Throwing Darts at ECT

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Ernest Hemingway
Take a look at the familiar names that appear in Wikipedia’s “List of people who have undergone electroconvulsive therapy [ECT]” and you’ll see names of people you probably recognize: Carrie Fisher, Lou Reed, Judy Garland. As a reader, I honed in on two names in particular: Ernest Hemingway and David Foster Wallace. Both men are regarded as among the best American writers of the 20th century, both received ECT, and both committed suicide.

ECT has been used for decades as a treatment for depression; about a million people a year undergo the procedure. A doctor applies an electrical pulse to the brain, which is believed to replicate a seizure-like event. In the past, movies like “One Flew Over the Cuckoo’s Nest” portrayed ECT like a visit to the electric chair. Today, ECT is now performed under anesthesia and delivers a shock between 70-400 volts.

There’s a tremendous amount of controversy as to whether ECT damages the brain. A 1991 study of 100 ECT patients found that no cognitive impairment occurred as a result of treatment. A 2012 fMRI study of 9 patients called “Electroconvulsive therapy reduces frontal cortical connectivity in severe depressive disorder” demonstrated that ECT resulted in a “decrease in functional connectivity” in the brain.

Among the most commonly reported side-effect of ECT is memory loss–about a third of ECT patients report memory impairment following treatment.

“Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business?” Hemingway asked his biographer. When doctors tried treating Wallace with ECT and various drugs, he likened the medical attempts to “throwing darts.”

The complaints of both writers shouldn’t be dismissed. Today we have unprecedented access to research data to help us make more informed decisions about our healthcare. There are alternatives to just about any form of treatment, including medication and therapy. In other words, you have some say over what kind of dart is used, and how it’s thrown. Or whether it should be thrown at all.

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