A Tale of Two Carries: Bipolar Disease and ECT

Actress Carrie Fisher had to be hospitalized last week for treatment of her bipolar disorder.

The 56-year-old, forever associated with her role as Princess Leia in the Star Wars franchise, admitted herself after the emergence of footage of her bizarre behavior during a performance on a Holland America Eurodam cruise ship in the Caribbean last week. Fisher is seen slurring her words and singing off key after “cleaning up” after her dog on stage.

Fisher has been very open about her battles with bipolar disease, giving interviews with Oprah and Diane Sawyer on the topic. She has also discussed the fact that she has undergone electroconvulsive therapy (ECT), as part of the treatment of her disease. In her November 2011 book Shockaholic, Fisher admitted to undergoing ECT on a regular basis.

In an interview with The Insider, Fisher states that ECT gets an unfair rap from Hollywood:

They would portray it like it’s a punishment, like if you were bad in the mental hospital. ” If you’ve been naughty you’re going to get ECT!” … [But] it’s done me a lot of good, a world of good.

Although it is not known whether Fisher is still getting ECT, her rep told TMZ “She went to the hospital briefly to adjust her medication and is feeling much better now.”

Another famous “Carrie” is in a similar situation.

Fictional CIA agent Carrie Matheson, played by actress Claire Danes, on Showtime’s hit series Homeland, also struggles from bipolar disease, and when she becomes psychotic after an especially manic period, admits herself to the hospital for ECT. Both the real and fictitious Carries are helped by the therapy, but both have to deal with the loss of memory that can occur after the procedure.

What is Electroconvulsive Therapy (ECT)?

Brain stimulation therapies involve activating or touching the brain directly with electricity, magnets, or implants to treat depression and other disorders. Electroconvulsive therapy is the most researched stimulation therapy and has the longest history of use.

First developed in 1938, electroconvulsive therapy (ECT) for years had a poor reputation with many negative depictions in popular culture. However, the procedure has improved significantly since its initial use and is safe and effective. People who undergo ECT do not feel any pain or discomfort during the procedure.

ECT is usually considered only after a patient’s illness has not improved after other treatment options, such as antidepressant medication or psychotherapy, are tried. It is most often used to treat severe, treatment-resistant depression, but occasionally it is used to treat other mental disorders, such as bipolar disorder or schizophrenia.

It also may be used in life-threatening circumstances, such as when a patient is unable to move or respond to the outside world (e.g., catatonia), is suicidal, or is malnourished as a result of severe depression. One study, the Consortium for Research in ECT study, found an 86 percent remission rate for those with severe major depression. The same study found it to be effective in reducing chances of relapse when the patients underwent follow-up treatments.

How does it work?

Before ECT is administered, a person is sedated with general anesthesia and given a medication called a muscle relaxant to prevent movement during the procedure. An anesthesiologist monitors breathing, heart rate and blood pressure during the entire procedure, which is conducted by a trained physician. Electrodes are placed at precise locations on the head. Through the electrodes, an electric current passes through the brain, causing a seizure that lasts generally less than one minute.

Scientists are unsure how the treatment works to relieve depression, but it appears to produce many changes in the chemistry and functioning of the brain. Because the patient is under anesthesia and has taken a muscle relaxant, the patient’s body shows no signs of seizure, nor does he or she feel any pain, other than the discomfort associated with inserting an IV.

Five to ten minutes after the procedure ends, the patient awakens. He or she may feel groggy at first as the anesthesia wears off. But after about an hour, the patient usually is alert and can resume normal activities.

A typical course of ECT is administered about three times a week until the patient’s depression lifts (usually after 6-12 treatments). After that, maintenance ECT treatment is sometimes needed to reduce the chance that symptoms will return. ECT maintenance treatment varies depending on the needs of the individual, and may range from one session per week to one session every few months. Frequently, a person who underwent ECT will take antidepressant medication or a mood stabilizing medication as well.

What are the side effects?

The most common side effects associated with ECT are headache, upset stomach, and muscle aches. Some people may experience memory problems, especially of memories around the time of the treatment. People may also have trouble remembering information learned shortly after the procedure, but this difficulty usually disappears over the days and weeks following the end of an ECT course. It is possible that a person may have gaps in memory over the weeks during which he or she receives treatment.

Research has found that memory problems seem to be more associated with the traditional type of ECT called bilateral ECT, in which the electrodes are placed on both sides of the head. Unilateral ECT, in which the electrodes are placed on just one side of the head—typically the right side because it is opposite the brain’s learning and memory areas—appears less likely to cause memory problems and therefore is preferred by many doctors. In the past, a “sine wave” was used to administer electricity in a constant, high dose. However, studies have found that a “brief pulse” of electricity administered in several short bursts is less likely to cause memory loss, and therefore is most commonly used today.

How often is ECT being used today?

Good question… without a good answer.

Statements that up to 100,000 people/year are given ECT are based on a study over 30 years old!

Finding out current statistics of use are nearly impossible as, unfortunately, only a few states collect data on ECT, and there is no national database for the information.

For more information about ECT, click here to go the Resounding Health Casebook on the topic.