Dr. David Boger presented to the U.S. Food and Drug Administration Neurological Devices Panel examining the reclassification of electroconvulsive therapy (ECT) devices on January 27, 2011. These are his remarks as published in the public record of the meeting.
Good afternoon. My name is Dr. David Boger. I’m a board certified adult psychiatrist in private practice in New York City.
I come to you today both as a physician who supports the use of ECT in carefully selected patient populations and as a patient myself who has undergone extensive electroconvulsive therapy. I refer you to my personal article I wrote entitled, “Shocking the Shrink: A Psychiatrist Undergoes ECT.” I’ve experienced episodic depressions characterized by sleep and appetite disturbance, impaired concentration, complete loss of interest in usual activities, hopelessness, debilitating fatigue, and prominent suicidal ideations since the age of 10. My father, incidentally, was unofficially diagnosed with depression which eventually led to his tragic suicide.
I saw a plethora of psychiatrists who eventually made the diagnosis of bipolar II disorder, a variant of manic depressive illness. I was introduced to lithium by a prominent psychiatrist at NIMH and in combination with antidepressants, first the tricyclics and then the newer SSRIs like Prozac, was able to maintain a high function for several years at a time.
Despite all the interventions, I still experienced recurrent depressions and hypomanic episodes every few years that sidelined me often for months at a time. It was not until 2003, when I had another rapid-onset severe bout of bipolar depression that my New York psychiatrist recommended, of course, ECT. At that time, I was dangerously depressed and actively suicidal, unable to make a commitment to refrain from self-harm and was so admitted to New York University Hospital. I stayed there almost a month receiving three ECT treatments a week. At that time, the protocols and equipment left me dazed for at least 24 hours with significant amnesia for events occurring around the time of treatments. I enjoyed a brisk but incomplete recovery. The suicidal feelings were quickly extinguished but a persistent sleep disturbance and low self-esteem persisted. I was discharged alert and fully oriented on a combination of antidepressants, antipsychotics, and mood stabilizers.
I suffered through manageable symptoms until December 2008, when the walls came crashing down. My mother’s Alzheimer’s disease took a major turn for the worse, and the responsibilities and challenges of resuming a medical practice seemed to overwhelm me. In January 2009, I was readmitted to NYU, imminently suicidal. I had made arrangements to buy lethal rat poison and ingest it.
By that time, the science of ECT, thank God, had evolved, and under general anesthesia, I received ultrabrief right unilateral pulse electric current administered to the right temple area only. The electrical current elicits a generalized motor seizure blocked from motoric expression by the inhibitory drug succinylcholine. I slept pain free during the process which lasted only minutes. In less than three weeks of three times a week treatment, I experienced a full recovery this time marked by absence of suicidal feelings, improved self-esteem, and the resumption of hope for the future.
In contrast to the treatments of 2003, the side effects were minimal. I was alert, clear-headed, and completely functional within an hour of treatment and experienced no lingering cognitive effects. It was decided with informed consent that I would receive monthly maintenance ECT treatments on an outpatient basis to reinforce the remission and to prevent relapse. I’ve continued these sessions for nearly two years. I’ve experienced no discrete depressive episodes and have had no problems with memory, concentration, or abstractive reasoning. On the days of treatment, usually scheduled early in the morning, I set aside the rest of the morning to sleep off the effect of the general anesthesia. By afternoon, I’m ready to go and, in fact, once taught a seminar for medical students at Mount Sinai in which I demonstrated the absence of side effects from my own ECT treatments.
While other pharmacological treatments had been useful in achieving partial remission of depressive symptoms, only ECT has eradicated entrenched suicidal ideation and allowed me to function at my highest capacity. Thanks to the improvement in the medical devices and more sophistication in the anesthesia techniques, I feel now as well as I have in my entire life. I don’t know how long treatments will continue, but to date I’m very satisfied with the results. I’m convinced that I would be dead if ECT were not available to me.
Thank you for the opportunity to speak here. Thanks.