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Shock of the Old

Electroconvulsive therapy makes a comeback

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Stowe Brooks was hit with his first bout of depression about three years ago. He's not sure if it was the medication or his body's own self-healing powers, but after two long years he finally pulled out of it, and started feeling like himself again. But then, last April, he was once again overcome with depression.

"I just went to bed," Brooks says. "I didn't want to talk to anyone. I just wanted everybody to leave me alone."

As a married man with two kids who owns a turkey farm in Union County, Brooks, 68, didn't have time to be sick. He went back to his doctor who, like the last time, prescribed a series of anti-depressants. "I took every kind of pill imaginable, but it didn't do me any good," he says.

As his depression grew progressively worse, his doctor recommended he go see a practitioner in Charlotte who specialized in treating depression. When it was first suggested that he try electroconvulsive therapy (ECT), Brooks balked. "I just didn't like the idea," he says.

But as he continued to spiral downward, he finally agreed.

In 1938, at the Department of Mental and Neurological Disease at the University of Rome, Dr. Ugo Cerletti began experimenting with a new electroshock apparatus to provoke epileptic fits in dogs and other animals. Then, after watching pigs being anaesthetized with electroshock before being butchered, he was struck with an epiphany: Why not try it on humans? In collaboration with Dr. Lucio Bini, Cerletti administered a series of electrical currents into the brain of a 39-year-old mental patient who had been diagnosed with schizophrenia. The electrical currents triggered patient convulsions and seizures, just as they had previously in the animals. After 11 such treatments, Cerletti determined he had successfully reversed the patient's psychosis. This was the first time a doctor had administered what is now known as electroconvulsive therapy (ECT). Today, according to the American Hospital Association, as many as 100,000 people receive ECT annually in the US, including many here in Charlotte.

Although there have been many technological and medical advances over the years, ECT remains a controversial and stigmatized treatment. Proponents say that's largely because of media misinformation, and stress that not only is ECT safe, but it is one of the most effective ways to treat depression, bipolar disorders, schizophrenia and other mental disorders. Critics, however, say the procedure is not properly regulated, and can cause serious and damaging side effects. We talked to some Charlotte area doctors and ECT patients to find out why this controversial treatment once considered so violent and inhumane is now making a comeback.

On the morning of Sept. 8 last year, Brooks and his wife arrive at CMC for his first ECT session. They take the elevator up to the psychiatry department on the fifth floor, and are led to an operating room. Brooks strips down to his underwear, dons a hospital gown, and stretches out on the bed. Nurses cover him with a couple of blankets to keep him warm. An intravenous anesthetic is administered, as is oxygen and a powerful muscle relaxant. Monitoring sensors are placed on his head and body to record his heart rate and brainwaves; blood pressure cuffs are placed on his arm and leg. A bite block is inserted into his mouth to prevent him from biting his tongue during the convulsions. Finally, a nurse attaches electrodes to both his temples. Brooks takes a long, nervous breath.

During the 40s and 50s, the first generation of ECT devices, called sine wave machines, were often used not to heal but to control troublesome and unruly mental patients. These early machines sent out intense bursts of electricity that often produced memory loss, brain damage and a host of other harmful side effects. This kind of barbaric treatment was immortalized in the 1975 film One Flew Over the Cuckoo's Nest. The image of Jack Nicholson uncontrollably thrashing about in agony during electroshock treatments has probably done more to stigmatize ECT than anything else, and it continues to plague the therapy even today. "The way ECT is portrayed -- with people shaking, breaking bones, breaking teeth, and biting their tongues -- that's just not true anymore," says Dr. Omar S. Manejwala, a psychiatrist at Carolinas HealthCare System, who treats about three to five patients a day with ECT. "It's a life-saving procedure that helps combat depression that has really suffered from media misinformation."

By the early 80s, new and improved ECT machines were introduced that delivered less electricity in brief pulses, causing less cognitive damage.

"Older machines were constant voltage devices," says Manejwala. "They would allow you to set the voltage, and then the current would vary. It turns out we can spare memory better by keeping the current constant and allowing the voltage to vary."

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