Shock Value

Much research has focused on reducing that side effect, but patient experiences vary tremendously, and it is nearly impossible to predict the extent of memory difficulties in individuals, according to Frank Moscarillo, executive director of the Association for Convulsive Therapy, who has conducted ECT at Sibley Hospital since 1968.

Barbara Winkler, 46, of Kennewick, Wash., who had more than 90 sessions of ECT at Yakima Valley Memorial Hospital, cannot recall her wedding, which occurred during the period she was receiving ECT. "It probably saved my life initially," Winkler said. "But the hardest part is probably the memory loss."

Others, like Tom Hempel, 59, from Pittsburgh, see memory lapses as "inconveniences." He jokes about "having an ECT moment." "I know it was worth it," he said.

Many in the ECT field say concentration and memory may also be compromised by depression. But it appears clear now that ECT can affect memory for much longer than the two to three weeks after which many physicians say most patients' ability to remember will return to normal.

Some patients have pointed to inconsistency in information about side effects. Vermont state legislator Anne Donahue, 51, thinks they were not sufficiently emphasized before her first round of treatment in 1995, while the informed-consent form provided to her at a second hospital in 1996 was much more complete and easy to read.

"This is an incredibly vital and valuable treatment, but you have the right to know the risks," Donahue said.

Although the overwhelming majority of ECT patients in the United States consent to the treatment, legislation governing involuntary ECT varies by state. The criteria are generally strict: A patient must be unable to make the decision, and they must be exhibiting dangerous behavior, such as not eating.

Also, there is no special license that a doctor needs to administer ECT in the United States. The American Psychiatric Association has issued practice guidelines, but in most states there is no regulatory body to see that practitioners adhere to those standards or to review the information on consent forms.

Nor is there any firm rule about when ECT is complete. Memory loss tends to get worse with more closely spaced treatments or larger doses of current, so doctors look for a plateau in improvement, when patients say they feel no additional benefit in symptoms.

"The desire to minimize memory loss while maximizing effectiveness is the holy grail," said Steve Seiner, director of the ECT service at McLean Hospital in Belmont, Mass., one of the largest such programs in the country. "The goal of ECT is to get them back to their base line." ·

Shirley Wang, who is completing an internship at Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center, has a degree in clinical psychology. Comments:health@washpost.com.