electroshock, shocktherapy
This is the title of an article in the Washington Post online. Another with opinions from different professionals, psychiatrists and psychologists alike as well as patients view. This article put’s ECT in a historic perspective and also discusses a recent article in the JAMA which is described in this blog a few day ago.
This blog about depression and it’s treatment especially with ECT is in the air for a while. I hope a lot of readers benefit from these scribbles. The truth be told, I learn a lot from writing these articles. Mostly I gather a lot of information for my work as a psychiatrist which end somewhere in a drawer or the “round archive” without being read at all. Since writing this blog I actually read them and when appropriate post the information on my blog. Surfing on the net nowadays is always accompanied by the question: Is this information relevant, blogable?
Now I take the privilege today to look back on my posts and make a round up of the most important sites with information about ECT relevant for interested readers in this subject, hope you like it.
1. About ECT for bipolar disorder from healthyplace.com, also more general information about ECT, the procedure, side effects.
2. Take it easy on ECT. Opinion of a patient treated with ECT about the side effects and the discussions about this topic in the media.
3. Another patient’s opinion about ECT and it’s side effects adding to the discussion in the media.
4. Electroconvulsive therapy (ECT): Treating severe depression and mental illness. Information by the Mayo Clinic. Very informative for patients facing the choice.
5. ECT get’s a makeover. On ABC News, the opinion of patients and doctors.
New article with proponents and antagonists of ECT, objectively written by Sibile Morency at ABC news.
A commentary in the JAMA by Prof Max Fink. In this commentayr he sumarizes the most important recent topics in ECT.
1. Remission for depressive illness with ECT: 55%-86%, these results compare favorably to the response rates in the STAR*D trial.
2. Relapse prevention after ECT, nortriptyline with lithium is first choice, continuation ECT for patients who relapse despite this treatment and for those who may not tolerate medication.
3. ECT is a primary treatment for psychotic depression.
4. ECT reduces the acute risk for suicide.
5. Medication resistance does not bare relation to treatment efficacy with ECT.
6. He still favours bilateral electrode placement.
7. Important side effects are anterograde-, retrograde amnesia.
8. Vagus Nerve Stimulation and Deep Brain Stimulation are not comparable in efficacy to ECT.
This is in short his few about the recent achievements in ECT treatment and it’s research. His preference for bilateral ECT is a topic for debate. Unilateral electrode placement is technically more complex but comparable in efficacy when done the right way. That is with supratreshold stimulus dosage after stimulus titration during the first session. Research with side effects should be done for the long term and focussed on individual differences
This is the title of an article from a patient treated with ECT and a nuanced opinion about this treatment, wish a lot of patients would read it.
A voice from the silent majority
Side effects of ECT, the possible memory loss is a topic for debate. Not only between psychiatrists but also between patients. Here is another story of how these side effects ruined the life of a patient. Made a comment to this post but it was not published on the blog as a comment. Here is another more positive opinion about ECT from a patient.
Side effects will be a topic for discussion for a long time. On this blog two other views are described in 2 posts. First a view from Prof Max Fink and here a post about an ongoing discussion with Prof Sackeim.
I will post your comment anyway.
Another short but concise introduction to ECT for patients can be found on this page of webMD. It is short but on this blog more posts about sites with information on ECT for patients can be found. Use the tags on the right column.
The information is reviewed by the department of psychiatry from the Cleveland Clinic.
Memory complaints after ECT a somatoform disorder . This needs some explanation. It is the title of an article by Prof M. Fink. A very distinguished physician with a tremendous amount of experience with ECT. In this article he summarizes the complaints of two patients treated successfully with ECT. They both have expressed their memory loss with great detail in the media and even psychiatric congresses. He also mentions Kitty Dukakis and her new published book and DVD: Shock.
The author doesn’t deny memory loss can occur after ECT but not to the extend as noted by the examples he mentions in this article. In his article he makes a case for defining these extraordinary cases with extensive personal memory loss as a somatoform disorder. This is a disorder consisting of unexplained physical complaints, inconsistent with known anatomy, physiology, or biology. According to the author:
The rare complaints of persistent loss of personal memories as a consequence of ECT are well within the family of these syndromes.
The demographic features of the complainants according to the author are well educated women, often nurses, with histories of prolonged depressive illness marked by somatic features and suicidal episodes. ECT was the last resort, reluctantly advised and administered, that resulted in relief of depression. The loss of personal memories is a new focus of illness making return to work impossible, however these patients function well in new roles as critics of psychiatry.
I don’t know, I can recognize his arguments but the problem is as stated in an earlier article that we do not know enough about the possible causes of memory loss. By that I mean the possibility that some patients are more vulnerable for this side effect. Vulnerable in a biological sense and the patients he describes could well be the ones we are looking for but we need better understanding of the etiology for discovery of high risk groups.
At this site from the publisher of the film you can view a trailer and buy the DVD. Through candid and intimate interviews with patients, doctors, and other experts, the film explores the myths, mysteries, and realities surrounding electroconvulsive therapy, a medical procedure used, most effectively, in treating severe clinical depression. ECT works by inducing seizures in a patient through electrical impulses to the brain. One of the interviewed is Kitty Dukakis, wife of the three-term Massachusetts governor Michael Dukakis.
I bought the DVD, will review it when I’ve seen it.
ECT for bipolar disorder is underused to my opinion. This article on HealthyPlace.com is an excellent description of the use of ECT with bipolar disorder
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