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The Surprising Benefits of Electroconvulsive Therapy - BBC website

Discussion in 'Other health news and research' started by TiredSam, May 4, 2018.

  1. Manganus

    Manganus Established Member (Voting Rights)

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    Location:
    Canary islands, Spain
    You may be right.
    But it doesn't change the fact.
    It can not be known with the required certainty.
     
  2. Trish

    Trish Moderator Staff Member

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    51,864
    Location:
    UK
    Since the article at the start of this thread did not refer to any research articles, I've tried a Google search and found this article:
    Neuropsychiatry(London) 2014
    Current electroconvulsive therapy practice and research in the geriatric population

    Nancy Kerner*,1 and Joan Prudic1

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000084/

     
  3. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    6,047
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    UK
    My doubts about the treatment of mental health problems are because I don't think doctors do a thorough job in checking for physical health issues that could be causing the mental health problems, before they label the patient, dose them up to the eyeballs on something to keep them quiet, and then dismiss them as not worthy of any more consideration. Any physical complaints are assumed to be a result of the mental health problems, not the other way around. And once someone has a mental health diagnosis they are apparently superman or superwoman - after all they can never be physically ill again according to current medical practice. There is, apparently, no point in "wasting" time and money investigating "mad" people, so their physical problems are often never found or believed.

    Another issue is that current medical practice virtually dismisses nutrient problems as being minor and of little consequence, and certainly there is no acceptance that low nutrients can cause depression. As long as (for example) ferritin is just within the reference range, or vitamin B12 matches the bottom of the reference range, then some patients are told that to treat these low levels is "unethical" because their results are in range.

    The issues with thyroid treatment are huge for people of all ages. Current medical practice is massively reducing thyroid hormone treatment (or refusing to supply it at all) once patients get to about 50+, because a TSH of 10 is apparently wonderful once you get older. The fact that Free T4 and Free T3 are bottom of range or below range is fine too, so we are told, because the TSH is around 10 and that's normal for old people. But it isn't. Modern endocrinology doesn't care about symptoms, only blood tests - and I didn't make that phrase up, several endocrinologists have told thyroid patients that.

    But it would appear that nutrient and thyroid problems are too expensive to treat, and too much like hard work. Just give the patient a prescription for anti-depressants. If the patient doesn't get better or refuses to take them then shrug your shoulders, label them as non-compliant, and dismiss them as not worth the effort.

    If the patients decide to treat themselves then they discover that they feel a lot better with iron levels which are mid range, or B12 levels which are top of range, and thyroid hormone levels which are in the upper half of the range. Depression may disappear , but unfortunately what happens is that you end up with lots of angry people who were allowed to rot for decades being told that they were fine, they only needed an anti-depressant.
     
  4. arewenearlythereyet

    arewenearlythereyet Senior Member (Voting Rights)

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    2,092
    I’ve had a lot worse
     
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  5. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    There is no comparison. Everyone who has ECT in the U.K. Has to have it approved by an independent physician and formally recorded. Based on this long term studies have been done. The fact that there is an established optimum dose means that there are reliable measurements of benefit that are not subject to the biases of psychological therapies. Nobody has a vested interest in using ECT. It is expensive and requires highly trained staff an nobody makes a profit.

    The effect is also extremely characteristic in time course. You can even predict the changes in thinking day by day and for times of day. It is a bit like trying to find the best places hang a radio aerial - as you move from time to time rather than place to place the mind seems to retune to normality rather than paranoid delusions.
     
  6. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    13,269
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    I don't think it is necessarily a matter of hindsight. My understanding is that the rules have been skewed by lay pressure. My wife's psychiatrist knew that ECT was likely to be the best option long before things got bad enough for it to be allowed. If she had had it three months earlier sh.e might only have needed one course instead of three. The problem appears to be simple prejudice/politics. And the availability of a dozen drugs to try first has lengthened the delay.
     
  7. Barry

    Barry Senior Member (Voting Rights)

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    8,385
    Was this all pretty much well understood in the 1950's and 60's, or is this level of understanding since then?
     
  8. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    No, I think the formal information stems from much more recently. I suspect 80's/90's although I don't know the papers first hand.
     
  9. Binkie4

    Binkie4 Senior Member (Voting Rights)

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    FWIW- I had 2 individual doses of ECT in the 60s. I was 17. I had no memory loss: took my A levels 6 months later and achieved v good grades, straight to uni. No further psych treatment other than GP antidepressants.

    My mother had ECT when she was 80 as an inpatient. It relieved her of a desperate depression. Terrible suffering.

    ETA: I am now 71 ( reverse numbers)
     
    Last edited: May 6, 2018
  10. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    @arewenearlythereyet, I take the point about being worried about who is prescribing ECT. However, my own experience was reassuring. In order for ECT to be prescribed an independent physician specifically assigned the job of assessing the right indications has to be called in. In my wife's case this was an Indian guy in his late fifties who was clearly used to spending one or more days a week simply fulfilling this task. He was impressively knowledgeable about the evidence and spent rather more than an hour assessing my wife.

    His job included explaining his decision to me since my wife was under section and rightly so because she did not actually exist as a person at this point. The problem was not sadness it was sheer insanity. The guy was brutally frank but in a compassionate way. He was obviously used to this job. He explained that without ECT the likelihood was that the person I knew would never return and the body would require long term institutional care. But with ECT there was a reasonable chance that could be avoided - and he was right.

    The guy who did the ECT was also interesting. He spent much of his time doing this as a specialist skill. He had a comfoRtable friendly room with a couch. He started by asking the patient what music they liked and selected something suitable. My wife likes opera and he said he did too so they talked about that for a while. After the first session my wife looked forward to her sessions so that she could chat about music. She was sedated so that she knew nothing about the procedure. Afterwards she was amnesiac but remembered that the sessions were much more pleasant than the rest of her inpatient routine. The first spark of wanting to be here tomorrow emerged.

    These people reminded me of colleagues in leukaemia oncology or transplantation medicine where the job is to somehow avoid tragedy on a daily basis. They beaR no relation to people who talk of 'biopsychosocial models'.
     
  11. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    Interesting. I actually posted my previous post before reading the third page of comments (brain fog), so hadn't realised the question had sort of already been answered. Thanks for the links and additional clarification, though!

    It does sound like it would help some people. My wariness of psychologists and psychiatrists remains, because I don't necessarily trust anyone with that kind of power, but I'm pleased to hear it can be very effective.

    I'm reminded of June Whitfield in Ab Fab talking about how pleasurable (and in her case addictive, because it's a comedy after all) the treatment was. It does sound like it might be a positive experience.
     
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  12. arewenearlythereyet

    arewenearlythereyet Senior Member (Voting Rights)

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    Thank you @Jonathan Edwards for sharing your story, it sounds a truly awful experience that you have both been through and quite a difficult subject to share so openly. It is quite an inspiring story and does certainly make me feel grateful to all those involved that led to such a positive outcome for you and your wife. It’s also reassuring to hear detail about the rules in place before prescription/treatment.

    I have never had ECT, nor had depression or really reviewed all the evidence to form an opinion of its effectiveness and my mind remains open as to whether it’s a good treatment or not for certain conditions. In fact my cousin had ECT as a teenager following a very traumatic life event that triggered her depression ...but since the event was so awful I’m not sure what good it has done ...this was carried out despite the objections of her parents. She was 14.

    I am experienced with neurologists in the NHS and sadly psychiatrists (despite never having a mental health condition) since the age of around 6 years. My experience of effective diagnosis and treatment is certainly not what you would call favourable. I suppose I am a biased layman.

    I have also lived through around 2-3 years of my wife having severe depression following several miscarriages (not at all the same I realise but at points she was quite severe). Your story resonates with me since these were truly awful times for us, so I can only imagine how awful it was for you.

    For us, luck rather than anything else led to us discovering that the depression and miscarriages were down to her undiagnosed hypothyroidism which meant she could come off the antidepressants that were initially prescribed. It was the practice nurse that had gone through a similar experience that spotted this not her GP who looked no further. The antidepressants didn’t work but the thyroid treatment did and we did manage to have a child (albeit a little later than planned). My wife is fine now...this was quite a transformation.

    I am reassured by your experience of how this works in the NHS currently and if it works for certain conditions then a careful considered prescription and treatment with good predicted outcomes seems all fine and dandy to me.

    However this does lead me to wonder though, what would happen if ECT does become more widely accepted as an early intervention treatment? I’m wondering what would have happened to my wife had the nurse not happened to have noticed that she had been dumped in the depression dust bin? What if this was someone who had no friends or family to look out for them?

    The mental healthcare provision is being looked at by the current government without considering improving diagnosis of alternatives (whether treatable or not). This is worrying.

    Losing ones memory when you have no support at home and you don’t actually have depression still seems a bit scary.

    Best wishes though I’m so glad it worked out well for your wife :)
     
  13. svetoslav80

    svetoslav80 Senior Member (Voting Rights)

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    Bulgaria
    Wondering if electroconvulsive therapy will cause me PEM, or will the general anesthesia save me? Has anyone tried?
     
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  14. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    MPs call for ban on electroconvulsive therapy for women in mental health care
    MPs call for ban on electroconvulsive therapy for women in mental health care (msn.com)
     
    Last edited: Mar 11, 2023
  15. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    This is worrying. I hope it is not an indication that ill-informed MPs are now in charge of detailed healthcare decisions.

    Very simply my wife would be dead without ECT. And so would tens of thousands of others.
    Maybe the fact that more women get ECT means they are lucky - getting better treatment.
    Has anybody thought of that possibility?
     
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