On ECT and dTMS
by Richard T. Kotomori Jr. M.D.
While preparing for a lecture on transcranial magnetic stimulation I was surprised to discover that electroconvulsive therapy actually may affect memory more than typically advertised. It turns out that most researchers in the literature reviewed minimized memory problems and overestimated benefit. While patients are religiously warned about temporary amnesia, it is generally minimized as something that resolves shortly after the treatment is completed. In fact, over one third of patients complain of long standing memory problems for extended periods of time and others feel themselves to have been permanently changed. The authors also point out that when researchers study memory they usually studied the anterograde memory loss (amnesia). However, autobiographical memory problems are what patients are most likely to complain about (1). That type of memory describes the personal memories of one’s life that make them who they are. Imagine not recalling your first love, your child’s emergency appendectomy or the day you got your driver’s license. The point is that those memories in the balance are what give you meaning and context in life.
Such information does not make me less likely to recommend ECT. My patients who had already received ECT were quite convincing with their complaints of memory loss and I was appropriately cautious with my referrals for ECT. However, it feels good to be vindicated.
There still is no debating that ECT is effective and saves lives. Contrary to the lessons of my training in residency, I recommend it as a last resort or for patients in dire straits, always with the understanding that memory and much more may be at stake. In my clinic 50% of patients who undergo dTMS for treatment of resistant depression reach remission by the end of treatment. I feel that the favorable side effect profile always warrants a trial of dTMS prior to consideration of ECT. Restoring the patient to help them enjoy a Quality Life is always the goal.
1) Diana Rose,Til Wykes,Morven Leese,Jonathan Bindman,Pete Fleischmann, BMJ VOLUME 326 21 JUNE 2003 bmj.com