This is the title of an impressive documentary of treatment with Electroshock or ECT. Three patients are portrayed as they’re being treated with Electro Shock Therapy (ECT) for their depressions. This documentary was made by Saskia Gubbels and her crew.
‘There will come a moment when I decide to lie down in the snow to die. Because living like this isn’t much of a life. It really isn’t. It’s death.’
These are the opening words of Lidwine in the documentary ‘0.8 Amps of Happiness.’ Severely depressed and suicidal, she has tried everything to break free from the downward spiral she finds herself trapped in. Electro Convulsive Therapy (ECT), popularly known as electroshock therapy, is her last resort. This therapy is often effective but has long encountered deep-rooted prejudice and fear. Director Saskia Gubbels intimately portrays three people who undergo electroshock therapy. She captures how depression has completely taken over their lives and those of their families and friends. Will they manage to escape the darkness of depression or psychosis? Will this treatment give them back just a tiny shred of their former state of happiness they so long for?
At the Museo di Storia della Medicina della Sapienza at the University of Rome they are organizing an exhibition around the Bini–Cerletti apparatus for the administration of electro-shock. The authors are very careful in expressing their appreciation for this therapy. They disregarding the period of development of treatment of severe mental illness in that period. Consisting of much more dangerous treatment alternatives. Moreover, littel is mentioned about the improvement of technique, apparatus and indications for treatment with ECT. In Italy the use of ECT is very rare. Italian colleagues regret this, they would also would like to have the possibility to use this very effective and safe treatment in severe cases.
Read a review on the use of deep brain stimulation (DBS). Wrote a lot of posts about this new treatment on this blog, mostly for treatment resistant depression. As with most new treatment options the new treatment is tried with other severe diseases. You can probably find some on this blog or down this post in the related posts section. The use of DBS in Alzheimer’s disease drew my attention. Stimulating certain brain regions in a disease with a neurodegenerative character seems almost impossible.
This review was written by members of the Canadian group who also published about the use of DBS in treatment resistant depression. They stimulated certain brain regions serving cognitive and memory functions (the fornix, part of the Papez memory circuit) in six patients with Alzheimer’s disease.
After 1 year of chronic high-frequency stimulation, glucose hypometabolism within the temporoparietal cortex that is characteristic of the diseased brain was largely reversed
Two patients improved on the Mini Mental State Examination, three others declined and one was unchanged. The average decline on points of the MMSE suggest a delay of this cognitive decline for these patients.
It was just a pilot study and needs further research. The authors have started a large multicenter trial
J. Schouenborg, M. Garwicz and N. Danielsen (Eds.)
Progress in Brain Research, Vol. 194
Deep brain stimulation: emerging indications
Travis S. Tierney, Tejas Sankar and Andres M. Lozano
Clear and short explanation on depression and it’s treatment, including ECT by Richard Jaffe MD.
Richard Jaffe discussed the “winter blues” and some of the treatment options that are available to those suffering with depression. He also highlighted some of the new refinements that have been made in Electroconvulsive Therapy (ECT)
New long term data on efficacy of deep brain stimulation for treatment resistant depression are available. The first follow up data up to 1 year were already promising. Published research about deep brain stimulation for treatment resistant depression showed that six months after surgery, 60% of patients were responders and 35% met criteria for remission, benefits that were largely maintained at 12 months.
The average response rate to DBS after two and three years were 46,2% and 75%. More than one-third of patients were in remission at year 3. But what’s more convincing functional impairment in the areas of physical health and social functioning progressively improved up to the last follow-up visit.
The Mayberg group published a follow up for 6 patients after 6 months and they subsequently reported on 12 month outcomes in an expanded sample of 20 patients. The last report at 3 years of follow-up as summarized above were also with 20 patients. The report on the extended follow-up of these 20 patients results from data from 3 to 6 years (mean=3.5 years) after DBS implantation. The mean duration of follow-up of the 20 patients was 42,1 months. In general patients required less medication after DBS implantation.
Two patients died by suicide during depressive relapses. This is of concern but stipulates the severity of the illness and it’s consequences. From the editorial:
One issue arising from this study requires special attention—that of suicide. Two of the 20 patients in this extended follow-up study committed suicide, and two others made suicide attempts. There is no evidence suggesting that DBS was related to these deaths. Rather, these suicides reflect the severity and seriousness of treatment resistant depression. In one of these patients there had been periods of sustained remission, but the patient relapsed and required a course of ECT prior to her suicide. The other patient had persistent suicidal ideation. These results underscore the high mortality in patients with treatment-resistant depression, even with careful and frequent monitoring by experienced and competent providers. It should serve as an impetus for us to continue to strive to develop new strategies to treat this patient population.
The first year three of the first six patients had hardware infections, no device related adverse events occurred after those three. Eight battery replacement surgeries were required during follow-up (mean time to battery replacement, 43.3 months).
Over the course of follow-up, eight patients were hospitalized for medical reasons on a total of 12 occasions. Half of these admissions were for psychiatric reasons (worsening depression, N=3; suicidal ideation, N=3), and the other half were for nonpsychiatric reasons
Other scarce reports on efficacy and follow up with DBS targeting other areas also show comparable results. Limitations of this study:
Open label, selected group of nonpsychotic unipolar depressed patients which leaves it unclear whether other forms of depression will also respond favorably.
Kennedy SH, Giacobbe P, Rizvi SJ, Placenza FM, Nishikawa Y, Mayberg HS, & Lozano AM (2011). Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. The American journal of psychiatry, 168 (5), 502-10 PMID: 21285143 Hirschfeld RM (2011). Deep brain stimulation for treatment-resistant depression. The American journal of psychiatry, 168 (5), 455-6 PMID: 21536698
Andrews SC, Hoy KE, Enticott PG, Daskalakis ZJ, & Fitzgerald PB (2011). Improving working memory: the effect of combining cognitive activity and anodal transcranial direct current stimulation to the left dorsolateral prefrontal cortex. Brain stimulation, 4 (2), 84-89 PMID: 21511208
McCambridge, A., Bradnam, L., Stinear, C., & Byblow, W. (2011). Cathodal transcranial direct current stimulation of the primary motor cortex improves selective muscle activation in the ipsilateral arm Journal of Neurophysiology DOI: 10.1152/jn.00171.2011
Last Friday had the pleasure of doing a presentation on the current practice of ECT for lay public. It was during the Publieksdag for the 140th birthday of the Dutch Association of Psychiatry during the annual conference in Amsterdam.
Also found some excellent information on ECT on the Internet: