An inmate with depression may provide many difficulties into the penal system. Among other things depression may make an inmate more prone to violent as well as suicidal tendencies. In cases such as this it is important for an inmate to receive swift treatment as, in this state, they are a hazard to themselves as well as others. Electroconvulsive therapy is a treatment method that has been used to effectively treat individuals with severe depression for many years. It has been found to treat the illness faster and more effectively than many other depression treatment options. This manuscript briefly discusses depression within the penal system as well as goes into detail about electroconvulsive therapy and how it is effectively employed to assist those suffering from severe depression.
An inmate within the penal system suffering from a mental illness presents unique challenges to the staff as well as fellow inmates within these facilities. Statistics indicate that inmates suffering from a mental illness are more prone to disciplinary problems within the correctional system and are also more prone to recidivism after release (James & Glaze, 2006). One may surmise that, as the severity of the illness increases, the identified risks increase accordingly. This makes it extremely important for the staff of the facility to treat the illness in the quickest and most effective way possible. The standard first-line treatment for most mental disorders involves pharmacological or psychotherapeutic treatments or a combination of both (Potter, Rudorfer, & Manji, 1991). In some cases pharmacological and psychotherapeutic methods take too much time or the inmate may not be able to tolerate the medications. In cases such as this, there are other methods which may be utilized in order to treat the inmate’s mental illness. This manuscript will focus upon the mental illness of depression while briefly discussing the effects it introduces into the penal system. It will also identify and discuss the method of electroconvulsive therapy and how it may be a prudent method for treating severe cases of depression within inmate populations. Due to time constraints the issue of informed consent in permitting treatment is not discussed.
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Literature Review
In order to compose a manuscript upon the subject of depression and electroconvulsive therapy, a solid definition was needed. Definitions were provided through the use of the Merriam-Webster Online dictionary for electroconvulsive therapy (Electroshock Therapy, 2010) and from WordWeb for depression (Depression, 2010). Additionally, the DSM-IV provided the symptoms which accompany a diagnosis of major depressive disorder (American Psychiatric Association, 2000) while the United Kingdom Advocacy Network (1995) provided a list of mental illnesses which ECT has been used to treat. James and Glaze (2006), through the Bureau of Justice Statistics, also provided statistics upon the mental illnesses and symptoms which are found within the penal system of the United States. It is upon this information that the manuscript’s conclusions are partly based.
The history of electroconvulsive therapy is discussed within the manuscript. Finger (2006) discussed how experiments upon the effects of electricity upon the brain can be traced back to Benjamin Franklin. Electroconvulsive therapy did not take its current form until 1938 when Cerletti and Bini started using electricity to treat those with mental illness (Endler, 1988). Weiner and Krystal (1994) discuss how the mainstream use of ECT declined greatly after the discovery of psychotherapeutic drugs in the 1950s and 1960s. Even though this is the case, Scott (2005) discusses how ECT is still the primary course of treatment for cases of severe depression.
ECT has been proven to be an effective means through which depression is treated. Janicak, Davis, Gibbons, Ericksen, Chang, and Gallagher (1985) as well as Rudorfer, Henry, and Sackheim (1997) found that ECT performed better in controlled studies than any other form of treatment for depression. Other studies have shown that ECT also outperforms antidepressants in average effectiveness (Abrams, 1997) as well as the speed of its effects (Rudorfer, Henry, & Sackheim, 1997).
While the administration of ECT is an effective treatment of depression, it is not curative. Sackheim, Haskett, Mulsant, Thase, Mann, Pettinati, Greenberg, Crowe, Cooper, and Prudic (2001) found the relapse rate of ECT patients to be around 90% within the first six months after treatment. The chance of relapse can be lowered by either a continuation of treatment through the use of mood stabilizers and antidepressants (Sackeim, 1994) or through maintenance ECT treatments for approximately four to six weeks after the initial sessions (Rasmussen, 2003). Gagne, Furman, Carpenter, and Price (2000) found that the best results were produced through a combination of psychotherapeutic drugs and maintenance ECT sessions.
Due to the controversial nature of ECT, the process of administration is briefly discussed within the manuscript. This was provided jointly by the Royal College of Psychiatrists (1995) as well as the Salford Community Health Council (1998). In this way, the facts about ECT may be better understood and controversial feelings about the treatment may be alleviated.
As with any treatment, ECT produces certain side effects within the patients who choose to undergo this form of treatment. One such side effect includes memory and cognitive impairment. Scott (2005) discusses how this is a common side effect that is associated with ECT sessions. While this may be the case, Lisanby, Maddox, Prudic, Devanand, and Sackeim (2000) found that the memories that are lost are more likely to be of an impersonal nature rather than personal. It has been reported by Calev (1994) and Weiner (2000) that patients suffering from cognitive and memory losses improve substantially once the treatments are completed with few patients complaining of residual effects.
Discussion
Severe Depression in Inmate Populations
Depression, as defined by WordNet, is “a mental state characterized by a pessimistic sense of inadequacy and a despondent lack of activity” (Depression, 2010). A survey conducted in 2006 by the Bureau of Justice Statistics on mental health problems of inmates within the penal system provides insight into the possible impact that depression may have upon those within the penal system. The survey found that within the 12 months prior to the conduction of the survey 23.9% within state prisons, 16.2% within federal prisons, and 30.4% within local prisons had experienced five or more symptoms indicative of major depressive disorder (James & Glaze, 2006). Symptoms that are included within a diagnosis of major depressive disorder include thoughts of revenge, persistent anger or irritability, or whether the individual has ever attempted suicide among other symptoms (American Psychiatric Association, 2000). Symptoms such as these may cause an inmate to act out violently against fellow inmates or staff as well as forcing staff to place the inmate under a suicide watch. This requires the institution to spend precious resources which may be better utilized elsewhere within the compound. In cases such as this, it would be helpful for the institution to have a treatment option at their disposal which could treat the inmates suffering from these symptoms swiftly with few side effects allowing them to integrate into the penal system with as few difficulties as possible.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is defined by Merriam-Webster Online as “the treatment of mental disorder and especially depression by the application of electric current to the head of a usually anesthetized patient that induces unconsciousness and convulsive seizures in the brain” (Electroshock Therapy, 2010). Early experimentation on the effects of electricity upon brain function may be traced back to Benjamin Franklin (Finger, 2006). ECT, as it is recognized today, was first used to treat mentally ill patients in 1938 by Cerletti and Bini (Endler, 1988) at which point it became a mainstream treatment. In the 1950s and the 1960s, psychotherapeutic drugs were discovered (Weiner & Krystal, 1994) replacing ECT as the premiere treatment for certain forms of mental illness though its use continues to this day. ECT has been utilized to treat a large array of conditions including (United Kingdom Advocacy Network, 1995):
Various neuropsychiatric conditions
Mania
Schizophrenia
Post-natal depression
Anxiety
Hypomania
Post-traumatic stress disorder
Puerperal psychosis
Currently, the only condition that ECT is the primary form of treatment for is that of severe depression (Scott, 2005). This is due to the fact of the severe symptoms caused by severe cases of depression such as extreme suicide attempts, suicidal thoughts, and refusal to eat.
As is evidenced above, ECT has been proven time and time again through research and practice to be an effective means to treat several different psychological disorders. In fact, there have not been any controlled studies conducted where any other treatment has outperformed the effectiveness of ECT in the treatment of depression (Janicak, Davis, Gibbons, Ericksen, Chang, & Gallagher, 1985; Rudorfer, Henry, & Sackheim, 1997). It has been calculated that the average response rate of patients with major depression to ECT treatment is 70% to 90% compared to the response rate of antidepressant medications which are most commonly the primary treatment prescribed for depressive disorders which is 60% to 70% (Abrams, 1997). There has even been evidence presented showing that ECT produces the desired effects faster than that of antidepressants (Rudorfer, Henry, & Sackheim, 1997).
While the facts discussed above provide a strong argument for the use of ECT as a primary treatment for individuals suffering from severe depression, just as with antidepressants, it is not a curative treatment. Relapse in patients that have undergone ECT sessions have been found to be around 90% within six months after treatment (Sackheim, Haskett, Mulsant, Thase, Mann, Pettinati, Greenberg, Crowe, Cooper, & Prudic, 2001). Therefore, in order to maintain the benefits of ECT sessions, it is necessary for a patient to receive future treatments within in the form of antidepressants and/or mood stabilizer medications (Sackeim, 1994) or weekly maintenance ECT sessions for approximately four to six weeks (Rasmussen, 2003). Gagne, Furman, Carpenter, and Price (2000) found that patients that received a continuation of a combination of the two treatment options were less likely to suffer from a relapse than those patients who received only antidepressant treatment. Therefore, if the patient is administered the proper treatment options after the cessation of regular ECT sessions the patient should continue to reap the benefits that were provided during the initial sessions.
Administration
As one may presume, ECT is a precise treatment method which, if administered improperly, may inflict more damage to an individual rather than aiding in their recovery. Researchers continuously review data as well as run tests on the many different aspects of ECT and how each one affects the outcome of an individual’s ECT session. This section briefly summarizes the procedure that is followed when administering ECT to an individual.
During the administration of ECT the first thing that happens is an anesthesiologist administers a general anesthetic as well as a muscle relaxer. This causes the patient to fall asleep as well as causes all of the patient’s muscles to relax preventing the muscles from convulsing during the administration of the electrical shocks. As the anesthetic is administered the patient is also given oxygen which continues for the duration of the session. After the induction of sleep, a small electric current is passed through the brain of the patient through two small pads that are placed in specific regions on either both sides or the same side of the scalp causing mild convulsions within the brain. Once the procedure is over it may be necessary for the patient to undergo more sessions of ECT in order to receive the most positive effect possible from the treatments (Royal College of Psychiatrists, 1995; Salford Community Health Council 1998).
Side Effects
As with any form of treatment through which something is being administered to an individual’s body, ECT does produce certain side effects. The side effects most concerning to individuals during the decision of whether or not to partake in ECT are that of memory and cognitive impairment. Individuals upon which ECT has been administered have been found to suffer from amnesia in respect to events that happen both before and after an ECT session (Scott, 2005). While this may be the case, research has shown that the event memories that are lost are more likely to be of an impersonal rather than personal nature (Lisanby, Maddox, Prudic, Devanand, & Sackeim, 2000). However, it has been reported that after the completion of a course of ECT, the patient’s memory losses improve substantially with a few patients reporting residual difficulties (Calev, 1994; Weiner, 2000).
Conclusion
Severe depression may introduce many different problems into an inmate population such as violent as well as suicidal tendencies. These are two propensities which a prison staff tries to suppress as quickly as possible. It has been found that sometimes, in severe cases of depression resulting in strong suicidal urges, psychotherapeutic drugs may not take effect quickly enough. In cases such as this, ECT may be the wisest treatment option available. Studies have found that ECT treats severe depression faster and more effectively than standard drug treatments which, in cases of violent and suicidal tendencies within the inmate population, is of the utmost importance. Once the initial ECT sessions have been completed, it should not be difficult for an inmate to receive continued treatments, both psychotherapeutic as well as ECT, to maintain the same positive effects that were produced by the initial treatments due to their incarcerated state. In this way, the inmate who suffered from the severe depression may be reincorporated into the prison population without posing a risk to themselves or others due to mental illness.
