Panel Cautiously Backs Shock Therapy : Calls Treatment Effective but Wants Use Limited to Severe Cases

Electroshock therapy, the controversial psychiatric treatment that led to the removal of Sen. Thomas F. Eagleton as the 1972 Democratic vice presidential nominee, received a limited endorsement Wednesday from a federal advisory panel, which said that the procedure can be “life-saving” for certain persons suffering the most severe forms of depression.

However, the panel urged that the use of shock therapy, also known as electroconvulsive therapy, be restricted to “a narrow range of severe psychiatric disorders” and to patients who do not respond to drugs or other forms of therapy. Patients who qualify as candidates for shock therapy should be advised of its potential side effects, which include confusion and memory loss, the group also warned.

‘It’s a Powerful Treatment’

“We do feel it’s a powerful treatment,” said Dr. Robert M. Rose, chairman of the department of psychiatry and behavioral sciences at the University of Texas, who served as committee chairman. “We do feel it’s an effective treatment.”

Shock therapy has been valuable in treating such serious mental conditions as delusional and endogenous depression, acute mania and certain schizophrenic syndromes, said the committee, convened by the National Institutes of Health to draft recommendations for health professionals. In a statement, the panel declared that the therapy “is not effective for patients with milder depressions.”

An estimated 8 million to 10 million adult Americans suffer major depressive disorders in any six-month period, according to Dr. Frederick K. Goodwin, scientific director of the National Institute of Mental Health. Of this group, about 1 million to 2 million persons suffer from the most “treatment-resistant” forms of depression and could be candidates for electroshock, he said.

Produces a Seizure

In such therapy, electrodes are placed on the scalp of an anesthetized patient and electricity is passed into the brain, producing a generalized seizure. The procedure received widespread publicity in 1972 when Democratic presidential nominee Sen. George S. McGovern (D-S.D.) dropped Eagleton, a senator from Missouri, as his running mate after it was revealed that Eagleton had received shock therapy twice during the 1960s.

Rose, saying the panel lacked adequate information regarding the current use of shock therapy, noted that past abuses and negative connotations associated with the procedure might have resulted in patients being “deprived” of the therapy in situations where it could prove beneficial. “We just do not know,” he said.

A NIMH survey of hospitals in 1980 estimated that 33,384 patients, or 2.4% of all psychiatric patients hospitalized, received electroshock during their hospitalization, a decrease of 43% since 1975.

On Wednesday the panel, citing one of shock therapy’s more significant side effects, noted: “Although the ability to learn and retain new information may return to normal in several months after the termination of ECT, significant treatment-related gaps in memory may persist.” The extent of memory impairment “varies from one patient to another,” it added.

The panel also recommended that hospitals and other facilities using shock therapy establish in-house review committees to prevent against its misapplication.

Standards Urged

“It is important to develop standards about the administration of ECT,” Rose said. “ECT has not enjoyed the kind of peer review that other medical and surgical procedures have enjoyed.”

The committee reached its conclusions after listening to two days of testimony from mental health experts and patients, some of it quite emotional. Dr. Peter Breggin, a Washington-area psychiatrist representing what he called the Ad-Hoc Committee for a Moratorium on Electroshock, called the procedure “dangerous, irrational and unproven” and said that the procedure should be banned from use on humans until “animal studies have proven its safety.” Breggin charged that the procedure caused “permanent brain damage,” a claim rejected by the committee.

In the United States in the 1940s and 1950s, according to the panel, electroshock “was often administered for the most severely disturbed patients residing in large mental institutions.” Often, the committee said, it was used in high doses and for long periods of time, which proved “ineffective” and “even harmful.” Moreover, the panel added, “its use as a means of managing unruly patients . . . contributed to the perception of ECT as an abusive instrument of behavioral control.”