that then leads to an episode of depression. Where most people would be able to bounce back from the stressor, patients who have a predisposition towards depression often continue to spiral down.”
In the most severe cases, depression can make it impossible for a person to function. “It affects you so that sometimes you can’t think straight,” said Seiner. “Your brain plays tricks on you. You can’t eat. You can’t sleep. The smallest task can seem completely overwhelming”
“The worst thing in my day was when my first eye opened in the morning,” Neville recalled. “The second worst thing in my day was when my second eye opened. It meant I had to get up and put on an act, trying to please people and fake everything. I got sick of faking my day.”
He would escape by driving out of town. “I would go to Starbucks and hang out, as far away as Connecticut or Rhode Island. I needed somewhere to kill the day. To get the day going. To get the day over with.”
Using ECT to Treat Depression
Effective treatments for depression include counseling, psychotherapy, and prescription medications. However, for an estimated 100,000 people a year in the United States, like Neville, these options fall short. And for them, ECT is safe, reliable, and effective.
The treatment has evolved since the 1930s, when psychiatrists hypothesized that grand mal seizures could help treat schizophrenia, based on the observation that some nerve cells in the brains of people with schizophrenia appeared to be arranged in a way that was the opposite of people with epilepsy. However, it turned out that the seizures were most effective in treating depression and other mood disorders.