Electroconvulsive Therapy:
A Second Opinion

Talking points from peer-reviewed journals

Compiled by Gary Null

May, 2001

Table of Contents	
Side effects: Effects on memory and cognition 	2	
Death by ECT  	4	
ECT doesn't prevent suicide  	5	
ECT is unnecessary  	6	
Relapse  	6	
Cardiovascular complications  	7	
ECT, women and the elderly  	8	
ECT with children  	9	
Longer hospital stays  	9	
ECT is brain damage  	9	
Brain changes during ECT 	13	
Changes in the electroencephalogram (E.E.G.) 	15	
ECT is Inhumane  	16	
Lack of efficacy  	16	
Adverse psychological effects  	16	
Epilepsy  	20	
Lack Of Efficacy  	21	

Side effects: Effects on memory and cognition

• In Freeman and Kendell's 1986 study, 74% of patients mentioned "memory impairment" as a continuing problem, and "a striking 30% felt that their memory had been permanently affected." The authors themselves admit that these symptoms were probably underreported because the patients were interviewed by the same doctors who treated them. 

• Despite this remarkably high incidence of impairment, the 1990 American Psychiatric Association task force cites Freeman and Kendell as indicating "a small minority of patients, however, report persistent deficits."

C. Freeman and R. Kendell, Patients' experience of and attitudes to electroconvulsive therapy, Annals of the New York Academy of Sciences 462 (1986), 341-352.

• "Controlled studies by Janis, carried out at Yale University, showed extensive, permanent loss of important personal memories and life history following routine ECT."

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing I.L. Janis, Memory loss following electroconvulsive treatments, Journal of Personality 17 (1948), 29-32; I.L. Janis, Psychological effects of electric convulsive treatments, Journal of Nervous and Mental Disease 111(1950),
359-397, 469-489; I.L. Janis and M. Astrachan, The effect of electroconvulsive treatment on memory efficiency, Journal of Abnormal
Psychology 46(1951), 501-511.

• "Many of the patients in a 1995 study developed irreversible retrograde amnesia that lasted at final testing two months after their last ECT….Following ECT, the four groups of patients lost or distorted the following percentages of their previously recalled memories: low-dose unilateral (29.8% loss), high-dose unilateral (26.8% loss), low-dose bilateral (47% loss) and high-dose bilateral (38.5% loss). These are extraordinary figures reflecting massive losses of retrograde memories of important past personal events."

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press
citing C. Sobin, H.A. Sackeim, J. Prudic, D.P. Devanand, B.I. Moody and M.C. McElhiney, Predictors of retrograde amnesia following ECT. American Journal of Psychiatry 152 (1995), 995-1001. 

• A 1998 study of patients exhibiting confusional states (similar to
post-traumatic amnesia among patients with head injury) following ECT show accelerated forgetting on a visual recognition memory task. Accelerated forgetting may reflect the effect of disrupted cerebral metabolism on either "consolidation" or memory "binding" processes.

Lewis P, Kopelman MD. Forgetting rates in neuropsychiatric disorders. J Neurol Neurosurg Psychiatry 1998 Dec;65(6):890-8. 

• Cognitive deficits are an undesirable effects of shock therapy (ECT). These include linguistic information processing difficulties and memory dysfunction as cognitive impairments associated with ECT.

Durr AL, Golden RN. Cognitive effects of electroconvulsive therapy: a clinical review for nurses. Convuls Ther 1995 Sep;11(3):192-201

• There is a gap between scientific studies of ECT, which conclude that side effects are short term and narrow in scope, and the reports of patients. The existing research paradigm fails to consider the potential for devastating and permanent memory loss with ECT. Electroconvulsive therapy and memory loss: a personal journey. Donahue AB. J ECT 2000 Jun;16(2):133-43

•"Shortly after ECT, patients recalled fewer events and event details than controls, with the deficits most marked for impersonal compared with personal events. At the 2-month follow-up, patients had reduced retrograde amnesia, but continued to show deficits in recalling the occurrence of impersonal events and the details of recent impersonal events. The amnestic effects of ECT are greatest and most persistent for knowledge about the world (impersonal memory,) compared with knowledge about the self (personal memory), for recent compared with distinctly remote events, and for less salient events."

The effects of electroconvulsive therapy on memory of autobiographical and public events. Lisanby SH, Maddox JH, Prudic J, Devanand DP, Sackeim HA. Arch Gen Psychiatry 2000 Jun;57(6):581-90

• "Autobiographic memory failures, if added across a course of ECT, may produce gross memory gaps that may be disconcerting to a patient and a patient's family, because the patient's sense of continuity with his or her own past may be disrupted."

W. Daniel, H. Crovitz, R.D. Weiner and H. Rogers, The effects of ECT modifications on autobiographic memory, Biological Psychiatry 17 (1982), 919-924. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.

• "…individuals whose prior treatments had included ECT were inferior to normal control subjects and to patients who had been spared ECT, and this inferiority was apparent on the following measures: verbal and nonverbal fluency, delayed alternation performance, tactual maze learning, continuous recognition of verbal and nonverbal material, delayed recall of a complex drawing, recognition of faces and houses, and identification of famous public figures. In some cases, the degree of deficit was related to the number of ECT received, patients who had been given more than 50 ECT being significantly worse than those who had sustained fewer than 50." 

Teuber, J.L., Corkin, S. & Twitchell, T.E.: A study of cingulotomy in man. Report to the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1976. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.

The issue is summed up succintly in the title of a year 2000 article in the prestigious Nature journal. "ECT damage is easy to find if you look for it."

Sterling P. ECT damage is easy to find if you look for it. Nature 2000 Jan 20;403(6767):242.

• "Publicly available data from the state of California's Department of Mental Health reveals that over 99% of ECT recipients complain of memory loss 3 months following treatment, with the average number of ECT sessions being 5 to 6."
 
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing A. Lazarow, Chief, Office of Human Rights, California Department of Mental Health, 1996.

• "In a chapter on the cognitive effects of ECT in a psychiatry textbook, Sackheim indicates that cognitive effects (disordered thinking), particularly amnesia, can be long lasting after shock."

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Sackeim, in Cognitive Disorders: Pathophysiology and Treatment, edited by Moos, et al 1992. 

• "The conclusion that amnesia can be a long lasting effect of shock is arrived at by both Squire and Weiner in separate studies. 

Squire, et al. Retrograde amnesia and bilateral ECT: Long term follow-up. Arch Gen Psych 1981;38:89-95.  Weiner, et al. Effects of stimulus parameters on cognitive side effects Ann NY Acad Sci 1986;462:315-325.

Death by ECT

• "New data has confirmed the probability of a significant death rate from ECT. A recent law in Texas requires the reporting of death within two weeks after ECT. From June, 1993, through August, 1994, eight deaths were reported among nearly 1,700 patients subjected to electroshock treatment. 

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press

• Over the course of the seven-year study, the risk of death doubled for patients receiving shock therapy. More than two-thirds of the shock patients had relapses and had to be readmitted during that time.

Seven year prognosis in depression. Mortality and readmission risk in the Nottingham ECT cohort. O'Leary DA, Lee AS. Br J Psychiatry 1996 Oct;169(4):423-9

• In California between 1984 and 1994, 28,437 patients received a total of 160,847 shock treatments. Three of the patients died. 821 patients, about 3% of the total, were judged incapable of giving informed consent after court review.

Use of ECT in California, revisited: 1984-1994. J ECT 1999 Dec;15(4):245-51. Kramer BA.

• A 57-year-old man suffered cardiovascular collapse, culminating in cardiac arrest with electromechanical dissociation following his eighth ECT treatment. Despite resuscitative measures, the patient died.

Cardiac rupture during electroconvulsive therapy. Ali PB, Tidmarsh MD. Anaesthesia 1997 Sep;52(9):884-6 

• "In a large retrospective study of 3,288 patients getting ECT in Monroe County, NY, ECT recipients were found to have an increased death rate from all causes."

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Babigian, H., et al. Epidemiologic Considerations in ECT. Arch Gen Psych 1984;4:246-253. 

• "Survival in 65 patients hospitalized and treated for depression was evaluated by researchers at Brown University. They reported that the 37 patients who received ECT had survival rates of 73.0% at one year, 54.1% at two years, and 51.4% at three years. In contrast, depressed patients who did not receive ECT had survival rates of 96.4%, 90.5% and 75.0% at 1,2 and 3 years respectively." 

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Kroessler, D. and Fogel, B. Electroconvulsive Therapy for Major Depression in the Oldest Old. Am J Geriatr Psych 1993;1:1:30-37. 

• The first three years of mandated recording of death within 14 days of ECT in the state of Texas yielded reports of 21 deaths. Eleven of these were cardiovascular, including massive heart attacks and strokes, three were respiratory, and six were suicides. 

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79 citing Don Gilbert, Commissioner, Texas Department of Mental Health and Mental Retardation, 1996. 

[The titles of the following studies are self explanatory]

Sudden death following electroconvulsive therapy. Weber DL, Ruvolo C, Cashin P. N Y State J Med. 1973 Apr 15;73(8):1000-1. 

Death after E.C.T. Gomez J. Br Med J. 1974 Jul 6;2(922):45. 

Fatal heart block and cardiac arrest following ECT. A case report. Malik MO. Br J Psychiatry. 1972 Jan;120(554):69-70. 

Myocardial infarction and fatal coronary insufficiency during electroconvulsive therapy. Hussar AE, Pachter M. JAMA. 1968 Jun 10;204(11):1004-7.

ECT doesn't prevent suicide 

Does shock therapy save lives by preventing suicide, as its proponents claim? There no science to back up that claim. 

• A study conducted in 1976 found no difference in suicide rates among 519 patients receiving shock therapy, antidepressant medication, or neither shock therapy nor antidepressant medication. 

Avery D, Winokur G. Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Arch Gen Psychiatry 1976 Sep;33(9):1029-37

• A year 2000 study compared 89 people with severe depression who committed suicide to a group of 89 similar, severely depressed people who did not commit suicide. The study found no suicide preventive effect for shock therapy. Rather, the study revealed that patients who did not receive continuing drug therapy after shock were far more likely to commit suicide than those who did. 

Treatment and suicide in severe depression: a case-control study of
antidepressant therapy at last contact before suicide. Bradvik L, Berglund M. J ECT 2000 Dec;16(4):399-408

Little, if any, evidence supports a long-term positive effect of ECT on suicide rates, especially if diagnostically heterogeneous groups are considered.

Electroconvulsive therapy and suicide risk. Prudic J, Sackeim HA. J Clin Psychiatry 1999;60 Suppl 2:104-10; discussion 111-6

• "Patients who committed suicide were more apt to have received ECT than those who died from other causes, but this difference was not significant. A control group of living patients matched for age, sex, and diagnosis had very similar exposures to ECT. which further indicates that ECT does not influence long-term survival. These findings combined with a close examination of the literature do not support the commonly held belief that ECT exerts long-range protective effects against suicide."

Does Electroconvulsive Therapy Prevent Suicide? Victor Milstein, Ph.D., Joyce G. Small, M.D., Iver F. Small, M.D., and Grace E. Green, B.A. Convulsive Therapy 2(1):3-6, 1986

A study of 1076 Iowans with major affective disorders found that mortality does not differ between patients having a lifetime history of ECT and patients never having had ECT. Mode of therapy received in the hospital has minimal influence on subsequent mortality, including suicide.

Does Treatment Influence Mortality in Depressives? A Follow-up of 1076 Patients with Major Affective Disorders. Donald W. Black, M.D., M.S.; George Winokur, M.D.; Emmanuel Mohandoss, M.S.; Robert F. Woolson, Ph.D.; and Amelia Nasrallah, M.A. Ann Clin Psych 1989;1:165-173

"There is little or nothing in the literature to suggest that ECT ameliorates suicide, whereas a significant body of literature confirms that it does not…. As they attempt to recover from ECT, patients frequently find that their prior emotional problems have now been complicated by ECT-induced brain damage and dysfunction that will not go away. If their doctors tell them that ECT never causes any permanent difficulties, they become further confused and isolated, creating conditions for suicide."

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.

ECT is unnecessary

• ECT emerged with no scientific evidence, and the absence of other suitable therapy for psychiatric illness was decisive in its adoption as a treatment. ECT is an unscientific treatment and a symbol of authority of the old psychiatry. ECT is not necessary as a treatment modality in the modern practice of psychiatry.

Time to abandon electroconvulsion as a treatment in modern psychiatry. Youssef HA, Youssef FA. Adv Ther 1999 Jan-Feb;16(1):29-38

• Electroconvulsive treatment (ECT) is increasingly used in North America and there are attempts to promote its further use world-wide. However, most controlled studies of efficacy in depression indicate that the treatment is no better than placebo with no positive effect on the rate of suicide.

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press

Relapse

•In a double-blind study of four different ECT modalities with depressed patients, 26 out of 90 patients failed to respond to therapy….Forty-one of the 70 who did respond (59 percent) relapsed, and there were no differences between treatment groups. 

Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Sackeim HA, Prudic J, Devanand DP, Kiersky JE, Fitzsimons L, Moody BJ, McElhiney MC, Coleman EA, Settembrino JM. N Engl J Med 1993 Mar 25;328(12):839-46

• A study of two different types of shock therapy conducted at the New York State Psychiatric Institute in New York City, 53% of 80 depressed patients studied relapsed within two months of treatment.

A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, Fitzsimons L, Moody BJ, Clark J Arch Gen Psychiatry 2000 May;57(5):425-34

• A more recent study by the same group shows that without active treatment, virtually all remitted patients relapse within 6 months of stopping ECT. The authors are among the leading advocates of ECT.

JAMA 2001 Mar 14;285(10):1299-307. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, Greenberg RM, Crowe RR, Cooper TB, Prudic J

Cardiovascular complications

• "Twenty-eight percent of a group of 42 patients undergoing ECT suffered cardiovascular problems including ischemic and/or arrhythmic complications following treatment. Seventy percent of the patients who had a history, physical or EKG evidence of cardiac disease developed cardiac complications."

The Identification and Management of Patients with a High Risk for Cardiac Arrhythmias During Modified ECT. Joan P Gerring. M.D. and Helen M Shields,  M.D.                                            J Clin psychiatry 43 4.

• "ECT-induced seizures cause a rapid rise in blood pressure; at the same time the brain experiences a significant reduction in blood flow."

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79 citing Webb, et al. Cardiovascular response to unilateral ECT Biol Psych 1990;28:758-766 . Rosenberg, et al. Effects of ECT on cerebral blood flow Convulsive Therapy 1988;4:62-73.

• "A Mayo clinic study of 34 elderly patients receiving shock found an 18% incidence of serious heart arrhythmias during treatment; 4 had ventricular tachycardia requiring IV lidocaine, 2 had supraventricular tachycardia requiring IV beta blockers. An additional 2 patients had other cardiogram changes."
 
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79 citing Tomac, T. and Rummans, T. Safety and Efficacy of Electroconvulsive Therapy in Patients Over Age 85. Am J Geriatr Psych 1997;5:126-130. 

• "After his eighth ECT, a 57-year-old man died of heart rupture."

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79 citing Ali, P.B. and Tidmarsh, M.D. Cardiac Rupture During Electroconvulsive Therapy Anesthesia 1997; 52: 884-895.

• "Physicians from Tulane University Medical School reported on a 69-year-old woman who developed brain hemorrhage during ECT. She was also left with epilepsy afterward. This was, as expected, associated with further deterioration in her mental status from her baseline depression. They conclude that the fragile vessels of the elderly may make some patients a particularly high risk for ECT."

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79 citing Weisberg, et al. Intracerebral hemorrhage following ECT. Neurology 1991; Nov: 1849.

ECT, women and the elderly
 
• Patients over 80 years had significantly more cardiovascular complications and falls (95% confidence interval) and tended to have a worse ASA (American Society of Anesthesiologists) scale rating and a somewhat less successful outcome.

Electroconvulsive therapy in octogenarians. Cattan RA, Barry PP, Mead G, Reefe WE, Gay A, Silverman M. J Am Geriatr Soc 1990 Jul;38(7):753-8

• Among elderly and other ECT patients, significantly more women than men are electroshocked: two to three times more women than men have been electroshocked in both Canada and the United States for many years.

Electroshocking elderly people: Another psychiatric abuse. Don Weitz. Changes: An International Journal of Psychology and Psychotherapy (vol. 15 no.2, May 1997). 

• A longitudinal study involving sixty five depressed patients 80 years and older found that for the ECT group, 27 per cent died within one year following the "treatment", but only 4 per cent of the "medicated" group died. In addition, one patient died after undergoing two ECTs. In other words, this study clearly show that electroshock threatens people's survival, especially if they are old and sick.

Kroessler, D. and Fogel, B.S. (1993). "Electroconvulsive therapy for major depression in the oldest old". The American Journal of Geriatric Psychiatry, l(l), 30-37.

• "Given that an estimated 50% of women in psychiatric hospitals have suffered sexual and/or physical abuse in childhood and that ECT is most commonly used on women, this raises the disturbing possibility that a number of patients are, in effect, being re-abused in the name of treatment.

Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999; citing Williams, J. & Watson, G. (1994). Mental health services that empower women: the challenge to clinical psychology. Clinical Psychology Forum, 64, 1117.

• "In an analysis of 34 persons over the age of 85 who were subjected to ECT, researchers at the Mayo clinic documented that 79% suffered treatment complications, including a 32% incidence of confusion and delirium, 67% incidence of transient high blood pressure, 18% incidence of serious heart arrhythmias during treatment, 2 patients with other cardiogram changes, 3 with falls, 1 hip fracture due to fall."
 
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79 citing Tomac, T. and Rummans, T. Safety and Efficacy of Electroconvulsive Therapy in Patients Over Age 85. Am J Geriatr Psych 1997; 5:126-130.

• "ECT-enthusiast Dr. Coffey and his associate Dr. Figiel found that 10 out of 87 (that's 11% of) elderly patients getting ECT for depression remained delirious between ECT sessions for no discernible medical reason other than the ECT itself. They documented by brain MRI scans that 90% of these unfortunate patients had lesions in the basal ganglia areas of the brain, and 90% also had moderate to severe white matter lesions."

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79 citing Figiel, Coffey, et al. Brain MRI findings in ECT-induced delirium J of Neuropsych and Clin Sci 1990;2:53-58.

• "Kroessler and Fogel's 1993 study on death rates reported above was done on the "oldest old," depressed patients at least 85 years of age. Mortality rates were significantly greater for those who received ECT, compared to those who did not." 

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79 citing Kroessler, D. and and Fogel, B. Electroconvulsive Therapy for Major Depression in the Oldest Old. Am J Geriatr Psych 1993;1:1:30-37. 

ECT with Children

• An article in the American Journal of Psychiatry reports that a 15-year-old girl with schizophrenia received 200 ECTs in 1 year. A 16-year-old girl diagnosed as suffering from dementia praecox was treated with 15 unmodified ECTs in 3 days. She developed an organic brain syndrome over a period of 3 weeks….Five patients were reported to have ended the course of ECT prematurely because of side effects. These included a depressed teenager who underwent a switch to mania after five ECTs; two whose treatment was discontinued because of increasing agitation; one who showed marked confusion after two treatments; and an 18-year-old female patient with bipolar disorder who developed neuroleptic malignant syndrome following one ECT, after which the course was terminated.

Half a Century of ECT Use in Young People. Joseph M. Rey and Garry Walter. American Journal of Psychiatry 154:5, May 1997

Longer hospital stays

• Lengths of hospital stay for patients receiving ECT were generally longer than for other depression hospitalizations, both for first ECT and later ECT series.

Epidemiologic considerations in electroconvulsive therapy. Babigian HM, Guttmacher LB. Arch Gen Psychiatry 1984 Mar;41(3):246-53

ECT is brain damage

• "As a neurologist and electroencephalographer, I have seen many patients after ECT, and I have no doubt that ECT produces effects identical to those of a head injury. After multiple sessions of ECT, a patient has symptoms idenctical to those of a retired, punch-drunk boxer...After a few sessions of ECT the symptoms are those of moderate cerebral contusion, and further enthusiastic use of ECT may result in the patient functioning at a subhuman level. Electroconvulsive therapy in effect may be defined as a controlled type of brain damage produced by electrical means."

Sydney Samant, M.D. Clinical Psychiatry News. March 1983.

• "Given that the average ECT procedure induces a level of electricity that is approximately 2 1/2 times greater than that required to induce a convulsion, the term ECT is really a euphemistic misnomer. It is not a "convulsive therapy." Rather, it is systematic brain damage, and the damage is the effect; the more current, the more brain damage."

John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79.

 •Early animal studies provided unequivocal evidence of brain damage, and indeed it was openly admitted by psychiatrists that this was the mechanism of improvement, and that the patient, "secures his readaptation to normal life at the expense of a permanent lowering of functional efficiency". 

L. Johnstone, Is the use of ECT a non-issue for psychologists, in: Clinical Psychology Forum, August 1992, pp. 30-31. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press

• Numerous studies, whose results are not reported in the official journals, confirmed widespread and often permanent impairment in a range of cognitive abilities, even after standard length courses of ECT ... 

Ibid.

• An appalling abuse is going on in our midst: thousands of people a year are having brain damage inflicted on them in the name of "treatment". 

Ibid. 

S. Sament, In favor of wider ECT ban, Clinical Psychiatry News (March 1983), 11.

• "The studies by Hartelius, by Ferraro et al., and by Alpers and Hughes were definitive. They demonstrated that ECT causes brain damage in monkeys, dogs, and cats, including hemorrhages and cell death. The "controversy" should have ended with these studies, as well as with a number of confirmations from other animal investigations in the 1940s and 1950s. Instead, the research stopped, and the coverup began."

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing B.J. Alpers, The brain changes associated with electrical shock treatment, Lancet 66 (1946), 363-369; A. Ferraro, I. Roizin and M. Helfand, Morphologic changes in the brains of monkeys following convulsions electrically induced, Journal of Neuropathology and Experimental Neurology 5 (1946), 285-308; A. Ferraro and L. Roizin, Cerebral morphologic changes in monkeys subjected to a large number of electrically induced convulsions (32-100), American Journal of Psychiatry 106(1949), 278-284.

• "ECT is closed-head electrical injury, typically producing a delirium with global mental dysfunction (an acute organic brain syndrome). Significant irreversible effects from ECT are demonstrated by many studies, including: (1) Inventories of autobiographic and current events memories before and after ECT; (2) Retrospective subjective observations on memory; (3) Autopsy studies of animals and some of humans. ECT causes severe and irreversible brain neuropathology, including cell death."

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press

• A patient recovering consciousness from ECT might understandably exhibit multiform abnormalities of all aspects of thinking, feeling, and behaving, including disturbed memory, impaired comprehension, automatic movements, a dazed facial expression, and motor restlessness.

R. Abrams, Electroconvulsive Therapy, 3rd edn, Oxford University Press, New York, 1997. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press. 

• "An organic psychosis may occur with few treatments. The syndrome may include disorientation, amnesia, agnosia, confabulation, aphasia, apraxia, and delirium, the latter being seen principally as the postseizure emergence of delirium."

M. Fink, Convulsive Therapy: Theory and Practice, Raven Press, New York, 1979. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.

• "ECT can acutely disrupt not only memory but 'perceptual, language and other cognitive functions', especially if the stimulus intensity is relatively high.

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing M. Fink, Reconsidering ECT in adolescents, Psychiatric Times (January 1995), 18. 

• "From the very beginning - based on animal studies, human autopsies, and clinical observation - ECT was known to cause brain damage. In fact, the brain damage was considered the principal element of the therapeutic impact. Later, with increasing concern about ECT's bad image, advocates began to deny these well-established observations."

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.

• "Some human and animal autopsies reveal permanent brain pathology. Some patients have persisting spontaneous seizures after having received ECT. Patients having received many ECTs score lower than control patients on psychological tests of organicity, even when degree of psychosis is controlled for."

D.I. Templer and D.M. Veleber, Can ECT permanently harm the brain?, Clinical Neuropsychology 4(2) (1982), 62-66. Cited in Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.

• "The question whether or not irreversible damage to the nerve cells may occur in association with ECT must therefore be answered in the affirmative."

Hans Hartelious.

•"Over twenty years ago Cotman reported in Science that ECT disrupts (protective) protein production by brain cells. More recent studies show that electric shocks to the brain also causes an increase the production of inflammatory proteins inside brain cells." 

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Cotman, et al. Electroshock effects on brain protein synthesis. Science 1971;178:454-456. Marcheselli, et al. Sustained induction of prostaglandin endoperoxidase synthase-2 by seizures in hippocampus J Biol Chem 1996; 271:24794-24799. 

• "C. Edward Coffey, MD, a leading proponent of ECT, conducted a study at Duke University Medical Center and the Durham VA Hospital which looked at the brain scans (by MRI) of patients before and after ECT. Out of 35 patients studied, 8 had changes on MRI after shock. That's 22%, or greater than one in 5, with anatomic brain effects. Among those with the brain changes, one patient suffered a stroke and two had new abnormal neurologic signs on exam within 6 months of the ECT."

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Coffey, et al. Brain Anatomic Effects of ECT ŒArch Gen Psych1 1991;48:1013-1021.

• "Weinberger looked at the effects of ECT on the brains of schizophrenics by comparing brain CT scans of those who had ECT with schizophrenics who never received shock. He documented that cerebral atrophy (brain shrinkage) was significantly more common in those who had been shocked." 

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Weinberger, et al. Structural abnormalities in the cerebral cortex of chronic schizophrenic patients. Arch Gen Psych 1979;36:935-939.

• "Another CT scan study done by Calloway looking at a similar group confirmed that frontal lobe atrophy (brain shrinking) was significantly more common in ECT recipients." 

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Calloway, et al. ECT and cerebral atrophy: a CT study. Acta Psych Scand 1981;64:442-445.

• "Andreasen used MRI scans to demonstrate a strong correlation between the number of previous ECT treatments to enlarged ventricles (loss of brain tissue). 
Andreasen, et al. MRI of the Brain in Schizophrenia Arch Gen Psych 1990;47:35-41. 

• "A study in England compared the brain CT scans of 101 depressed patients who had received ECT to 52 normal volunteers. They found a significant relationship between treatment with ECT and brain atrophy. In fact ECT recipients were twice as likely to have a measurable loss of brain tissue in the front area of the brain and a tripling of the incidence of a loss of brain tissue in the back of the brain. Most significantly, the brain abnormalities correlated only with ECT, and not with age, alcohol use, gender, family history of mental illness, age at the time of psychiatric diagnosis, or severity of mental illness." 

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Dolan, RJ, et al. The cerebral appearance in depressed subjects Psychol Med 1986;16:775-779.

• "An animal study sought to discover whether giving supplementary oxygen during shock would prevent brain damage; they also gave vitamin E to lessen the effects of damaging 'free radical' molecules that get released during a shock seizure. They found no difference in the brain damaging effects of ECT-induced seizures by giving oxygen and vitamin E. These findings disprove the claim that modern ECT methods (complete with anesthesia and oxygen) are any less damaging to the brain than uncontrolled seizures."
 
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Manoel, et al. Brain damage following repeated electroshock in cats and rats Rev Rom Neurol Psych 1986;24:59-64.

• Brain Damage and Memory Loss from ECT

Dr. Peter Sterling, Ph.D., Associate Professor of Neurobiology at the University of Pennsylvania, made the following overall conclusions based on a thorough review of all the scientific literature on ECT when he testified before the Standing Committee on Mental Health of the Assembly of the State of New York in 1978:

"1.Convulsions caused by electrical shocks to the brain are accompanied by alterations within the brain. Many of the brain's natural protections are broken down. Mentioned in particular are the massive rise in blood pressure, the breakdown of cerebral auto regulation of blood flow, and the breakdown of the blood-brain barrier. 

"2.Such changes can lead to alterations in brain chemistry and physiology. The change most easily measured in humans is the alteration of the EEG toward a form that is commonly recognized as pathological. 

"3. Such changes are also associated in many studies with gross pathology such as brain swelling (edema) and particularly brain hemorrhages which lead to the irreversible death of neurons. 

"4. Such changes are also associated with persisting, probably permanent amnesias for life events and experiences. 

"5. Such amnesias may only be detected when patients are questioned in detail about their life histories before and following the administration of shocks. 

"6. At all levels, from changes in blood pressure to losses in memory, there is extreme variability. Losses can, however, be catastrophic after only a few shocks. In general, the younger and healthier the animal or person, the less permanent damage may result. 

"7. Such losses of memory can and do occur without any necessary changes in overall intelligence as measured by a psychological test and without any other detectable neurological abnormalities. This finding is common not only with ECT but in brain damage accompanying other kinds of insult such as trauma or toxicity."

Brain Damage and Memory Loss from ECT: Testimony Prepared for the Standing Committee on Mental Health of the Assembly of the State of New York. October 5, 1978. Dr. Peter Sterling, Ph.D. Associate Professor of Neurobiology, Department of Anatomy, School of Medicine, University of Pennsylvania 

Brain changes during ECT

• "The electricity passing through the brain causes massive, simultaneous excitation of vast numbers of neurons. The inhibitory mechanisms that normally hold neurons in check…are overwhelmed by the excitation. As the excitation builds and swamps the inhibitory mechanisms, it spreads throughout the brain. When the excitation reaches the motoneurons of all the body's muscles, there is massive, convulsive muscular contraction. The muscles contract so powerfully that tendons may be torn from the bones, the bones themselves may be broken, teeth chipped and broken, and so on. The massive requirements for oxygen and the interruption of breathing caused by the convulsion often causes anoxia…. This overall response resembles the "grand mal" seizure that occurs in epilepsy."

Ibid.

• Accompanying the convulsion, there is a tremendous rise in blood pressure: changes in arterial pressure from 80mm Hg to 220mm Hg, or almost 200%, have been recorded.

Brain Damage and Memory Loss from ECT: Testimony Prepared for the Standing Committee on Mental Health of the Assembly of the State of New York. October 5, 1978. Dr. Peter Sterling, Ph.D. Associate Professor of Neurobiology, Department of Anatomy, School of Medicine, University of Pennsylvania citing Plum, F., Posner, J.B. & Troy, B.: Cerebral metabolic and circulatory responses to induced convulsions in animals. Arch. Neurol. 18:1-13, 1968. 

• "With the onset of the seizure, cerebral blood flow rises dramatically -- as much as 400%. Cerebral oxygen consumption also rises as much as 400%. In accomplishing such massive increases in blood flow, the automatic mechanisms that normally regulate cerebral blood flow are overwhelmed….These changes accompanying ECT are not modified by the administration of anesthetic, paralytic drugs or oxygen. 

Ibid;  citing Plum, F., Posner, J.B. & Troy, B.: Cerebral metabolic and circulatory responses to induced convulsions in animals. Arch. Neurol. 18:1-13, 1968 and Posner, J.B., Plum, F. & Van Poznak, A.: Cerebral metabolism during electrically induced seizures in man. Arch. Neurol. 20:388-395, 1969.

• "The extremely high cerebral blood pressure and the breakdown in auto regulation of cerebral blood flow during the seizure frequently ruptures small, and occasionally large, vessels in the brain." Madow (1956) reviewed 42 cases of autopsy assembled from 26 published reports on patients who had recently received ECT. Twenty-five (60%) had either petechial hemorrhages or large infarcts. About three-quarter of these patients were over forty, but the frequency of hemorrhage in the group under forty was the same as for the older group."

Ibid; citing Madow, L.: Brain changes in electroshock therapy. Am. J. Psychiat. 113:337-347, 1956.

• "There seems every reason to suspect…that subarachnoid or intracerebral bleeding accompanies ECT about half the time. This is supported by numerous studies in animals autopsied after being subjected to ECT. For example, Alpers and Hughes (1942) found bleeding in 23/30 cats (77%); Heilbrunn(1943) found petechial or larger hemorrhages in all of the rats that convulsed in his experiments to ECT; Heilbrunn and Weil (1942) made similar findings in 17/21 (81%) rabbits. Wherever bleeding occurs in the brain, neurons lose their supply of oxygen and nutrients -- and die." 

Ibid; citing Alpers, B.J. and Hughes, J.: Changes in the brain after electrically induced convulsions in cats. Arch. Neurol. & Psychiat. 47:385, 1942; Heilbrunn, C.: Prevention of hemorrhages in the brain in experimental electric shock. Arch. Neurol. & Psychiat. 50:450, 1943; and Heilbrunn, G. and Weil, A.: Pathologic changes in the central nervous system in experimental electric shock. Arch. Neurol. & Psychiat. 47:918, 1942. 

• The electrical shock causes damage to the blood-brain barrier. This has been shown experimentally in animals, and there is every reason to believe that it happens in humans as well. Whatever the cause, the loss of this protective barrier exposes the brain tissue to components of the blood from. it is normally protected."

Ibid; citing Aird, R.B., Strait, L., Pace, J.W., Hrenoff, M.K., and Bowditch, S.C.: Current pathway and neurophysiologic effects of electrically induced convulsions. J. Nerv. & Ment. Dis. 123:505-512, 1956; Angel, C., Hartman, A.M., Burkett, J.L. and Roberts, A. J.: Effects of electroshock and trypan red on the blood-brain barrier and response retention in the rat. J. Nerv. & Ment. Dis. 140:405-411, 1965; Lee, J.C. and Olszewski,J.: Increased cerebriovascular permeability after repeated electroshock. Neurol. 11:515-519, 1961. 
 
• "The combination of raised cerebral blood pressure and ruptured blood-brain barrier often causes another problem, cerebral edema….As the pressure inside the skull rises from the swelling, capillaries are closed. Their linings are damaged by anoxia making them even more leaky. This leads to more edema and damage." 

Ibid; citing Fishman, R.A.: Brain Edema. N. .Engl. J... Med. 293, 14: 706-711, 1975; Klatzo, I. and Seitleberger, F.: Brain Edema. Springer-Verlag, N.Y., Inc., 1967. 

• "Edema has been noted in the human retina, an easily visible part of the brain, as a consequence of shock."

Ibid; citing Winnick, H.Z., Landau, l.L., AssaIl, J. & Tomim, B.:"Microvascular changes during insulin-coma treatment" in Rinkel, M.: Biological Treatment of Mental Illness. L. C. Page & Co., N.Y. 1966. 

• "Even if the brain receives enough oxygen during a seizure, the brain may exhaust its sources of nutrients and be irreversibly damaged. It means that the abolition of electrical activity and the coma that sometimes follows a seizure can occur even though adequate oxygen is supplied."

Ibid; citing Posner et al. 

• "There are changes in a host of brain chemicals as the result of ECT. Synthesis of protein and RNA are inhibited within five minutes of ECS, with the decrease persisting for a number of hours. The levels of neural transmitters (acetylcholine, norepinephrine, serotonin) and their related enzymes also change."

Ibid; citing Essman, W.B.: Neurochemistry of Cerebral Electroshock. Spectrum Publication, Inc., Flushing, N. Y.,Wiley 1973.

• "Following ECT, there is a marked rise-in cerebral levels of arachidonic acid. This compound has been shown to cause aggregation of blood platelets when injected into the cerebral blood supply, resulting in small "strokes" throughout the brain. Conceivably the rise in arachidonic acid associated with ECT could be a source of brain damage."

Ibid; citing Essman; Bazan, N.G.: Biochem-Biophys. Acta. 218:1-10, 1970; J. Neurochem. 18:1379 1385, 1971; and Furlow, T.W.,Jr. & Bass, N.H.: Stroke in rats produced by carotid injection of sodium arachidonate. Science 187:658-660, 1975. 

Changes in the electroencephalogram (E.E.G.)

• "The EEG changes markedly during and following ECT….of 42 patients with normal EEGs before ECT, half (21) had abnormal EEGs following treatment. One-third of these abnormalities were severe "cerebral dysrhythmias". The EEG patterns resembled those commonly seen in epileptic patients in the periods between epileptic seizures."

Ibid; citing Mosovich, A.,& Katzenelbogen, S.: Electroshock therapy, clinical and electroencephalographic studies. J. Nerv. & Ment. Dis. 107: 517-30, 1948. 

• "The frequency of damage increased with increasing number of shocks:. after 16-42 shocks, half the patients showed cerebral dysrhythmia... These changes were often extremely long lasting. Thus, 68/82 patients showed the dysrhythmia the day following ECS, and 20 patients still had the pattern 10 months later. For all anyone knows, the changes were permanent."

Ibid.

• "These findings have been confirmed in modern studies using anesthesia, oxygen, and muscle paralysis."

Ibid; citing Abrams, R., Fink, M., Dornbush, R. L., Feldstein, S., Volavka, J. and Roubicek, J.: Unilateral and bilateral electroconvulsive therapy: Effects on depression, memory, and the electroencephalogram. Arch. Gen. Psychiat. 27:88-91, 1972; and Volavka, J., Feldstein, S., & Abrams, R.: EEG and clinical change after bilateral and unilateral electroconvulsive therapy. EEG Clin. Neurophysiol. 32:631-639, 1972.

ECT is Inhumane

• "ECT was originated in Italy in 1938 by Bini and Cerletti who observed the effects of electric current in rendering slaughter house pigs into a state of unconsciousness. That the electrical shocks did not actually kill the pigs led the doctors to try it on human beings. The first human subject understandably feared that he was indeed about to be slaughtered. When the first shock did not render him unconscious, he beseeched the doctors, "Not again, it's murderous!". Cerletti himself translated the victim's plea as "Not another one! It's deadly!""

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.

Doctors frequently respond to complaints about ECT treatment by deciding that the patient is in need of more treatment. Increased exposure to the brain-damaging effects of ECT can almost always be relied on to eventually put an end to the patient's protests ("complaints").

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press.

Lack of efficacy

• There is no conclusive evidence that ECT is better than antidepressant treatment.

A. Rifkin, ECT versus tricyclic antidepressants in depression: A review of evidence, Journal of Clinical Psychiatry 49 (1988)3-7. 

• "A review of controlled studies of ECT efficacy found that both ECT and sham ECT were associated with "substantial improvements" and that there was little or no difference between the two. The authors concluded, "Whether electrically induced convulsions exert therapeutic effects in certain types of depression that cannot be achieved by other means has yet to be clearly established."

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing T. Crow and E. Johnstone, Controlled trials of electroconvulsive therapy, Annals of the New York Academy of Sciences 462(1986), 12-29.

• "At the Consensus Conference on ECT…advocates were unable to come forth with a single controlled study showing that ECT had a positive effect beyond 4 weeks. Many studies showed no effect, and in the positive studies, the improvements were not dramatic."

Electroshock: scientific, ethical, and political issues. Peter R. Breggin. International Journal of Risk & Safety in Medicine 11 (1998) 5-40 IOS Press, citing Consensus Conference: Electroconvulsive therapy, Journal of the American Medical Association 245(1985), 2103-2108.

Adverse Psychological Effects

• "Twenty people who reported having found ECT upsetting were interviewed about their experiences in detail. A variety of themes emerged, including feelings of fear, shame and humiliation, worthlessness and helplessness, and a sense of having been abused and assaulted. This had reinforced existing problems and led to distrust of psychiatric staff. Few had felt able to tell professionals of the strength of their reactions, implying a possible hidden pool of trauma."

Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• "Doctors who give ECT have shown remarkably little interest in their patients' views of the procedure and its effects on them and only recently has this topic received any consideration in the literature."

Abrams, R. (1997). Electroconvulsive Therapy. 3rd edition, Oxford/ New York: Oxford University Press; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• "What is never discussed in the literature is the profoundly damaging psychological effects ECT can have." 

Lindow. V. ( 1992). A service user's view. In H. Wright & M. Giddey (Eds.), Mental Health Nursing: From First Principles to Professional Practice. London: Chapman & Hall; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• "Conscious attitudes towards ECT are `time and again', in long-term therapy, succeeded by feelings that it was cruel and destructive. There is 'a revival of threatening and punitive parental figures' who are often, like the physician, initially credited with good intentions."

Johnstone, L. Adverse psychological effects of ECT. Journal of Mental 8(1). Feb 1999; citing Abse, D.W. & Ewing, J.A. (1956). Transference and countertransference in somatic therapies. Journal of Nervous and Mental Disease, 123, 32-40.

• "The procedure may evoke unconscious meanings in both doctor and patient; for example, G. J. Wayne writing in the Psychoanalytic review observed that `It has all the characteristics of an overwhelming assault...and this can be documented by the reactions of some patients who have had this treatment.'"

Wayne, G.J. (1955). Some unconscious determinants in physicians motivating the use of particular treatment methods. Psychoanalytic Review, 42, 83-87; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• In a study of the conscious and unconscious attitudes towards ECT in 30 psychotic patients, the authors concluded that 'the majority of patients found electric shock to be a traumatic experience.'

Fisher, S., Fisher, R. & Hilkevitch, A. (1953). The conscious and unconscious attitudes of psychotic patients towards electric shock treatment. Journal of Nervous and Mental Disease, 118, 144-152. Cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• "Psychological reactions to ECT often compound patients' difficulties and defences; for example, obsessional people might need to become even more controlled."

Winnicott, D.W. (1947) Physical therapy of mental disorder. British Medical Journal, May 17, 688689; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• Interviews with ten women admitted to a state hospital in California between 1957 and 1961 and their relatives revealed a uniform confusion and bewilderment at the loss of memory in everyday life. Sometimes their forgetfulness, for example of previous hostile outbursts, was welcome to their husbands. Fear of future ECT stopped some women from confiding emotional upsets, and family relationships were subtly altered on all 
levels.

Warren, C. (1988) Electroconvulsive therapy, the self and family relations. Research in the Sociology of Health Care, 7, 283-300; cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental  Health 8(1). Feb 1999.

• "Most people who have had ECT are profoundly ignorant about the whole procedure, and say that they were given no or inadequate explanations."

Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.
• "Sixty-nine per cent did not know that ECT involved a convulsion."

Hughes, J., Barraclough, B.M. & Reeve, W. (1981). Are patients shocked by ECT? Journal of the Royal Society of Medicine, 74, 283-285. 

• "Only 21% said they were given a good explanation of the procedure."

Freeman, C.P.L. & Kendall, R.E. (1980). ECT: patients' experiences and attitudes. British Journal of Psychiatry, 137. 8-16. Cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• In one survey by an organization of former ECT recipients, 35.1% of respondents described ECT as 'damaging' with another 16.5% saying it was `not helpful.' Those who were dissatisfied were likely to express very strong views against it, using words like 'brutal', 'barbaric' and 'degrading'. Psychological after-effects included loss of confidence, dignity and self-esteem; fear of hospitals and psychiatry; anger and aggression; loss of self; and nightmares. 

UKAN (United Kingdom Advocacy Network) ( 1996). ECT Survey. The Advocate, Issue I, Spring/Summer, 24-28. Cited in Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• Interviews with 516 psychiatric patients revealed a large minority (37.1 %) who said ECT was unhelpful or very unhelpful, with a high proportion of the latter group strongly condemning it. Psychological effects included fear, flashbacks and nightmares.

Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999; citing Rogers, A., Pilgrim, D. & Lacey, R. (1993). Experiencing Psychiatry: Users ' Views of Services. London: Macmillan.

• "The recently formed organization ECT Anonymous has collected several hundred reports from people who say that ECT has had a variety of disabling physical and psychological effects on them."

Johnstone, L. Adverse psychological effects of ECT. Journal of Mental Health 8(1). Feb 1999.

• In interviews with 20 ECT recipients who found treatment upsetting, nearly everyone reported that explanations of treatment and its effects had been completely inadequate or nonexistent, and that there had been little or no opportunity for discussion of treatment options.

Ibid.

•  Patients consented to ECT despite inadequate explanations and the fact that many of them already had doubts based on the experiences of relatives or other patients. This is explained by their feelings of extreme desperation and powerlessness. Patients felt they could not risk alienating the doctors, on whom they were dependent for any hope of a cure.

Ibid.

• Nearly all participants insisted that their apparent agreement was from being fully informed consent: 'I wasn't physically taken to the suite or anything, I walked there on my own, but I felt it was forced on me,' said one former patient. 

Ibid.

• Fourteen out of twenty participants reported a very high level of fear.

Ibid.

• "When asked what was the most frightening aspect of receiving ECT, participants most commonly mentioned feelings of being helpless and out of control, and worries about long-term damage."

Ibid.

• For several, ECT was a confirmation that they were truly mad, and had reached the last option.

Ibid. 

• "Fear is the only psychological reaction to ECT that has been investigated to any extent. However, these participants described a complex range of emotional responses including feelings of humiliation, increased compliance, failure, worthlessness, betrayal, lack of confidence and degradation, and a sense of having been abused and assaulted."

Ibid.

• "…the perception…that ECT is an intervention reserved for the extremes of madness, produced a strong sense of shame and stigma. According to one patient, 'I was deeply, deeply ashamed of having ECT...this was real serious stuff, this was a mad person'. "  

Ibid.

• " ECT was experienced by several participants not just as a sign of madness, but also as a punishment for and confirmation of badness."

Ibid.

• "…ECT had left some participants with a lasting distrust of mental health professionals and hospitals: 'When I was in hospital last time I was terrified that they were going to give it to me again. They promised they wouldn't, but can I trust them, can I trust them ? I was terrified, I hated walking across the room where they did it.'

Ibid.

• "Nearly all participants were convinced that ECT and all its disadvantages could have been avoided had the right kind of counseling and support been available instead."

Ibid. 

• "All the participants except one were very clear that they themselves would refuse ECT if they were ever offered it again. The exception was a man who said that he would consent as a `very, very last resort' if he ever became ill again." 

Ibid.

• "…the study does confirm that for a certain proportion of patients, ECT is a deeply and lastingly traumatic experience."

Ibid.

• "we must be careful not to discount the possibility that some of  [the patients'] concerns also have a factual basis; for example, that ECT does cause definite cognitive impairment, and anxiety about brain damage is not just a psychological phenomenon but an understandable response to a real danger."

Ibid. 

• "ECT may be undermining therapeutic work in ways that professionals are unaware of. One woman appreciated her psychiatrist's sensitive attempts to build a relationship with her, but lost all trust in him when he subsequently prescribed ECT. Another was encouraged to direct her anger outwards, while simultaneously being forced to undergo a treatment that increased her anger and self-blame to the point of self-harm."

Ibid.

• "…ECT may actually exacerbate existing psychological problems." 

Ibid.

• "ECT may be leaving some people with a distrust of psychiatric services that undermines any future attempts to form therapeutic relationships. They may be both unhelped - perhaps even in a worse state and at the same time harder to reach."

Ibid.

• "If up to a third of people will suffer psychological trauma after ECT, and if there is no way of identifying these individuals in advance, the ratio of costs to benefits may begin to seem unacceptably high."

Ibid.

Epilepsy 

• "In a review of the literature on the well-known ECT complication of epilepsy, researchers calculated that the age-adjusted incidence of new seizures after ECT was fivefold greater than the incidence found in the non-psychiatric population." 

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Devinsky, O. and Duchowny, M.S. Seizures after convulsive therapy: A retrospective case survey. Neurology 1983;33:921-5.

• "Persistent brain wave disruption to the point of status epilepticus has been reported to occur following ECT. Individual reports by Drs. Weiner and Varma on different patients both describe acute disorientation and deterioration of intellectual function immediately following ECT. This was found to be due to ongoing epileptic brain wave forms that was initiated by the ECT."
 
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Weiner, R.D. Prolonged confusional states and EEG seizure activity following ECT and lithium use. Am Journal Psych 1980;137:1452-1453. Varma, N.K. et al. Nonconvulsive status epilepticus following ECT. Neurology 1992;42:2263-264.

Babigian, H., et al. Epidemiologic Considerations in ECT. Arch Gen Psych 1984;4:246-253. 

Lack Of Efficacy

• "In the large NY study cited earlier, the death rates from suicide among depressed patients given ECT were slightly higher at the 1 year mark. By 5 years the suicide rate was the same for depressed patients who got ECT as those who didn't."

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Babigian, H., et al. Epidemiologic considerations in ECT. Arch Gen Psych 1984;41:246-253. 

• "In a University of Iowa study of treatment effectiveness, 1,076 depressed patients were categorized according to whether they received ECT, or high doses of anti-depressant medications, or low doses of anti-depressant medications, or neither (ECT nor meds). Long term follow up revealed that all groups had the same suicide rates, indicating that the incidence of suicide is not affected by treatment. The authors conclude: 'Therefore, active biological treatments, such as ECT, may not be deemed as 'lifesaving' now as in the past.'"

Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Black, et al. Does treatment influence mortality in depressives? Ann Clin Psych 1989;1:165-173. 

• "The same findings are documented in three other studies: ECT does not prevent suicide in depressed patients."
 
Appendix to John Breeding, Ph.D. Electroshock. Based on an article published in the Journal of Humanistic Psychology, Winter 2000, Vol. 40, No. 1, pp. 65-79, citing Eastwood, et al. Seasonal patterns of suicide, depression, and ECT. Br J Psych 1976;129:472-475.  Babigian, et al. Epidemiological considerations in ECT. Arch Gen Psych 1984;41:216-253. Milstien, et al. Does ECT prevent suicide? Convulsive Therapy 1986;2:3-6.