Remember shock therapy?
In the movie "One Flew Over the Cuckoo's Nest," it made Jack Nicholson's facial contortions put the Joker's to shame.Well, times have changed.
Electroconvulsive shock, used in Ken Kesey's novel as an inhumane punitive tool of terror, has gained renewed credibility among Utah psychiatrists for the treatment of severe depression.
In fact, ECT is the treatment of choice when antidepressant drugs and other therapies prove ineffective.
"ECT hasn't always been pretty, but it has always been valuable," said Dr. Lowry Bushnell, clinical director of the Neuropsychiatric Diagnostic Program in the Western Institute of Neuropsychiatry. "Now it's valuable and it's not distasteful."
It's being performed with increasing frequency at several Utah hospitals, including the Western Institute, with few risks and great success, he said.
"Effectiveness varies, dependent on the selection of patients. If you are treating a person for depression with ECT and it turns out he doesn't have depression, he won't benefit - just like treating a person with insulin who doesn't have diabetes," Bushnell said. "But among well-selected patients, the effectiveness runs in the range of 90 to 95 percent."
Bushnell, president-elect of the Utah Psychiatric Association, said severe depression can be lifted by ECT within a few weeks - restoring otherwise dysfunctional patients to good mental health.
Yet, it hasn't always been a well-accepted treatment.
In the 1940s and 1950s, ECT was widely used in mental hospitals for treatment of problems as diverse as schizophrenia and obsessive-compulsive disorder. Critics said it was misused - even abused - and use tapered off.
Electroshock began to fall into disfavor in the 1970s due to public misunderstanding and fear heightened by such movies as "Cuckoo's Nest," Bushnell noted. With the advent of antidepressant medications, some hospitals stopped shock treatment entirely.
But medicines, psychiatrists soon discovered, don't help everyone. Those severly depressed patients beyond the reach of drugs became good arguments for the rivival of ECT.
However, because the treatment generally requires hospitalizations, Bushnell said it still may be the treatment of last resort.
The basic concept and effectiveness of ECT hasn't changed since the 1930s, but the comfort to the patient has been dramatically altered for the better.
The therapy is administered at the Western Institute in a room that's as fully equipped as any hospital surgical suite. Patients, who must give full consent to the treatment, are given muscle relaxants and a short-acting general anesthetic before a small amount of energy is delivered through electrical connections placed on the head.
The two-second shock, passed through the brain, induces a short seizure, ranging in length from 20-60 seconds. For reasons still not fully understood, the seizure relieves the symptoms of depression in most patients.
Following treatment, patients awaken in the recovery room with no unpleasant memories, since they were asleep throughout the entire procedure.
"The risks are low," said Bushnell, who administers ECT assisted by an anesthesiologist and two nurses. "in fact, it's probably safer to have ECT than to have a filling put in a tooth, so far as the medical risks involved."
Once serious side-effects of ECT - broken bones, heart attacks and severe memory loss - have largely been eliminated as methods have been refined.
Some patients still experience severe headaches following ECT, but they seem to lessen with subsequent treatments. Mild nausea, confusion and temporary memory loss have also been reported occasionally.
"But peoples' minds always clear and their memories always return to normal again," Bushnell said.
The number of treatments needed during one hospitalization depends on the patient's recovery; most have seven to 10 treatments.
Because chronic depression commonly recurs, Bushnell said additional ECT treatments are often needed in combination with antidepressant medications.
Occasionally ECT is used to treat manic and schizophrenic behavior. But the majority of patients who receive electroshock therapy are severely depressed.
Regrettably, Bushnell said, it isn't being administered to everyone who could benefit. Many severely depressed persons refuse the treatment, largely because of the stigma still associated with ECT.
The local psychiatrist blames the resistance on such movies as "Cuckoo's Nest."
Bushnell said his concern is that in a nation of 260 million people, every time a movie such as "One Flew over the Cuckoo's Nest" is shown, thousands of people who need mental health care will fail to get it.