Treatments your doctor won't tell you about

Depression
The usual treatment: Antidepressants, talk therapy, or a combo of both.

Smart option: Electroconvulsive shock therapy (ECT) Hollywood portrayals such as "One Flew Over the Cuckoo's Nest" and "Requiem for a Dream" haven't won "shock therapy" many fans, but it's no science fiction: Studies show ECT offers remarkable symptom relief.

Today, outpatients are given general anesthesia and a muscle relaxant, so there are no dramatic muscle convulsions. The treatment lasts just a few seconds, and patients wake up a couple of minutes later. Scientists are still unclear how exactly it works (just as they are with more accepted antidepressant meds). ECT is administered 6 to 12 times over 1 month, depending on a patient's needs, according to the American Psychiatric Association.

Why it may be better: ECT boosted quality of life in nearly 80% of patients, Wake Forest University School of Medicine researchers found, and it relieved depression symptoms for 83% to 95% of patients in a North Shore–Long Island Jewish Health System study — a greater success rate than the 50% to 70% who improve on antidepressant meds.

Why it's kept quiet: Though an estimated 19 million Americans are depressed in a given year, just 100,000 adults receive ECT annually, in part because of its past: Risks in the 1930s and 1940s were due to misuse of equipment, incorrect administration, and improperly trained staff. Today, given correctly, one of the main concerns is that ECT patients often develop varying degrees of memory impairment, says Charles Welch, MD, a psychiatrist at Massachusetts General Hospital in Boston. About 12% of patients suffer amnesia for as long as 6 months after treatment, especially if they're female (memory problems last just 4 to 8 weeks when electrodes are placed on only one side of the head). Because of this and the associated costs — private insurers may approve only a few sessions at a time — APA guidelines state it's best for patients who haven't responded to meds or who prefer ECT to other treatments. Still, "There is an inappropriate reluctance on the part of psychiatrists to refer people to ECT," Welch says.

ECT Pros: Success rate: 83% to 95% of patients go into remission. Improves reported quality of life in nearly 80% of patients. Boosts efficacy of anti-depressants in some people Cons: Needs to be repeated every 6 to 12 months in most patients to prevent relapses. Partial memory loss, ranging from weeks to months. Requires anesthesia and muscle relaxants, raising costs.

Real-life endorsement: Former Massachusetts First Lady Kitty Dukakis turned to ECT in 2001 after 17 years of depression that resisted other antidotes. She still undergoes a six-treatment series every 10 months. The memory loss she experiences — forgetting phone numbers and directions, mostly — are "a trade-off. I needed something much more dramatic than what antidepressants did for me," explains Dukakis, 71, who chronicled her experience in the 2006 book "Shock: The Healing Power of Electroconvulsive Therapy." After the initial round of ECT, "I just felt that relief immediately," she says. "I remember waking up and seeing my husband and smiling — and I had not smiled for a long time. It has changed my life."

Breast reconstruction
The usual treatment: Federal law requires insurers to pay for breast reconstruction after a mastectomy — however you choose to do it. Yet the overwhelming majority of women are offered only saline or silicone implants.

Smart option: The DIEP flap. In this sophisticated operation, a plastic surgeon moves a patient's abdominal skin and fat to her chest, transferring and reattaching blood vessels and sometimes nerves in the process. Named for the deep inferior epigastric perforator abdominal blood vessels that are used, the DIEP flap is an advancement of the TRAM flap, a more common, slightly easier technique that sacrifices grafted abdominal muscles to build a new breast. The DIEP flap leaves these abdominal muscles intact — the surgeon pushes them aside briefly to remove tissue behind them.

DIEP Flap Pros: Looks and feels more natural than implants; potential for sensation in reconstructed breast. Built-in tummy tuck; reconstructed breasts gain and lose fat with the body Cons: Surgery lasts up to 12 hours, with average of 4 days in hospital. COST: May have to fight insurers to pay for it

Why it may be better: "Preserving the abdominal muscles means you can still lift your kids and do all your daily activities," says John Hijjawi, MD, an assistant professor of plastic surgery at the Medical College of Wisconsin. There's also a chance you can regain sensation in your breast: A study of 24 women at Methodist Hospital in Houston found that every woman who received a nerve transfer regained some sensation within 6 months. Patients have less post-op pain, a shorter recovery, and fewer abdominal hernias than those who get TRAM flaps, according to the University of Texas M. D. Anderson Cancer Center and Mayo Clinic studies, and a lower risk of the complications associated with implants (such as pain, asymmetry, and the need for future surgical replacement). The DIEP flap's emotional benefits are also significant: "Many women don't think of it as a reconstruction — they think of it as a real breast," says Joshua L. Levine, MD, a plastic surgeon in New York.

Why it's kept quiet: Less than 100 surgeons in the country can do the surgery; thus, just 7% of US breast reconstructions in 2006 were DIEP flaps, says the American Society of Plastic Surgeons. And despite the Women's Health and Cancer Rights Act requiring insurers to cover postmastectomy reconstruction, surgeons and patients "may have to jump through hoops" to get coverage for the $30,000-plus DIEP flap surgery, admits Levine, delaying surgery for months or years.

Real-life endorsement: One Ohio breast cancer survivor fought for 18 months before her insurer approved DIEP flap coverage. "All of us want to live, but you want a quality of life after cancer, and insurance companies are holding walls in front of women," says the 54-year-old, who requested anonymity because she's forbidden to discuss her insurance settlement. Despite the long wait, she says, "it is still the best thing I ever did."

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