Shock therapy and the brain

Others are left distraught. They've been shocked -- and feel no better than before.

In recent decades, electroconvulsive therapy, or ECT, has undergone a transformation, many psychiatrists say. The body no longer thrashes violently, as depicted in movies a generation ago; it lies still, under medication, with the thrashing confined to the mind. Techniques are more precise, they say; the brain better understood.

Although exact numbers are not available on how many people get modern ECT -- estimates have ranged from 30,000 to more than 50,000 a year since the early 1990s -- scientific interest in the treatment has surged, in part because of the acknowledgment that drugs don't help many deeply depressed people, particularly older adults, a growing and hard-to-treat population. The government is funding some 20 ECT studies to see how different techniques and treatment combinations affect behavior.

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Altering biology

Recently, researchers have looked directly at how the bolts of current alter biology, by studying the brains of shocked rodents. And in June, a leading medical journal published the results of a broad survey detailing what former ECT patients think about the treatment.

Yet far from proving the effectiveness of ECT, the emerging research has only accentuated its unknowns and shortcomings. After more than 60 years of experience, doctors still don't know exactly how the shocks affect the brain, whether they cause permanent damage, or why they affect depression. Although the techniques and technology have improved, ECT itself appears no more effective than it ever was, studies show.

When it comes to treating older people in particular, doctors have no scientifically rigorous evidence establishing the treatment's safety or effectiveness, according to an exhaustive review of the literature published last month. "Proponents have been saying it's safe and effective, but their statements go beyond what we know for elderly people," said John Bola, a mental health researcher at USC who studies treatment effectiveness. "It starts to sound more like an advertisement than a statement of fact."