DEPRESSION: Out of the Shadows
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DEPRESSION: Out of the Shadows + TAKE ONE STEP: Caring for Depression, with Jane Pauley  

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Chapter 9: Electroshock Treatment [6:56]

Electroshock therapy (ECT) can treat depression safely and effectively, especially in the elderly.

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Transcript: Chapter 9 - Electroshock Treatment

SHERWIN NULAND: (VO, DR. NULAND READING FROM BOOK) Just as physical pain loses its intense reality once it has been eased, the anguish of profound melancholia evades even the most determined attempts at clear perception...

NARRATION: (DR. NULAND READING) After checking himself into a psychiatric hospital, Shep Nuland found that medication and talk therapy did not help him.

NARRATION: (PHOTO OF DR. NULAND AND CHILDREN) His two children became his lifeline

DR. SHERWIN "SHEP" NULAND: (VO, PHOTO OF DR. NULAND AND CHILDREN) When I was in the hospital and when things were very bad and at their blackest,

DR. SHERWIN "SHEP" NULAND: (OC) I would open the drawer. It was an empty drawer. And in that drawer was a picture of those two children. And when I looked at that picture, I knew that I had to get better. And I knew that I would get better. And I had to do it for them and would do it for them.

NARRATION: (DR. NULAND AT DESK) Within a week of his admission, Shep's medical team recommended a frontal lobotomy, a surgical brain procedure that was likely to reduce Shep's distress, but at great personal cost

DR. SHERWIN "SHEP" NULAND: (VO, LOBOTOMY DOCTOR PICTURE) The majority of people who had lobotomies become passive rather inert intellects for the rest of their lives.

DR. SHERWIN "SHEP" NULAND: (OC) It would have been the end of everything creative in me.

NARRATION: (DR. NULAND AT DESK) Much to Shep's relief, a young resident on the ward intervened and pleaded that electroshock treatments or ECT be tried first.

DR. SHERWIN "SHEP" NULAND: (VO, DR. NULAND AT DESK) But as you can imagine,

DR. SHERWIN "SHEP" NULAND: (OC) I leaped at that opportunity rather than have someone put an ice pick between my frontal lobes and the rest of my brain.

NARRATION: (FOOTAGE OF One Flew Over the Cuckoo's Nest) At the same time Shep had his ECT, Hollywood was painting a barbaric picture of this procedure in the 1975 movie," One Flew Over The Cuckoo's Nest," but for Shep, the procedure did indeed work.

DR. SHERWIN "SHEP" NULAND: (VO, FOOTAGE OF One Flew Over the Cuckoo's Nest) I often visualized it

DR. SHERWIN "SHEP" NULAND: (OC) as these snarled wires all enmeshed, one in the other, millions of them. And somehow the electroshock therapy burnt the connections away, destroyed the connections so that if I had a particular thought, it no longer immediately led to a pathological thought. And I was free to be myself again. And I first began to feel a little bit of that at about the tenth or eleventh treatment.

DR. SHERWIN "SHEP" NULAND: (VO, PANNING SHOT OF HOME) When I finally did come out of the hospital, I came out of the hospital with nothing. But I was happy. I was happier than I had been in years,

DR. SHERWIN "SHEP" NULAND: (OC) because I knew, somehow I knew that the bad stuff was over. I think I knew it because I had been about as deep into the depths as anybody could go, and I had those two wonderful children. I had what really mattered to me in my life.

NARRATION: (SUE AND BUCK POWELL WALKING DOWN HALLWAY) ECT has come a long way since the 1970's and is now considered a highly safe and effective treatment, particularly for serious depression.

It works especially well among the elderly whose aging brains and bodies can be less responsive to medications and therapy.

NARRATION: (SUE POWELL TALKING TO DR. MCDONALD) Sue Powell is here at Emory University in Atlanta, Georgia for her ninth electroshock treatment. With no prior history, she was stricken at age 65 with late-onset depression. She found herself becoming confused and irritable.

BUCK POWELL: (VO, SUE POWELL TALKING TO DR. MCDONALD)When you're around someone like this every day, you know, it comes on so gradual until

BUCK POWELL: (OC) you don't notice it at first. And then as things begin to get progressively worse, then you do begin to notice.

SUE POWELL: (OC) I've always been just an outgoing, bubbly personality. Now here, listen to me say that about myself, but it's the truth.

BUCK POWELL: (OC) But it's true.

SUE POWELL: (OC) And, um, then to all of a sudden withdraw and not want to be with your friends or talk or interact in any way, and just be downright rude to 'em, that was just not who I was.

NARRATION: (SUE POWELL IN BED BEFORE ECT) Depression afflicts about fifteen percent of older adults and as many as twenty five percent in nursing homes. Its symptoms can often be mistaken as early signs of Alzheimer's disease or dementia.

Though the cause of Sue's depression is unclear, she had been diagnosed with high blood pressure, which has been linked to depression in the elderly.

NARRATION: (SUE POWELL IN ECT PREP, ECT TREATMENT) Her illness became life threatening when she stopped eating and lost over 60 pounds. Six electroshock treatments over a period of several weeks were needed before some improvement was seen.

Experts are uncertain how ECT works. What they do know is that it creates a seizure in the brain and may alter the brain's chemical balance.

While ECT often works more rapidly than medication, there are possible side effects including short-term memory loss. There is also the possibility of a relapse. For now, sue will take medication and have regular checkups every six weeks.

DR. WILLIAM MCDONALD: (VO, SUE POWELL IN BED AFTER ECT) The fact is, older people relapse at very high rates.

DR. WILLIAM MCDONALD: (OC) So whereas a younger person, somebody in their 30s who gets depressed, the chances that they'll have another depressive episode some time in their life are 50/50. An older person who has a lot less of their life to live, the chance that they'll have another depression is about 80%.

BUCK POWELL: (VO, CU OF SUE POWELL) She cooks the bread, and I was the dishes...

BUCK POWELL: (VO, SUE POWELL IN BED AFTER ECT) If you had seen her when she came in here, and look at her today, she's a different person.

BUCK POWELL: (OC) she's just back to her old self. And I'm just happy.

NARRATION: (SUE POWELL IN BED AFTER ECT) Social support, medication and talk therapy can alleviate the symptoms of depression in the elderly, but for any age group that is treatment resistant, ECT is close to eighty percent effective.

DR. MCDONALD: (OC) I think the real travesty is in people who've waited two, three, four, five years. Why do they wait? One Flew Over The Cuckoo's Nest. I mean, there's a stigma associated

DR. MCDONALD: (VO, SUE POWELL IN BED AFTER ECT) with ECT. You wait two, three, four years though, and a lot of other things have happened in your life. And you've lost a job. You've ruined a relationship. And so people really need to get in and get treatment.

NARRATION: (SUE POWELL IN BED AFTER ECT) For many people, depression is a chronic illness that can be managed with the appropriate treatment.

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