Brattleboro Reformer
Friday, October 16, 1998

Front Page (Top half -- with large color photo of protest and long article, the article is continued on front sections back page)

(The photo had the following under it: PROTEST TREATMENT - A pedestrian walks past a group protesting against the use of electric shock therapy in front of the Brattleboro Retreat on Thursday. "I'm a person who has received shock therapy and I'm here to protest against it," said Morgan Brown, right, who said he involuntarily was given electric shock therapy while unconscious from a drug overdose. "I believe the only thing it does is damage people."

Retreat touts shock therapy
By James Pentland
Reformer Staff

BRATTLEBORO - Medical professionals from around the Northeast converged on the Brattleboro Retreat Thursday to hear a noted authority speak on the practice of electric shock treatment.

Visitors also were treated to a tour of the Retreat's new electro-convulsive treatment (ECT) center, which opened in April. After many years of sending patients out to Brattleboro Memorial Hospital or Dartmouth-Hitchcock, the Retreat has recognized the importance of ECT in the treatment of major depression, according to Frederick Engstrom, medical director.

"In the 1980s and the early 1990s, the quality of the treatments had not kept up," Engstrom said. "Then we decided ECT really had a future here and we should do it right."

Dr, Percy Ballantine, one of two doctors in charge of administering ECT, said the controversial therapy is used primarily on elderly patients for whom medications aren't working or are causing complications.

"it's a way of getting a person to have a seizure," he said. The theory, he said, is that the seizure helps to restore the natural electrical rhythm of the brian, much as a defibrillator restores heart rhythm. He said it's effective in about 80 to 85 percent of cases.

A small group of sign-carrying protesters outside the Retreat held a different view. Morgan Brown said he's known people who killed themselves after a series of shock treatments, and he believes he's been damaged ny it, too.

"I have real trouble with my memory, and I'm more depressed than before," he said. "I've been homeless and jobless since."

Laura Zielger, another protester, said she also knows many people who believe ECT caused them long-term damage. Some have recurring hallucinations, and some are unable do the kind of creative work they used to do, she said.

"(Doctors) took someone with problems and made them a whole lot worse," she said.

Zielger said doctors don't know why ECT works, but she believes brain damage is the reason. People who've been shocked no longer feel depressed because they can no longer feel anything, she said. In addition, she noted, patients are often elderly, vulnerable and dependent on family members who are making decisions for them.

Harold Sackheim, professor of clinical psychology at Columbia University's College of Physicians and Surgeons and chief of the Department of Biological Psychiatry at the New York State Psychiatric Institute, acknowledged in his talk that the issues around ECT were not thoroughly investigated until recently.

ECT is the most effective anti-depressant treatment available, he said, but loss of memory and high rates of relapse in patients treated with ECT are major clinical concerns.

"What good is ECT if the benefits are not maintained?" Sackheim asked. "Relapse rates are far higher than has been appreciated in the United States."

Shock treatment, introduced in the United States in the 1940s, resulted in the release from institutions of hundreds of thousands of patients previously thought untreatable, he said, but controversy over its invasive nature almost eliminated the practice in ensuing decades.

"It would have disappeared, but many private doctors believed it effective," he said.

The classic belief was that the seizure itself produced the anti-depressant effects, Sackheim said, while the level of current seemed to have a direct connection to the degree of cognitive damage. More recent research shows the most effective treatment to be a high dosage of electricity (three or four times the threshold for inducing seizure in the patient) on one side of the brain only.

Memory loss, particularly of the time preceding the treatment, is common, and can extend far back in time, he said.

Anne Donahue, a Northfield resident and president of Vermont Protection & Advocacy Inc., said she suffered memory loss from the shock treatment she received.

"I've permanently lost the memory of two years preceding the treatment, and of specific events for ten years prior," she said.

She believes the medical establishment has downplayed ECT's adverse effects, and has done virtually no research into long-term memory loss. However, she said, she's encouraged that Sackheim's organization, which receives one-fourth of all the psychiatric research dollars in the United States, recently received a $5 million grant to conduct that research.

"I'm supportive," Donahue said, "I believe ECT is a valuable treatment. It probably saved my life."

Whatever the pros and cons, Retreat staff say an in-house treatment center is preferable to the old system of transporting patients elsewhere.

"It was awful moving people in the middle of winter," Ballantine said.

"Depression is dismal." noted Cherie Moran, coordinator of the center. "You don't want people seeing you. It's very private here."

Susan king, a registered nurse from Yale Psychiatric Institute in New Haven, Conn., said she had come with four colleagues for the day, both to hear Sackheim and see the center. She said she had met Moran and Ballantine when they visited Yale, and she was impressed by the new facility.

"The clinic is very appropriately set up," she said. "It's state of the art."

Treatments are given three days a week, for anywhere from zero to four patients a day, Moran said. Each patient receives from three to 16 treatments. Patients undergo general anesthesia which outs them under for 5 minutes. Almost all treatments are unilateral (one side of the brain only), Engstrom said, although the Retreat does not test patients' seizure threshold.

"We will be doing more to determine patients' thresholds," Engstrom said following Sackheim's presentation.

The center was renovated and equipped at a cost of about $200,000, Engstrom said, and is not a money-maker.

"ECT used to be very profitable," he said. "Today, with managed care, we get the same amount mo matter the treatment. (The center) has lost us money and we anticipate it will continue to do so."

No state permit was required for the project, officials said, because the capital and operating expenses did not meet the threshold to trigger a Certificate of Need review.