A barbaric procedure for shocking incorrigible mental patients into vegetable-like compliance. That's the popular image of electroconvulsive therapy, or ECT. Yet in responsible hands, ECT is one of the most effective and, arguably, safesttreatments for severe depression. More potent, it seems, than antidepressant drugs, ECT works about as rapidly for antidepressant nonresponders (its usual clients) -- and perhaps more often -- than thyroid hormone or lithium (7,8). Most importantly, for some people nothing else seems to work. Even some orthomolecular psychiatrists use it (9,10); and more than one psychiatrist has told me that if he were severely depressed ECT would be his own treatment of choice.

Yet ECT continues to be controversial. Although it is safe enough for most elderly people who can't handle antidepressant drugs, it is, nonetheless, dogged by a reputation for causing permanent memory loss, even brain damage. Proponents of ECT insist that, at its worst, ECT only erases memories for the time around which it was administered -- a small price to pay. But some people swear it's robbed them of precious older memories. Although controlled studies have yet to corroborate these complaints, even proponents admit that insensitive research methodology may be to blame (7).

If you do have to resort to ECT, research suggests memory problems can be minimized without compromising clinical efficacy if (a) ECT is administered bifrontally (11); (b) a moderate dose of anesthetic is used, and concomitant psychotropic drugs are avoided (7,8); (c) the lowest "dose" of brief pulse current necessary to provoke an adequate seizure is used (not all ECT clinics are equipped to do this) (7,8); (d) ECT is given no more than two or three times a week (7); and (e) you spend a few hours resting in a dark, quiet room after you come to (12). Anecdotally, psychiatrist Abram Hoffer claims that megadoses of vitamin B3 can also prevent ECT-induced memory loss (9).

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8. A. Khan et al., "Electroconvulsive Therapy," Psychiatric Clinics of North America, 16 (September 1993): 497-513.

9. Abram Hoffer, Common Questions on Schizophrenia and Their Answers (New Canaan, Conn.: Keats Publishing, 1987).

10. Harvey M. Ross, Fighting Depression (New Canaan, Conn.: Keats Publishing, 1992).

11. F. J. Letemendia et al., "Therapeutic Advantage of Bifrontal Electrode Placement in ECT," Psychological Medicine, 23 (May 1993): 349-360.

12. P. Suedfeld et al., "Reduction of Post-ECT Memory Complaints Through Brief, Partial Restricted Environmental Stimulation (REST)," Progress in Neuro-Psychopharmacology & Biological Psychiatry, 13 (1989): 693-700.