The treatment

Press, 24 May 1977, Page 19

The treatment

The controversy arises over whether the use of E.C.T. to treat endogenous depressions and psychoses can be justified at all. Many psychiatrists, including those in Christ- . church, say they look on E.C.T. as a last resort. “E.C.T. is used only if it is indicated that the only alternative is drugs, which are less certain and less prompt,” said Dr Dobson. Last year 1500 treatments of E.C.T. were given at Princess Margaret Hospital. Until the 1930 s many mentally ill patients were simply locked up, placed in strait jackets, or left to cope with their illness while under supervision. The therapeutic benefit from convulsions was mentioned first by Von Meduna in 1935. Cerletti and Bini began using electricity in 1938. “The improvement in the depressive state is due to the actual convulsion, and insulin or cardiazol injections have been used to bring these about,” said Dr Dobson. Indoklon is also an alternative to electricity but it is considered technically difficult with no advantages.

For many years E.C.T. was given “straight.” The electrodes were clamped on the head of the conscious patient, often in an open ward, and the current turned on. The patient lost consciousness at the onset of convulsions which occasionally caused fractures and body stiffness. Yet the improvement noticed in patients encouraged psychiatrists and doctors to continue giving E.C.T. with some refinements. In Christchurch all stages of the treatment take place apart from other patients in fully equipped suites in Sunnyside, Princess Margaret and Calvary hospitals. Patients are given an anaesthetic and later a muscle relaxant in the preparation room and then wheeled into the treatment room. They say that their last feeling is the prick of the needle giving the anaesthetic. During the actual treatment the amount of electricity used is limited to the amount needed to cause the convulsion. Thirty joules — which is less than half the current used for cardial resuscitation — is usual. The electrodes are nor-

mally placed only on the non-dominant side of the head as this is said to reduce memory loss. The electrodes used to be placed on the head bilaterally — that is, on both sides. After the convulsion, the patient is resuscitated and taken to the recovery room for a cup of tea. The age of a patient is no barrier to treatment. Young people also require relief from psychotic depression, although less frequently, said Dr Dobson. One woman who became very depressed during her three pregnancies received treatments of E.C.T. during her last pregnancy and said that she was completely cured. A senior professional woman who received two treatments a day at first said that E.C.T. was very carefully administered in the best interests of the patient. Another woman who has reservations about the therapy says that she was treated too impersonally; fears which troubled her were not explained. “We don’t jump on E.C.T. as the first line of treatment,” said Dr Hall. In the first quarter of 1977, there were 250 ad-

missions at Sunnyside, of whom 24 received E.C.T. Since 1958 antidepressant drugs, particularly the tricyclic group, have been used. “They are successful in a wider spectrum of disorders but they are much less effective in really severe attacks with retardation, refusal of food and depressive delusions,” said the “British Medical Journal.” Counselling is very effective for the right disorder, said Dr Dobson. Talking out the problem can help a great deal but often it alone is not sufficient to alter the patient’s mood so that he can cope with problems. Some patients with chronic melancholia say that they were not aware of having any specific problem. In most depressive eases a combination of counselling and drugs are sufficient. However, where the patient seems intent on committing suicide, refuses to eat and drink, or suffers from delusions such as feeling worthless or “rotten inside,” E.C.T. gave prompt relief where some drugs might take up to 10 days or more to act, said Dr Dobson.