Abstract
SAN DIEGO—A course of electroconvulsive therapy (ECT) every 9 or 10 months keeps her cyclic depression at bay, Kitty Dukakis said in an invited lecture at the annual meeting of the American Psychiatric Association (APA) here in May. Dukakis, the wife of former Massachusetts governor and 1988 Democratic presidential nominee Michael Dukakis, hopes her candor will help counter inaccurate and harrowing portrayals of ECT, such as those in the 1975 film One Flew Over the Cuckoo’s Nest, based on Ken Kesey’s 1962 novel. “Patients who are not helped by antidepressant medications and psychotherapy should not have to suffer for months, and in some cases, years, without ECT being an option,” noted Dukakis, who said she first received ECT in 2001, after experiencing deepening “bouts of despair” over 2 decades. Now 70 years old, she details her depression and its treatment, along with her earlier dependence on alcohol and amphetamine diet pills, in Shock: The Healing Power of Electroconvulsive Therapy (New York, NY: Avery; 2006), written with medical journalist Larry Tye. Dukakis’ willingness to speak out has helped boost public and physician awareness of ECT’s safety and efficacy, said Max Fink, MD, professor emeritus of psychiatry and neurology at the Stony Brook University School of Medicine, Stony Brook, NY. Results from 2 recent multisite collaborative studies also are prompting increased use of ECT worldwide, Fink noted. Remissions occurred with ECT in 86% of 394 patients with majordepressivedisorder completing the Consortium for Research in ECT study (Kellner CH et al. Arch Gen Psychiatry. 2006;63[12]:1337-1344) and in 55% of 290 patients completing a multisite study led by researchers at the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, in New York City (Sackeim HA et al. JAMA. 2001;285[10]:1299-1307). These rates compare favorably with those obtained from use of antidepressant medications in similar patients. In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial— the first study to examine the effectiveness of medication and other treatment for patients who did not become symptom-free after initial medication— about 30% of patients initially treated with citalopram experienced a remission. Among 727 patients whose symptoms did not remit with citalopram or who could not tolerate it, remission occurred in about 1 in 4 patients given either bupropion, sertraline, or venlafaxine. Thus, STAR*D patients had about a 55% chance of achieving remission with their first or second course of medication (Rush AJ et al. N Engl J Med. 2006;354[12]:1231-1242). However, among 235 patients not reaching remission in the first 2 rounds, fewer than 1 in 5 became symptom-free after switching to a third medication (Fava M et al. Am J Psychiatry. 2006; 163[7]:1161-1172). Despite its utility, “ECT is widely stigmatized as a last-resort treatment,” said Fink, an ECT specialist for more than 50 years. The lack of required ECT instruction in US medical schools and psychiatry residency training programs, he said, has limited practitioners’ ability to recognize patients who may benefit from ECT (Fink M and Taylor MA. JAMA. 2007;298[3]:330-332). Major depressive disorder accounts for an estimated 70% to 80% of ECT use. National statistics for use of ECT are lacking; only a few states mandate reporting of this treatment.
Published Version
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