Posted by Blue Cheer on May 10, 2000, at 1:00:15
In reply to Re: ECT literature search, posted by Cam W. on May 9, 2000, at 23:42:19
> While preparing for a presentation to public health nurses on depression during pregnancy and postpartum, I came across many journal articles, both for and against ECT. All of the latest ones (last 2 to 3 years) consider ECT to be the best and safest antidepressant therapy we have.
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> ECT is the treatment of choice in pregnant women with major depression. The high levels of cortisol in a pregnant mom's blood stream do more damage to the baby than either ECT (and it's prep meds) or the SSRIs. ECT is also the treatment of choice in the old-old (>75 yrs).
>
> One article researched psychiatrists' views on ECT worldwide. The findings were that if a psychiatrist was trained in the U.S. in the 1970s, they were less likely to use or recommend ECT. European psychiatrists use it routinely.
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> The stigma surrounding ECT comes from Hollywood. Movies like "One Flew Over the Cuckoo's Nest" and "Snakepit" paint a dismal picture of this treatment. Granted, in the past, currents were too high and muscle relaxants weren't used. Even today, seeing someone getting an ECT treatment gives me the shivers, but I am told (especially by the people with refractory bipolar disorder that I have presented to) that, other than some amnesia and sometimes a headache, this these treatments have literally saved their lives.
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> Fred, I am not trying to discount your experience, especially the part about 'forced treatment'. I have not heard of anyone in my area, who wasn't a danger to themselves and not refratory to all medication, to be forced to have an ECT. I actually have never heard of anyone being forced, but then again, I've never asked.
ECT is arguably the most effective treatment in the history of psychiatry, but efficacy isn't everything. I've been hospitalized for mania and depression for over 30 years, and have taken 55 Rx psychotropic drugs (56 counting one dose of topiramate). I've read literally hundreds of articles on ECT, from Dr. Max Fink's _Convulsive Therapy_ to articles in _Good Housekeeping. =) In fact, I just read one in the current issue of _Psychology Today_ (p. 23 or 28?). It describes a treatment-refractory bipolar patient who underwent a series of 18 ECT treatments, and now has difficulty remembering where she lives if she strays farther than 4 blocks from her home. Also, I've witnessed the results of ECT in acute-care psychiatric facilities as recently as 1995, and in long-term facilities from the 60's through the 80's. ECT advocates claim an 80% improvement rate as opposed to a 65% improvement rate for drugs -- in depression. My experience has been that approximately one in five improve, and not without sequelae. Although movies have depicted it as a barbaric assault, I'd rather weigh the risk/benefit ratio. Many treatments in medicine are theoretically unappealing (defibrillation of the heart), and not well understood, yet they can be life-saving, too. Although it's a powerful intervention in severe medicine-resistant mania, schizophrenia, and suicidal states (neuroleptic malignant syndrome, too), I'd only use it as a last resort for major depression. Even if it works, booster treatments are often required and sometimes fail. Then you're back to psychopharmacology -- square one. rTMS is an alternative and safer treatment. ~~~ Blue Cheer
poster:Blue Cheer
thread:32651
URL: http://www.dr-bob.org/babble/20000508/msgs/33002.html