Tuesday, July 24, 2007
Anthony Mauger woke up at 5 a.m. one morning nearly 10 years ago and heard a message in his head telling him to kill himself. He wrote a goodbye note to his wife, then jumped off the back deck of their Kensington home, falling the 14 feet hard enough to wake her with the sound of his thud.
The 66-year-old organic chemist succeeded only in smashing his knees and skull. After surgery at Suburban Hospital, he was transferred to Potomac Valley Nursing and Wellness Center in Rockville for intensive psychiatric care.
Mauger had been depressed for about six months, his wife, Inge, remembers. His sleep had been poor, and he was making strange claims that he could not go on vacation or walk. The slew of antidepressants Mauger tried made no difference. After four more months watching her husband deteriorate, Inge Mauger was desperate. "Nothing is happening," she said to his psychiatrist. "Isn't there anything you can do?"
"We can try ECT," he replied.
Better known as shock therapy and seared into our collective consciousness as the involuntary procedure depicted in "One Flew Over the Cuckoo's Nest," electroconvulsive therapy remains a controversial treatment, often used, as in Mauger's case, only after other treatments fail. Its popularity has waxed and waned in its 70-year history, but an estimated 100,000 Americans undergo ECT each year, according to a 1995 survey of more than 17,000 psychiatrists, and its use appears to be steady or increasing since then.
The number of treatments in California -- one of the few states that have mandatory reporting -- increased from about 13,000 to more than 20,000 between 1994 and 2004. Although the District, Maryland and Virginia do not require such reporting, Johns Hopkins Hospital treats about 125 people with ECT annually, a number that has not changed much recently, according to Irving Reti, head of Hopkins's ECT unit; at Sheppard Pratt outside Baltimore, ECT physician Jack Vaeth says his service does about 60 treatments a week, an increase over the past decade.
While no one fully understands why ECT works, many psychiatrists believe that using an electric current to produce a "grand mal" -- or generalized brain -- seizure can "reboot" the brain when medications and psychotherapy fail. Just last week, a commentary in the Journal of the American Medical Association (JAMA) suggested that, despite its demonstrated effectiveness, ECT remains underused, primarily because of its stigmatized history.
The treatment is "miraculous" and "lifesaving," say some patients and doctors, and yet the costs -- primarily memory loss -- can be significant. Many individuals who believe that ECT kept them alive when they were suicidal also urge caution about its use.
Mauger, as an older individual with "treatment-resistant" depression, is a fairly typical patient. Initially scared, he decided to try ECT weeks after his psychiatrist and wife first urged him to. By the seventh of his 12 treatments, he felt his depression lift.
"He sat up and said, 'I'm not depressed anymore,' " his wife said. "I was amazed."
His one relapse years later quickly responded to another course of treatment. "I am terrified of what would have become of me without ECT," Mauger says.
A Long-Term Goal
An acute course of treatment usually comprises eight to 12 sessions, administered two or three times a week at a hospital. Studies show that more than 70 percent of severely depressed patients experience quick improvements. (About 50 to 60 percent respond to antidepressants.)