Report Endorses ECT Despite Evidence of Dangers

Draft Surgeon General’s Report Endorses ECT Despite Evidence of Its Dangers

A call to action . . .

December 17, 1999
MedscapeWire

The four paragraphs allotted to ECT in the draft of the Surgeon General's Report (SGR) on Mental Health misrepresent this very controversial procedure as "safe and effective." In reality, it is neither.

The Report cites one main source — Weiner & Krystal, 1994 — six times in the report; and only five other sources are cited. Clearly, the Surgeon General’s Office simply did not do its homework, since there is a vast quantity of material that indicates that ECT is not safe. Nor is it effective, since all agree that any benefits — a lifting of depression — are short-term.

It is important to note that the "Weiner" cited so frequently in the Report is "Richard Weiner, head of the American Psychiatric Association’s task force on ECT, and also the head of the task force or committee which petitioned the FDA to reclassify the shock machine from Class III to Class II back in l982, and [has] spearheaded that unsuccessful attempt up until the present," writes Linda Andre, head of the Committee for Truth in Psychiatry, the national organization of shock survivors.

Andre continues: "Doug Cameron’s book names Weiner as the central figure in one of the greatest frauds perpetrated on the American public, ‘The Great Electroshock Hoax’ (title of book), in which machines were designed to be ever more powerful while the public was being told they used ‘less electricity.’

"As a paid ‘consultant’ to shock machine companies, Weiner] designs virtually all of the shock machines in the United States, and thus is responsible for upping the electricity on each new generation of shock machines. . . . He admits getting $$ from shock machine companies but says it’s deposited in his ‘research’ account. [He] won’t say how much. Shock machine companies thank him in their instruction annuals. Krystal is simply his young protégé. . . ."

If you are outraged by this whitewash of an extremely dangerous and controversial procedure, write David Satcher, M.D., Ph.D., U.S. Surgeon General, 200 Independence Avenue, S.W., Washington, D.C. 20201, Phone: 202-690-7694, Fax: 202-690-6960.

Below are some of the assertions made by the Surgeon General’s Report, followed by the reality:

SGR: "ECT is regarded as a safe and effective treatment for depression . . ." (Weiner & Krystal, 1994).

Reality: ECT is an extremely controversial procedure, which is certainly not safe. It has resulted in death, and always results in memory loss. It may also damage cognitive abilities. Consider some of the dangers:

Death. For example: In a study of 3,288 people who received ECT in Monroe County, New York, ECT recipients were found to have an increased death rate from all causes (Babigian, H., et al., "Epidemiologic Considerations in ECT," Arch Gen Psych 1984; 41:246-253). Brown University researchers evaluated survival rates in 65 patients who had been hospitalized and treated for depression. According to their report, the 37 patients who had ECT had survival rates of 73 percent at one year, 54.1 percent at two years, and 51.4 percent at three years. This contrasts with people who were depressed who did not receive ECT; their survival rates were 96.4 percent, 90.5 percent and 75 percent at one, two and three years, respectively. (Kroessler & Fogel, "Electroconvulsive Therapy for Major Depression in the Oldest Old," Am J of Geriatric Psychiatry 1993; 1:1:30-37). In Texas, the only state that keeps such records, the first three years of mandated recording of death within two weeks of ECT yielded reports of 21 deaths (11 cardiovascular, three respiratory, and six suicides (Don Gilbert, Commissioner, Texas Department of Mental Health and Mental Retardation, 1996). (A 1995 report in USA Today noted that a 1993 study of elderly ECT recipients in Texas found that 27 percent of them were dead within a year, compared to 4 percent of a similar group who had been treated with medication.)
Cardiovascular problems. For example: The seizures induced by ECT cause a quick rise in blood pressure, while the brain experiences a significant reduction in blood flow (Webb, et al., "Cardiovascular response to unilateral ECT," Biol Psych 1990; 28:758-766. Rosenberg, et al., "Effects of ECT on cerebral blood flow," Convulsive Therapy 1988; 4:62-73). The Mayo Clinic found that there was an 18 percent incidence of serious heart arrhythmias during treatment of 34 elderly people receiving ECT. The same study found that 79 percent of these individuals suffered treatment complications (Tomac and Rummans, "Safety and Efficacy of Electroconvulsive Therapy in Patients Over Age 85," Am J Geriatr Psy 1997; 5:126-130). Eleven percent of 87 elderly people receiving ECT "remained delirious between ECT sessions for no discernible medical reason other than the ECT itself." MRIs of these people showed that 90 percent of them had lesions in the basal ganglia areas of the brain, and 90 percent also had moderate to severe white matter lesions (Figiel, Coffey, et al., "Brain MRI findings in ECT-induced delirium," J of Neuropsych and Clin Sci 1990; 2:53-58).
Epilepsy. For example: Researchers who reviewed the literature on the ECT complication of epilepsy calculated that "the age-adjusted incidence of new seizures after ECT was fivefold greater than the incidence found in the non-psychiatric population" (Devinsky & Duchowny, "Seizures after convulsive therapy: A retrospective case survey," Neurology 1983; 33:921-5). See also Weiner, RD, "Prolonged confusional states and EEG seizure activity following ECT and lithium use," Am Journal Psych 1980; 137:1452-1453, and Varma, NK et al., "Nonconvulsive status epilepticus following ECT" Neurology 1992; 42:2263-264).
Memory loss. For example: 'Data available from the California Department of Mental Health reveals that more than 99 percent of ECT recipients report memory loss three months following treatment, with the average number of ECT sessions being five or six (A. Lazarow, Chief, Office of Human Rights, California Department of Mental Health, 1996).' "Many cases involve losses that prohibit a return to normal activities in the home or at work. Indeed, there are repeated warnings in the literature against giving ECT to individuals who earn their living through mentally taxing work" (Breggin P.R., "Neuropathology and Cognitive Dysfunction From ECT," Psychopharmacology Bulletin 1986; 22:2, 476-482. Valentine M, Keddie HMG, Dunne D, "A comparison of techniques in electroconvulsive therapy," Br J Psychiatry 1968; 114:988-96).

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The SGR minimizes the possibility of permanent memory loss, although it does admit that "permanent memory loss remains a legitimate topic for longitudinal study. According to the report, "The most common side effect of ECT is confusion after each treatment, which generally clears within an hour. TRANSIENT [report's emphasis] amnesia of varying degrees is also common, but it resolves within several months, except for some persistent loss of memory for the period immediately surrounding the treatment itself (Weiner & Krystal, 1994; Rudorfer et al., 1997). Although there is OCCASIONAL [our emphasis] anecdotal evidence of PERMANENT [report's emphasis] memory loss caused by ECT (beyond the treatment period), permanent memory loss remains a legitimate topic for longitudinal study."

SGR: "ECT has become a carefully regulated procedure and requires either explicit written informed consent or, much more rarely, the approval of a court appointed guardian."

Reality: ECT is not carefully regulated. Despite repeated attempts by the American Psychiatric Association to get the Food and Drug Administration (FDA) to reclassify the ECT device as Class II, it remains in Class III. Class III means that the machine has not gone through the rigorous FDA testing required of medical devices, including safety testing and efficacy assessments. In other words, this is the FDA's highest risk category.

Reality: There is no explicit written informed consent statement, since the standard forms completely misrepresent ECT's dangers. For instance, although the standard forms usually say that only one in 200 ECT recipients experience memory loss, memory loss occurs in virtually all ECT recipients. (The American Psychiatric Association admits that the one-in-200 figure is "impressionistic," rather than arrived at through research.)

In order to give informed consent, anyone considering ECT must be provided with enough information about the potential risks of this controversial procedure. Such information must include the potential loss of memory (both short- and long-term) as well as damage to future ability to retain new knowledge. These side effects have been found to be among the most disturbing results reported by patients who have received ECT.

SGR: "Claims that ECT induces brain damage have been unsubstantiated by research (Greenberg 1997; Weiner & Krystal, 1994). The current practice of ECT is considered safe and clinically effective (Depression Guideline Panel, 1993)."

Reality: Many experts in the fields of psychiatry and neurology have reported that ECT does cause brain damage. See the following:

--Weisberg L., Elliott, D., Mielke, D. Intracerebral hemorrhage following electroconvulsive therapy. Neurology Nov. 1991, v41,n11 :1849.

--Sterling P. 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, 1978.

--Madow L. Brain Changes in Electroshock Therapy. The American Journal of Psychiatry 1956; 113:337-347.

--Alpers B. The Brain Changes in Electrically Induced Convulsions in the Human. Journal of Neuropathology and Experimental Neurology 1942; 1:173-180.

--Calloway S.P., Levy R., et al. ECT and Cerebral Atrophy A Computed Tomographic Study. Acta Psychiatra Scandinavia 1981; 64:442-445.

--Friedberg J. Shock Treatment, Brain Damage, and Memory Loss: A Neurological Perspective. The American Journal of Psychiatry 1977; 134:1010-1013.

--Breggin P. Neuropathology and Cognitive Dysfunction >From ECT. Psychopharmacology Bulletin 1986; 22:476-479. Breggin P. Toxic Psychiatry, (New York: St. Martin's Press, 1991), Chapter 9, Shock Treatment is Not Good for Your Brain.

--Ferraro A., Roizin L. Cerebral Morphologic Changes in Monkeys Subjected to a Large Number of Electrically Induced Convulsions (32-100). The American Journal of Psychiatry 1949; 106:278-284.

--Levy N., Serota H.M., Grinker R. Disturbances in Brain Function Following Convulsive Shock Therapy. Archives of Neurology and Psychiatry 1942; 47:1009-1029.

--Afield, W. Testimony of Dr. Walter Afield for the Texas House of Representatives Public Health Committee, in Support of House Bill 2452. April 18, 1995.

--Bielski V. Electroshock's Quiet Comeback. The San Francisco Bay Guardian, April 18, 1990, p.17.

--Templar D., Hartlage L., Cannon W., Preventable Brain Damage: Brain Vulnerability and Brain Health, (New York: Springer Publishing Company, 1992). Chapter 8, ECT and Permanent Brain Damage.

SGR: "The reasons for ECT's effectiveness are not known (Weiner & Krystal, 1994)." and

SGR: "Adverse cognitive effects of ECT have been reduced by modern advances in treatment technique, including oxygenation, reduction in the electrical dose by the use of brief pulse stimulation, and unilateral electrode placement over the nondominant cerebral hemisphere (Rudorfer et al., 1997). Since severe mood disorders also have pronounced effects on cognitive abilities, it is difficult to disentangle the effects of the illness from those of the treatment."

Reality: Although psychiatrists have long maintained in public that they do not know how ECT works, there are many who believe that it works by causing brain damage. Indeed, there are frequent references in the psychiatric literature to indicate that brain damage causes temporary euphoria as well as memory loss. Medical literature is full of references to euphoria in people brain-damaged after trangulation, gunshot wounds to the head, concussion, brain operations for tumor, electrocution and stroke. (It has been claimed that brief-pulse, low-dose, unilateral ECT is less damaging than bilateral. However, there are no claims that it is as effective in causing the lifting of depression that is the desired result of ECT. This is logical: Less brain damage, less euphoria.)

Consider the following statements: "Most brain-injured patients are euphoric. This sense of well-being, of lack of concern or anxiety about self or about anything else, may seem quite out of keeping with the severity of the patient's problem . . . This euphoria may be very disconcerting unless properly evaluated as a typical sign of brain injury." (Wepman, Joseph J., Recovery from Phasia, Ronald Press, 1951 (cited in an amicus curiae brief submitted by the Committee for Truth in Psychiatry in John Doe, et al., v. D. Michael O'Connor, et al. Superior Court of the State of California. No. C 646194).

"There is a relation between clinical improvement and the production of brain damage." (Kahn, Frink, and Weinstein, 1956 (cited in a letter from Marilyn Rice of the Committee for Truth in Psychiatry to Mr. James R. Veale, Executive Secretary, Panel on Neurological Devices, Food and Drug Administration, 9/23/81).

"Reports on remissions in psychotic patients . . . after head injuries . . . suggest that organic interference with cerebral function is likely to . . . be the effective agent in shock therapy." Lothar Kalinowsky, cited in a letter from Marilyn Rice to Paul H. Blachly, M.D., Editor, Convulsive Therapy Bulletin, University of Oregon (5/2/77).

Doctors know this. "For instance," wrote Marilyn Rice, "even though psychiatrists have traditionally assured patients there will be no permanent memory loss, their literature is full of warnings to each other: don't do this to people whose livelihood depends on memory." (Marilyn Rice was a senior economist in the U.S. Department of Commerce and the country's top expert on the Gross National Product before the eight shock treatments she received in 1973 wiped out decades of accumulated nowledge, ending her career. She founded the Committee for Truth in Psychiatry to fight for stronger informed consent laws.)

Doctors warn each other that they should think hard before prescribing ECT for (to quote only a few): "those intellectual workers who must earn their living by retained knowledge" (Cannicott, 1962); "the office worker who has to use his high intellectual centers for a livelihood" (Dolenz, 1964); "patients who depend upon their memory to function professionally" (Martin, 1965); "intellectuals" (Ottosson, 1967); "patients where memory impairment would be a serious handicap" (Valentine, 1968): "cases where a patient's work might be handicapped by memory impairment" (Zinkin, 1968); "those who earn their living by relying upon memory and other cognitive functions" (Cronin, 1970); "the man who uses a highly trained memory in the exercise of his profession" (Sargant, 1972); "patients engaged in an intellectual kind of work" (Sargant, 1973); "patients with jobs requiring an intact memory" (Hacket, 1974); "a patient . . . who requires the very highest mental powers for his profession" (Davis, 1975).

"Another giveaway," added Rice, "is that every variation in technique that is tried, as well as every new machine, is heralded with the claim: No more brain damage. No more memory loss."

SGR: "[ECT] has the advantage over pharmacotherapy of more rapid resolution of symptoms (Weiner & Krystal, 1994)."

Reality: "No conclusive answer is available to the question whether ECT is superior to anti-depressants in the treatment of depression" (Rifkin, Arthur, M.D., Journal of Clinical Psychiatry, January 1988; 49:1).

It is not surprising that ECT is hardly ever used in state hospitals. In "The Making of a Psychiatrist," Dr. David Viscott wrote that "finding that the patient has insurance seemed like the most common indication for giving electroshock." According to a report from the Journal of Nervous and Mental Diseases in 1975, Dr. Q.R. Regestein discovered that "the ready insurance payments for any number of ECT further encourage errors in judgment concerning the efficacy of such treatment."

The fact that the psychiatric literature is full of references to the damaging effects of ECT, including deaths, raises the question of whether the benefits of this controversial treatment which experts note are short-term at best outweigh the permanent damage it may cause.

According to John Friedberg, M.D.: "Electrically induced seizures . . . are an iatrogenic injury to the brain. Even if they could be proved to relieve mental anguish more often than they cause it, and even if some patients ask for ECT and are pleased with its effects, the question of whether to pursue happiness through brain damage cannot be decided scientifically. This is a value judgment, which, in the interest of freedom and dignity, must be left to the fully informed individual" (Friedberg, John, M.D., "ECT as a neurologic injury," Psychiat. Opinion, 14:18).

ECT survivor Marilyn Rice (who died in 1992) said that she was against prohibiting ECT "because I have respect for the kind of suffering for which it might be rationally accepted. In fact, people do accept it, people who have had it before and know what it will do to their memory. What I would urge is that patients be told the truth about its memory effect, and then be allowed to make up their own minds."

In 1989, more than a thousand former recipients of mental health services from all over the United States and the territories attending a national self-help and advocacy conference, "Alternatives '89," in Columbia, S.C., passed a resolution demanding a ban on forced ECT and calling for the opportunity for truly informed consent on ECT and the creation of a range of alternatives to ECT.

There is a small window of opportunity in which to influence the final document.

Contact:
David Satcher, M.D., Ph.D.
U.S. Surgeon General
Assistant Secretary for Health
Hubert H. Humphrey Building, Rm. 716G
200 Independence Ave., SW
Washington, DC 20201
202-690-7694

Susan Blumenthal, Ph.D.
Assistant Surgeon General
DHHS
5600 Fishers Lane, Room 18-66
Rockville, MD 20857
301-443-2270

Thomas Bornemann, Ed.D.
Deputy Director
SAMHSA/CMHS
5600 Fishers Lane, Room 15-99
Rockville, MD 20857
301-443-0001

Richard Nakamura, Ph.D.
Deputy Director
NIMH
5600 Fishers Lane, Room 8235
Bethesda, MD 20892
301-443-3673

Pat Rye
Managing Editor
SGR on Mental Health
SAMHSA
Rockville, MD 20857
301-443-3689

This alert was compiled by Susan Rogers, Mental Health Association of Southeastern Pennsylvania.

National Mental Health Consumers Self-Help Clearinghouse

1211 Chestnut Street Philadelphia, PA 19107
800-553-4539 Fax: 215-636-6312

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Draft Surgeon General’s Report Endorses ECT Despite Evidence of Its Dangers

A call to action . . .