Major depression is a persistent, deep sense of sadness that affects a person’s quality of life and interferes with the ability to perform day-to-day activities. Patients may have restlessness or irritability, difficulty sleeping (or sleeping too much), changes in appetite, increased fatigue, trouble with concentration or memory, feelings of hopelessness or thoughts of suicide and death.
According to the American Psychiatric Association, depression affects nearly 10 percent of adults in the U.S. in any given year. Women are affected twice as often as men. Although depression can occur at any age, most patients are in their late teens to early 20s when symptoms first appear.
The exact cause of depression isn’t known. However, family history of depression, changes in brain chemicals, having a chronic or disabling illness, use of certain medications and undergoing serious difficult life events (like a death, divorce or job loss) raise the risk of clinical depression.
Major depression is typically treated with a combination of medications and psychotherapy. Antidepressant drugs aim to correct chemical imbalances in the brain that are thought to contribute to depression. Finding the right drug/dose can be tricky. Not all patients respond to the same medication. It can take several weeks to determine if the drug will work for the patient. If it doesn’t, doctors need to try a different drug and wait to see if that one controls symptoms. Sometimes other medications are prescribed in addition to antidepressants.
Psychotherapy is the use of “talk therapy.” The treatment may involve only the patient or the patient and family. The American Psychiatric Association reports significant improvement in depression is often seen after 10 to 15 sessions of psychotherapy.
ECT for Depression
ECT is electroconvulsive therapy. Though it is often referred to as “shock therapy,” there is no real electric shock involved. Instead, a small current is passed through the brain to purposely generate a minor seizure (a period of abnormal electrical activity in the brain). Scientists believe the seizure somehow changes the chemistry of the brain, and thus, how the brain functions.
ECT was first developed in 1938 and commonly used in the 1940s and 1950s for patients with severe mental illness. Today, the group Mental Health America, estimates about 100,000 people a year receive ECT.
Umesh Mehta, M.D., ECT Director with the Carrier Clinic in Belle Meade, NJ, says modern ECT is much more humane than the treatments used in the past. Patients are first evaluated to ensure they are appropriate candidates for ECT. They must also have a physical exam to get medical clearance for the procedure. Once approved for treatment, electrodes are placed onto the scalp to monitor brain wave activity. Then, the patient is given three different types of medication. The first drug dries up mouth secretions so the patient doesn’t choke or inhale fluid into the lungs. The second is an anesthetic to make the patient sleep. The third medication is a muscle relaxant to prevent the body from jolting during the treatment.
The ECT electrodes can be placed in three different ways. In right unilateral treatment, they are placed on the right side of the head. This position provides the mildest form of ECT. In bi-frontal placement, the electrodes are placed on the two front sides of the head. In bilateral placement, the electrodes are placed at the same point on both sides of the head. It provides the strongest degree of ECT.
Once the ECT electrodes are in place, an electrical wave is passed through the brain for about four to six seconds. The resulting seizure lasts for 20 to 40 seconds. The patient wakes up and is taken to the recovery room. The total time under anesthesia is only five to seven minutes. The treatment may be repeated about three times a week until patients are feeling better. Mehta says most patients need an average of eight or nine treatments. Maintenance ECT sessions are given anywhere from weekly to every few weeks or months to maintain the effects of the therapy.
The one side effect of concern associated with ECT is memory problems. It doesn’t affect everyone. However, Mehta explains that some patients have a hard time remembering some things that happened before the ECT therapy. Others have difficulty remembering new things. For most people, the memory problems only last a few days. But some have trouble with memory for three to six months.
Mental Health America estimates severely depressed patients have about an 80 percent improvement in symptoms after ECT. Mehta says ECT is especially useful for pregnant women who can’t take antidepressant medications because of a risk of side effects to the fetus. He adds the treatment is also useful for other mental health problems, like bipolar disorder and catatonia (inability to move because of extreme muscle rigidity), as well as mental health symptoms associated with other diseases (like Alzheimer’s and Parkinson’s).
AUDIENCE INQUIRYFor general information about depression or ECT:
American Psychiatric Association, http://www.healthyminds.org
American Psychological Association, http://www.apa.org/helpcenter
Centers for Disease Control and Prevention http://www.cdc.gov/Features/dsDepression
Mental Health Alliance, http://www.mentalhealthamerica.net
National Institute of Mental Health, http://www.nimh.nih.gov
BIBLIOGRAPHY“Current Depression Among Adults- United States, 2006 and 2008,” MMWR: Morbidity and Mortality Weekly Report, October 1, 2010, Vol. 59, No. 38, pp. 1229-1235.
Kellner, C., et al., “Bifrontal, Bitemporal and Right Unilateral Electrode Placement in ECT,” British Journal of Psychiatry, March 2010, Vol. 196, pp. 226-234.
Sackeim, Harold, Ph.D., et al., “Effect of Concomitant Pharmacotherapy on Electroconvulsive Therapy Outcomes,” Archives of General Psychiatry, July 2009, Vol. 66, No. 7, pp. 729-737.
Smith, G., et al., “A Randomized Controlled Trial Comparing the Memory Effects of Continuation Electroconvulsive Therapy Versus Continuation Pharmacotherapy,” Journal of Clinical Psychiatry, February 2010, Vol. 71, No. 2, pp. 185-193.
Yildiz, A., et al., “Combination of Pharmacotherapy with Electroconvulsive Therapy in Prevention of Depressive Relapse,” Journal of ECT, June 2010, Vol. 26, No. 2, pp. 104-110.
Research compiled and edited by Barbara J. Fister
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