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News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences
Dr. Ray DePaulo
“I’d never sell ECT as a panacea,” says Ray DePaulo, “but I couldn’t be a depression-treating doctor without it.”
Hopkins Psychiatry Director DePaulo and colleagues know the dilemma of electroconvulsive therapy. They regularly witness the changeover, seeing patients with “incurable” depression—those severely suicidal or psychotic or rigid in catatonia’s hard shell—assume a fully normal life. “It’s more than that,” says DePaulo. “More than a few come to see life as a blessing following ECT.” But, he adds, “we’ve also all seen patients who lose memories and become distressed, especially if they’re not prepared.”
So ECT is a rose that’s sometimes thorny. Keeping a close watch may mitigate the barbs, however, and plays a part in Hopkins’ high benefit-to-risk ratio. So electrodes are positioned to minimize memory effects. Current is pulsed rather than continuous. Experienced eyes monitor vital signs and length of seizure. The patient population is select, making ECT far from routine.
As important, transparency must mark dealings with patients and families, says DePaulo. “You insist that family is involved. You lay out the good and the bad, from anesthesia risks to muscle aches to the delirium as you come out of it. And of course, you fully describe and answer questions about cognitive and memory risks, most patients’ greatest concern.”
For a few months afterward, he says, memory for facts, events or names learned around the time of ECT is typically lost. Recall of events before the treatment and absorbing knowledge afterward can waver. The latter typically resolves in jumps over the coming weeks or months, such that, as a rule, the ability to learn and remember entirely recovers. “Still,” DePaulo says, “there's no absolute wall of protection; past memories can be permanently lost.”
That's why research is key. Could knowing ECT biology show how to deliver its benefits without the risks? “That’s the goal,” says DePaulo.