Electroconvulsive Therapy

[Hutan]

If it was capable of causing severe depression it was probably capable of causing severe memory loss - as might the surgery have been.

For sure. I did skim a few papers on the condition before posting the article, and a common symptom of a colloidal cyst is memory loss. The woman does acknowledge that if she was the only one who had suffered permanent memory loss she would just put it down to her particular circumstances. But, she says that she knows of many other people who have also suffered memory losses. The woman's words about the large impact of losing memories of important times in your life were powerful.

If severe permanent memory loss was not a frequently seen side effect of multiple ECTs, then that is all the more reason for this woman's clinicians to have investigated the cause of the memory loss. The cyst wasn't found as a result of an investigation of her cyst-related symptoms.

The memory issues pre-dated the surgery, which was after the discovery of the cyst in 2004

In May 2000, a doctor recorded her primary complaint was the severe memory loss she was having.

A month later in a session with a clinical psychologist she indicated she only had “islands of memory” and could not not recall her son’s graduation. Again, her doctor reassured her any memory loss brought on by ECT would only be for the treatment period and “not significant.”

In September and October 2000 she again expressed “extreme concern” at the memory loss associated with her ongoing ECT treatment and the anaesthetics she believed were contributing to her weariness. Her doctor noted her short-term memory was significantly impaired.

Despite the ongoing ECT, her depression worsened.

In February 2004, her psychiatrist noted Hodgson’s angry outbursts were also leaving her feeling embarrassed.

300 ECT sessions is a huge number so it isn't representative of the usual situation.

This woman's experience regarding the frequency and total number of ECTs is unusual. But, she also has had the benefit of having a family who stuck with her through that whole ordeal, and a medical cause for her depression was found. Possibly part of her rarity is the fact that she is still alive and has the capacity to tell the story, and her willingness to actually do so.

There have been very credible corroborated testimonies given in a royal commission investigating harm done to young people in state and religious institution care in New Zealand of young people being given ECTs as a punishment.

As I recall, at that time in NZ there was one MRI scanner.

That's a good point. It's easy to forget how medicine has advanced incredibly on many fronts.

ECT has changed over time due to the known effect of memory loss. All my patients were warned of this, and they had a right to refuse treatment.

That's great. I'm sure that you practiced diligently and compassionately. But it is clear from the investigation that the reporter did that even now in our country there is no standard approach to informing patients and their families of risks - it looks as though things could be done better at the national level.

These patients are desperate and may not have free choice, so the rules have to be strict and medical conduct exemplary.

 

[Sid]

300 ECT sessions is far beyond the normal standard of care. I don’t know what NZ was like in 1994 but in 2024 Europe MRI is done routinely. The article also mentioned that the surgery for the benign cyst caused a stroke.

The fake expert quoted at length is a known psychologist and ideological activist who denies the existence of mental illness and who openly stated on twitter it’s all just trauma response. Can’t reason with people who don’t accept basic premise of reality.

 

[Sid]

Maybe the fact that more women get ECT means they are lucky - getting better treatment.
Has anybody thought of that possibility?

More women get ECT for the simple reason that more women get depression than men. It’s a 60:40 split. There’s no conspiracy. The activists are trying to spin this into some women’s rights issue.

 

[Arnie Pye]

More women get ECT for the simple reason that more women get depression than men. It’s a 60:40 split. There’s no conspiracy. The activists are trying to spin this into some women’s rights issue.

I'm sure I'm not alone in this, but my depression was fixed by taking sufficient iron to boost my ferritin to mid-range. Until I treated myself doctors would prescribe 2 or 3 months of iron supplements and then never re-test or prescribe again for several years. When I did my own testing and treating to get my ferritin to mid-range my depression vanished - but it took nearly two years. Two or three months worth of iron wasn't even touching the sides.

A few years ago, when Twitter was still Twitter and I could still read it, there was a thread I found from a young woman complaining that her ferritin level was only 6 and she felt terrible and her doctor thought it was "good enough". This opened the floodgates and the thread ended up with what seemed like thousands of women saying pretty much the same thing over and over again. Doctors think that raising ferritin level to just within range is "good enough" or any level close to, but under, the range was also "good enough". I wouldn't be surprised if depression was a common side effect in women due to the fact they have periods for many years and they are permanently short of iron.

I have seen suggestions in articles from doctors and researchers that the reference ranges for iron and ferritin in women are too low because doctors expect that women are always going to be "a little bit anaemic", and this is "normal for women".

I was first diagnosed and treated with anaemia aged 10, then again at 13 but was not treated, then I was diagnosed and treated aged 15. After that doctors mostly stopped testing me for anything but Full Blood Counts which will show anaemia if haemoglobin is under range. But iron deficiency begins long before some women show low haemoglobin, and should be treated, but rarely is, in my experience.

I agree there isn't a conspiracy. There is just this entrenched belief that women whinge a lot for no reason.

 

[Jonathan Edwards]

The woman does acknowledge that if she was the only one who had suffered permanent memory loss she would just put it down to her particular circumstances.

Memory loss is a well established problem with ECT and informed consent includes explaining that. My wife lost a lot of memory to begin with but almost all of it has returned. Moreover, for things that were disappointing to have forgotten, prompts have brought them back.

The argument posed in the press about ECT is always too black and white. There are downsides but the upside far outweighs them. People with severe biological depression often die or simply vegetate in institutions - far worse than death for all concerned. Activists who want to tell horror stories should come up with a decent alternative before they put people off the one thing that can bring their life back.

 

[hibiscuswahine]

. That's great. I'm sure that you practiced diligently and compassionately. But it is clear from the investigation that the reporter did that even now in our country there is no standard approach to informing patients and their families of risks - it looks as though things could be done better at the national level.

These patients are desperate and may not have free choice, so the rules have to be strict and medical conduct exemplary.

I agree, there should always be informed consent. Records don't often show the process of informed consent and psychiatrists should always record this discussion, otherwise they can be sued just like surgeons if they don't mention postoperative infections etc. We were taught always to record the whole extent of the risks and benefits of the treatments and the alternatives and discuss anaesthetic risks (which the anaesthetist would also go over but we would do this initially with the client and their family).

I think it is very difficult to comment on the amount without knowing her full psychiatric history. It could be the psychiatrist was excessive with this treatment (or there could have been more than one over time). I do know a few clients in our service who had 200 over a couple year period. This client had a very high risk of suicide. Only with a full history could one say her's was excessive.

The practice of psychiatry and the use of ECT changed quite a lot during my training, which is good as ECT has been used as a tool for torture and coercion in NZ on children and adults and I met some of those people that experienced this during my years of practice.

I think there is a standard approach to informed consent and that is what I was taught as a member of this college. You will probably be aware that many of our psychiatrists are not trained in this college. But of course, any psychiatrist can omit telling people of the risks and they are open to be sued regardless of ACC's position. She appears to have grounds for that but the passage of time will sadly make this difficult.

Any client or mental health professional (other than the treating psychiatrist) can complain about their clients or their own current and past care. Clients under the Mental Health Act can access a lawyer and question their treatment under the Mental Health Act and get them to argue on their behalf in front of a judge. All psych services have an area District Inspector - a lawyer who overseas clients rights and treatments and they are very active in their work especially around seclusion and detention.

Losing one's autobiographic memory due to ECT is very difficult and I hope she is getting counselling or mental health support (paid by the government).

There are several anti-ECT groups in NZ and other groups that are anti-the Mental Health Act (coercion). There has been so for many years, It comes up in the news every so often. I think it is good for people to tell their stories and look at our mental health system and get the justice they deserve. There is no doubt there has been appalling treatment in our mental health service over the years. I think it is important to recognise that things have changed it this area but also there will always be mistakes, errors, rogue practitioners etc. just like in any other area of medicine.

Interestingly, although ECT has always had a very negative reputation, I found when I had to prescribe it for people with severe depression, they and their family are willing to have ECT even with the known side effects as there is no other treatment available. They are given time to decide and written information. Often I don't think people appreciate the remarkable recovery people have with ECT. It is life saving.

 

[Hutan]

The argument posed in the press about ECT is always too black and white.

I don't think that article was too black and white. It acknowledged the benefits of the therapy. But a number of things appear to have gone wrong in this case - inadequate informed consent; repeated treatment far beyond what anyone seems to think is reasonable and ongoing at that high frequency even when severe side effects were being noted; inadequate investigation of alternative reasons for the symptoms. Perhaps 'that wouldn't happen now', but I think it is still valid to report on it, especially when it is clear that the informed consent documentation is still inadequate.

Activists who want to tell horror stories should come up with a decent alternative before they put people off the one thing that can bring their life back.

I don't think the article would put me off if I or a loved one was being recommended ECT. It would make me a better informed consumer though. I don't think the woman the article is about, or the journalist are 'activists who want to tell horror stories'.

It is legitimate to point out problems with a treatment without offering alternative treatments. That is what many of us are doing with GET and a whole range of pseudoscience treatments.

There does seem to be some similarities with the situation with GET. Exercise does help some medical conditions, but we know that prescribed exercise can also cause harm, especially if clinicians aren't listening to what their patients are saying. The fact that it helps some people does not mean that it fixes everyone and all conditions. If exercise regimes don't solve a problem, clinicians should consider the possibility that their hypothesised cause of the disease is wrong and look for other causes.

That 'consideration of other causes' is what didn't happen in this ECT case. A 'decent alternative' to dozens of ECTs per year, year after year, and something that does not appear to have been done, was to properly investigate the cause. Another 'decent alternative' that also seemed not to occur in this case might be acknowledging that ECTs can cause permanent harm if frequent enough, and involving the patient and/or their family in weighing the costs and benefits of a treatment plan.

 

[SNT Gatchaman]

Daily Beast: Scientology Is on the Brink of Killing an Entire Medical Industry

The Atlantic’s 2001 article explained that ECT had emerged from a terrifying past to become a safe and effective treatment for some of the worst effects of serious mental illnesses. But Scientology, through its campaigns and by pushing legislation, was promoting outdated myths about the procedure for a public that knew little about it.

“It’s an incredible story that goes back decades," says Harold Sackheim, one of the national figures who is most associated with ECT and helped develop many of its advances at Columbia University. "I've been dealing with this since entering the field in 1979. And Scientology looks like it's going to be successful at killing an industry."

“It’s under-appreciated how severe depression can be,” a provider from a major national university said, asking not to be named for fear of retaliation from Scientology. “For those folks, it is remarkable the turnaround that they can have. We have a woman in her 60s, and the difference between when she’s ill and not is so profound. After six or eight treatments, she’s living her life again. Suddenly her thoughts make sense. It’s one of the most dramatic treatments I’ve seen in medicine.”

To this day, Scientology, based on Hubbard’s writings, considers psychiatry to be the most evil force in the universe. And in writings only meant for Scientologists, Hubbard claimed that psychiatry has been around for trillions of years. (Cosmologists estimate the universe’s age at about 13 billion years, and psychiatry emerged only in the late 19th century.)

In Hubbard’s cosmology, based on hundreds of lectures he gave over decades and many books that he authored, we are all immortal beings he called “thetans” which have lived countless times. Over that span, which he referred to as our “Whole Track,” we have lost sight of who we were and how powerful we were in the past. Only through Scientology counseling, Hubbard claimed, could we recover memories of our entire Whole Track and regain godlike abilities.

In November, researchers at UC San Diego reported findings which suggested that the seizures induced by ECT increase something called “aperiodic activity” in the brain, which has been described as the brain’s “background noise.”

“We’re now seeing that this activity actually has an important role in the brain, and we think electroconvulsive therapy helps restore this function in people with depression,” UC San Diego’s Sydney Smith told Science Daily when the studies became public.

"They managed to get Somatics to write in its manual that it causes brain damage without any proof that it does," Dr. Ziad Nahas adds, echoing others who said the settlement set a bad precedent.

Somatics itself, in its most recent product manual for its ECT device, the Thymatron System IV, found a way to fight back, at least in a footnote: “In the interests of avoiding litigation we provide here our warning that Scientology and its affiliate CCHR have threatened to sue ECT device makers and psychiatrists in the USA who do not deliver a warning that ECT can cause brain damage, regardless of any evidence about it.”

“Other than that, these companies have succeeded, but at great cost," McCall says. "The M.O. from Scientology seems to be to file as many suits as possible and ratchet up costs until it breaks the bank.”

 

[hibiscuswahine]

NZ uses two USA sourced machines (and the adhesive pads to deliver ECT).

https://nzihe.org.nz/a-biomedical-look-at-ect/

The link is from a biomedical engineer who fixes ECT machines for Te Whatu Ora Health NZ

Compared to other countries, New Zealand has a relatively low rate of therapy per capita population. In 2017, the most recent statistics I have access to, 265 people received ECT, resulting in 2914 treatments. This averages eleven administrations of ECT per patient.
/QUOTE]

 

[shak8]

QUOTE="SNT Gatchaman, post: 548359, member: 7967"]Daily Beast: Scientology Is on the Brink of Killing an Entire Medical Industry[/QUOTE]

A life-saving modality. My cousin survived because of treatments, and also a neighbor.

The Hollywood Scientology cabal needs legal prosecution over its agenda.

 

[Nightsong]

In November, researchers at UC San Diego reported findings which suggested that the seizures induced by ECT increase something called “aperiodic activity” in the brain, which has been described as the brain’s “background noise.”

Intrigued by this reference, I spent a few minutes looking in to this. The reference to ECT altering aperiodic activity on EEG appears to be this exploratory study (n=9) in Nature Translational Psychiatry. If it replicates it might bring us a little closer to understanding the mechanism; it seems that only in recent years interest grew as methods evolved to more reliably separate the aperiodic spectral component out from the oscillations which are far better characterised. There's also a newer preprint that also suggests that both ECT and magnetic seizure therapy increase the aperiodic exponent and a 2022 paper that looked into the aperiodic power spectral slope relative to ADHD risk.

 

[SNT Gatchaman]

The preprint is also published: Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity (2023, Nature Translational Psychiatry)

 

[Jonathan Edwards]

The reference to ECT altering aperiodic activity on EEG appears to be this exploratory study (n=9) in Nature Translational Psychiatry. If it replicates it might bring us a little closer to understanding the mechanism;

I would be sceptical that this will lead to any enlightenment. People study EEG because you can measure things. They love complicated mathematical procedures like power spectra. But nobody has any idea how brain rhythms relate to thought. They are almost certainly just gross co-ordinating and triage mechanisms. Nothing to do with content of thought, which is what is wrong in the conditions being treated.

ECT must presumably alter synaptic strength or dendritic responsiveness in individual neurone. It certainly has a major effect on memory.

 

[Sid]

This case series reports on use of ECT in four people with difficulty swallowing (one case also mentions gastroparesis and severe weight loss). However, these issues occurred in the context of late life depression.

Her medical history was positive for hypertension and gastroparesis. She also reported a 100-pound weight loss over 12 months

complaints of difficulty swallowing despite normal endoscopy. Her reported inability to swallow resolved after the first two ultrabrief RUL ECT at 70% of maximum device output

https://www.ajgponline.org/article/S1064-7481(21)00519-4/abstract

 

[SNT Gatchaman]

Blood biomarkers of neuronal injury and astrocytic reactivity in electroconvulsive therapy (2024)
Sigström, Robert; Göteson, Andreas; Joas, Erik; Pålsson, Erik; Liberg, Benny; Nordenskjöld, Axel; Blennow, Kaj; Zetterberg, Henrik; Landén, Mikael

Despite electroconvulsive therapy (ECT) being recognized as an effective treatment for major depressive episodes (MDE), its application is subject to controversy due to concerns over cognitive side effects. The pathophysiology of these side effects is not well understood. Here, we examined the effects of ECT on blood-based biomarkers of neuronal injury and astrocytic reactivity.

Participants with a major depressive episode (N = 99) underwent acute ECT. Blood was sampled just before (T0) and 30 min after (T1) the first ECT session, as well as just before the sixth session (T2; 48–72 h after the fifth session). Age-and sex-matched controls (N = 99) were recruited from the general population. Serum concentrations of neurofilament light chain (NfL), total tau protein, and glial fibrillary acidic protein (GFAP) were measured with ultrasensitive single-molecule array assays. Utilizing generalized least squares regression, we compared baseline (T0) biomarker concentrations against those of our control group, and calculated the shifts in serum biomarker concentrations from baseline to immediately post-first ECT session (T1), and prior to the sixth session (T2).

Baseline analysis revealed that serum levels of NfL (p < 0.001) and tau (p = 0.036) were significantly elevated in ECT recipients compared with controls, whereas GFAP levels showed no significant difference. Relative to T0, serum NfL concentration neither changed at T1 (mean change 3.1%, 95%CI −0.5% to 6.7%, p = 0.088) nor at T2 (mean change −3.2%, 95%CI −7.6% to 1.5%, p = 0.18). Similarly, no change in total tau was observed (mean change 3.7%, 95%CI −11.6% to 21.7%, p = 0.65). GFAP increased from T0 to T1 (mean change 20.3%, 95%CI 14.6 to 26.3%, p < 0.001), but not from T0 to T2 (mean change −0.7%, 95%CI −5.8% to 4.8%, p = 0.82).

In conclusion, our findings suggest that ECT induces a temporary increase in serum GFAP, possibly reflecting transient astrocytic activation. Importantly, we observed no indicators of neuronal damage or long-term elevation in any assessed biomarker.

Link | PDF (Nature Molecular Psychiatry) [Open Access]