Stuff You Should Know - How Electroconvulsive Therapy Works

Episode Date: May 14, 2013

With the exception of lobotomies, no other psychological treatment has a worse reputation. But thanks to some thoughtful tweaks, ECT has lately emerged from the dark ages and toward the respectable forefront of treatment for major depression. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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Hey, everybody, do you ever scream at your printer or hurl empty ink cartridges across the room? We all do, which means that you likely suffer from cartridge conniptions caused by irritating ink cartridges constantly running out of ink. It's the worst, everybody. We can all agree on that. But thankfully, the Epson EcoTank Printer is the perfect cure.

It's cartridge-free, conniption-free, and prescription-free. With big ink tanks and a ridiculous amount of ink, you can finally kiss expensive ink cartridges goodbye. Yeah, so check out the Epson EcoTank. Just fill and chill. Available at participating retailers and at epson.com. Welcome to Stuff You Should Know, from HowStuffWorks.com. Hey, and welcome to the podcast.

I'm Josh Clark, and there's Charles W. Chuck Bryant, which means it's time for Stuff You Should Know. And indeed, shocking edition. See, I take the rap for a bad pun, but you, in fact, said that before you recorded. I know, before we recorded. Oh, so okay. I have a public image I have to carefully consider.

Gotcha. Chuck. Yes. Have you ever seen or read or both one Fleur de Cougar's Nest? Yes, both. Oh, yeah? Did you like the book more than the movie or vice versa? Both.

The book was great. I've seen the movie a dozen times. Yeah. One of my faves. It is a great movie. I haven't read the book. Although I was a Ken Keesey fan. I thought he was a cool dude.

Yeah, I've read a few of his. What else did he write? He did the, well, actually, he didn't write. That was Tom Wolf that wrote the Electrical 8S trip, but Keesey was figured prominently, obviously. Oh yeah, he was the main character. Keesey wrote the, oh crap, I'll come back to it. Okay.

He wrote the, what was it? The book. Well, if you haven't seen or read one Fleur de Cougar's Nest, you totally should. It is like Chuck was saying, one of the best movies of all time. It is a great book, apparently. And one of the things that factors into it,

sitting in an insane asylum in the 50s, I would say, maybe 60s, and one of the, I guess, almost a character in this movie or book is electroconvulsive therapy. Yes. So the staff uses to basically keep the patients in check. Just the very threat of getting electroconvulsive therapy, shock treatment, a type of shock treatment,

we should say, is enough to just keep everybody very docile and calm and settled down when they start to get riled up. You can just ask them, do you want some shock treatment? They're like, no, no, everything's good. Right. Everything's fine. And apparently, because of that,

and Keesey worked as an orderly mental institution in Oregon, so he saw his first hand when he wrote it. Sure. Because of that, ECT got a pretty bad rap over the course of a couple of decades, the point where it's basically forced, almost out of existence. Yeah.

And it wasn't just Keesey making this stuff up. Like he said, he was a disorderly, like the fat boys. But there was also a study in 1985 by the National Institutes of Health that found that was pretty common practice among mental institutions at the time. Because it was drug-free. Yeah.

It was just using electrical shock. And it wasn't a lobotomy. Right, and the effects were temporary. And apparently, it worked to keep everybody in line. But that's a gross abuse of this pretty effective therapy for mental illness. Yeah, for severe depression. And these days, it is approved

by the National Institute of Mental Health, the APA, the AMA, and the US Surgeon General. And they all say that if used properly, ECT these days, in a tweaked version of what they did back then, is can be very beneficial. And Kitty Dukakis, wife of Michael Dukakis, former presidential nominee,

till he wrote in a tank, wrote a book. Because she had it, and it's called Shock, the Healing Powers of Electroconvulsive Therapy. And it helped her out. Now, I've read excerpts and reviews and stuff. And she doesn't like championing it for everyone or anything. But it gives a lot of great history

and then says how it has helped her in her journey through depression. Apparently, it also helped it cav it. Oh, yeah? Yeah. Interesting. It did not help so much Sylvia Plath or Ernest Hemingway. Right.

But yeah, it's been used on a decent amount of people. Apparently, about 100,000 Americans a year undergo electroconvulsive therapy. Six feet under? Who got shocked? George. The James Brown one? Oh, yeah, yeah, that's right.

Yeah. We've already spoiled that show, so we might. Right. We should just do dramatic readings from scripts. Yeah. So we should also say before we go forward, it's very easy to call it electroshock therapy. Right.

That's kind of right. Electroconvulsive therapy is a type of shock therapy. And shock therapies, the aim is to shock your system into having a convulsion. Because, as far back as Hippocrates, it was noticed that people who have mental illnesses, who experience convulsions, tended to feel a little better after they experienced their seizures.

Yeah. So what you're trying to do with any kind of shock treatment is induce a seizure and a convulsion. Because no one knows why, still to this day. But it does something to your brain and can cure, whether temporarily or permanently, mental illness. Yeah, I wonder how this, I didn't think about it till just now.

I wonder how it ties in with a temper tantrum, like a kid feeling better afterward, or more settled afterward, or an adult that just loses it. And then I think everyone's truly lost it before in some emotional way. And then afterward, you're like, boy, I feel more relaxed now. Right, like resetting after a catharsis.

Yeah. I bet you it's sort of similar pathways in the brain. Right, except this is with electricity. Exactly. So let's talk about the history of shock therapies and electroconvulsive therapy, or ECT. That's easier to say. So one thing that they did in the 20th century,

they started to experiment with insulin shock, where they would just dose the crud out of somebody with insulin and basically bring them into a coma. And in the coma, they would have convulsions? Is that right? Yeah. Like that was the point. Like they figured out this guy named

Lattice Laos van Meduna, who was a Hungarian physician. Is that real? Yeah. He figured out that if you take insulin and inject it in somebody, it puts them in a coma, a temporary coma, that you can bring them out of with glucose. Right. And then while they're in the coma, they have seizures.

And he was one of the ones, probably the first modern physician to suggest that there was a link between seizures or seizures in the curing of mental illness. Right. He took it one step too far in saying that schizophrenia and epilepsy were counterproductive maladies. Right. So if you had one, you couldn't have the other.

Yeah, not true. He was wrong about that, but he was right about seizures having a curative effect on mental illness, though. Interesting. But he was the one who started championing using insulin to produce seizures. So he led the way, followed by Italian scientist in the 1930s, who finally brought electricity into it.

Well, hold on, there was another guy, too. Oh, before the 1938 guys? Yeah. Like right around the same time, there were all these competing shock therapies. OK. And there was the insulin guy. And then there was another dude named Manfred Sekel.

And he was testing something called metrizol, which is a respiratory stimulant. And when you give somebody this stuff, they have seizures. And it's very reliable. And it's very powerful, more powerful than insulin. And it requires less recuperation time and hospitalization time. The problem is it's so powerful that like 42% of patients

who had shock therapy using metrizol suffered spinal fractures because the convulsions were so hardcore. Yeah, like the exorcist? Yeah, and then some. Now are we electricity? Yeah. In 1938, they discovered electricity. No, wait.

That's not true. That was close. I think it was like the 20th. These Italians, they were scientists. And they said, we can use this to jolt this guy with these delusions. He's clearly suffering. Let's shock him with electricity.

And the delusions receded after several treatments. And then just a few years later in the 1940s, it was being used as a regular treatment in the US for schizophrenia, depression, bipolarism. But it's not like it is today. No, you said they've tweaked it. They've definitely improved it. They figured it out like we were a little barbaric before.

No anesthesia back then. Yeah, so you were wide awake and conscious when they applied an electroshock to your brain. Like in cuckoo's nest. Yeah. Violent physical reactions with the body that don't happen these days. Like the convulsions were very powerful.

Yeah, because A, there's anesthesia. And they also, these days, put muscle relaxers and stuff everywhere except the big foot. Is there a big foot? The foot, eighth single foot. Well, one has a blood pressure cuff on it. I'm sure it is the big foot of the two. But yeah, they introduced it intravenously.

And then they put a blood pressure cuff around your ankle. So your body isn't like convulsing anymore. But they can tell what's going on by EEGs and stuff. And then the single foot's movement. Yeah, because you're keeping the muscle relaxer and I guess the anesthesia out of the foot. Yeah, so someone's actually a doctor looking just at your foot. Supposedly, I haven't seen that anywhere else.

I saw it. Yeah, I saw that. Like even with the muscle relaxants, your fists are going to clench and unclench, and your chest might heave. And they'll still put a tongue thing in your mouth to keep you from biting your tongue off. Right, but the cumulative effect of it

is not going to be felt at all by you, because you're out under general anesthesia. And you probably feel pretty good. Yeah, that's true. Thanks to Mr. Muscle Relaxer. The war on drugs impacts everyone, whether or not you take drugs. America's public enemy number one is drug abuse.

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uses to get away with absolutely insane stuff. Stuff that'll piss you off. The property is guilty, exactly. And it starts as guilty. It starts as guilty. Cops, are they just, like, looting? Are they just, like, pillaging? They just have way better names for what they call,

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Apple Podcasts, or wherever you get your podcasts. And then the way you've always seen it on TV, even when they portray modern, like on Six Feet Under, they show people are always rendered like zombies, like lobotomized essentially. And that's not what's going on these days. No, well, even back then, it was kind of a caricature of what a person looked like coming out of it

because there is memory loss associated with it. Yeah, and there still is. Yeah, there was then, there still is now. So I think that it's almost like that's what some artists rendering or some directors rendering of what somebody with memory loss looks like. And so that's what just kind of got picked up in the popular culture following ECT

is you're just like catatonic, lobotomized, zombie-like. But really, that's shorthand for it. There's weird memory loss. Yeah, and these days are gonna check you out a lot more beforehand, I think, especially in the media portrayed it as some, like a McMurtry in One Fleur of the Cuckoo's Nest. He's causing problems, they'll just drag him in there,

strap him down and shock him. These days you're gonna- Five disorderly to hold him down. Exactly. You're gonna go through a battery of pretreatments like blood tests, electrocardiograms. They're gonna give you a physical, they're gonna give you a mental, and they're gonna make sure you're a good fit

all the way around for this kind of treatment. It's not as, I don't know if it was willy-nilly back then, but that's how it appeared to be at least. And there was, there's actually a decision by the FDA. It's an electroconvulsive therapy machine. It's a class three, I believe, device. Just the strictest classification. And so it was up for reclassification for a little while.

And they said, you know what? We're gonna stick with this classification because it's used for electroshocks. And a lot of people said, whoa, whoa, whoa. Like that's old stuff. Yeah, you guys, this is, you're still looking at it under the medieval use from the 40s and 50s. Things have changed by then.

But I have to say, I mean, it's, I kind of am comforted by the fact that you still have to go to a doctor. It's not like the same thing as going to, for like laser hair removal. Sure. Like you can also get ECT in the same office. Like it's very much medicalized.

And I think it should be because we still don't understand what the mechanisms are. Yeah, that's true. They will pulse your brain. You know, you've got these little things about the size of a quarter of these pads on the side of your head, either on both sides or one side.

And they pulse you with, for one millisecond, even though I think recently, even shorter, like millisecond, 0.25 to 0.37 milliseconds. Yeah, that's what they're starting to use. And I guess that that's like, is it for more humane purposes or works better? Yeah, I think they're finding that it works at least as well, but there's also fewer side effects.

Like apparently a one millisecond pulse of electricity is enough to really interrupt memory consolidation, I guess. Whereas like a quarter of a millisecond, it's not so bad. All right, in these days, you're gonna get it two to three times a week for three to four weeks is a typical treatment. Yeah, that's a course. Five or 10 minutes at a time.

Yeah, from the time that they inject you with the anesthesia till the time you start to wake up is about 10 minutes. Which I mean like, that doesn't sound like much, but if you're doing that two to three times a week for several weeks, although that's a period of your life that you have a lot of trouble remembering much of. I don't think it's a picnic still. No, because you are still coming out of it.

You're still groggy, coming out of anesthesia. You can still be confused. What's ironic is now that they use anesthesia, you probably look more like the portrayal of people coming out of ECT in the 50s than they did back then. Because they were anesthetized? Yeah, they weren't. No, yeah, that's what I mean though.

Today, that's funny. I didn't think about it like that. I found one step, well, I found one step that said it is effective in 75 to 80% of people these days with severe depression, whereas antidepressants are only effective about 60% of the time. Yeah, and that's pretty much what they're using it for. It's just like major depression is pretty much the thing

that they found like, okay, it's really effective for this. Like when drugs don't work? Well, that's usually when they're turning to it, is after antidepressant, after antidepressant hasn't worked. But this is like a pretty significant rebound, 100,000 people a year getting this, and it coming under wide medical and public acceptance. Sure.

Because just as recently in the 80s, there's a stat in this article that says, between 85 and 2002, the use of ECT in England dropped by half. Wow. And that was because there was a rise of antidepressants. It's like, you can take these pills, or we can put electrodes on your brain and zap you. What do you wanna do?

Right. People as physicians, I guess, were finding that there were plenty of people out there who don't respond well to antidepressants. Shock therapy's a great alternative. And if you suffer from major depression and you are suicidal, or at risk for suicide, they may hop right to ECT

because the results are so much faster. That makes sense. I know. Well, one of the interesting things they pointed out too was that once you've had ECT, if drugs were not previously effective on you, then the antidepressants can extend the good effects of the ECT longer.

Right, yeah. Which was interesting, because I guess they can work in concert if you go ECT first. Which makes it sound like the ECT goes in there and shakes things loose, and then the drugs come in and keep their functioning going. Keep the new and improved functioning going.

And we should say, all this is theory. No one knows specifically what ECT does to the brain. We just know it works. Then we should also say no one's exactly certain how antidepressants work. Right. Or what effects they have on the brain. But there's a couple of theories

that are kind of brain based. One is that the idea is that the electricity changes how blood flows. Yeah. Or how cells metabolize things. And that leads to some sort of improved function. Yeah, the other one is they think it might release certain chemicals that can help out.

And everything I've read sort of likens it to a control-alt-delete reset. Or some sort of reset function on your brain. I think they likened it in here to turning the stereo down. Like there's just so much noise and this just sort of resets a troubled brain. Right, yeah, there was a study from Scotland in 2012 where they did brain scans of people

with major depression before ECT and after a round of ECT. And they found that these regions associated with mood and emotion were less active. Right. And so they said that they basically altered the functional connectivity of these regions between the regions so that the person could think more clearly was less distracted.

And they think that that had an effect on reducing their depression. Well, and they tested with placebos too. And I think like anytime you test with a placebo, you're gonna find that some, there's gonna be a little bit of it that works. But, you know, but not always. And that's what they found here is that

some of the people that were told that they received ECT put under. Didn't you think this was kind of mean? Yeah, they had put them under and say they did it and not do it. That the people with ECT did recover faster, but there were some that received the fake treatment that did recover as well.

So they think that might have just been because they received that extra TLC from a proper clinician. Yeah. And the free drugs. That's true. So we should say there are risks to it. Like there's at least two types of memory loss

associated with ECT. One is you have trouble making memories around the appointment. Right. Which is to be expected. And that usually fades. Then there's larger memory loss of past events long before your ECT therapy. Yeah.

But that also fades. Not in all people though. So there is like memory loss associated with it. Right. With zapping the brain with electricity. Who would have thought? A figure. And then you can also die.

One in 10,000 patients undergoing it dies. But they say that that's one in how many? One in 10,000. So every year 10 people die from ECT in America. Wow. But they say that that's typically a reaction to or a result of anesthesia. Like just going on.

Oh right. Yeah. Which is dangerous in and of itself. You're gonna get headaches obviously and some muscle pain. But I don't think it's anything quite like the old days. As far as muscle pain and stuff like that. Yeah. And you will still find people that poo poo it of course.

But this article points out a lot of those people are the same people that are pretty anti-psychiatry in general and stuff like this. So that seems like a bit of a leap to me. What? From the author to say that. Yeah. At least she wasn't just like Scientologist.

Yeah. Hate it. True. You got anything else? I got nothing else. Let's go try this out. I would certainly try it out if I needed it. Okay.

Yeah. I would too. I'm appealing to me about using electricity over drugs. Yeah. Like drugs are some great thing to pump your body full of. Yeah. It's just, I don't know. I wonder if it's going to become more and more widespread.

You know? Yeah. And if it comes back gangbusters man. That's really gonna be impressive. Cause it was almost gone. Yeah. True. You know?

Imagine if the lobotomy came back. Yeah. I mean I know it's still around but it's not back. But not the. Sure. You know, ECT is back baby. Maybe a little bloodletting. A little leaching.

Right. If you want to learn more about electroconvulsive therapy type that word in the search bar at howstuffworks.com. Let's see if you can do it on the first try. And since I said search bar, I guess it's time for message break. Stuff we should know. The war on drugs impacts everyone.

Whether or not you take drugs. America's public enemy number one is drug abuse. This podcast is gonna show you the truth behind the war on drugs. They told me that I would be charged for conspiracy to distribute 2200 pounds of marijuana. Yeah and they can do that without any drugs on the table. Without any drugs of course.

Yes they can do that. And I'm the prime example of that. The war on drugs is the excuse our government uses to get away with absolutely insane stuff. Stuff that'll piss you off. The property is guilty. Exactly. And it starts as guilty.

It starts as guilty. Cops, are they just like looting? Are they just like pillaging? They just have way better names for what they call like what we would call a jack move or being robbed. They call civil acid for it. Be sure to listen to the war on drugs on the iHeart radio app, Apple podcast

or wherever you get your podcasts. How's that New Year's resolution coming along? You know the one you made about paying off your pesky credit card debt and finally starting to save a retirement? Well you're not alone if you haven't made progress yet. Roughly four in five New Year's resolutions fail within the first month or two.

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and encouragement you need to do it. We keep the show fresh by answering list of questions, interviewing experts and focusing on the relevant financial news that you need to know about. Our show is chock full of the personal finance knowledge that you need with guidance three times a week and we talk about debt payoff. If let's say you've had a particularly

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Listen to How to Money on the iHeart Radio App, Apple Podcasts or wherever you get your podcasts. And now listen to me. Yes, and I'm gonna call this misheard song lyrics. Oh yeah. Can't remember which one we asked about this. Panama Canal, was that it? Oh, okay.

Everyone has misheard sound lyrics. Excuse me while I kiss this guy. Jimi Hendrix, wrapped up like a douche. Manfred Mann, that's not what he's saying. No, it wrapped up like a douche. Like he's talking about craps. Is he? Craps are some other sort of gambling.

I don't think so. Because Springsteen wrote the song and it was cut loose like a douche and he's talking about a car engine. I've heard gambling. Springsteen wrote it. Okay. And then Man for Man changed it.

And it's funny, Springsteen has come out and said, you know that song didn't become popular till it became about feminine hygiene. And then it was like a big deal. Yeah. Or there's a bathroom on the right, CCR. Instead of a bad moon. Bad moon, right?

Yeah, I hadn't heard that one. There's a bathroom. No, I know the song, but I mean like, I've never heard anybody thinking he's saying there's a bathroom on the right. It's fairly common. Okay. All right, so we got one from Cheryl.

Hey guys, first of all, I wanna say you're still keeping me company on days when I get time to work on my art projects. You're still as great as ever. I was just listening to Panama Canal and I thought I'd pop you a quick note to give you a grin. I misinterpreted lyrics where my specialty is a kid

far and away in my most famous moment was when I was five or six listening to Madonna with my auntie. And I would sing, Papa Dom Bridge, I'm in trouble deep. She said, thing is this really made sense to me. And logically, if a bridge is made out of Papa Dom's, which are, do you know what those are? Sort of like a flatbread, like a crispy tortilla sort of.

No. It's like a crispy flatbread. Gotcha. So if a bridge was made out of Papa Dom's, it would be bound to be weak. And if someone were to walk over it, it would break and they fall on the river below and hence be in trouble deep.

And my dad still teases me about that to this day. It does make sense in a certain way. Yeah, Cheryl, Papa Dom Bridge, well done. That's why Yumi's mom, she's from Okinawa, she calls Madonna Papa Dom Preach. Oh, calls her that? Yeah. That's her name.

Papa Dom Preach again. My friend Fox had the best misheard song lyric ever and I was racking my brain earlier, trying to remember it and I cannot. Yeah. There's some good ones out there. I'll try and remember and post it or something. I'll get in touch with Fox.

Okay. It was a funny one. Nice. You got any good ones? I'm like racking my brain right now and I know I've got one and I can't remember it. Do you have one, Jerry? Jerry looks like she does.

What does it look like, Jerry? Do you want to go with? Jerry just said if you did not hear, instead of voice is scary by... Till Tuesday. Baby man and Till Tuesday. Horses scare me. Hush hush, keep it down.

Horses scare me. Don't attract any horses because they scare me. Do you know that technically Till Tuesday was the first band I ever saw alive? Oh really? At my first concert, Hall and Oats, at the University of Toledo Coliseum. They opened up, huh?

Yeah, Till Tuesday opened up. Nice. Well, I never really thought about that because I always say, oh, my first concert was Cheap Trick. Yeah. I don't say it was John Waite who opened up for Cheap Trick. Was it really John Waite?

Yeah. Man, I would have loved to have seen that one. And those are real concerts. Like I went to Kenny Rogers and stuff when I was a kid and people were like, Kenny Rogers is real? Yeah. It is.

It's about to say the same thing. I met concerts that my family didn't drag me to. Gotcha. That I paid my own loan for and like where I smelled marijuana for the first time. Like a real concert. I didn't smell any marijuana at the Hall and Oats concert. Well, I did a Cheap Trick.

I was like, what is that? I'm sure. I've never smelled that before in my life. Yeah. Cheap Trick. And everyone around me said, that is the devil's smell. Stay away.

Yeah. And you did? I did. Good going, Chuckers. Is that it? That is it. Well, thanks to Cheryl for kicking off a pretty great little chat.

You should get Yumi's mom to call her Papa Don Bridge now. Yeah. See if you can get that done. Hey, listening to Papa Don Bridge? Yeah. Papa Don Bridge, that's Papa Don Bridge. Uh, what do you want?

Oh, if you have any great marriage stories, we want to hear them. We haven't asked for that ever, have we? Yeah. And I don't mean wedding day fun. I mean marriage. I would take wedding day fun. Those are two different things.

All right. Well, whatever you want to send either way. Related to marriage, you can tweet to us at S-Y-S-K podcast. You can join us on facebook.com slash stuff you should know. You can send us an email to stuffpodcast at discovery.com and as always, go check out our awesome website,

stuffyoushouldknow.com. For more on this and thousands of other topics, visit howstuffworks.com. This episode of Stuff You Should Know is brought to you by jackthreads.com. The war on drugs is the excuse our government uses to get away with absolutely insane stuff. Stuff that'll piss you off.

Cops, are they just like looting? Are they just like pillaging? They just have way better names for what they call, like what we would call a jack move or being robbed. They call civil acid work. Be sure to listen to the war on drugs on the iHeart radio app, Apple podcast, or wherever you get your podcasts.

Hi, how are you? It's Chiquis from Chiquis and Chill Podcast. Welcome to the show. I talk about anything and everything. I did have a miscarriage when I was 19 years old. And that's why I'm a firm believer and an advocate of therapy and counseling. The person that you saw on stage, the person that you saw in interviews,

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