Simon Wessely: ‘ECT is in my own advance directive’

[Jonathan Edwards]

@Alvin, if you actually know something about this, can you indicate what it is you know and how you know it rather than being dogmatic.

I said that I had been taught that ECT worked and read enough recently to confirm that.

You raised the issue of traumatising events and I have no idea why since I am not aware that anyone thinks they play an important role in the sort of psychotic depression normally treated with ECT. Medical graduates such as myself would nowadays say that psychotic depression was both biochemical and a delusional state, commonly known by lay people as madness or insanity.

What evidence do you have for ECT killing brain cells?

The medical profession do not consider ECT obsolete. This appears to be your personal opinion.

If you have some useful insights to share could you give us some idea what they are based on?

 

[Barry]

You raised the issue of traumatising events and I have no idea why since I am not aware that anyone thinks they play an important role in the sort of psychotic depression normally treated with ECT.

I did state on another thread a while back, that my mother knew what was happening to her no matter what the medical staff said she would not. It actually frightened her greatly. But I was too young to know what the benefits might in fact have been; she did come out of hospital various times, much improved, and eventually stayed out of hospital with a sort-of-normal life. I have no idea how much the ECT contributed to that, but it may well have done.

Edit: As @Jonathan Edwards pointed out next post, I got my wires crossed here.

 

[Jonathan Edwards]

I did state on another thread a while back, that my mother knew what was happening to her no matter what the medical staff said she would not. It actually frightened her greatly.

Have we got crossed wires? Alvin was talking about traumatising events causing depression rather than ECT being traumatic. It may well have been in the past. And it may still be frightening. My wife found it great fun because the doctor who did it was another opera fan and played Verdi to her while she was being anaesthetised. It was the one bit of being in a psychiatric unit that she has fond memories of.

 

[Barry]

Have we got crossed wires?

Yes, I'm sorry. My fault.

 

[Barry]

You raised the issue of traumatising events and I have no idea why since I am not aware that anyone thinks they play an important role in the sort of psychotic depression normally treated with ECT.

Getting my wires untangled. There was one event early when my mother was very young, a few years old I believe. Her baby sister had died, whom she adored and made a lot of fuss of. As was the rather macabre protocol of the time, everyone, even the children, had to kiss the deceased and say goodbye. She used to say the shock of finding her baby sister so cold and still and lifeless, was profoundly upsetting to her. When she lost my father, and became quite psychotic, she frequently talked about (and seemed to relive very deeply once or twice) this very early experience. She apparently hid under the coffin.

But of course I have no way of knowing if this had any influence on causing my mother's condition. It could just as possibly be that anyone with certain mental health problems is more vulnerable/prone to focus on such traumas, even if not a cause. I don't know either way.

Edit: Just remembered properly. My mother was made to kiss her baby sister, not just touch her. Edited above accordingly.

 

[Alvin]

@Alvin, if you actually know something about this, can you indicate what it is you know and how you know it rather than being dogmatic.

I said that I had been taught that ECT worked and read enough recently to confirm that.

ECT is effective in alleviating depression in a good majority of cases, because of how it alters brain function. It has been claimed to only kill bad brain cells and spares healthy ones (a reference from a book i read decades ago), to fix brain imbalances and so on.

Typically many who have undergone ECT have memory loss, personality changes, and often changes in various facets like self introspection, global planning, affect, personality, agreeability and so on. In many cases patients lose their cognitive "edge". Some have very subtle side effects beyond the intended relief of depression but there is no way to predict this beforehand.
How this affects patients is not universal, it varies greatly depending on type of ECT used, number of treatments, how much electricity used per jolt and so on. The most severely affected lose their ability to be independent because they can no longer care for themselves.

the data obtained by the Guardian highlighted the need for large randomised placebo-controlled clinical trials – a proposal some proponents of ECT have argued would be unethical

https://www.theguardian.com/society/2017/apr/17/electroconvulsive-therapy-on-rise-england-ect-nhs

You raised the issue of traumatising events and I have no idea why since I am not aware that anyone thinks they play an important role in the sort of psychotic depression normally treated with ECT. Medical graduates such as myself would nowadays say that psychotic depression was both biochemical and a delusional state, commonly known by lay people as madness or insanity.

ECT has been used for almost every type of mental disorder from depression to schizophrenia to autism to internet addiction and beyond. The success rates for many of these conditions has not been stellar.

What evidence do you have for ECT killing brain cells?

The medical profession do not consider ECT obsolete. This appears to be your personal opinion.

If you have some useful insights to share could you give us some idea what they are based on?

It is difficult to cite personal experience and research because i did not document them in journals being experience and people i have dealt with but there are many resources that cite various sources that show ECT and indeed many other depression treatments are not always the best treatments. I have linked a few below but they are not exhaustive (just a quick google search).
https://www.huffingtonpost.com/dr-peter-breggin/electroshock-treatment_b_1373619.html
https://www.vox.com/first-person/2018/7/24/17603616/depression-treatment-severe-ketamine-special-k
https://www.ect.org/effects/headinjury.html
https://www.theguardian.com/uk/2000/jan/23/anthonybrowne.theobserver

 

[Barry]

Typically many who have undergone ECT have memory loss, personality changes, and often changes in various facets like self introspection, global planning, affect, personality, agreeability and so on. In many cases patients lose their cognitive "edge". Some have very subtle side effects beyond the intended relief of depression but there is no way to predict this beforehand.

My mother definitely lost memories. But if (and I have no way of knowing) the ECT was what got her back out of hospital and back with her family again, then the compromise (as life always is) was probably the best at the time. The alternative would likely have been the rest of her life in hospital, and never with her family again. She came out of hospital the final time when I was 10.

 

[Alvin]

My mother definitely lost memories. But if (and I have no way of knowing) the ECT was what got her back out of hospital and back with her family again, then the compromise (as life always is) was probably the best at the time. The alternative would likely have been the rest of her life in hospital, and never with her family again. She came out of hospital the final time when I was 10.

I understand
I'm sorry to hear about this, its never easy to tread into difficult places and i apologize to everyone i have rubbed the wrong way here

 

[Barry]

I understand
I'm sorry to hear about this, its never easy to tread into difficult places and i apologize to everyone i have rubbed the wrong way here

No Alvin, not at all. I was actually just trying to report as objectively as I could manage the facts of the matter, that to me seem pertinent. Which touches on aspects both you and @Jonathan Edwards have mentioned. I was not getting at you Alvin at all, so don't think that. I've tried not to suggest which way those facts point, because I absolutely don't know. In the past I've tended to be very anti-ECT, as much as anything because of the very personal connection and it being very emotive. I was too young at the time to see there may well have been benefits, and only ever saw what I perceived as the downsides; impressions ingrained when young tend to stick with you. Since joining S4ME I've tended to be less subjectively driven about it, especially as I so strongly believe in the principles of, and need for, good science.

And to that end, we have to be prepared to "tread into difficult places". You definitely do not need to apologise for that.

 

[James Morris-Lent]

Let's just remember our basic risk-reward calculus. I gather that ECT is used as a last resort in dire situations where there really is little to lose. Risk of some memory loss is frankly negligible compared to the decent prospects of pulling someone out of the psychotic states we're talking about. I think this evaluation holds even if we admit to knowing absolutely nothing about what depression is physiologically.

Obviously it looks pretty barbaric, especially in light of all of the perverse things that have emerged from certain quarters of medicine and psychiatry. It certainly 'feels' like something in the same vein as lobotomy. So it's natural to be prejudiced against it. But the evidence for it makes it look like a lucky gold-strike to me, so we need to get past our prejudice because this is serious shit and anything that helps is a godsend.

 

[Alvin]

Let's just remember our basic risk-reward calculus. I gather that ECT is used as a last resort in dire situations where there really is little to lose. Risk of some memory loss is frankly negligible compared to the decent prospects of pulling someone out of the psychotic states we're talking about. I think this evaluation holds even if we admit to knowing absolutely nothing about what depression is physiologically.

Obviously it looks pretty barbaric, especially in light of all of the perverse things that have emerged from certain quarters of medicine and psychiatry. It certainly 'feels' like something in the same vein as lobotomy. So it's natural to be prejudiced against it. But the evidence for it makes it look like a lucky gold-strike to me, so we need to get past our prejudice because this is serious shit and anything that helps is a godsend.

But one could unfortunately make the same argument for CBT/GET for ME/CFS, nothing else is available so why not try it. The poor science involved doesn't matter because there is nothing else that could do what this might. I seem to recall an S4ME thread where it was argued that if CBT/GET were abandoned clinics would close and jobs will be lost so thats one reason it should not be withdrawn because there is nothing else to offer. Are we going to agree to that? There are many anecdotal claims of CBT/GET effectiveness.

 

[James Morris-Lent]

I find that line of reasoning to be in bad faith, to put it bluntly. It doesn't matter if two arguments are superficially structurally similar; what matters is if they hold water in their given situation. If you don't like ECT, argue against it on its own merits. Don't validate the poor arguments put forth by BPS people by using them to justify your own preferred conclusions. That doesn't help anything.

 

[Alvin]

I find that line of reasoning to be in bad faith, to put it bluntly. It doesn't matter if two arguments are superficially structurally similar; what matters is if they hold water in their given situation. If you don't like ECT, argue against it on its own merits. Don't validate the poor arguments put forth by BPS people by using them to justify your own preferred conclusions. That doesn't help anything.

I could go on a long discussion of bad faith, the history of ECT is very gruesome but i suspect that would go over badly.
Of course it matters that they are similar, that is the point, arguing we should consider it when there are no other options echos something that is used against us, i find both appalling and i can't say since one is not our disease we should not look at the similarities.

 

[James Morris-Lent]

the history of ECT is very gruesome

Maybe so but that should not much influence our judgment of the practice today, which seems adequately civil. Knowing the history is useful for other things but the merits of the practice today can be judged without reference to the history.

Of course it matters that they are similar, that is the point, arguing we should consider it when there are no other options echos something that is used against us, i find both appalling and i can't say since one is not our disease we should not look at the similarities.

Okay, I see the misunderstanding here. I certainly agree we shouldn't do something just because there are no other options - that would be ridiculous reasoning. We should do something if we believe possible benefits outweigh possible risks. I mentioned that ECT tends to be used as a last choice to emphasize that the risks weigh out as especially acceptable in the situations it is used in. Frankly, from what I've read I suspect it should be used less reluctantly; if it were to be used as an earlier option, that would heighten the weighting of possible risks and we would need to consider that carefully.

 

[Alvin]

Maybe so but that should not much influence our judgment of the practice today, which seems adequately civil. Knowing the history is useful for other things but the merits of the practice today can be judged without reference to the history.

That may sound good on the surface but the history of terrible abuses of this technique should not be forgotten. Someone once said history does not repeat itself but it does rhyme. ECT has been used on children, in mental hospitals involuntarily and worse.
https://www.huffingtonpost.com/bruce-e-levine/are-we-really-okay-with-e_b_162242.html


And if we want to talk about today there are protests to this day to ban it by people it has harmed
https://www.irishtimes.com/news/ire...ished-protesters-tell-rally-in-cork-1.2639845
https://www.cchr.org/newsletter/vol...onvulsive-therapy-for-what-it-is-torture.html

Okay, I see the misunderstanding here. I certainly agree we shouldn't do something just because there are no other options - that would be ridiculous reasoning. We should do something if we believe possible benefits outweigh possible risks. I mentioned that ECT tends to be used as a last choice to emphasize that the risks weigh out as especially acceptable in the situations it is used in. Frankly, from what I've read I suspect it should be used less reluctantly; if it were to be used as an earlier option, that would heighten the weighting of possible risks and we would need to consider that carefully.

I did already post a reference that shows a more effective therapy, not that i advocate it either but if we are going claim its the last resort its not.
https://www.vox.com/first-person/2018/7/24/17603616/depression-treatment-severe-ketamine-special-k

 

[James Morris-Lent]

the history of terrible abuses of this technique should not be forgotten. Someone once said history does not repeat itself but it does rhyme.

I don't know the history in much depth but I agree any problems should be documented and held in mind (that's what I meant by 'useful for other things'). But it looks like there are a lot of precautions in place today to make sure it's not used cavalierly. Maybe it is in some instances and that should be eliminated.

I did already post a reference that shows a more effective therapy, not that i advocate it either but if we are going claim its the last resort its not.
https://www.vox.com/first-person/2018/7/24/17603616/depression-treatment-severe-ketamine-special-k

Ketamine looks promising but digging into the research a little bit it seems like there's a long way to go in evaluating its safety and efficacy.

And if we want to talk about today there are protests to this day to ban it by people it has harmed
https://www.irishtimes.com/news/ire...ished-protesters-tell-rally-in-cork-1.2639845
https://www.cchr.org/newsletter/vol...onvulsive-therapy-for-what-it-is-torture.html

The second link I find highly dismissible since it makes a lot of basic errors. ECT doesn't cause 'brain damage'; the seizure itself does not KO the patient because the patient is already anesthetized, and it doesn't cause violent muscle contractions because the patient is also pharmaceutically paralyzed.
The first link I think highlights the issue of memory loss which does certainly seem to be an important adverse effect to consider. Again, if it's not administered cavalierly I think the risks are often acceptable. I'm certainly sorry for any patients who were inappropriately given ECT and experienced memory loss.

 

[Barry]

the seizure itself does not KO the patient because the patient is already anesthetized, and it doesn't cause violent muscle contractions because the patient is also pharmaceutically paralyzed

I think it was not always this way. It may be some of the present-day arguments are based on earlier forms of treatment. My mother used to speak of having a gag in her mouth and being strapped to the bed to stop her injuring herself. That is why it is called electro-convulsive therapy. It triggers an epileptic fit I believe.

 

[Alvin]

But it looks like there are a lot of precautions in place today to make sure it's not used cavalierly

I don't even know where to start on this one. Children younger then 4 being treated with ECT, sounds cavalier to me. Disproportionately women, whose hysteria and unwillingness to follow gender roles is used as evidence of mental illness is another. I could explain the more graphic examples and even court orders forcing people to undergo it. There was even research proposed that it could treat social deviants and race uprisings...

I am really starting to think the adage one generation learns something and the next one forgets it is entirely true.

Ketamine looks promising but digging into the research a little bit it seems like there's a long way to go in evaluating its safety and efficacy.

I don't advocate using it, its the same trap as ECT but if it works equally or better then if your advocating ECT it should get a fair shake.

The second link I find highly dismissible since it makes a lot of basic errors. ECT doesn't cause 'brain damage'

I have posted many links that go into this in this thread already

I'm certainly sorry for any patients who were inappropriately given ECT and experienced memory loss.

Memory loss is not caused by improper ECT, its caused by ECT.

 

[Jonathan Edwards]

ECT is effective in alleviating depression in a good majority of cases, because of how it alters brain function. It has been claimed to only kill bad brain cells and spares healthy ones (a reference from a book i read decades ago), to fix brain imbalances and so on.

I do not think you will find that explanation anywhere in the professional medical literature. It sounds like an explanation for lay people. Nobody knows how to tell which are bad brain cells and which are good!

It seems that in the end you are agreeing that ECT is effective treatment for the narrow range of illness for which it is considered appropriate. Everyone knows it is not a good idea for other things.

 

[arewenearlythereyet]

gag in her mouth

At least nowadays people should know not to put things in people’s mouth while they are having a seizure, but for induced seizures I think they use a mouth guard nowadays to protect teeth and tongue ...the thought of a gag makes me feel quite angry. (oh well it’s a last ditch attempt no matter if they choke to death as a result of our treatment etc.)

I’m finding this quite difficult to read but appreciate people talking about it.

I don’t like to quote the mayo clinic nowadays, but the following seems useful in terms of context for the procedure

https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894

I still worry about the proliferation of this technique inappropriately and hope that existing safeguards are sufficient for preventing abuse by sloppy doctoring (rife in the neurology world from my experience)