Geriatric Depression and its treatment: ECT
Treatments for Major Depression
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is simultaneously the oldest, most effective, most feared, and most effective somatic (non-psychotherapy) treatment for major depression. As early as the 1930s, it became apparent that patients with severe mental illness would often have improvement in their symptoms after suffering a series of epileptic seizures. These observations led to studies, initially with chemicals, and then more safely with electrical current, to induce seizures under controlled conditions in order to treat psychiatric illness.
Most peoples’ knowledge of ECT comes from the brutal, involuntary treatment rendered upon the character McMurphy, played by Jack Nicholson in One Flew over the Cuckoo’s Nest (1975). For a much more realistic portrayal of modern day ECT administration, I would direct the reader to the Showtime series Homeland, in which the protagonist Carrie Matheson (Claire Danes) is treated. With proper selection of a willing patient, medical support, and anesthesia, ECT has come a long way.
ECT is a series of between 9-12 treatments, done outpatient or occasionally inpatient at a hospital, where the patient is put under a brief anesthesia and given a muscle paralyzing agent. There are potential side effects, the most common of which is temporary memory disturbance, that can occasionally be prolonged. Electroconvulsive therapy is particularly effective for severely depressed, sometimes psychotic senior patients. There is no question ECT is the most effective treatment for severe depression.
I hope this series of blogs on depression and its treatment have been helpful, and have encouraged the reader in two ways- to seek treatment if struggling and to know that there are many treatments available for the geriatric psychiatrist to bring to bear in alleviating that suffering.
