October 13, 2006

Electroconvulsive therapy discussion hosted at the MGH

For many the image suggested by the words "shock therapy" is Jack Nicholson violently convulsing on a gurney in the 1975 movie, One Flew Over the Cockoo's Nest. But according to Kitty Dukakis, wife of former Massachusetts Gov. Michael Dukakis, (right) and journalist Larry Tye — co-authors of a new book on electroconvulsive shock therapy (ECT) — that is not an accurate portrayal of a remarkable therapy that helps millions of people with depression each year. In their new book Shock: The Healing Power of Electroconvulsive Therapy, Dukakis, a longtime patient of MGH psychiatrist Charles Welch, MD, and Tye demystify the controversy surrounding ECT and portray not only Dukakis's story of depression, ECT treatment and recovery but also the incredible impact ECT has had on countless others since it was first used in the 1930s.

In a discussion of the new book hosted at the MGH Sept. 22, Dukakis and Tye joined Welch, Scott Rauch, MD, MGH director of Psychiatric Neuroscience Research and Neurotherapeutics, and Darin Dougherty, MD, of the Psychiatric Neurotherapeutics Unit, to examine the history, medicine and science of the controversial psychiatric procedure.

In the book, Dukakis openly discusses her lifelong battle with depression and her decision to try ECT as a last resort treatment that, she says, saved her life. " Has it changed my life? You bet it has," said Dukakis about the treatment she began at the MGH in 2001. She explained that for years she suffered from major depression and wasn't interested in the world around her, but after the procedure noticed a marked change. "I experienced relief from the depressive symptoms right away. Dr. Welch is a miracle doctor. He gave me hope." In addition to thanking the doctors and nurses at the MGH, Dukakis expressed gratitude to Maureen McGlame, senior clinician of MGH Psychiatry, for her support and friendship throughout the years.

Tye explained that one of his aims in writing the book was to explain that "ECT is back." Approximately 100,000 people per year in the United States and one million people worldwide receive the treatment. The procedure has evolved into a humane, respectful process that incorporates anesthesia, muscle relaxants and skilled clinicians so that the only sign of a seizure is a slight twitch. Since its first use in the 1930s, ECT has been carefully studied and in some cases may be more effective than the best antidepressants.

Welch explained that more than 18 million Americans suffer from major depressive disorder and praised both Dukakis and Tye for educating readers about the seriousness of the condition and the real risks and benefits of ECT. The most common side effect of the procedure is memory loss. He also explained that although the mechanism underlying ECT is not entirely understood, the electrical seizure could in some way "reset" the brain's precisely calibrated chemical pathways back to normal functioning. Continued treatment is needed to prevent relapse in most patients.

Dougherty discussed other device-based psychiatric treatments being explored at the MGH, including deep brain stimulation, vagus nerve stimulation and transcranial magnetic stimulation. The event concluded with a series of compelling questions and answers about the treatment.