Electroconvulsive Therapy

Maybe I wasn't "utterly" against ECT. But humans take their cues from society, and society was against.

I see, like you, the difference it makes to (most) treated seriously depressed persons.

But it has a cost in the currency memory loss, why it's important to do a careful assessment of the pros and cons of the alternatives.

 

ME/CFS patients are still routinely prescribed treatments that worsen symptoms. The disease itself, combined with inappropriate treatments, can trigger depression. It would be unfortunate for such patients to be routinely prescribed ECT.

 

I think one of the most important issues to consider in this therapy is that it is has been historically used without the person's consent (since the victim is usually deemed "mentally ill" and therefore magically unable to have an opinion about their body or health care.) Considering some of the things we know about the psych credo in general, it is or won't be any different today.

This is an unusually dangerous procedure to inflict upon a person, especially if they are not allowed to refuse it for medical (or any) reasons which are being--heinously--ignored. I think the same is true for antipsychotics, but actually to a lesser degree, because afaik (which is not far) APs don't risk traumatizing your central nervous system, and giving you the PEM of a lifetime, with quite possibly damage to the brain.

I do not want a tool like this in the hands of people like those who kidnapped Bob. Otherwise it is like returning to the middle ages of mental health care, which was not care but rather disdain and harm.

 

A member of my family had ECT on and off over the years through the 1950s and '60s. She spent years in and out of hospital; no real idea how much credit due, if any, to ECT for the times out of it. But she did tell me how she still remembered what the doctors insisted she would have no memory of (but did!) - of having a gag between her teeth and being strapped down to a bed so she would not injure herself ... the 'C' for convulsive means just that. She apparently used to tell them she knew what was going on as it was happening, but they did not believe her. She said it was truly terrifying.

 

I'd be fairly concerned about this:

I suppose memory loss (temporary or permanent) would be easy to notice if it were of something obvious like your spouse's name, your phone number, your address, etc... But how would you even know if you lost a memory of something more obscure, like your first trip to the beach?

 

Definitely an outlier, but here's an article and commentary about a 55-year-old woman given ECT who lost 30 years of memories.

https://www.mdedge.com/psychiatry/article/62301/ect-wipes-out-30-years-memories
https://www.mdedge.com/psychiatry/article/62376/ect-and-memory-loss

 

I think it is a mistake to judge a treatment on one's initial emotional reaction. Appendicectomy is pretty barbaric and revolting but it has saved thousands of lives. So has ECT I think. My understanding is the evidence for effectiveness is cat iron - in part because there are dose response studies that overcome the subjective bias issue.

Anecdotally my wife's life was saved by ECT. The alternative was twenty years on a chronic psychiatric ward being tube fed. Instead she has been completely well for ten years.

I see ECT as diametrically opposite to CBT. It is the bona fide evidence based side of psychiatry. Psychiatrists use it far too reluctantly because of the irrational stigma. The psychiatric treatments to be wary of are the ones they want to use more and more because it boosts their egos.

 

Memory loss is very real. Shared holiday memories are lost. But after talking about the past and looking at photo albums it comes back over a period of years. It is distressing but it is a trivial price to pay for having your loved one become the person they used to be again. Nothing can be nearer to hell than looking after a body that once housed your loved one but instead houses a sort of evil zombie. Depressive illness is something far worse than sadness.

 

The type of psychiatrist who uses ECT is not scum I can assure. Those dealing with severe psychotic illness are the salt of the earth. They have seen so much real misery that they know they have to do the best for people.

The long term effects are well documented and they are acceptable.

 

There have been reported deaths from ECT, some due to the anaesthesia but most due to cardiac events which could not be definitely linked. I think anti-psychotics are equally dangerous - or safe if you think the risks are small.

For the 30 years we were together, my husband had bipolar disorder with delusional episodes: a Messiah complex in which he found the explanation for all mental illness. He sent his very long thesis to Thomas Szasz (The Myth of Mental Illness) and R. D. Laing (The Divided Self). He even got a reply from Szasz.

After 30 years, he left for an old heart throb because I could no longer work full time and be his physical ad emotional prop (where have I heard that before!). He found the grass was not greener after all and a couple of years later, in 2001, he admitted himself to a clinic and was prescribed a fairly new, 'atypical' anti-psychotic along with a cocktail of other psychotropic drugs. It turned him into a zombie who could barely walk. He wasn't aware of this and when I said something to him he decided to stop the AP. Consequently, his psychiatrist refused to treat him any longer and the clinic would no longer have him as a patient.

The AP he was prescribed is known to be dangerous, especially for anyone with a heart condition, as my husband had, but they took that risk without telling him. On the day he left the clinic he died suddenly of a heart attack. Of course the coroner could find no definite cause and effect.

ETA: after a bit of reading on the risks it appears that APs are a great deal more risky to life than ECT. It seems patients are 6 times more likely to die from lightning than ECT. On balance I think I would use ECT if I had extreme depression, having seen what it's like first hand.

 

Bone marrow ablation with stem cell transplant is a blunt tool but it saves thousands of children's lives. Do we need more than that?

Lots of treatments would be better refined but it isn't always practical.

I think ECT is quite sensible scientifically. Psychotic illness is likely due to brain connection plasticity forming disadvantageous pathways. ECT undoes recent connections - hence heemory loss. It is the logical thing to use.

A lot is known about which subgroups benefit. The pity is that it is also known that it is most useful if used early but the rules are that it cannot be used until all else has failed and two independent physicians have agreed to use it.

 

My concern is for ME/CFS patients misdiagnosed as refractory depression patients, after antidepressants, therapy and exercise don't improve their condition.

Patients might even agree to ECT, particularly if it is the only treatment option offered to them.

 

I think the points about barbarism is a red herring ....you can argue most medicine is barbaric. Its about poor quality application that’s the worry and people having their memory wiped against their will and inappropriately ..and any other long term effects that no one knows about because they choose not to look.

I think because the brain houses the person (as oppose to a leg arm, spleen or whatever) we should have much better people that are more heavily regulated for conduct and professionalism before any more life changing treatments are done...speaking as a recipient of a string of unprofessional neurologists who did act in a negligent and damaging way, I’m not convinced that the people who reside here are not the sloppiest and most cavalier of sorts whereas they should be the very very best.

Don’t get me wrong depression is a horrible comdition to live with and I have lived with someone close to me that has had this ..thankfully only bad for a few years. I can’t imagine what going through this indefinitely would be like. It takes a very strong person to live through that and I’m not sure it’s even possible when it’s a close loved one.

I do wonder what’s the next step for depression diagnosis when the lunatics have actually taken over the asylum.

What’s the next step for PWME once the bps lot argue it’s a form of depression ...removed from your home, straight jacket followed by ECT while they chant false CBT in your ear?? I would rather dodge the pottery classes at a MUS clinic than have this sort of power in the hands of these people. It truly is a frightening prospect for me and the subject of nightmares.

 

The potential problem is, can one be sure that all cases where the treatment has had no effect, or adverse effect, have been properly monitored, recorded and reported?

 

I can understand that it is a pity, but that is always with hindsight surely, when it only later becomes evident there is likelihood of benefit unachievable any other way. If used earlier there would presumably be excessive risk of using a heavy duty tool on those who might yet benefit from lighter interventions. Medicine must be full of such tricky balancing acts.

 

I'm skeptical. What's the evidence and how much of it is the same-old for psychological treatments?

 

No, it can not be known with the degree of certainty that scared laymen wish.
On the other hand, we know with great certainty that the alternative is worse - in average.

 

Some might regard the reference to "scared laymen" as potentially pejorative. Not to mention "cavalier".