Patient Information About ECT from PATIENTS!

andrel at pie.org andrel at pie.org
Fri Feb 3 00:57:02 EST 1995



To User:net:Juli Anne at aol.com

This is the first and only informed consent statement about shock
treatment (ECT) written by persons who had shock. It has been endorsed by
over 500 ex-ECT patients. We call ourselves the Committee for Truth in
Psychiatry because our purpose is to work for truthful informed consent
for future patients.
We would like to see the federal government, through the FDA, or states
through their Offices of Mental Health, adopt this statement.

                   PATIENT INFORMATION ABOUT ECT

WHAT IS ECT GOOD FOR?

     ECT is good for the intense physical suffering that goes with
derangement of the nervous system. Such derangement can come about either
through an overload of normal emotion (that is a nervous breakdown) or by
imbalances in body chemicals that affect emotions.

     What ECT does is to produce profound emotional relaxation. The
patient sleeps and eats well and her or his body has an opportunity for
rest and repair. When the relaxing effect wears off, which is in a few
days or weeks, the patient may remain well or she may relapse.

WHAT IS ECT AND HOW IS IT GIVEN?

     Electroconvulsive therapy (ECT), also known as shock treatment,
consists of a seris of grand mal epileptic seizures induced by electric
shocks through the brain.

     The essence of a grand mal epileptic seizure is the intensely rapid
"firing" of every brain cell. In a natural seizure this activity of the
brain causes the body to thrash about wildly, but when a seizure is
induced in ECT the movements of the body are largely suppressed by a drug.
In either case, if a complete grand mal seizure is occurring in the brain,
the person is unconscious.

     An ECT treatment is usually given in the morning before breakfast.
First the patient receives an injection to reduce secretions in the mouth.
Then she is taken to the treatment room, where she is given a general
anesthetic through a vein in the arm. This takes effect quickly and is
followed by another drug through the same needle, this being the one that
suppresses muscle movement. The anesthetic is not necessary for the shock
treatment as such, for the shock would produce unconsciousness, but it is
given to spare the patient the feeling of becoming paralyzed. Next, two
electrodes are applied to the head and a current passed briefly between
them. (Most commonly, the electrodes are on the temples and the shock is
about 140 volts for half a second, but these particulars may vary.) The
brain seizure that is triggered by the shock lasts about a minute.

   Throughout the treatment procedure the patient does not experience pain
or discomfort, but she awakens soon afterward in a state of confusion.
When the confusion subsides, she can resume her daily routine. Headache,
mild muscle soreness, or nausea sometimes occur, but these usually respond
to simple medication.

     Treatments are usually given three times a week, and a typical course
of ECT consists of from six to ten treatments.

     ARE THERE ADVERSE EFFECTS OR RISKS?

     ECT has one adverse effect that occurs in all cases. That is memory
loss.

     During a course of treatment the patient experiences a cumulative
eradication of memory, which begins with recent events and learning and
thoughts (including worries), and gradually extends to the distant past.
Once the course is ended, memory gradually returns in the opposite time
order until, in about a month, the patient has regained the main outlines
of her personal history and also knowledge and skills acquired early in
life. After this length of time there is little further automatic return
of memory, although a good deal more has become strong enough that it can
later be revived by reminders or efforts at relearning.

     The extent of the permanent memory loss varies with the number of
treatments, age of patient, placement of electrodes, and other factors,
but the pattern of loss is the same for all patients. The loss is total or
near total for the period of the ECT course and tapers back over previous
years with smoothly diminishing severity and no precise cut-off point. The
patient's remaining memory appears "spotty" in that the smooth amnesic
blanket has merely dimmed some memories but submerged others, depending
upon their original relative clarity.

     In addition to this erasure of pre-shock memory, which is certain to
occur, there may also be a permanent adverse effect upon memory function
after the shocking. That is, the patient's memory for new experiences and
new learning may fade rapidly.

     Some patients do not mind their memory changes and seldom have
occasion to notice them. At the opposite extreme are persons whose work or
way of life is made impossible by them. In between are persons who
gradually adjust to various degrees of handicap.

     Aside from adverse effects on memory, ECT contains also, like other
major medical and surgical procedures, some element of ordinary risk.
Fatalities are very rare, but there is a slight possibility that a stroke
or heart attack could occur during a treatment. There is also the
possibility that a particular individual may experience one or more
untoward after-effects in addition to the expected deleterious effect on
memory.

     HOW DOES ECT WORK?

     ECT is one of a number of drastic psychiatric treaments, including
insulin coma and psychosurgery, that relieve suffering temporarily. All of
them "work" by destroying brain tissue. That is their common denominator.
In ECT both the electrical shocks and the grand mal seizures are
destructive. For some still unknown reason, reducing the size of the brain
not only reduces the amount of stored memory but also counteracts states
of physical pain and any kind of emotion.


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If you have had ECT and would like to add the authority of your experience
to our efforts to obtain informed consent, please send the following form
by regular mail, or e-mail an electronic version of the form to
andrel at pie.org.

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                                             Date:

To: Committee for Truth in Psychiatry
    P.O. Box 1214
    New York, NY 10003

     I have undergone electroconvulsive therapy (ECT)(Shock treatment) and
I know or suspect that I was not truthfully informed of its nature or
consequences.

     In the interests of protection of future patients, I endorse the
statement of Patient Information About ECT that has been proposed to the
FDA by the Committee for Truth in Psychiatry (FDA Docket No. 84P-0430)
and, in so doing, I become a member of the Committee.




                                              Name and Address:

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