Q. Can you tell me your thoughts about ECT (electro convulsive therapy) and TMS (electromagnetic stimulation)?

  A. Most individuals view ECT as the best way to acutely treat depression, and it is. Surprisingly, ECT is still the overall most effective acute treatment for both depression and mania. It is highly effective in bringing very manic patients back down to their normal baseline. The old horror scenarios of ECT made famous by One Flew Over the Cuckoos Nest just are not how it is any more. An individual is anesthetized, given a muscle paralyzing agent so there is virtually no movement, and ECT started. Most folks have a seizure for 30-45 seconds, wake up a few minutes later, and are just a bit groggy from the seizure and anesthetic agent. Manics come down a bit almost immediately. Most depressives feel better after the first treatment, too. Normally it takes 3 or 4 treatments to really kick in (both in mania and depression) and then 2 more treatments are given. This treatment is empirical, and it was just found patients do better with 2 treatments after they are better.

Some folks can get 15 to 20 treatments, and some only 2 or 3 total. It is whatever works. The problems with ECT are many-fold, but manageable. First, it is really expensive, so insurance companies need a good rational for using it as an acute treatment. You have to pay an anesthesiologist, psychiatrist, nurse, recovery room, and so on. There can be some memory impairment for a week or two following ECT in a small percentage of patients. The memory comes back. Still another problem is only treatment refractory depressives get referred for ECT in most places. The ECT is not as good as it use to be for this reason. Only folks that have failed everything else get referred, so the response rate is not what it use to be. Finally, ECT, like antidepressants, stops working after a while. It is a very safe and effective treatment modality, and probably is underutilized.

As far as electromagnetic stimulation for depression, I do not know much about it. I have read a few reviews, and it sounds like it is not very good, and probably a hoax. However, I will hold off judgment until I see some data. If things work, they usually get out on the market (it did) and are used quickly and effectively (it was not) by a lot of people. I doubt its the answer.