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CHICAGO (AP) - Patients who underwent electroshock therapy for depression had an unexpectedly high relapse rate in a study that has refocused attention on the procedure 25 years after ``One Flew Over the Cuckoo's Nest'' made it seem like torture.
The treatment fell out of favor after that Oscar-winning movie, a satirical look at life in a mental hospital. But it has since made a comeback, with 100,000 Americans a year now getting it, according to the National Mental Health Association.
Electroconvulsive therapy, or ECT, is most commonly used to treat severe depression that has not responded to medication or psychotherapy.
A study of 84 patients in Wednesday's Journal of the American Medical Association found that without follow-up medication, depression returned in 84 percent of patients within six months. Among patients who received antidepressant and anti-psychotic medication after ECT, 39 percent relapsed.
Previous research reported relapse rates of 20 percent with medication and 50 percent without.
The higher-than-expected relapse rates in the latest study reflect a debate over the procedure's benefits and risks.
Columbia University psychiatry professor Harold Sackeim, who led the study and is one of ECT's most vocal supporters, said that it remains the most effective treatment for depression but that his findings illustrate the need for accompanying medication.
Dr. Peter Breggin, a Bethesda, Md., psychiatrist, called the study ``an open admission that electrical shock is worthless.''
He said the high relapse rate supports critics' theory that ECT causes brain damage that for a few weeks prevents patients from expressing sadness or depression, while leading to possible long-term memory loss.
Dr. Richard M. Glass, a deputy JAMA editor, said in an accompanying editorial that the study highlights the need ``to bring electroconvulsive therapy out of the shadows.''
Major depression affects about 10 percent of Americans 18 and older yearly, or about 17 million adults, according to government estimates. It has a mortality rate as high as 15 percent, mostly from suicide, Glass said.
``The results of electroconvulsive therapy in treating severe depression are among the most positive treatment effects in all of medicine,'' relieving symptoms in 50 percent to 90 percent of cases, Glass said.
Still, he wrote, ``on the face of it, producing convulsions with electric current seems like a strange way to treat illness.'' And more than 60 years after ECT was introduced, doctors still do not know exactly how it works.
Patients typically receive three shocks weekly, under anesthesia, for up to a month, followed by medication.
ECT is endorsed by the AMA, the National Mental Health Association and the American Psychiatric Association, which recently published a report that says there is no evidence ECT causes brain damage.
Linda Andre, director of the anti-ECT group Committee for Truth in Psychiatry, criticized Sackeim for failing to investigate ECT's side effects and said it is because of his ties to the industry.
The study was funded by the National Institute of Mental Health. Manufacturer MECTA Corp. donated the ECT equipment. Sackeim said he has worked for MECTA as an unpaid consultant but has no financial interest in the company.
Most relapses in the study occurred soon after ECT, suggesting that drug treatment should perhaps begin during ECT instead of afterward, Sackeim said. ECT also could be gradually tapered off instead of abruptly stopped.
Jerry Kirk said he has had ECT every three weeks since 1995 to control manic depression, even though he claims it has caused long-term memory loss and learning difficulties. Kirk did not want to reveal his location and employer because of the stigma of electroshock - one so great it forced vice presidential candidate Thomas F. Eagleton off George McGovern's ticket in 1972.
``It's a trade-off,'' said Kirk, an executive with a six-figure salary. ``Six, seven years ago, I couldn't work or hold down a job.''
On the Net:
JAMA: http://ajam.ama-assn.org
National Mental Health Association: http://www.nmha.org
National Institute of Mental Health: http://www.nimh.nih.gov
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