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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by ed_uk on November 30, 2004, at 8:05:02
Hello,
I was just looking at the MIND website. MIND is a mental health charity for England and Wales. I found an interesting factsheet about psychosurgery. How much is psychosurgery used in America? The following article gives the psychosugery statistics for the UK.
Psychosurgery("Neurosurgery for Mental Disorder")
Introduction
This factsheet is written for people who are considering psychosurgery and their friends and relatives, professionals, and students.
What is psychosurgery?
Psychosurgery, or neurosurgery for mental disorder (NMD), is a neurosurgical treatment on the frontal lobes of the brain (the part behind the forehead), involving the limbic system. The limbic system is a part of the brain concerned with functions not under conscious control, and with emotional response. Psychosurgery is not generally carried out to alter behaviour. It is usually used to treat severe, incapacitating, non-schizophrenic mood disorders when all other attempts at treatment have failed and the alternative is continuing suffering for the patient. Nowadays, it is most commonly used to treat severe depression and obsessive compulsive disorder. It is not considered to be curative, and people who undergo psychosurgery will probably continue to need psychiatric support following the procedure even if it is considered to be a success.[1]
What happens during the operation?
As there is no international consensus on the best target site for the operation, a variety of techniques are in use at different treatment centres. Most procedures aim to interrupt the nerve circuits within the limbic system.[2] All of the different types of psychosurgery are irreversible.The following operations have been used in the UK:
stereotactic subcaudate tractotomy
stereotactic anterior cingulotomy
stereotactic anterior capsulotomy.
The techniques are all called ‘stereotactic’ because they involve the use of specially constructed frames which are attached to the patient's skull and hold the probes which are put into the brain. Used together with neuro-imaging (computerised tomography (CT) or magnetic resonance imaging (MRI) scans) and dedicated computer software, stereotactic techniques allow the probes to be guided precisely (to within one millimetre) to any desired target within the brain. The stereotactic frame means that the siting of the probe is fixed and mechanical, and there is no error due to faltering hand movements.The neurosurgery procedure is carried out under general anaesthetic and lasts about one and a half hours, most of this time being taken up with X-rays to monitor the position of the probe. The hair is not shaved.
Subcaudate tractotomy
In subcaudate tractotomy, two incisions are made in the forehead - within a skin crease if possible – and two burr-holes are then made in the frontal bone above the air sinuses (i.e. in the forehead). The stereotactic frame is then attached, and then any part of the frontal lobe of the brain can be targeted with the probe, where a lesion is produced using radio-frequency (heat). The wounds are stitched after removal of the stereotactic apparatus.[3]Bilateral capsulotomy
In bilateral capsulotomy, incisions are made, one on each side of the midline on top of the head, and probes are passed into the part of the brain called the internal capsule. A small electric current is passed, which destroys a small part of the brain tissue. The electrodes are then removed and the wounds stitched.[4]Anterior cingulotomy
Anterior cingulotomy uses a similar technique to produce lesions in an area of the brain called the anterior cingulate gyrus.Post-operative
With all of the above techniques, patients sit out of bed on the second day and are mobile on the third day after the operation.What are the side effects?
Some of the side effects that may occur, can be associated with any brain operation, and some are specific to psychosurgery. The risks associated with brain surgery are damage to the blood vessels (for example, causing stroke - this is very rare in psychosurgery), confusional states, and epilepsy. Immediately after the operation, fluid in the tissues may cause pressure in the front of the brain (post-operative frontal oedema) leading to confusion; this may last up to a month.The adverse effects, associated specifically with psychosurgery, include headaches, which may be severe and may last for some days, and, in the long term, weight gain, and apathy. Weight gain is associated with anterior capsulotomy and subcaudate tractotomy, but not with cingulotomy; the reason for it is not known. Some personality change has been reported following psychosurgery in some people, but this is considered to be rare. There is no evidence that psychosurgery causes intellectual impairment, and in some cases, IQ scores have been raised, probably because of relief of symptoms which had severely impaired concentration before treatment.[5]
Rehabilitation must be gradual because recovery is a slow process.
Where is psychosurgery practised?
At present, there is no centre for psychosurgery in England. Psychosurgery is carried out in centres in Whitchurch Hospital, Cardiff and Ninewells Hospital, Dundee. Dundee uses anterior cingulotomy for resistant depressive disorder, and anterior capsulotomy or anterior cingulotomy for intractable OCD.[6]Who decides on the treatment?
British practice in psychosurgery involves a referral from a local psychiatrist to the psychosurgical team, and not just to the neurosurgeon alone.Good practice guidelines state that the full hospital notes are always needed for assessment, and a close relative should accompany the patient and be interviewed as well. In cases where a patient has never responded to medication or ECT (electroconvulsive therapy), there is the possibility that all physical treatments, including surgery, are inappropriate. Psychiatric conditions that will not be helped include personality disorders, uncomplicated schizophrenia, and anorexia nervosa.[7] Psychosurgery is not performed on people under the age of 20.
Can psychosurgery be given without the patient’s consent?
No.Consent and the Law
The United Nations resolution on The protection of persons with mental illness and the improvement of mental health care (A/RES/46/119),[8] passed on 17 December 1991, includes the following statement:“14. Psychosurgery and other intrusive and irreversible treatments for mental illness shall never be carried out on a patient who is an involuntary patient in a mental health facility and, to the extent that domestic law permits them to be carried out, they may be carried out on any other patient only where the patient has given informed consent and an independent external body has satisfied itself that there is genuine informed consent and that the treatment best serves the health needs of the patient.”
In England and Wales
In England and Wales, psychosurgery is covered by section 57 of the Mental Health Act 1983, which covers all patients, whether voluntary or detained under another section of the Act. Under section 57, psychosurgery and treatments specified in Department of Health regulations as giving rise to special concern, can only be given if:a) the patient consents and
b) a multidisciplinary panel appointed by the Mental Health Act Commission confirms that his/her consent is valid and
c) the doctor on the multidisciplinary panel certifies that the treatment should be given. Before doing so he must consult two people, one a nurse and the other neither a nurse nor a doctor, who have been concerned with the patient's treatmentThe following is taken from the Code of Practice to the Mental Health Act 1983:
“Treatments requiring Consent and a Second Opinion
Section 57 reflects public and professional concern about particular forms of treatment; such treatments need to be considered very carefully in view of the possible long-term effects and the ethical issues that arise. Procedures for implementing this Section must be agreed between the Mental Health Act Commission and the hospitals concerned.Before the responsible medical officer (rmo) or doctor in charge of treatment refers the case to the Mental Health Act Commission:
a) the referring doctor should personally satisfy himself that the patient is capable of giving valid consent and has consented;
b) the patient and (if the patients agrees) his family and others close to him should be told that the patient's willingness to undergo treatment does not necessarily mean that the decision to proceed has yet been taken. The patient should be made fully aware of the provisions of Section 57;
c) for psychosurgery, the patient's case should be referred to the Commission prior to his transfer to the neurosurgical centre for the operation. The Commission will usually visit and interview the patient at the referring hospital at an early stage in the procedure.”In Scotland
Those operations that are performed in Scotland, come under the provisions of the Mental Health (Scotland) Act 1984, and are overseen by the Mental Welfare Commission for Scotland, who provide independent clinical assessments for all patients. These are conducted by a group of three commissioners with at least one medical representative. This means that, before surgery can be performed, the individual’s suitability for the procedure and ability to give informed consent will have been assessed by the mental health team who have referred them to Dundee, the team in the Dundee hospital, and the Mental Welfare Commission for Scotland.[9]Statistics
How many people are treated with psychosurgery?
The Mental Health Act Commission panel authorised seven operations to go ahead in England and Wales in 1999-2000 and two in 2000-2001.[10] Prior to that:1997-1999 17 operations in England and Wales
1993 23 operations in England, Scotland and Wales
1992 27 operations in England and Scotland
1991 17 operations in England
1990 26 operations in England.There has been one death associated with psychosurgery in over 3,000 procedures.[11]
The cost of psychosurgery
The cost of the operation and perioperative care was between £6,000 and £7,000 in 1997. When post-operative care is included, this increases to about £13,000.The alternative to psychosurgery would in most cases be a high-cost, protracted period of high-dependency inpatient care.
What is the success rate?
Most reports on results of psychosurgery relate to a form of operation, which is no longer performed - subcaudate tractotomy. A method using radioactive yttrium rods, it was discontinued because it became impossible to obtain the yttrium.Of 42 patients on whom data was available, doctors reported significant improvement in 12 cases and some improvement in 22. Six cases showed no change, two showed some deterioration and none of the patients showed any significant deterioration.[12]
During the period when the Geoffrey Knight Unit (now closed), at the Maudsley Hospital in south London, was forced to suspend operations for technical reasons, they continued to admit patients for trials of high dose and combined antidepressants, which has reduced the need for psychosurgery in recent years.[13] This suggests that, at least for some people, other treatment options have not always been fully tried before resorting to psychosurgery.
What is Mind’s view on psychosurgery?
Mind's Policy on Physical Treatments[14]makes the following statements about psychosurgery:“Psychosurgery is a neurosurgical operation occasionally used where no other treatments have helped, in particular for severe obsessive-compulsive problems or depression. The techniques are more precise than in the past and it is no longer used to control aggression.
It involves the destruction of brain tissue or function, is irreversible and carries a risk of apathy, excessive weight gain, loss of inhibition and epilepsy. Although follow up studies show the majority of patients seem to improve, these uncontrolled studies have been said to provide ‘virtually no scientific support for the efficacy of the treatment at all’.
The research has been criticised for failing to assess adverse effects adequately, especially the effect on personality; neither does it adequately assess users' views of outcome.
In England and Wales the treatment can only be given with consent, and authorisation by an independent doctor and two other people appointed by the Mental Health Act Commission.
Mind is concerned that failure to relieve suffering may lead inexorably towards increasingly invasive procedures. Psychosocial and other alternative forms of healing should always be explored and kept open. Mind is particularly concerned at the use of an irreversible procedure which carries serious risks when so little is known about its action.
Mind is not happy with the continued use of psychosurgery and believes that there should be a rigorous review to determine whether any continued use is justified.”
Are there any alternative techniques?
A short paper from Sweden in The Lancet, October 1999,[15] reported an alternative procedure which was tried on four patients with long-standing treatment-resistant obsessive-compulsive disorder (OCD). In this operation, electrodes were implanted using a stereotactic frame, as in the standard neurosurgical operations, but they were left in place and used to stimulate a small area of the brain, and not to destroy cells. The target cells were those aimed for in capsulotomy. Beneficial effects were seen in three of the four patients. In one patient, anxiety and obsessional thinking were relieved when the stimulation was on, but returned when it was turned off. During continuous stimulation, for a period of two weeks, her compulsive behaviour and rituals reduced by 90 per cent. The paper does not indicate how long the experimental treatment was continued for, but concludes that long-term stimulation may be useful in the management of severe OCD.
Posted by ed_uk on November 30, 2004, at 8:42:31
In reply to Psychosurgery, posted by ed_uk on November 30, 2004, at 8:05:02
I also thought that I'd post this information for anyone who is interested. I would like to hear your opinions. It would be particularly useful to hear from people who have had ECT.
Making sense of ECT
This booklet is for anyone who wants to know about electroconvulsive therapy (ECT). It is one of the most controversial treatments in modern psychiatry, used for conditions, such as severe depression, which have not responded to other interventions. For some people, it has been a life-saver. But others have found it far from satisfactory, and consider the risk of long-term side effects to be an unacceptable consequence.
What do I need to know before I have ECT?
The law states that people have the right to make an informed decision about which of a number of treatment options to choose, and whether, or not, to accept the treatment a doctor suggests. To consent properly to a particular treatment, people need information to enable them to weigh up the risks and benefits, in the light of available evidence.Before any treatment begins, the doctor should provide you with full information about the treatment, any unwanted effects and what the alternatives would be, including the alternative of having no treatment at all. Information should be given in language that you can understand. This means that technical information should be explained, using everyday terms. It also means that if your first language is not English, and your understanding of English is not adequate for you to understand fully, you should be provided with an independent interpreter. Having a relative or friend acting as a translator is not good enough. You should be able to have the information in writing, and have someone go through it with you, face to face. The information should include the specific nature of the treatment, its purpose, the chances of its success, any side effects or risks involved, and the way of administering it.
You should be allowed time, afterwards, to decide whether, or not, to go ahead with the treatment. You may want to talk this through with a relative, friend or adviser, before signing a written consent form specific to the proposed treatment. It can be hard to take in a lot of new information at one go, especially if you are depressed and taking medication. The Royal College of Psychiatrists recommends that you have a friend, relative or advocate with you, when you are given the information, so that they can go over it again, with you. You should not be afraid to ask your psychiatrist, or another member of staff, to explain it to you more than once. The Royal College of Psychiatrists also recommends that, if your relatives or close friends disagree with your treatment, this should be recorded in your notes, together with the reasons for proceeding with the treatment.
When you have signed a consent form, you should be informed that you can change your mind at any stage in the treatment and that, should you do so, the treatment will be stopped. At each stage of the treatment, the doctor should confirm with you that you are continuing to consent.
The ECT Handbook, which has been produced by The Royal College of Psychiatrists, states:
'You can refuse to have ECT and you may withdraw your consent at any time, even before the first treatment has been given. The consent form is not a legal document and does not commit you to have the treatment. It is a record that an explanation has been given to you, and that you understand, to your satisfaction, what is going to happen to you. Withdrawal of your consent to ECT will not in any way alter your right to continued treatment with the best alternative methods available.'ECT can only be given without consent if you are detained in hospital under the Mental Health Act 1983, and this is authorised by a doctor appointed by the Mental Health Act Commission (a second opinion appointed doctor, or SOAD). This doctor must visit you and consult with your own doctor, a nurse, and another professional involved in your care who is neither a doctor nor a nurse.
The only exception to this is in an emergency. In such cases, treatment can begin, under section 62 of the Act, pending the arrival of the SOAD, for patients without capacity to consent, in a life-threatening situation, where the common law might be invoked. (See Getting the best from your approved social worker ) For more advice on your rights, ask whether there is an advocacy service or patients' council at the hospital. Mind's Legal Unit and your local Community Health Council may also be able to help. (For more detailed information on the Mental Health Act, and consent to treatment, see Mind Rights Guide 3: Consent to treatment . For information about advocacy, see The Mind Guide to Advocacy .)
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What is ECT and why is it controversial?
ECT involves sending an electric current through the brain to trigger a seizure, or fit, with the aim, in most cases, of relieving severe depression. The treatment is given under a general anaesthetic and using muscle relaxants, so that the muscles do not contract, and the body does not convulse during the fit.No-one seems to be able to give a clear explanation of how ECT works, and this is a cause of controversy. On the one hand, its critics describe it as a crude treatment that causes brain damage; on the other hand, its supporters defend it as an effective and life-saving technique.
Mind conducted a survey, in 2001, of mental health service users who had received ECT. (Shock Treatment: A Survey of People's Experiences of Electro-convulsive Therapy [ECT].) It reported that as many people found it unhelpful as helpful:
'I would happily die rather than have ECT again.'
(Woman, Yorkshire.)'If I had not received ECT I would be dead by now.'
(Woman, Staffordshire.)36 per cent of those treated in the last five years found it helpful in the short term (within the first six weeks of treatment)
27 per cent found it unhelpful or damaging in the short term
43 per cent felt that it was unhelpful or damaging in the long term.
Two-thirds of all those asked, and almost half of those who had had ECT in the last two years, would not agree to have it again.Many psychiatrists are convinced that it is an effective treatment for seriously depressed people, when no other treatment has been effective or available. They would argue that it is a suitable treatment when it is important to have an immediate effect, for example because a person is so depressed that they are refusing to eat or drink, and are in danger of kidney failure.
Other controversial issues are also discussed later. They include:
differences of opinion about how ECT works
whether, or not, it is always used as a treatment of last resort
whether, or not, it is effective in preventing suicide
the adverse effects, including memory loss, which may be very significant in some people.
Back to topWhat is it used for?
ECT has been used to treat all types of mental distress in the past. It is now most commonly used to treat severe depression and, occasionally, mania, schizophrenia and catatonia.In treating schizophrenia, The ECT Handbook recommends that ECT should be limited to patients who can't take, or who respond poorly to antipsychotic drugs, when psychotic symptoms (such as hallucinations) accompany a mood disorder (such as depression) or great agitation or immobility. It also states that:
'ECT is unlikely to be effective in the treatment of obsessional compulsive disorders, but may be of benefit to some patients with both obsessive-compulsive and depressive symptoms.'Because, when it works, ECT usually works very quickly, some psychiatrists think it is the best treatment for severe postnatal depression. It can minimise the time that the new mother is not able to care for and bond well with her baby. (See Understanding Postnatal Depression )
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Where will I have my treatment?
People usually receive ECT as inpatients in a hospital, although outpatient treatment is possible. The ECT Handbook recommends that the ECT treatment centre should consist of a suite of at least three rooms. The waiting area should be comfortable and provide a relaxing environment. Accessible from the waiting area should be a treatment room, with a recovery area leading off it. The suite should be organised so that patients are able to move easily from waiting room, to treatment room, to recovery room.A nurse, who the patient knows and trusts, should escort the patient to the ECT suite and, preferably, stay with him or her during all stages of treatment. In some clinics, relatives or friends are allowed to accompany patients throughout the treatment, if both agree.
'A minimum number of trained staff must be present for a treatment session to take place. As well as the anaesthetist and psychiatrist, there must be one person to help with the anaesthesia and one person to recover each person who has not regained consciousness.'In the treatment room, an electrocardiogram machine, to measure blood pressure and temperature, should be easily accessible. There should also be adequate resuscitation equipment, including a defibrillator (a machine to restart the heart should it stop beating). A standard box of drugs should be kept in the unit, in case of cardiac arrest or medical emergency.
All staff working in the ECT unit need regular training, updating and practice in basic and advanced life support techniques. The ECT Handbook states: 'A senior psychiatrist, preferably a consultant, should be responsible for ECT clinics and, in particular, must advise on appropriate treatment facilities, develop a treatment policy, and train and supervise staff.'
Some psychiatric units fall short of these guidelines. A survey of the 230 sites in England and Wales that provide ECT found that:
20 per cent showed substantial departures from best policy, practice and training
32 per cent did not have a dedicated ECT suite of three rooms
36 per cent did not have a nurse in the recovery room trained in basic life support and resuscitation techniques
27 per cent did not have regular visits from a named consultant psychiatrist
5 per cent did not have either copies of The ECT Handbook (the Royal College's publication) or the hospital's own policy for ECT.
Back to topWhat should I expect from a treatment session?
ECT is carried out under a general anaesthetic and with a muscle relaxant (this is what is known as 'modified' ECT). Because of the anaesthetic, you must not eat or drink anything for at least six hours before ECT. An anaesthetist, a psychiatrist and one or more nurses should be present during the procedure. You will lie on a bed, and your jewellery, shoes and dentures (if necessary) will be removed. You should not be wearing any hair lacquer, creams, make-up or nail polish, or have any metal slides or grips in your hair.Once you are comfortable, you will be given a general anaesthetic, via an injection. Later, while you are asleep, you will receive an injection of muscle relaxant to minimise the convulsions caused by the electric current. Because of the muscle relaxant, you will be given oxygen, and the anaesthetist will look after your breathing, using a face mask and a pressure bag. Two padded electrodes will be placed on your temples (see opposite page). A mouth guard will be placed in your mouth, to stop you biting your tongue.
Modern ECT machines deliver a string of brief, high-voltage, direct-current pulses, about 60 to 70 pulses a second, for three to five seconds, which results in a seizure, or fit. This will cause you to stiffen slightly, and there will be twitching movements in the muscles of your face, hands and feet. The seizure should last 20 to 50 seconds.
The seizure threshold
The strength of electric current needed to produce a fit is called the seizure threshold. This varies from person to person. It is higher in men than in women, and it increases with age, meaning that older people need a stronger electric current to produce the desired effect. The 'dose' of electric current given to you will be adjusted to take this into account.Other things that affect it are the exact position of the electrodes on your head, the amount of anaesthetic you have been given, and other medication you may be taking. If the dose is too low (below the threshold), there will be no benefit from the ECT. But the higher the dose, the greater the risk of unpleasant side effects, so it's important to get the dose as close as possible to the threshold.
Immediate after effects
After the convulsion, the mouth guard is removed and you will be turned on your side. The anaesthetist will provide oxygen until the muscle relaxant wears off (after a few minutes) and you start breathing on your own again. You will slowly come round, although you may feel very groggy. You may sleep for up to an hour, after treatment.The immediate effects of ECT include headache, confusion, nausea, disorientation, loss of memory, apathy, aching muscles and physical weakness (see below).
The immediate effects of ECT include headache, confusion, nausea, disorientation, loss of memory, apathy, aching muscles and physical weakness. If you are an outpatient, you will need to have someone with you to accompany you home. You should not drive, and you should not return alone to an empty house.
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What's the difference between bilateral and unilateral ECT?
ECT may be given by placing one electrode on each temple (bilateral) or by placing both electrodes on one temple (unilateral), and this makes a difference to the effect ECT will have. The National Institute for Clinical Excellence (NICE) says there is evidence of cognitive impairment after ECT. This is greater when electrodes are applied bilaterally. In unilateral ECT, electrodes placed on the dominant side of the brain cause more harm than if they are placed on the non-dominant side (see below for more information).The ECT Handbook recommends unilateral ECT when:
a very rapid response to treatment is less important
you have responded well to unilateral ECT in the past, and
it's thought particularly important to minimise memory loss.
It recommends bilateral ECT when:a very rapid response to treatment is desirable
previous bilateral ECT has been effective, and
it has not caused significant loss of memory.
Back to topHow many treatments will I need?
The ECT Handbook says there should not be a pre-set number of treatments, but that you should be assessed after each treatment to see if another one is necessary. Most people respond to a course of between four to eight treatments, although older people and men may need more. It's usual to stop after eight, or so, treatments, if there has been no change at all in the patient's symptoms. The treatments should take place two or three times a week, not daily. The Code of Practice to the Mental Health Act 1983 states that the proposed maximum number of applications of ECT should be written down on form 38, when the patient consents to treatment.Back to top
Who should avoid having ECT?
Before a course of ECT treatments, you will need a full medical examination. You will be asked about your medical history, any medicine you are taking, any drug allergies, and whether you are pregnant. If you have any physical problems, these should be treated, as far as possible, before you have ECT.The ECT Handbook emphasises that the risks and benefits of the treatment must be carefully assessed, and that you and your family should be involved in the discussion. (See below for a checklist of questions to ask.)
Cardiovascular problems
When assessing whether to give you ECT, it's important that doctors take into account any heart and related problems you may have. It may be hazardous to give you an anaesthetic if you have a serious chest disease.Pregnancy
ECT is occasionally used in pregnancy. However, an anaesthetist may not be happy about giving a general anaesthetic to a pregnant woman, except in a medical emergency.Medication
The British National Formulary (BNF) advises caution in using ECT if the patient is taking SSRI antidepressants (selective serotonin re-uptake inhibitors), because these drugs may prolong the seizures. Drugs that raise the seizure threshold (so that a higher dose of electric current has to be used) should also be avoided. This includes benzodiazepine tranquillisers. (See below)Back to top
How does it work?
No theory provides a clear explanation. Some give very little information. The ECT Handbook says:
'[ECT] produces a seizure which affects the entire brain, including the centres which control thinking, mood, appetite and sleep. Repeated treatments alter chemical messages in the brain and bring them back to normal.'NICE says that it changes the way brain cells respond to their chemical messengers:
'Although ECT has been used since the 1930s, there is still no generally accepted theory that explains its mechanism of action. The most prevalent hypothesis is that it causes an alteration in the post-synaptic response to central nervous system neurotransmitters.'Psychiatric opinion about how it works is divided. Dr Brian Harris, a consultant psychiatrist and senior lecturer, is quoted as saying:
'No-one knows how it works, but it does; quicker than medication'.The author, Dr Anthony Clare, has said:
'Interest centres on the possibility that ECT acts on the neuro-transmitters believed to hold the cause of severe depression. ECT certainly affects these monoamines, but in complicated ways, and it has not hitherto been possible to produce a coherent explanation.'Dr Simon Green, a psychologist, comments:
'It does work through changes in brain chemistry, but comparing this favourably with the current generation of pharmacologically specific drugs would be similar to the assumption that a broken television could be mended as readily with a sledgehammer as with a screwdriver: you might jog the right bit.'The electrical activity in the brain that ECT causes is accompanied by increases in blood flow, oxygen levels and use of glucose in the brain. The blood-brain barrier also becomes more permeable during ECT. (The blood-brain barrier is a physiological mechanism, which acts to prevent a large number of substances from crossing the protective cell membranes and entering the brain cells. It also becomes more permeable as a result of stress.)
Brain damage
Other psychiatrists believe that ECT works through causing brain damage. People may experience a temporary lifting of mood after ECT, but this can be explained by post-traumatic euphoria, which typically follows head injury. This causes amnesia, denial, euphoria, wide and unpredictable mood swings, helplessness, submissiveness, confusion and disorientation.Dr Peter Breggin, a well-known critic of modern psychiatry, has reviewed the research conducted on ECT and concluded that it was the brain damage caused by ECT which explained its so-called 'effectiveness'. Ironically, a leading supporter of ECT in the USA, Dr Max Fink, has also blatantly stated that where there is no evidence of brain damage, there is no improvement:
'Where there is no evidence of impaired mental function and no electroencephalographic alteration [changes in recorded brain waves] clinical improvement does not occur.'Back to top
Does it save lives?
'It was a life-saver to me, as I was very depressed and highly suicidal.'
(Woman, Wiltshire, ECT six or more years ago.)ECT does sometimes prevent death when someone is profoundly depressed, no longer eating or drinking, and in a critical state. But there is no good evidence that ECT prevents suicide. Even a paper (by David Avery and George Winokur) often cited in support of the view that ECT prevents suicide, had to conclude that, in their study, treatment was not shown to affect the suicide rate. Other studies have shown that psychiatric hospital admission can increase the risk of suicide.
(If you know someone who is feeling suicidal, you can help by just being there and listening in an accepting way. Discuss strategies for seeking help when suicidal thoughts occur. Creating a personal support list is a useful way of reviewing every conceivable option. Persuade the person to keep, by the phone, a list of individuals, helplines, organisations and professionals they can call when they are feeling suicidal. See Useful organisations, and Mind's booklet, How to Help Someone Who is Suicidal )
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What do users say about ECT?
'The effect of the treatment was amazing. All psychotic thoughts diminished, and I started to feel as if I was finally being lifted from the big, black hole I had been in. I honestly believe that, had I not received ECT, I would not be living the full, happy and healthy life that I am living today.'
(Woman, Hertfordshire, ECT in the last two years.)'Under no circumstances would I choose to have ECT. I would rather go down fighting than submit to that abomination.'
(Woman, no area given, ECT six or more years ago.)'It just seems to help me out of my depressed state of mind very quickly.'
(Man, no area given, ECT three to five years ago.)'It was hell on earth.'
(Woman, Dorset, ECT three to five years ago.)There is a wide split among people who have had ECT about how helpful it is. In Mind' s 2001 survey, of all those asked:
29 per cent found the treatment helpful or very helpful in the short term (within the first six weeks)
36 per cent found it unhelpful, damaging or severely damaging.
Among those who had received ECT more recently, the results were the opposite:36 per cent found the treatment helpful or very helpful in the short term
27 per cent found it unhelpful, damaging or severely damaging.
Over the longer term, a much higher percentage rated the treatment as unhelpful, damaging or severely damaging:63.5 per cent of all those asked
43 per cent of those who had treatment in the last two years.
Over the longer term, a much higher percentage rated the treatment as unhelpful, damaging or severely damaging:63.5 per cent of all those asked
43 per cent of those who had treatment in the last two years.
Back to topWhat are the adverse effects of ECT?
Psychiatry recognises the following risks of ECT: 'Each application inevitably leads to a variable period of drowsiness, confusion and anterograde amnesia [forgetting new information], commonly causes headache and nausea, and may lead to the occasional loss of personal memories; moreover each application inevitably requires a brief anaesthetic that involves additional risks of morbidity and mortality [illness or death] that are slight, but never negligible.'In its appraisal document on ECT, NICE says that cognitive impairment happens immediately after each session, as well as following a course of treatment.
Both critics and supporters have suggested that ECT works through causing brain damage, or 'acute organic brain syndrome' (see above). Some of the symptoms listed above may subside quickly, but memory loss, apathy (emotional blunting), learning difficulties, and loss of creativity, drive and energy may last for weeks, months, or even permanently.
Loss of memory
Memory loss can mean losing both good and bad personal memories, and having difficulty remembering new information. (It is, perhaps, worth noting that people with epilepsy experience memory loss after a fit.)Comments recorded in Mind’s 2001 survey suggested that psychiatrists seriously underestimate the potential extent and devastating effects of memory loss in some people:
‘Permanent loss of reading and numeracy skills.'
(Man, West Midlands.)‘I don’t play the piano, organ or violin any more, as I can’t remember how to. It seems my long-term memory has gone forever. Memories from my past five years, and more, have become either vague or have gone.'
(Man, Berkshire.)‘I qualified as a maths teacher. Following all this ECT, I have no understanding of the maths concepts used in my further education courses, or even O-level standard.'
(Woman, Cleveland.)‘I can remember hardly anything about my past life, only very little bits. As for bringing up my three daughters, I can’t remember a thing.'
(Woman, Yorkshire.)According to The ECT Handbook:
‘The evidence suggests that neither new learning, nor memory for information from the past, are permanently impaired. Objective memory impairment (on specific memory tests) is reversible. Some patients may, however, be left with discrete memory gaps for specific autobiographical events, the explanation for which is unclear.'However, psychiatric research reflects users' reports that memory loss can persist, and that this is different from the memory loss caused by depression. In one study, more than half of the patients (55 per cent) felt that they had not regained normal memory function, three years after receiving ECT.
An American psychologist conducted detailed autobiographical interviews with 19 people who were about to have ECT, and with a control group who did not have ECT. He then questioned both groups about the same information afterwards. He found that all the 19 patients showed a number of instances of forgetting their former memories, unlike the control group whose memories were unchanged. He followed up half of the ECT patients a year later, and there had been no return of the lost memories.
In another study, it was reported that memory complaints are common six to nine months after bilateral ECT, and were reported by 60 to 70 per cent of patients interviewed.
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Bilateral versus unilateral ECT
Research indicates that the two ECT techniques carry different risks of memory impairment. It seems that bilateral ECT causes more severe memory loss than unilateral. In unilateral ECT, the electrodes are applied to the non-dominant side of the brain, to focus energy away from the speech centre. (The speech centre is usually on the left-hand side in right-handed people, but not always.)Peter Breggin has criticised the theory that unilateral ECT is a less harmful procedure. He points out that non-dominant brain functions include:
'the creative faculties, such as imagination, and the use of metaphor; visual and spatial capacities, as well as musical and motor abilities, such as coordination, dance and athletics; the quality or vibrancy of personality; initiative and autonomy; and insight.'Other critics have commented that unilateral ECT:
'assumes that one side of the brain is less valuable than the other. Humanistic psychologists would not agree. Instead, they might argue that the non-dominant side is essential to creativity. The placing of the electrodes unilaterally increases the concentration of current in one part of the brain, and the damage to this part is more severe than in bilateral ECT. EEG results one month after unilateral ECT confirm that it is possible to detect which side of the brain is damaged.'The emotional impact
The emotional and psychological effects of ECT are under-estimated and under-researched. A report from the USA points out that studies measure successful outcome in terms of symptom-reduction, rather than quality of life and social functioning.Many people feel abused by the treatment:
'I felt very much that I was being punished for not coping and being out of work.
I still feel this. I felt empty and numb.'
(Woman, Birmingham.)'I was an outgoing, fairly confident person, and now I feel worthless and scared.'
(Woman, England.)'ECT was done to me, not done for me. That’s the total sense of how it felt. It paralleled sexual abuse, which I experienced as a child. Someone doing something to my body against my will.'
(Woman, Surrey.)In depression, some people may feel guilt-ridden, and believe they are evil or harmful to others. They may see ECT as being a deserved punishment, and it can confirm the very feelings of worthlessness that characterise depression. In Mind’s 2001 survey, 22 per cent of recent recipients felt that they were being punished.
Physical injury
Injuries to teeth and mouth are risks associated with ECT, because the electrical stimulus contracts the jaw muscles, bypassing the muscle relaxant. High stresses are produced during the forceful closure of the jaws, and tooth damage or loss may result, in spite of the use of mouth guards.Spontaneous seizures following a course of ECT are rare, and not more common than in the general population. They were reported by one per cent of the respondents to Mind’s 2001 survey.
Death following ECT is relatively uncommon, but does happen. It’s been estimated that the risk is about 4.5 deaths per 100,000 treatments, or four or five among 16,700 patients. This is no higher than the risk associated with having a general anaesthetic.
Side effects mentioned in Mind's 2001 survey
Not everyone feels damaged by ECT, but for those who do, the feelings can be devastating. Mind’s 2001 survey was not scientific research, but does reflect the experiences of 418 people, one third of whom found ECT helpful.The following short-term side effects (lasting up to six weeks) were reported. (They are listed, here, in order of frequency, with the most frequent first):
headaches
drowsiness
confusion
loss of past memories
dizziness
disorientation in time or space
difficulty concentrating
inability to remember new information
suicidal tendencies after the treatment
apathy
inability to recognise people
loss of reasoning ability
fear and anxiety
feelings of helplessness
sense of betrayal
visual problems
loss of previous skills (reading, music, languages)
sleep problems
feelings of worthlessness
neck or back pain
loss of creativity
epileptic seizures
sexual difficulties.
Permanent side effects, again in order of frequency, were:loss of past memories
difficulty concentrating
fear or anxiety
inability to remember new information
feelings of worthlessness
feelings of helplessness
sense of betrayal
loss of previous skills
loss of creativity
suicidal tendencies after the treatment
loss of reasoning ability
sleep problems
confusion
apathy
headaches
inability to recognise people
disorientation in time and space
personality changes
neck or back pain
visual problems
sexual difficulties
drowsiness
muscle ache
dizziness
nausea
epilepsy.
Cause for concern
Muscle relaxants prevent broken bones and sedate the brain, making it more difficult to induce a seizure. The voltage has to be increased to reach the threshold. Patients are often taking psychiatric drugs, which also raise the threshold. The Royal College of Psychiatrists has stressed the dangers of this and called for more research.
Back to topWhat are the added risks for older people?
There are additional concerns in using ECT for older people, as there are with many medical procedures. The risks of treatment include an increased chance of heart problems, stroke and falls. The effect on an ageing brain is also recognised as potentially more damaging, with a greater possibility of memory loss.Older people will be at much higher risk of dying than younger ones, but this age group is seen as more likely to be at risk of dying from the inability to eat or drink during severe depression, and so the benefits are seen as outweighing the risks.
ECT is sometimes considered less risky for the elderly than taking tricyclic antidepressants, which can have an adverse effect on the cardiovascular system. Opinion is divided about whether the newer SSRI drugs are any better. A survey of psychiatrists working with elderly people found that those who did choose the newer drugs often did so because of cardiovascular risk. Some psychiatrists believe that, since these antidepressants are so much safer, there is now no reason to choose ECT rather than drug treatment for elderly patients.
Antidepressants and ECT are not the only possible responses to depression. There is a body of knowledge and expertise in counselling and psychotherapy with elderly people, but these approaches are under-used. (See Talking treatments, below.)
Back to top
What are the alternatives to ECT?
There are many possible causes of depression, including life events, and psychological, social, biochemical and genetic factors. All of these interact to some degree. There are, consequently, various approaches to treatment. If the guidelines of the Royal College of Psychiatrists are being followed, you will only be offered ECT (in most cases) if you have tried other treatments and found them unsuccessful, unhelpful or unacceptable.Most psychiatrists take a primarily biochemical approach to treatment, and offer antidepressant drugs. If these do not work, they then suggest ECT. They will not always try all the available types of drugs, nor will they always consider other approaches, such as talking treatments, arts therapies, and other alternatives or additions to medication.
The problem with treating depression in this way, as an illness with a biological basis, is that it often follows a stressful life event, such as bereavement, divorce or redundancy. People need time and space to make sense of their pain, and come to terms with loss. ECT seems inappropriate in such situations, unless the person has become morbidly preoccupied with the traumatic event, and buried in depression that looks unlikely to lift.
Antidepressant drugs
People have very varied responses to medication. But there are different types of antidepressant available, and you may need to try several before finding one that works. Information about all of the different antidepressants currently prescribed in the UK is available in Making Sense of Antidepressants .Talking treatments
Your GP is a good starting point for exploring psychotherapy and counselling, which can help you to deal with the problems underlying and surrounding your depression. The treatment works by providing an opportunity for you to talk, in a way that assists you to understand yourself better. It can then help you to work out a more positive and constructive way of living. Increasing numbers of GPs are employing counsellors in their practices, but if not, they should be able to refer you to other sources of psychotherapy or counselling. Your local Mind associations may offer free, or low-cost, talking treatments.Cognitive behaviour therapy (CBT) is a practical, short-term aid to helping someone to cope with depression. A person's thoughts have a powerful impact on their feelings and behaviour, and it's possible for someone to think themselves into a state of extreme distress. But it's also possible to do the opposite, and challenge negative thought patterns that feed depression.
If you think you might be interested in CBT, talk to your GP about getting a referral to a clinical psychologist. (See Mind's booklets, Understanding Talking Treatments , Understanding Depression and Making Sense of Cognitive Behaviour Therapy )
Arts therapies
Therapies using art, music, drama, dance or creative writing may be very powerful in helping to lift depression. Even someone who is so profoundly depressed they can't speak may be moved by music or poetry, which then begins a process of recovery. These therapies are available in some psychiatric units and community mental health facilities. (See Useful organisations.)Complementary therapies
Complementary and alternative therapies have proved to be particularly helpful when people are experiencing stress-related symptoms, anxiety and depression. They can help people relax and feel better. Complementary therapists stress the connection between mind and body, and are not concerned with merely treating symptoms. There are many different therapies, including homeopathy, herbal medicine, acupuncture, aromatherapy, meditation, reflexology, neurolinguistic programming, and various types of massage. (For further information, see Further reading.)Physical activity
Physical activity has proved to be very beneficial when tackling problems like depression. It works by changing levels of chemicals in the body that influence mood. (For more information, see The Mind Guide to Physical Activity .)Self-help groups
Many people experiencing emotional distress find it helpful to share their feelings with others going through similar difficulties. There are self-help organisations for people suffering from depression. (See Mind's booklet Understanding Depression , and Useful organisations. Or ask at your local Mind group.)Transcranial magnetic stimulation (TMS)
In the last 10 to 15 years, interest has grown in this new technique. Neurologists have been using TMS as a research tool for some time, and it seems clear that it may be useful for treating depression. Some researchers feel that it may be an alternative to ECT.It involves creating magnetic fields through an insulated coil conducting an electric current, which is placed on the surface of the scalp. Rapidly changing magnetic fields cause electrical currents to flow within the brain. This affects the nerve function, without causing an epileptic fit. The technique has been investigated in various ways, by using different positions of the coil, by stimulating different areas of the brain, and by changing the signal frequencies, for example.
The first trials of TMS for depression used only small, selected groups of patients, with no control group for comparison. As a result, it was not clear whether this was really an effective treatment for depression. More recent research continues to suggest that it may become an alternative to ECT.
It is considered to be a safe procedure. The most important safety concern is the risk of seizures, but no seizures have been reported since the introduction of guidelines for safe use of the technique. This may seem a strange concern, given that ECT is considered to have failed if it does not cause a seizure. But, if similar results can be achieved without seizure, it would be a great advantage. There may be some local scalp pain or headache at the time of treatment, but there have been no reports of harmful effects.
The technique is still being researched, and is not yet available as a treatment.
Vagus nerve stimulation (VNS)
VNS was initially developed for treating epilepsy, but has been tried for depression in the last few years. It involves placing an electronic device under the skin in the left chest wall, with an electrode connecting it to the left vagus nerve in the neck. Putting the device in place takes about an hour. Once working, it sends mild, electrical pulses to the nerve, at intervals.Side effects can occur, but usually only when the stimulation is on. They include voice alteration, shortness of breath, neck discomfort, and coughing, all of which apparently diminish over time. It's reported to lift depression, and is available in various centres throughout Europe, including the UK.
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What are the pros and cons of ECT?
People's experience of ECT varies enormously. It's a short-term treatment, which can't directly address underlying despair or practical problems, and does not prevent future depression. Memory problems are widely reported, though for some people they are only temporary. Some people also feel violated by ECT.However, ECT can lift depression, and the speed of response may be an important consideration, for instance in preventing kidney failure in someone who is not eating or drinking. ECT may help people enough for them to begin looking for a different solution. Some people feel that after ECT they are better able to make use of other forms of treatment and support.
One service user, who has commented favourably on his ECT treatment, makes the point that ECT, on its own, is not enough: 'On more than one occasion in my life, the intervention of ECT has been beneficial and not damaging. The initial help given, it's been all the more possible to gain from the skills and the patience of a clinical psychologist. It is true that ECT should not be used to excess, and it is also true that usually more than ECT is needed. But the different therapies and treatments can, and should, be seen as complementary, rather than in competition.'
Back to top
Questions to ask your doctor
If ECT is recommended, you should ask the following questions:What is the reason for suggesting ECT?
What are the risks associated with ECT?
How could ECT help me?
What are the side effects?
Are there any long-term effects?
Has every alternative treatment been tried, including different drug treatments, or talking treatments?
What treatment will be offered in addition to, and after, ECT?
What is the risk of physical deterioration or suicide?
How many treatments are proposed?
Is unilateral or bilateral ECT proposed?
How will the dosage be decided?
Posted by linkadge on November 30, 2004, at 10:34:59
In reply to Re: MIND guide to Electroconvulsive therapy, posted by ed_uk on November 30, 2004, at 8:42:31
I would have SST (stereotactic subcaudate tractotomy) hands down before having ECT.
Linkadge
Posted by ed_uk on November 30, 2004, at 11:09:30
In reply to Re: MIND guide to Electroconvulsive therapy, posted by linkadge on November 30, 2004, at 10:34:59
Really? ....... I suppose that the damage is much more localised.
Ed
Posted by Peddidle on November 30, 2004, at 12:56:49
In reply to Re: MIND guide to Electroconvulsive therapy, posted by ed_uk on November 30, 2004, at 8:42:31
I found this website with a video that discusses ECT as well as shows an actual ECT treatment, and it--you can download it for free. I thought it was interesting...it's not at all scary to watch.
http://www.emoryhealthcare.org/departments/fuqua/patient_info/Electroconvulsive_Th.html
Posted by ed_uk on November 30, 2004, at 13:28:02
In reply to Re: MIND guide to Electroconvulsive therapy, posted by Peddidle on November 30, 2004, at 12:56:49
Hi,
Thank you for the link.
Ed.
Posted by vwoolf on November 30, 2004, at 13:34:22
In reply to Psychosurgery, posted by ed_uk on November 30, 2004, at 8:05:02
I find this subject very disturbing. I have visited several other official national mental health websites about contemporary psychosurgery(I remember Canada and Australia particularly) and the general trend seems to advocating an increased use of this form of intervention.
It seems to me that so much of what happens in Psychiatry is done without understanding what actually happens or the dynamics of the human mind. Treatment is often very much at the same level as cold showers and straight jackets, but with a more scientific kind of label.
Posted by vwoolf on November 30, 2004, at 13:42:49
In reply to Re: MIND guide to Electroconvulsive therapy, posted by ed_uk on November 30, 2004, at 8:42:31
I underwent ECT in the late sixties. I was severely depressed as a result of incestuous childhood sexual abuse, and this was the first line of therapy that was indicated. To me it felt like an enormous punishment. I was seventeen and was not consulted - my mother signed off all the papers. It left me with a badly damaged memory, even today, of new events. I lost a lot of my longer term past memory. I was left apathetic and totally depressed as soon as I set foot back in my home environment. I feel very strongly that ECT should not be used except as a very last resort. It is invasive and abusive, and was in many ways worse than the original abuse that had caused my depression.
Posted by ed_uk on November 30, 2004, at 14:24:57
In reply to Re: MIND guide to Electroconvulsive therapy, posted by vwoolf on November 30, 2004, at 13:42:49
Hello vwoolf,
I am sorry to hear that you had such a bad experience with ECT. I expect that being forced to have ECT would be very traumatic for almost everyone. Most psychiatrists still claim that ECT doesn't cause long-term memory loss. I think that they have clearly spent too much time listening to each other and not enough time listening to the views of their patients. At the moment, in England, people can be forced to have ECT if they have been 'sectioned' under the mental health act. It is not possible to force anyone to have psychosurgery. A few years ago I spoke to the psychiatrist in charge of ECT at my local hospital, I was shocked when he told me that ECT is no longer controversial. I sometimes wonder whether certain psychiatrists are more delusional than their patients!
What did you think of the MIND guide to ECT? In general, I have a high opinion of MIND because they concentrate on the beliefs of those who use the mental health system. They have a useful website.
Recently, the UK National Institute for Clinical Excellence (NICE) reviewed the use of ECT. NICE is an organisation which controls the availability of drugs and other treatments on the National Health Service. Here is an extract from the press release.....
Setting standards for ECT use in England and Wales
The National Institute for Clinical Excellence has issued guidance on the use of electroconvulsive therapy (ECT). In summary the guidance recommends that:
• ECT is used only to achieve rapid and short-term improvement of severe symptoms after other treatment options have failed and/or when the condition is considered to be potentially life-threatening, in individuals with:
• severe depressive illness
• catatonia
• a prolonged or severe manic episode.
• The decision to use ECT should be made jointly by the individual and the clinician(s) responsible for treatment, on the basis of an informed discussion.
• Valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. Consent should be obtained without pressure or coercion, and the individual should be reminded of their right to withdraw consent at any point.Apparantly, some psychiatrists were not happy with this advice because they felt that it would restrict the use of ECT.
Regarding psychosurgery, it is very rarely used in the UK at the moment. I wonder whether that will change?
Regards,
Ed.
Posted by linkadge on November 30, 2004, at 14:37:51
In reply to Re: MIND guide to Electroconvulsive therapy » linkadge, posted by ed_uk on November 30, 2004, at 11:09:30
The neurological dammage of ECT has been the subject of many studies. Some well respected and independant researchers found minimal dammage when the procedure was done in certain ways.
But to be honest I would prefer SST (psychosurgery) to ECT.
SST, in general is more effective than ECT, generally leaves no memory loss. Its effects on affective disorders are much longer lasting.
Linkadge
Posted by ed_uk on November 30, 2004, at 15:06:28
In reply to Re: MIND guide to Electroconvulsive therapy, posted by linkadge on November 30, 2004, at 14:37:51
.....I'd always be really scared to have psychosurgery because you can't reverse the effects.
Regards,
Ed.
Posted by Iansf on November 30, 2004, at 16:17:18
In reply to Re: MIND guide to Electroconvulsive therapy, posted by linkadge on November 30, 2004, at 10:34:59
> I would have SST (stereotactic subcaudate tractotomy) hands down before having ECT.
>
>
> Linkadge
>
What exactly is that? Thanks.
Posted by linkadge on November 30, 2004, at 16:23:42
In reply to Re: Linkadge » linkadge, posted by ed_uk on November 30, 2004, at 15:06:28
"I'd always be really scared to have psychosurgery because you can't reverse the effects. "
Neither can the effects of ECT. (if things go wrong)
Linkadge
Posted by linkadge on November 30, 2004, at 16:25:59
In reply to Re: MIND guide to Electroconvulsive therapy » linkadge, posted by Iansf on November 30, 2004, at 16:17:18
Basicacally it is a fairly advanced neurosurgery where they sever some of the connections between the caudate and the amygdala etc.
These certain parts of the brain are overactive in depression, and tame down in most people when AD's are taken. Contrary to popular belief, depression isn't because something isn't happening in the brain, but rather because too much is happening in certain areas.
Linkadge
Posted by jack smith on November 30, 2004, at 17:17:25
In reply to Re: MIND guide to Electroconvulsive therapy, posted by linkadge on November 30, 2004, at 16:25:59
> These certain parts of the brain are overactive in depression, and tame down in most people when AD's are taken. Contrary to popular belief, depression isn't because something isn't happening in the brain, but rather because too much is happening in certain areas.
>Link, I think that is a slight overstatement. From what I understand, it can be either over-activity, under-activity, or, more likely, a combo of both. But really, most of this is relatively unsupported theory, and we are far, far away from knowing what the "cause" of depression is---I would bet it varies much with people and it certainly isn't limited to "physical" causes, certainly trauma at some point in life can be a "cause" for depression in some at least.
JACK
Posted by linkadge on November 30, 2004, at 17:57:19
In reply to Re: MIND guide to Electroconvulsive therapy » linkadge, posted by jack smith on November 30, 2004, at 17:17:25
I agree with you that it isn't that clear cut,
and that depression tends to be a combination of overactivation and underactivation of certain brain regions.
We don't know all the causes but, we do know that most effective antidepressants, ECT, SST, Sleep deprivation, medication, exercise etc, all seem to activate the prefrontal cortex, and tame down the limbic system, amygdala, and caudate.
Linkadge
Posted by vwoolf on December 1, 2004, at 2:59:45
In reply to Re: MIND guide to Electroconvulsive therapy, posted by ed_uk on November 30, 2004, at 8:42:31
Hi Ed, thanks for the stimulating discussions you generate.
I have to admit that my response to articles about ECT is always emotional, so I am perhaps not a good person to judge the MIND site. On first reading it last night, it seemed to be a balanced article that was trying to present both sides of the argument without bias. In fact, I was vaguely under the impression that it was in favour of ECT. Rereading it in the light of day, I can see that it is in fact very cautious about promoting ECT - it actually seems to emphasise the idea that ECT causes brain damage, and is a rough, little understood, dangerous way of treating psychiatric distress. Or am I still not reading it right? Help!!!
I wish they would put the very clear warning that information needs to be full and exhaustive in bold characters - psychiatric patients (like me) find it difficult to take in information under emotionally charged circumstances, and I actually didn’t even notice these lines when I first read the article. The same applies to the fact that consent should not be given at once, but the patient should go away with written information about the procedure and be given time to think over the decision. Very often, as in my case, psychiatrists are eager to push their solution through without respecting all the protocol, and decisions are made far too lightly. The article is clearly and simply written for the layman.
The comment by the psychologist, Simon Green, that it is comparable to trying to fix a television set with a sledgehammer rings very true for me. It does cause brain damage, and I believe that a part of my life has been taken from me by the use of ECT, both in memories lost, and in my inability to remember things today. Before the ECT I had a very clear photographic memory. Today I battle to recognize people I have met many times, and can watch the same movie over and over as if I had never seen it before. The damage seems to be related only to visual memory fortunately, so it has not interfered with my studies or professional development to any great degree, but it is hampering nonetheless.
I notice that you have put the articles on ECT and Psychosurgery together. I agree that they have a great deal in common as being little understood, invasive, brutal methods of trying to make uncomfortable problems go away, regardless of the outcome for the person involved. I believe that ECT is still very common in the US. I have come across websites which make it possible to identify doctors who use this procedure as their first, and often only, method of treatment. Dr Shock himself is alive and well, and living somewhere in North America - was it in Philadelphia?
Warm regards.
Posted by ed_uk on December 1, 2004, at 9:08:48
In reply to Re: MIND guide to Electroconvulsive therapy, posted by vwoolf on December 1, 2004, at 2:59:45
Hi Vwoolf,
I put the articles about ECT and psychosurgery together because they are both physical treatments. I suppose that I should have posted the info about insulin coma in the same thread. As far as I know, about 10 000 people a year have ECT in the UK. Don't quote me on that because I didn't check! I think in the US it's about 100 000. Is that right?
Regards,
Ed.
Posted by JohnM4402 on December 1, 2004, at 11:55:13
In reply to Re: MIND guide to Electroconvulsive therapy, posted by ed_uk on November 30, 2004, at 8:42:31
I am having ECT done next month so I will have the chance to form my own opinion about it's effectiveness and side effects.
Posted by ed_uk on December 1, 2004, at 12:23:38
In reply to Re: Interesting Article » ed_uk, posted by JohnM4402 on December 1, 2004, at 11:55:13
Hi!
Good luck! Are you having ECT for depression or something else?
Regards,
Ed.
Posted by JohnM4402 on December 1, 2004, at 14:26:19
In reply to Re: Interesting Article » JohnM4402, posted by ed_uk on December 1, 2004, at 12:23:38
> Hi!
>
> Good luck! Are you having ECT for depression or something else?
>
> Regards,
> Ed.Yes, I am having it for treatment resistant depression. I am really looking forward to doing it. My doctor recomended me for it about a year ago but I only agreed to it recently because my depression has gone from bad to worse. Also one of the reasons I did not do ECT earlier was the amount of time I would need to take off work. I have told my boss that I will need at least 4 weeks off for a 'medical procedure'. My doctor at first told me I needed 6 weeks off but he says 4 may be enough depending on how I feel. I really wish I could go now and do the treatment but I decided to wait until I could finish the project I am working on for my Job in mid January. It would have caused problems with my work if I did this in the middle of a project.
Posted by Shalom34Israel on December 1, 2004, at 19:33:11
In reply to Psychosurgery, posted by ed_uk on November 30, 2004, at 8:05:02
Psychosurgery is used by psychiatrists to control unruly patients who are unsatisfied with their psychiatric treatment. It does not treat the underlying mental illness. At present, scientists and psychiatrists do not understand the causes of serious mental illness.
Psychosurgery is NOT making any kind of serious comeback in the USA. In the UK, it may be another story but then again those people dont have the individual rights Americans have. In Australia, the original lobotomy is still legal, unfortunately.
Youve got to remember in these UK/British type countries they have a strong caste system and doctors are "authority figures" more than they are in America. Doctors in these countries can force treatments like psychosurgery more easily on patients than they can in America. In fact in America, its impossible to force a patient to have psychosurgery anymore. And has been since the early seventies. And things wont change here in the good ole USA either.
Psychosurgery is nothing but an infringement of individual civil rights plain and simple and doctors who perform it should be sent to prison. Its not tolerated in the USA and it shouldnt be tolerated anywhere. Its even outlawed in Russia!
Shalom
Posted by Shalom34Israel on December 1, 2004, at 19:50:34
In reply to Re: MIND guide to Electroconvulsive therapy, posted by linkadge on November 30, 2004, at 10:34:59
> I would have SST (stereotactic subcaudate tractotomy) hands down before having ECT.
>
>
> Linkadge
>You have rocks for brains.
Shalom
Posted by Shalom34Israel on December 1, 2004, at 19:51:48
In reply to Re: MIND guide to Electroconvulsive therapy » linkadge, posted by ed_uk on November 30, 2004, at 11:09:30
> Really? ....... I suppose that the damage is much more localised.
>
> Eddont listen to this fruitcake guy linkage or whatever the hell his name is. He's an idiot.
Shalom
Posted by jujube on December 1, 2004, at 20:23:49
In reply to Re: MIND guide to Electroconvulsive therapy, posted by Shalom34Israel on December 1, 2004, at 19:51:48
> > Really? ....... I suppose that the damage is much more localised.
> >
> > Ed
>
> dont listen to this fruitcake guy linkage or whatever the hell his name is. He's an idiot.
>
> ShalomYour messages would be taken more seriously and appreciated if you could learn to be respectful, civil and a bit more humane. People who have to resort to name calling have never been, nor will they ever be, effective orators. PLEASE BE NICE.
>
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