“It used to be called electroshock therapy, but they felt that wasn’t quite horrifying enough. ‘If we could underscore the writhing…’ ” he jokes in his new HBO documentary, The Great Depresh.
But Gulman, 49, agreed to do it — and it worked. After three sessions he was no longer shaking from his anxiety, and by 10 sessions he felt his depression — which had left him suicidal at times — lifting.
ECT is often misunderstood, but it has significantly improved over the years, says Dr. Sarah Lisanby, a psychiatrist and researcher at the National Institute of Mental Health.
“ECT has changed dramatically since it was first introduced in the mid ’30s,” she tells PEOPLE. “In the early days, in the 1930s, 1940s, they didn’t use anesthesia. That was part of the historical image that has led to some of the stigma about it, because without anesthesia, when you do ECT, the body shakes like a person with epilepsy.”
“Modern ECT is done under anesthesia,” she continues, “the body does not move at all, because the anesthesia relaxes the muscles and protects the body during the seizure. And we use less electricity than in the old days. That has dramatically improved the safety profile of ECT.”
And it works. “The amazing thing about ECT is that it was and remains the most effective and rapidly acting treatment that we have today for severe depression,” Lisanby says. “In research studies, the typical response rate is about 80 to 90%. In routine clinical practice, most people have a complete recovery from their depression with ECT.”
The main downside, Lisanby says, is patients still experience some memory loss — “but when we use less electricity and we use the more modern electrode placements, the amount of memory loss is greatly reduced,” she explains. “It’s not zero, there is still some memory loss, but it is much less than it was in the early days.”
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That was something that Gulman experienced, and he initially panicked when he couldn’t remember the jokes he uses to start his set.
“I started crying in the shower: ‘Oh my god, I’ve erased my brain!’ ” Gulman tells PEOPLE. “I called my psychiatrist and he said, ‘Don’t worry, it’s normal. It’ll come back to you.’ And it did.”
Gulman is doing well, and between ECT, medication and therapy he’s able to manage his depression, though he’s aware that it may return.
“Unfortunately, ECT isn’t a permanent cure,” Lisanby explains. “It is important to go on a maintenance treatment after you finish a course of ECT. If you do it and then you get no treatment afterwards, your risk of relapse in the first six months is extremely high. But, with effective maintenance treatment, which can be a combination of medications and continued ECT, this dramatically reduces the relapse rate.”
And just a few ECT treatments — around one per month — is sufficient. “That can be sustaining for people long term. I’m talking years,” she says.
The next step, Lisanby says, is to continue improving the “safety and efficacy” of ECT. That’s one of her goals as a researcher.
“What we’re really striving for is something that would not cause memory loss, because you shouldn’t have to choose between your memories and your mood,” she says. “And people with severe depression deserve to have the safest, most effective treatment that we can provide.”
If you or someone you know is considering suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), text “STRENGTH” to the Crisis Text Line at 741-741 or go to suicidepreventionlifeline.org.