Just wondering if there is any case data for ECT from March, 1943 around anywhere. Just wondering.

Did anyone ever dare to ask what does "treatment resistant depression" actually mean?

It seems to me that this is psychiatry's latest Orwellian-like distortion of words...

If ECT or drugs don't work in depression it's not because the patient is "treatment resistant" , it's because the methods simply do not work... so easy to blame the patient when you come up with some impressive sounding pseudo-jargon to explain things isn't it? ..

Chemical imbalance anyone?..

Psychiatry ... deceptive as always..

Philip:

ECT is the most effective treatment we currently have for depression. Even David Healy supports its use and co-wrote a book about ECT, which basically lamented the fact that it wasn't used more often.

In a 2003 systematic review (Lancet 361:799-808), ECT was superior to sham treatment (i.e. placebo) in six studies with an average effect size of 0.91, and in 18 studies comparing it to medications, had an average effect size of 0.80. The studies HAVE been done, and it is very, very effective.

Unfortunately, as you mentioned, the effects are not long-lasting, and there is a high relapse rate following ECT (65-85% relapse rate within 6 months without medications, 26% with Paxil).

Take care.

I find it hard to understand how a treatment with a "65-85% relapse rate within 6 months" could be deemed effective. And what about memory loss and confusion? Shouldn't that figure into its "effectiveness"? Electroshock "works" the same way banging your stopped watch on the table does. And forced electroshock is a disgrace.

Quote: "ECT is the most effective treatment we currently have for depression"

Quote: "The studies HAVE been done, and it is very, very effective."

Quote: "there is a high relapse rate following ECT (65-85% relapse rate within 6 months without medications, 26% with Paxil)"

How about the devastating side effects? Memory loss, Brain tissue damage, and others?

Where are the long term studies on those not so pleasant side effect results?

Is the short term fix approach, and tainted/marginal results worth the risk?

Most effective or not effective?

OK, you get in line for a good zap, and tell us all how it worked out for you?

If it's so safe, why wouldn't you step to the plate and go for it?

Good Luck

"I find it hard to understand how a treatment with a '65-85% relapse rate within 6 months' could be deemed effective."

This is a fair question. But it tells me less about the efficacy of ECT and everything about our mental health care paradigm. The pharmaceutical industrial complex and APA are market-driven. Time and treatment is money, quick fixes are preferred under this paradigm. As such treatments are designed to quick fix the problem. I do get a bit tired of the reactionary conspiracy paranoia that often accompanies criticism of the psychiatric establishment. Drugs and ECT are not, in themselves, evil or bad. The way they are used is bad.

Treatment of severe depression, some acute psychotic states, and mania can be aided, but not fixed, by ECT. That initial six months of bliss before the relapse is a critical period in which gives patients breathing room. This period before relapse is when the patient must be helped to re-arrange lifestyle, set up healthy routines, engage in intense talk (CBT) therapy, so the relapse is lessened, maybe even avoided.

Unfortunately the current paradigm views ECT and hard drugs as ends in themselves. They are not. They should be the very last resorts after all other non-med treatments have been tried. In an ideal world, there would be enough trained counsellors and shrinks to treat every mentally sick citizen for free. But this world is far from ideal. Thus, in a capitalist, market driven culture, where time and treatment is money, hard drugs and ECT are proposed as first lines of treatment, rather than last. Talk therapy, personal trainers, dieticians all require lots and lots of time and discipline, and this means a lot of money.

The mental health system is a microcosm of our larger culture: we love quick fixes, short cuts and the easy route. The pharmaceutical industrial complex and psychiatric establishment are more than happy to oblige us.

Thankfully, web sites like this exist and cut through the psychiatric and pharmaceutical bullshit, remind those of us who question authority - we are not alone in our suspicions.

Treatment, like mental illness, is not black and white. It requires a balanced, measured approach, and if ECT can prevent me from cutting my wrist, I'll try it, but only as a small part of an overall balanced approach.

From an up-close point of view, having had my father killed from it when I was just a baby, this is what I think of ECT: NO IT IS NOT LONG LASTING...... that said, when one has a completely suicidal family member, no way to endure any longer watching the person 24/7 all day and night and that person agrees and there is no other help around and no hospitalization possible for long enough, this is what it does: It rips away your thoughts and memory temporarily so that you FORGET you are going to kill yourself. By the time you emerge COMPLETELY from the daze and memory loss and confusion, from what I and the person enduring it could ever tell, you go on - albeit w/ some crappy med that in one case kills you in the end, memory intact. But you don't take up the knife. Or the gun. And it is humane from a time perspective. Weeks of suicide watch wears down the most well-meaning and loving and praying family member.

That is the best way I know how to put it. And was my experience with beloved family members.

Please do not attack me for this statement.

Francesca:

You have to remember that ECT is usually reserved for those who are actively suicidal, are no longer eating and drinking, are in a depressive stupor, and/or are psychotic. These are the most severe cases, and as such it is amazing that there is anything that can help them as effectively as ECT can.

Yes, there is a high rate of relapse, which is why most physicians will recommend antidepressants to reduce the risk of relapse by half, particularly with Paxil. And yes, there are memory impairments that are important side effects that should always be taken into consideration. This is all part of the risk-benefit analysis that must be done with any patient.

Is ECT perfect? Not by a long shot, but it's the best treatment we have for those who have very severe major depression.

Take care.

The saga of the FDA's scandalous treatment of the electroconvulsive therapy device is too long to summarize here; it is so long it requires three chapters in my book on the history of shock treatment just published by Rutgers University Press, "Doctors of Deception: What They Don't Want You to Know About Shock Treatment." Please read chapters 9, 10 and 11 for the full story.

The short version is that ever since FDA gained jurisdiction over medical devices in the 1970s, former ECT patients and concerned citizens have lobbied the FDA to conduct an independent scientific clinical trial to determinate whether ECT damages the brain. The American Psychiatric Association lobbied against a safety investigation, and with its money and power, cowed the FDA into taking the position, expressed in the Federal Register in 1990, that ECT devices should be reclassified to Class II rather than investigated for safety. But the agency never went forward with reclassification, nor did it take any action when it called on the manufacturers to produce safety and efficacy data in 1995 and the manufacturers ignored the call.

In other words, there are other risky devices the FDA neglected to investigate, but there is no other device the FDA so proactively and steadfastly REFUSED to investigate, because of its capitulation to industry. There is, I am quite sure, no other device whose FDA docket consists of more than 40 volumes including large numbers of letters from patients who experienced permanent amnesia and brain damage pleading with the agency to take action to protect future patients.

The manufacturers cannot produce data to prove their devices safe, because none exists. The little research which has been done confirms that shock treatment is neither safe nor effective. For example, the January 2007 issue of Neuropsychopharmacology published the first study in 21 years which followed up patients as long as six months (the previous study in 1986, which included only a couple dozen patients, had found that shock causes permanent extensive amnesia.) The Neuropsychopharmacology study was notable for having been done by a researcher who was concurrently, and had long been, a consultant for shock machine companies (though this was not revealed to readers). Even so, it was forced to conclude that "This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings."

Nevertheless, there is no evidence that FDA is now any less afraid of wrath of the American Psychiatric Association than it has ever been, and the APA promotes ECT as if its life depends on it---for it does.

Nor is there any evidence that FDA now intends to do anything other than what it has consistently expressed the wish to do: reclassify ECT devices into Class II, the low risk category, without requiring manufacturers to prove their devices safe, and without conducting a safety investigation itself.

It is up to an informed public---all of us---no matter what our opinion is of shock treatment--to put pressure on the FDA to do what its own law requires. Either ECT must be proven safe to brain and memory (a scientific impossibility) or ECT devices must be taken off the market (a political impossibility). FDA must not be allowed to simply capitulate to the APA finally and forever.

Another generation of patients must not suffer permanent amnesia, cognitive disability and brain damage because government is afraid of a powerful special interest group.

In 2003, the national organization of persons who have received ECT, the Committee for Truth in Psychiatry, petitioned the FDA to maintain the ECT device in Class III. Appended to the petition were more than 600 pages of evidence of shock treatment's lack of both safety and efficacy, consisting mainly of articles published in medical journals. There is no evidence that the agency has ever read or considered this material, but it can be viewed by anyone who visits the FDA's public reading room.

The term "treatment resistant depression" seems to mean depression that doesn't improve from any of the treatments that someone can make a profit from. A different kind of system would offer even treatments that might be less lucrative.

My only serious objection to ECT is that it can be forced on people. It doesn't seem unreasonable to me to have it available to people who are informed of it's possible pros and cons and choose it for themselves anyway.

I wasn't actively suicidal and hadn't stopped eating and drinking when I had some ECT treatments forced on me in the mid-1970s. The MH professionals who force people to have ECT don't have to live with the life-long consequences of it - they usually don't even have any contact with the people who give it to for more than a few months after the treatments stop.

Ray Sandford of Minnesota, who is currently undergoing forced "maintenance" shock treatments, is not suicidal or in a stupor, or anything like that. National Public Radio had a show about his plight last year: http://www.npr.org/templates/story/story.php?storyId=98273451 -
and Ray and others talk about his still-continuing treatments in this video: http://www.youtube.com/watch?v=2fJpvNHqXm0

The ECT seems to be doing him nothing but harm, but a lot of people are having a lot of money be paid to them as a result of the ECT that he is being forced to have. It is a failure of psychiatry that they cannot prevent ECT from being used in this way by some of their colleagues.

"Is ECT perfect? Not by a long shot, but it's the best treatment we have for those who have very severe major depression.

Take care.

Posted by: dguller at April 14, 2009 01:19 PM"
-----------
Then, tell us why the United States FDA orders a safety effectiveness data due with a timeline for reports?

To read one or 2 studies and to quote Healy as reasoning for the quoted statement above left by a commenter is reckless in my opinion.

Ray Sandford is being forced to endure ECT in Minnesota for out patient treatment, and though verbal, his wishes to stop ECT are not being upheld.

Watch a video interview here. The MindFreedom advocacy group has not been able to stop Ray's forced treatment in Minnesota, it's up to all mental health advocates here to speak out and stop this inhumane and barbaric treatment--even more, now!

Skeptic,

How can people engage in CBT and lifestyle changes after ECT when the chances are great they will barely be able to remember the simple things in their lives?

Kind of reminds of the stories commentators have told on this blog about people who are in patient psych being forced to attend therapy groups highly doped up on meds. Somehow these people were supposed to benefit from these therapies in that condition.

Stephany:

It wasn't "one or 2 studies" that I based my opinion on. The meta-analysis that I cited had analyzed TWENTY FOUR studies in total. Oh, and I thought you liked Dr. Healy's work?

The fact is that ECT is the most effective treatment we have for severe major depression. There is no point arguing about it, because study after study have demonstrated this fact. That does not preclude its having significant cognitive side effects that must also be considered. However, usually when ECT is used, the situation is extremely dire -- e.g. someone is so depressed that they are malnourished and starving due to a severe loss of appetite -- and thus extraordinary measures become appropriate.

Take care.

Stephany:

Oh, and one more thing.

The FDA also ordered an assessment of the efficacy and safety of external heart defibrillators, dialysis catheters, hip joints, spinal screws, a heart pump and other products.

Any particularly sinister aspects of dialysis catheters that I'm missing? I mean, there MUST be, otherwise "tell us why the United States FDA orders a safety effectiveness data due with a timeline for reports"??

Take care.

D Guller..

Why do you bother to post your psychiatric pseudo babble on here, do you think you are going to get anything other than a hostile reaction from people who have been severely damaged by your profession?

It is downright insulting ..

ECT is a barbaric practice , my grandmother was given ECT , under "drugged consent" and while suffering from post-natal depression and grief from the loss of my uncle, who died tragically in a motor cycle accident...
She has severe memory loss and was never the same.
My best friends mother was ECT'd to DEATH after years of the psychiatric system..
It is quite simply astounding that you would dare to defend and promote this disgusting abuse of human rights and human life..
There is only one psychiatrist this side of the pond that I trust..
His name is Dr Michael Corry, he is totally against ECT and the use of Psychotropics.. Maybe you should take a leaf out of his book and get some ethics and a soul! (oh but I forgot psychiatry doesn't believe in that does it?)

http://www.depressiondialogues.ie/

(Michael Corry's website)

I believe that any forced OR coerced (even subtly - another term for this is lying or not giving full info. and this goes on all the time) is disgusting and if anyone was on the ball well over half the "profession" would be in prison garb. That said, if a person is acutely suicidal OVER TIME, and nothing is helping, and the one family member is about to keel over with worry and praying, every day, that his or her son or daughter will not do the deed that day, what else is there? If the person is in psychotic depression or catatonic what are the options. In certain instances, barbaric though it may be, ECT proved several times to be humane in my family. Believe me, if there had been any other humane alternative that would have worked, we would hav opted for that in a heartbeat. And even after all the vigilance, and terror, one's child is killed in the end by ZYPREXA.

truthman30,
Thank you very much for the URL. I have dual citizenship, will probably be moving back to Ireland in the next few years so this is very helpful to me.
Sherry (who used to live in Dun Laoghaire--but can't afford to do so now)

My comments on what dguller said:

"You have to remember that ECT is usually reserved for those who are actively suicidal, are no longer eating and drinking, are in a depressive stupor, and/or are psychotic."

Actually, around here (Vancouver Island) and elsewhere, you don't have to be nearly as sick as that to be threatened with electroshock. In fact, you don't even have to be depressed. You can just be angry.

"These are the most severe cases, and as such it is amazing that there is anything that can help them as effectively as ECT can."

Why is it amazing? Hosing patients down with cold water would achieve much the same result.

"Yes, there is a high rate of relapse, which is why most physicians will recommend antidepressants to reduce the risk of relapse by half, particularly with Paxil."

So, best case scenario, we're looking at 30-40% relapse within six months? Thanks, you can keep it.

"And yes, there are memory impairments that are important side effects that should always be taken into consideration."

Psychiatry doesn't see electroshock's side effects as 'important.' Every psychiatrist I've discussed the matter with has minimized them.

"This is all part of the risk-benefit analysis that must be done with any patient."

Yeah, but, unfortunately, the 'risks' and 'benefits' tend to be weighed by the psychiatrist, who has a vested interest in proceeding with the treatment. And, of course, in the case of forced treatment, the patient's feelings on the matter are completely disregarded.

"Is ECT perfect? Not by a long shot, but it's the best treatment we have for those who have very severe major depression."

And given that the 'best we have' is so f-ing awful, perhaps we should reserve it for those who wish it, after being fully informed of the risks.

Guller, I will address you once, due to you directing 2 comments toward me.

I do not know why you would assume I "liked Dr. Healy's work".

Don't assume anything about me, and what I think about Healy or you for that matter does not belong in this discussion.

This discussion is already going off topic, the bottom line is the equipment is up for review for safety.

I appreciate this article, but will no longer comment in this thread as a result of certain commenters.

Truthman said, "Did anyone ever dare to ask what does "treatment resistant depression" actually mean?"

Thank you. My "treatment resistant depression" was due to the fact that I was getting the wrong treatment.

I walked into the psychiatrist's office depressed but functional - I was working and attending grad school. By the time he was through with me I was on multiple medications, I had stopped attending classes, I rarely left my house, I was being told that my situation was such that ECT was my only hope, and I had been hospitalized multiple times. At the end of my psych career (in 2002) I was given a prescription to attend what amounted to an adult day care where the treatment plan included making elementary age crafts and sitting in a circle talking about nonsense all day. If you want to reinforce hopelessness and helplessness, then may I recommend that treatment plan.

My medical records from that time period say: "Treatment resistant depression," "severe recurrent major depression," etc.

Since leaving AMA in 2002, after a pretty hellish withdrawal and after the fog cleared I went back to school, graduated with a third degree and have worked full time ever since. I didn't get better under my psychiatrist's care for very good reasons, none of which had to do with mental illness.

ECT was not my only hope, and it was not the only thing left to try. They need to stop saying things like that to people.

AA,

You asked me:

"How can people engage in CBT and lifestyle changes after ECT when the chances are great they will barely be able to remember the simple things in their lives?"

That's a good question, to which I have no answer, because I have no direct experience with ECT. My cursory understanding of the treatment suggests to me that in very exceptional cases, it can be an effective treatment. My preferred treatment for the most severe, chronically suicidal depressed person would be to first try an anti-depressant combined with CBT, and slowly try to work in lifestyle adjustments. But if all these options have failed, and the one remaining treatment available is ECT, why not? Especially if the patient wants to try it. For the most severe cases, you get to a point where the options are (a) suicide or (b) one or two treatments that haven't been tried yet, one of which might be ECT.

Thankfully, I haven't reached that point in my depression, but if I did, I would want to try anything to prevent me from offing myself. I realize your question was more related to supposition that people who undergo ECT are not able to undergo CBT because the ECT has rendered them drones. I have no answer. Are there no cases that show ECT has helped someone to a point where they can function in the world and become self-reliant or resist killing themself?

"...if ECT can prevent me from cutting my wrist",said The Skeptic.
See the comic at the link please.
LINK

Francesca:

First, I’ve told you what the guidelines recommend regarding who to use ECT on. It is usually after multiple prior treatments have failed and a person is still in significant distress and unable to function, OR there is an emergency situation involving starvation, stupor, active suicidal ideation and/or acute psychosis. I cannot speak to what every psychiatrist actually does in the real world, but the guidelines are the guidelines.

Second, I would love to see the studies that show that hosing down the most severely ill of those with major depression is an effective treatment.

Third, we need to keep things in perspective. ECT has an 80-90% response rate and a 60-70% remission rate in the most severely ill of those with major depression. You would refuse this treatment and recommend others against using it, because its remission rate is “only” 60-70%? Wow. I suppose you would recommend against cancer treatments, because they have horrific side effects and are not 100% curative?

Fourth, ideally ECT should be reserved for those who freely choose to use it, but what about those who are actively suicidal and do not want to get treatment? What about those who are so unmotivated that they refuse to answer your questions? What about those who are so unconcerned about their life that they are starving to death? Should we just let them die? I hate declaring people incapable to consent to treatment, but there are times when it is necessary. Where I practice, after declaring someone incapable to consent to treatment, we have to find a suitable substitute decision maker, usually a person’s spouse or first-degree relatives. If they agree, then we give ECT. So, consent is provided by a patient’s family, just not always by the patient.

Take care.

AA:

You wrote that "chances are great they will barely be able to remember the simple things in their lives". What are the chances of this severe form of retrograde amnesia from occuring after ECT?

Take care.

dguller,

If you're going to make comments like this: "You would refuse this treatment and recommend others against using it, because its remission rate is “only” 60-70%? Wow. I suppose you would recommend against cancer treatments, because they have horrific side effects and are not 100% curative?"

I think you'll find people won't welcome you into this dialogue. I know you can't argue coherently but, still, please refrain from telling me what I think. No, I wouldn't refuse the treatment because of its remission rate, dumbass. I would refuse the treatment because its effects are devastating.

The issue is informed consent. I have no problem with electroshock if it's what patients want after being truly informed of its risks and benefits. And, for what it's worth, yes I would speak out strongly about forced chemo and radiation or any other forced treatment.

You're in a forum here where most of the participants have been harmed by your profession. Step back and have a little respect. There's plenty of "rah, rah, drugs, electroshock, go!" websites. This site is not about that and perhaps discussion of electroshock's effects should be left to those who have suffered them.

I will not be responding to any more of your posts directed at me. You have all the usual attributes of any person authorized by law to label, sequester, humiliate and demean.

Forgot to put in my last post ...

It really doesn't matter what the guidelines are if the guidelines aren't followed.

dguller,
Here's a key problem with communication between you and many people who've had the misfortune of spending time with your colleagues. You said:
"First, I’ve told you what the guidelines recommend"

You live in a world of guidelines. The rest of us live in the real world. You're like one of those cardinals in the Vatican who exist to refute any legitimate problems the regular churchgoer may have with the church. We regular peeps were taught certain things by the nuns. The Vatican reserves a class of people they trot out to mouth Official Policy when needed. The Official Policy, of course, is totally meaningless in the real world in which the rest of us live. It's the old Nixon White House deniability trick and it works. Except with people who know better.

And to answer your (presumably rhetorical because your mind's already made up) questions:
"Fourth, ideally ECT should be reserved for those who freely choose to use it, but what about those who are actively suicidal and do not want to get treatment? What about those who are so unmotivated that they refuse to answer your questions? What about those who are so unconcerned about their life that they are starving to death? Should we just let them die?"

My answer is YES. That's what INFORMED CONSENT is all about. I've been where you're describing and I'd rather die than submit to ECT and yes, I've seen it do temporary wonders.

Here's what it's like in the real world, dear doctor: ECT WASN'T recommended when I was refusing treatment or unable to speak or eat. Or during the two years in which I never got out of bed (and how I wish I was exaggerating). Oh no, I got the ECT recommendation from a doctor in designer clothes who'd met with me a whopping twenty minutes earlier. She had a ward of 22 patients. 14 of them were receiving ECT. The rest of us were being urged in the most unseemly manner to submit to it.

You see, just because I had untreated hypothyroidism doesn't mean I can't count. Do you really think we patients can't do the math? This woman got $120 per hour for talk therapy upstairs. Downstairs she raked in $350 every fifteen minutes for her "therapy." Hey, she had those designer suits to pay for. It took my husband and my therapist to get me out of there unscathed. We nearly had to hire a lawyer.

My niece's job is to take care of people post ECT. She's been doing this job for 20 years now. She's had the opportunity to watch your colleagues turn moderately depressed people into vegetables. Heck of a job, Brownie.

I am an incest survivor. If you were to overcome me physically, drug me into unconsciousness to violate my body you would be signing my death warrant. Make NO mistake about it, dguller. My life issue is control of my body. I would never, ever get over that kind of violation. And for what? So *you* could feel better, could feel as if you'd "done something". "We had to destroy the village to save it."

I used to work as a geriatric social worker years ago in an isolated rural area. I had many clients living in tar paper shacks with wood heat and no running water. People pressured us all the time to "do something". I had to grapple with the ethical and moral issues involved as a young woman. I finally realized we all wanted to "do something" because WE wanted to sleep better at night. The fact we would be killing these people's souls to save their bodies was irrelevant. There are worse things than death. One of them is loss of freedom and control of your very body. You really have nothing else in life.

Geez, now I'm sitting here wondering why the hell I bothered to write all this? It's not as if you'll ever listen. You're way too full or yourself to hear anything the rest of us have to say here. But honestly, doesn't it cause you just a moment's pause to hear so many of us say how much better we're doing without you and your colleagues? Just what do you make of these stories, anyway? Even before I was finally diagnosed and treated correctly (no thanks to the 30 or so psychiatrists I've seen in my time) I was doing much, much better once I got off the meds and out of "therapy." Once I got away from the psychiatrists--and their colleagues the mental "health" workers--I was able to get out of bed, stay out of the hospital, work part time on an Americorps position which restored my dignity. There is nothing, nothing dignified about what your profession does to people. Nothing.

I feel pretty good most days now. I work part time. I still know I'd be better off dead than having ECT. I feel very strongly about this when I am in my "right mind" so I don't know where you get off thinking you should be entitled to override my expressed wishes should I slip into a depression.

Sherry:

Thank you so much for sharing your story.

I am extremely happy that you have been able to recover from your illness, especially without the help of my profession!

I am actually quite shocked that your physicians never checked you for hypothyroidism, because it is usually part of the standard medical work-up for depression to check TSH levels, according to our guidelines. If your hypothyroidism was the cause of your depression, then it is malpractice for your psychiatrists to have treated you with psychiatric medications, and to have threatened you with ECT no less!

I am sorry for your traumatic past experience, and it is certainly your right to refuse treatment, according to your values, and I would encourage you to make your wishes known to loved ones for the record. That way, if you ever find yourself in a situation where you are declared incapable to consent to treatment, then your substitute decision makers can make decisions in keeping with your values, including refusing treatment.

I wonder what you would have physicians do if you were in a state of delirium due to a treatable medical illness, with sepsis for example? Would you tolerate being treated against your will in that case? Or would you demand that you be left untreated, because you would be horribly violated? Are your reservations mainly with psychiatric treatment, or do they include standard medical interventions that you did not consent to due to an organic brain pathology?

Also, I am intrigued by your niece’s work with post-ECT patients. Does she work in a hospital or in a long-term care residence? Did she know the ECT patients before they received ECT, or does she only come into contact with them after treatment?

Thanks for your time.

Hi Skeptic,

Let me clarify my position.

When I am suffering withdrawal symptoms from my psych med tapering, the last thing I am interested in is CBT. By the way, I have memory problems when the withdrawal symptoms are strong.

I realize that you're not going to always feel perfectly and at some point, you have to push yourself. But because of my experiences, I have a hard time visualizing people who have had ECT with the common memory problems engaging in CBT.

If you wanted to do ECT, as long as you are informed of the risks, that is ok. But sadly, that isn't always the case.

deguller said, "Fourth, ideally ECT should be reserved for those who freely choose to use it, but what about those who are actively suicidal and do not want to get treatment? What about those who are so unmotivated that they refuse to answer your questions? What about those who are so unconcerned about their life that they are starving to death? Should we just let them die?"

What you don't seem to understand is that there are people on this board who have been in that condition. And for some of us the reason it got that bad was iatrogenic. When people are loaded up on more and more medication and continually decline that ought to be a clue that what you're doing not only isn't helping, it's making a bad situation worse.

"ECT has an 80-90% response rate and a 60-70% remission rate in the most severely ill of those with major depression."

I think the point of the current inquiries are to explore whether those stated remission rates (and the current guidelines) might simply be wrong. As Philip quotes from one study: "In contrast to the 70%-90% remission rates expected with ECT, remission rates, depending on criteria, were 30.3%-46.7%."

Given the amount of bias and conflicts of interest being increasingly revealed in psychiatric research, it's difficult for many people to reconcile what is quoted in studies versus what they plainly see all around them. As Marcia Angell said in a recent New York Review of Books article: "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine."

(Thanks Philip for the link http://www.nybooks.com/articles/22237 in your article at http://www.furiousseasons.com/archives/2009/01/marcia_angell_kicks_ass.html )

Lisa:

Excellent points. Sometimes it IS hard to know when an exacerbation of symptoms is due to the illness or the treatment. There are clues that one can use, but sometimes the best thing to do is a trial off medications to see if there is a difference. This is definitely not an exact science, and is ultimately a matter of differing probabilities that require the patient to be a partner in the decision-making process.

dguller, you are "so right" in your profession; your professional guidelines, your DSM, your academic medical hierarchy, your basically fake profession....I understand how you can show up on this blog and presume your Rightness and Righteousness. It fits with all your colleagues. It fits with your" profession". No matter what you do or say, no matter what you have seen or not, you are talking to people here who have suffered and been severely abused or, in the case of some families, KILLED by the gods of your profession that it doesn't matter what you say from high up on your mighty horse.

Please go away. Philip seldom yanks posters here. For the sake of any goddess you choose, I wish he would yank you now. A holier-than-now shrink, no matter how "well meaning", is all but unbearable to most of the people here at this particular moment in time, on this painful and abysmal topic, no matter how "right" you are sure you are or even ....are. Let us who have walked in the valley of death speak. Go away. Please.

dguller,
It seems less than honest to me to compare a medical condition which could directly kill a person, like sepsis, with a state of mind which may (or may not) lead someone to kill themselves in some way. Behavior and state of mind can be influenced by environment, for better or worse. At the time I was made to have shock treatments, I was locked up inside an institution which subjected me to a mind-numbing daily routine of meetings and activities which only increased my feelings of hopelessness and futility. Despite that, I was not suicidal or anything close to it.

I think there may have been things that happened in my life that I was unable to come to terms with, and unable to get over or put in context in such a way that I could get beyond them and look forward to other things, and that may have been at the root of my despairing state of mind. The ECT may have made all that seem irrelevant, I guess, but it didn't really do anything to make me less ill-equipped to face the future. I was probably lucky to have had only a small number of shock treatments, but I still have a lot of permanent memory loss as a result.

It would be best, I think, if noone were ever forced to have shock treatments. But since that's not likely to happen anytime soon, I think some kind of mitigation fund should be set up. I think a portion of the profit made from every forced shock treatment should be set aside to provide some compensation to people who experience life difficulties that may be related to ECT that they were forced to have, or misled into having. Just something to help make up for some of the damage that may have been done - or at least the effects of that damage. That might take away some of the financial incentive for forced shock treatments, and perhaps create a little hint of accountability where none exists now.

Kent:

Excellent points.

Your idea of a mitigation fund is a great one, and I would definitely support it. It might also be a good idea to extend it to all involuntary treatments, including emergency surgeries, for example, just to make sure that everyone who has been harmed by medicine against their will could be compensated.

Regarding your first point, you are correct that suicidality fluctuates, but I think that ECT is reserved for those who are actively suicidal and have a history of suicide attempts, usually a recent one, which makes the likelihood of their committing suicide higher. Also, you did not address those who have stopped eating and drinking due to severe amotivation, for example. That is certainly a sure fire way to die, and requires an intervention, I think.

You also made a point that ECT -- and probably medications, too -- do not automatically dispel whatever psychosocial stressors precipitated the depresion. You are absolutely correct. I'm not a huge fan of biological psychiatry, even though I do believe that medications are extremely useful in many severe cases, but I certainly try to understand my patients in terms of their life history, stressors, maladaptive coping strategies, and so on, and to reflect that understanding to them so they can use it to change. However, many patients aren't interested in that type of treatment, and only want medications, which is too bad.

Thanks.

Phil:

The guidelines are certainly wrong in some respects, which is why they are updated every few years as more research is done. They are not infallible, and no-one claims that they are. However, they are the standards of care at this time, and all physicians are highly recommended to follow them.

That said, Dr. Angell is absolutely correct that the current system is incredibly flawed with conflict of interests all over the place. That does not mean, however, that all research must be rejected as fabricated and false. Rather, we have to take a case-by-case analysis and not chuck the whole edifice at the onset.

You asked about ECT remission rates. ECT has a RESPONSE rate of 80-90% and a REMISSION rate of 15-25% over 6 months (which increases to about 75% over 6 months when ECT is followed by Paxil). I was incorrect when I wrote that ECT's remission rate was 60-70%. I meant that it gets around that high when continuation medications are used.

Thanks.

dguller,
Rather than engage in the kind of point-by-point discussion which you seem to prefer, may I offer you some feedback about your communication style? You say you care, that you're "not like those other psychiatrists," that somehow you're different. We here, of course, have been to this particular movie any number of times and will get to do so again, I'm sure. From time to time your ilk wanders in to assure us they're the "good guys," then proceeds to attempt to browbeat us into submission. This is exactly what you have done here. The astonishing thing is your lack of insight about your effect on people.

Your preferred style of communication (if you want to call it that, communication usually being a two-way street, but not in your case) seems to be that of debate. Can you tell me just how you see this fitting in with compassion and healing?

Debate is competitive, concerned with scoring points and winning--your style exactly. This is totally at odds with the kind of healing your profession claims to concern itself with. It is an activity of the brain--the left brain, actually--and the kind of healing your constituents seek is that of the heart. You are doomed to miss the boat, because you're always standing at the wrong pier. Of course, you'll never realize this because winning is what turns you on, it's what matters most to you. As long as you score points you feel you've somehow accomplished something. You never notice the something you've accomplished is at odds with your stated goal. That, I suspect, is because your stated goal is not really your goal at all. Winning is your goal and you don't care who you trample in your rush to the reinforcement and adrenalin high of victory. You're as big an addict as any I've ever seen.

Your colleagues have perpetrated any number of instances of malpractice upon me. The last series of events nearly killed me. At that point they resorted to outright lying to cover their butts. At this point I am in recovery mostly from iatrogenesis. I will be 61 this month. I'm able to work part time at a demanding job, but have lost so many years in the work force I am unemployable. My stamina isn't what I'd like it to be. I'm not sure how much of this is being 61 and how much is the result of decades of hypothyroidism. I've run the numbers and it makes no sense at my age for me to attempt to work full time even if there was work available. I intend to string my keepers along until I'm 65 and can switch from disability to retirement. At that point I will hire a lawyer to move heaven and earth to expunge my mental health record entirely. If you think I'm going to move into seniority, knowing that older women are special targets of your profession (I've seen it all, you see, and from both sides of the desk) you are very much mistaken. My sweetie and I will be moving in four or five years, either out of the US or to another region and there will be no mention of any mental health history in the records I take with me. I will not put myself in danger of "treatment" by your esteemed colleagues--or yourself, should I end up in Toronto. (Did I mention how much I love Toronto? Film festival, interesting ethnic groups, wonderful people, it just goes on and on with that place.)

Your colleagues, by the way, DID test my thyroid. Every so often I would agitate for them to do so and they would, mainly to shut me up, I suppose. My test results didn't change much over the years--always "low normal." They refused to discuss the shopping list of hypothyroid symptoms I exhibited, all of which have improved greatly with treatment. I was scoffed at when I brought up the notion of menopause, which is probably just as well. At least I escaped being "treated" for that, too, although I went through it by myself with very little understanding of what was going on.

Years ago, one doctor--who was roundly jeered at and castigated by his colleagues, your colleagues--actually said "Your test results are normal but you have all the symptoms of hypothyroidism. I'd like to start you on treatment to see if it helps." Alas, this fine gentleman died several weeks later of a heart attack. His colleagues still make cruel jokes about him. These colleagues, by the way, are the very people you seem to think I should entrust with my care. (Oh, I can hear you now, up there in Toronto, telling yourself these guys are the exception and not the rule, missing the boat once again.)

While my test results haven't changed, the way you idiots read them have. Well, at least in some circles. Seems you all can't get together on this. Once again I agitated to have my thyroid tested. I simply couldn't believe I could have all these symptoms (which no one was willing to discuss--apparently medications are a much sexier topic) and NOT have something wrong with my thyroid.

Thanks to the new way of reading the same old test results, I finally got treatment. But wait. I almost DIDN'T get treatment because no one bothered to tell me the results. Six months later I happened to be seeing the PA for a sinus infection. On my way out the door I happened to remember to ask about those old test results. Had I not done that I might well be dead by now (and you would have missed the joy of scoring points off me today, which I'm sure you will because I'm interested in genuine conversation, not debate so I'm not as motivated as you are in playing your game) because I was seriously contemplating suicide at the time.

As for my niece, she works in a Very Famous Hospital, attached to a Very Famous Med School. You would recognize it. She works on the wards and in the outpatient department so yes, she knows these people over time and pre-, during and post-"treatment". I'm afraid you won't score any points there, doctor. The fact is, your profession routinely turns moderately depressed people into talking cabbages.

I cannot believe you actually think you're engaging in conversation here. And to think you were smart enough to get the credentials to label my thoughts. Remarkable.

Some days I really regret switching majors from pre-med. Had I persevered, at least I could have written myself a scrip for some levothyroxin and saved myself decades of misery at the hands of YOUR profession. Deny it all you want, you're stained with the same blood.

Sherry:

Thanks for your comments. I probably could have done without the ridicule and insults, but your points are well taken. Your physicians appear to have truly missed the boat with your care, and I am sorry that it took so long for you to get adequately treated. You have every right to be furious at my profession, and I would feel the same way if I were in your position.

Good luck with working until retirement, expunging your mental health records, and moving out of the U.S. with your partner.

I wish you well.

D Guller is just as indoctrinated and his mindset is just as warped and twisted as all the other sick psychiatrists out there. The psychiatric belief system encourages a complete disregard for human rights. He's here to stir shit up and try to counteract the negative comments about psychiatry. That's all! .. He is a clever troll ... The tone of his posts are totally robotic and soulless , he cares nothing for people being drugged to death or ECT'd into drooling vegetables. He is here to defend his profession , he's not here to engage on an equal level. I know the truth about psychiatry, and his attempt at blinding people with pseudo facts and figures is absolute nonsense. He doesn't give a crap about mental illness. He makes his money destroying peoples lives, all psychiatrists of his ilk care about is their ego and a paycheck. Most of them are completely mad themselves and a large number of them are sadistic sociopaths, they hate humanity and they hate people. Ultimately it's all a huge power trip for them.

I read somewhere, that there won't be any justice in this world until the last banker is hung by the entrails of the last bishop..
Well, as far as I am concerned psychiatrists are even worse than those blood sucking vampires.

Psychiatrists are not human, they don't think like human beings, they don't recognize human emotions, personalities or idiosyncratic diversities . To them we are all just giant lab rats. The quicker people realize the lie, fraud and absolute bullshit that psychiatry is...the better.. as far as I am concerned. The whole profession and what it does to people is vile..

Dear truthie,
Geez, you said that so much better than I.

Thanks.
Sherry (who's trying to remember if she asked you if you live in Eire and, if not, do you?)

truthman30:

So, psychiatrists are subhuman monsters who should be systematically executed. Fantasizing about the mass murder of a group of people, eh? The perfect hallmark of a healthy mind.

I think I'll take your diagnosis of my sociopathic personality with a very large grain of salt.

dguller,
I was thinking of people who end their lives by passive means (such as not eating or drinking) when I put the phrase "in some way" at the end of my sentence about people killing themselves. I think people who don't want to eat or drink should not have any violent or intrusive actions taken against them - attempts to convince or entice them to give up their fasts, and to try and understand why they don't want to drink or eat anything at all, should be the most that anyone else does in the way of intervention into their lives. Anything more than that shows a disrespect for their personal boundaries, I think. The right to not do something, especially something that affects primarily one's own self, should generally be more unrestricted than the right to proactively do something.

Your statement that "ECT is reserved for those who are actively suicidal and have a history of suicide attempts" flies in the face of my own personal experience, and of what I know of the experiences of most others who have been forced or coerced into having shock treatments.

I think a mitigation fund is especially called for in cases of people who have experienced forced ECT, or other kinds of forced psychiatric treatment, because I believe such forced treatment often leads to a lifetime of poverty and hardship. People should be compensated for the long-term difficulties that result from such extreme kinds of unwanted intervention in their lives. Traditional psychiatry and the mainstream mental health system in many industrialized countries (including Canada and the United States)seem to have very little of any real value to offer many people who experience extreme mental distress, and when that is the case I think people should be left alone, or be free to pursue other alternatives.

It is quite remarkable Mr Guller how you react so quickly to my emotive posting about your profession whilst at the same time the posts on furious seasons are heaving with tales of damage done by your profession, and your response to those is quite measured and clinical and polite...

If I were to diagnose you Mr Guller, I would say that you have a definite god complex and super ego goin on there... way beyond the realms of a sociopath actually... I'd say you get a huge kick out of your status , I'd say you just love to sit and judge people, bet it makes you feel good does it? .. Poor unfortunates coming to you for help and you can marinate soundly in your schadenfreude mind , relishing in the fact that you're on the "normal" side of the fence... Safe behind your fascist DSM ..
Psychiatry doesn't diagnose real diseases , it brands vulnerable people with a potential death sentence.. your psychiatric mind is so inherently anti-human , you don't know the meaning of empathy, love and the human condition because you have no respect for anything that human beings experience.. It is you and your kin of psychiatrists that are the sick ones.. Karma will get you all in the end..

And by the way..
I said nothing about psychiatrists being systematically executed..
That was your interpretation on my analogy of bankers and bishops..
Looks like your subconscious mind dreamt that one up Mr Guller , not mine.
My mind is perfectly healthy thanks very much, I am off SSRI'sI 7 years now, I am grateful to have no part n your disgusting and brutal inhuman murderous machine anymore..
And I am grateful to have broke free when I did..
Some are not as lucky as me..

But I will always remember what you almost did to me , you and your twisted colleagues , prescribing dangerous drugs like Paxil , drugs that make people actually end up with real mental llness as opposed to the life traumas that they begin with..
I flew over the cukoo's nest Mr Guller..
But now that I know about your hideous cult of fraud and lies , I will continue to make others aware of it , and if that ruffles your feathers, then that;s just tough..
Get a real job ..
Your a friggin fraud and you know it..

Dear guller,
Can you not tell the difference between anger and symptoms?

Not very perceptive, that.

Kent:

Fair enough. I suppose that I look at things a bit differently. When I encounter someone brought to the emergency room by family members because they are severely depressed and have stopped taking care of themselves due to the utter hopelessness and lack of motivation that they experience, I cannot in good conscience simply send them back home to die if they refuse to be hospitalized. This is particularly true when their cognitive distortions and punitive core beliefs are so severe that it is essentially impossible to engage in a therapeutic relationship with them. This is especially true when psychosis is involved.

At that point, I tend to look upon them in the same way as I would look upon a patient in the midst of a delirium as being not in their right mind and whose perspective would likely change when adequately treated.

I suppose our disagreement comes down to what it means to be able to consent to treatment. In Ontario, a person must be able to understand and appreciate the pros and cons of receiving and rejecting treatment for their signs and symptoms. I often find that patients in the above situation are unable to meet this criterion, because their psychic distress is so intense that they cannot process information properly. It is a different story if someone is calm and has thought things through, is able to repeat, in their own words, the aforementioned pros and cons. In that case, they have a right to refuse treatment, even if it should result in their death.

These are difficult ethical issues, because we all have conflicting values about these matters, creating a massive grey area. You raise many valid points that all psychiatrists should definitely consider, especially in regard to the issue of involuntary treatment, because it essentially robs people of their rights, which is always a serious matter.

I have just one question about something you wrote. You mentioned that due the low efficacy of psychiatric treatments – and I would appreciate if you clarified what you mean by “real value” of a treatment – that those in emotional distress who are on the verge of death should be left alone or free to pursue “other alternatives”. What are these “other alternatives”?

Thanks.

Truthman30:

Yes, where did I EVER get the idea that you endorsed the wholesale slaughter of me and my colleagues in psychiatry? Hmmm. Maybe it was when you quoted with approval a statement that implied that true justice would only exist on this planet when all bankers and priests were executed, and then stated that psychiatrists are even WORSE than they are, because we are subhuman sociopathic monstrosities! I suppose that was just a product of my subconscious fantasies. ;) Or maybe you still haven’t learned that what you write has IMPLICATIONS that you are responsible for?

Anyway, I am very happy to hear that you have fully recovered and no longer require psychiatric treatment. The fact that you are staying away from those you wish massacred is one of the best outcomes I could possibly imagine.

Congratulations, and I hope you live a long and happy life.

Sherry:

Actually, I can tell the difference between anger and a symptom.

My point was only to mention the irony of someone who approves of the mass killing of an entire group of people passing judgment upon my alleged inhuman and sociopathic tendencies. However, I suppose I should not have made a sarcastic remark about truthman30’s healthy state of mind. After all, irrespective of his angrily calling for my execution and declaring me a monster, I’m sure he’s just a lovely peach of a guy. :)

Furthermore, I am surprised that someone like you, who is adamant about protecting the rights and livelihoods of individuals from harm, actually endorses the principle of systematically killing off an entire group of people when a few of them have wronged you. I mean, supporting collective punishment? Another irony, I suppose. Unless, "you said that so much better than I" now suddenly means, "I disagree with that"?

dguller,
By saying mainstream psychiatry has very little of "real value" to offer many people, I mean that it does little or nothing to help them discover what is important to them, pursue their dreams, fulfill their potential, or leave them ultimately better off than they were before being "treated". The long-term results for people treated by psychiatry in the U.S., Canada, and many other industrialized countries (perhaps most) are actually worse than people with psychiatric diagnoses in less developed countries.

You refer to people who are in the most extreme situations, saying they are "on the verge of death" - I think they are a tiny portion of the people who are forcibly treated by the mental health system(s), but if someone is truly suicidal, then I think they should be watched so that they don't have the opportunity to act on their suicidal impulses. But I think generally that more emphasis should be put on trying to help people find reasons why life might be worthwhile for them.

I also believe that people can easily be labelled "a danger to self" when in fact they are not.

I think it may be a more helpful alternative for many people to try and help them make sense of the distressing experiences they have had, and find a way to put them in some kind of context that makes sense.

Someone who I used to know many years ago when I lived in Boston, Judi Chamberlin, once said something about the importance of allowing people "the dignity of risk" - it is healthy to let people take their own risks and live with the consequences. She recently gave this interview to the Boston Globe that expounds on these kind of issues more eloquently than I would be able to (it's not about ECT specifically, but it has some worthwhile things about modern psychiatric treatment in general in it).

I'm just a poor person living a fairly desperate hand-to-mouth existence, so I can't dwell too much on the theorietical aspects of these things. I think that is one thing that many mental health professionals often fail to appreciate - how desperate economic circumstances can be an overwhelming factor in the lives of the people who they see as patients.

Dear Philip:

Quote: "BTW, I know that when I post on ECT that fights often erupt in comments due to the emotional nature of the subject. Please don't go there this time out."

Do you think it's time to close this thread?

Philip Dawdy responds: sadly, yes.