The Question of Memory Loss
In their interviews—and in the book itself—Tye and Dukakis have been frank about the risks as well as the benefits of ECT. The biggest risk, and for many patients the scariest, appears to be memory loss.
"A study in Britain, involving 166 patients who had finished ECT a year or so before, found that 'a striking 30% felt that their memory had been permanently affected, although the majority meant by that [that] they had permanent gaps in their memory around the time of treatment, not that their ability to learn new material was impaired,"" Tye wrote.
He added, "ECT doctors call mem ory losses tragic yet rare. . . . ECT critics call them brain damage."
"ECT is remarkably safe," countered Fink. "The issue of memory loss is an exaggeration. Here's an analogy: Have you ever heard of surgeon who was able to work without [causing] bleeding? There's no such thing as a seizure without acute memory loss. Why keep arguing about memory loss?
"Every study has shown that if you have a patient who is severely depressed or psychotic and you do a memory test today, then do a memory test after the last ECT treatment, there will be a decrement in memory during that period. But if you examine them 4 to 8 weeks later, they say their memory is better than it was when they were ill."
Dukakis, who writes extensively about her memory loss following ECT and who had to pause during an interview to look up her own phone number, disagrees with Fink's assessment. "It's tragic in a way. He has pooh-poohed this memory loss every step of the way. He's wrong. He's just wrong. Of all the patients we talked to who had ECT, I have not met one who has not had some experience with memory loss," she said.
In Tye's chapter about memory loss, he cited a study by Harold A. Sackeim at Columbia University that found that in 38 of 306 ECT patients studied, "memory and other cognitive deficits lasted six months, which was the time limit of the study."
He also wrote about Anne Donahue, a Vermont state legislator who claims to have lost 6 years' worth of memories following ECT. Responding to a critic who called Donahue's claims "a personal conviction," Tye noted, "it might be tempting to accept [the] brushoff except that Donahue has undergone repeated EEG tests, taken neuropsychological exams at leading medical centers, and compiled evidence suggesting her memory issues are related to both her underlying depression and her ECT treatment." Tye also quotes one neurologist who wrote, "I agree with Anne's assessment that these EEG changes and her retrograde amnesia are likely permanent sequelae" of her ECT.
Lisanby agrees. "Memory loss is a recognized side effect of ECT. The degree depends on how the treatment is given. The decision to use ECT is a clinical one, and it depends on the context. The patient and the physician have to weigh the benefits. It is the most effective and most rapidly acting treatment we have. When there is a need for immediate response, it is rapidly effective in serious conditions. But there are recognized serious side effects, amnesia being one of them.
"The approach with any medical treatment is to be straightforward about the risks and the benefits," she added. "That should apply to all treatments, including ECT."
Dukakis offered what may be the definitive response to those who are overly defensive about the issue of memory loss: "The control ECT gives me over my disabling depression is worth this relatively minor cost. It just is. It's a quid pro quo, like everything we do in life. It is also easier to accept the losses of memory since I was warned to expect them and since most of the memories come back."
Lisanby, who is the director of the Brain Stimulation and Neuro modula tion Division in the Department of Neuroscience at the New York State Psychiatric Institute and associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons, said she is recommending Shock both to patients who are contemplating undergoing ECT and to physicians.
"It is important for us as physicians to hear about the patient's experience of ECT," she said.