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

I found this publication interesting:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137581/

There are two FDA documents linked that are interesting, too.

Edit: And here's a critical voice: https://www.cchrint.org/2018/06/13/renewed-calls-for-electroconvulsive-shock-therapy-ban/

 

Twitter is buzzing for the past few days about ECT. Apparently this guy has announced the debate and not everyone's happy about it. Open tweets to see the discussion..
https://twitter.com/user/status/1033305095797190657

https://twitter.com/user/status/1033970983655419904

https://twitter.com/user/status/1033748339869851648


Some negative experiences:
https://twitter.com/user/status/1033327792988016640

https://twitter.com/user/status/1033690637894397953


Seems like the biggest issue is not the ECT in itself, but the possibility of it being used inappropriately and it seems that it does occasionally happen.

 

And btw, I'm not against ECT, but the thought of someone potentially trying to use it on people with somatization/somatoform disorders is a bit frightening.

 

Yes, you've got a good point there. When you look at it retrospectively, all sort things can appear to be triggers or play a causal role in depression. But its always hard to tease apart cause and effect.

My ex partner suffered from a mix of anxiety and depression, sometimes severe, and when the anxiety got bad, he always attributed it externally - to some upcoming event or current problem. I soon learned that these external attributions were pretty unreliable.

 

Just as a matter of general interest, it was reported by Wallis that ECT was used in several cases of depression arising from the Dalston, Cumberland epidemic in 1955. The outcomes do not appear to be reported. As Jenkins comments that the description is well worth reading, the link to it is here:
www.era.lib.ed.ac.uk/bitstream/handle/1842/9382/Wallis1957_FULL.pdf?sequence=1&isAllowed=y

 

Should be interesting:
Motion ‘This house believes that electro-convulsive therapy (ECT) has no place in modern medicine.’
https://twitter.com/user/status/1041637286197297153

 

I recall reading that ECT used at a higher current/voltage is more effective, because it burns out areas of the brain. The same article (sorry, can't remember where, it was years ago) stated that the vendor of only approved ECT device would verbally instruct practitioners on how to open it and extend the range of shock into that zone.
The potential for live zombie status is too high, it's among the rare things in medicine that I believe should be illegal. Some things are just too risky/too open to abuse.

 

But the point is that it is used for people who are already live zombies, like my wife. I am glad to have her back alive and well. Your argument seems to me to be based on emotion and hearsay rather than what is good for people. The stuff about burning out bran is nonsense. The ECT practitioners know all about the physics. They do not listen to 'vendors'.

 

I’ve been dipping into this debate occasionally. I hate the very thought of this type of treatment, BUT I have also seen it be highly effective on an individual well known to me.

This person had a complete turn around in their life after treatment. And now 20+ years later, is still leading a, full, active, and productive life. I have no doubt that without this treatment, the outcome would have been quite different. Like Jonathan’s wife, this individual was completely not functioning. The person we knew and loved was gone - and that person quite simply returned to us after treatment.

 

I guess big part of the problem with this treatment comes from the denial of side effects. Just like with antidepressants and withdrawal, which was dismissed for a long time, but is finally gaining recognition, the promotion of ECT as this magical tool without any major side effects reminds me of why I don't trust psychiatrists. Clearly it can be helpful and clearly it can have profound effects on memory. Need to wheigh prons and cons and be open about it. Of course, if there's no person anymore, the answer is probably pretty simple, but I understand it is offered to patients who are functional as well. I've seen anecdotal reports of patients being pressured into undergoing ECT. Not good.

 

I think that's the problem with any treatments if they are used inappropriately. They not only harm the individual treated, but also others who might actually benefit are put off.

 

I think what the discussion around the use of ECT highlights is just how little we know about how the brain functions and how that functioning can go wrong. There seems to be some reasonable amount of anecdotal evidence that people have been helped.

The problem comes when psychiatrists decide to extrapolate from those results the idea to expand the use of ECT when they do not have any clear idea of distinguishing with some precision who might benefit.

As usual, IMO, this is because it's not about patients. But I'm quite cynical.

 

Yes, the information I had was third hand at best, but persuasive as it was within the context of a long article quoting individual cases with sad results from ECT. How certain what is the cause of those endpoint? I don’t know. On a topic like this, 3rd hand is often the best info we can get, outside professional experience.

I’m glad to hear of your wife’s recovery.