Posted by blueboy on July 3, 2008, at 13:42:24
In reply to ECT...I am scared to death, posted by john51 on June 28, 2008, at 6:12:06
> I have been to countless pdocs over the years and have tried just about every possible pmed and many combinations. My pdoc is basically saying that the only thing left to try is ECT. I have agreed to do it but I am SCARED TO DEATH at the prospect of the memory loss, possible loss of cognitive abilities, and from what others have told me...terrible headaches between treatments.
>
> Has anyone out there got any thing to offer either pro or con involving ECT???
>I am a bit anti-ECT, although not completely. My biggest problem with it is actually not with the procedure so much, as the failure of the Powers That Be to develop any rational protocol based on comprehensive research. Really, considering how long the procedure has been around (I know "The Bell Jar" refers to events in the 50's or 60's), the lack of solid record-keeping and research is unconscionable. If ECT were a new drug anti-depression drug being marketed by a pharmaceutical company, the FDA would laugh at the application.
In fact, the only reason we have ANY long-term statistics for broad population samples is because several states passed laws requiring psychiatrists and facilities to report all ECT treatment, including reported side effects, for six months after treatment is administered. Texas is the only one I am sure of, but I think California may have a similar law.
In spite of numerous anecdotal accounts of "ECT ruined my life", and similar accounts from some psychiatrists, and despite the frequency, expense and physical trauma of the procedure, only the most primitive attempts to quantify (much less explain) memory loss and other commonly reported cognitive problems have been made. Plus, the little work that has been done is inadequate in duration (short term only), sample size, sophistication of testing, breadth of testing, frequency of testing, controls (the best study I saw used a control group but did not attempt to regress the statistics for natural improvement in "learning the test"), etc.
And there has been absolutely no attempt to create validated protocols for testing/observation before or during a course of ECT therapy and adjusting the therapy against quantified guidelines. The protocol consists, pretty much, of people and their doctors deciding "this isn't helping" or "I'm getting more memory loss or cognitive problems than I can handle" and discontinuing therapy.
Medical science gets an "F" for ECT. They don't seem to have even a *clue* how or why it works, or for what patients. The APA's suggested informed consent form states a "20%" chance of short term memory loss; the best I can tell, however, they have no sound scientific basis for this number. They have no idea whether or not, or to what degree or in what kinds of people, long-term memory loss or cognitive disfunction may or may not occur. There is no scientifically-based protocol for maintenance treatments or adjunct drug therapy.
All this, despite the fact that the procedure has been performed on tens of thousands of patients annually for over 50 years -- Newsweek estimated 30,000 to 50,000 patients per year in 1990 -- at least some of whom claim to have had profound and permanent mental impairment.
(Even worse, most states will allow ECT to be given forcibly to non-criminal patient's, in extreme cases!)
Okay, rant over :) I would actually get ECT if I were desperate enough, especially if I were getting close to suicide. It does appear to be successful in perhaps half the cases, and extremely successful in some cases, in significantly reducing depression for a temporary period. I'd guess something like six months. And, in all fairness, a lot of people do seem to have minimal side effects. (All patients have some side effects, since all patients undergo repeated general anesthesia and severe physical convulsions. General anesthesia by itself, even without medical error, has inherent side effects such as grogginess, significant side effects (e.g. bad sore throat) perhaps 10% of the time, severe side effects (e.g. stroke) in perhaps 1 out of 10,000 cases, and causes death in perhaps 1 out of 250,000 cases. Most ECT patients report headaches and body soreness.)
In my own case, I was seriously considering getting a course of ECT, after decades of unsuccessful and often painful drug therapies for depression. Luckily I spent money at a national clinic to get a special diagnosis; I was rediagnosed from "major depressive episode" in the DSM's lexicon, to "Bipolar II", which apparently explains how badly I reacted to some of the drugs I tried. So I got a reprieve and can now try heaven-knows-how-many different new drugs, sigh.
Actually, the Lamictal I'm now taking appears to be doing some good with almost no side effects. Feel free to pray for me if you do that, or wish me well if you don't.
Bottom line: I'm scared of ECT, too. For myself, I've pretty much decided I won't do ECT unless I find myself actually forming plans to commit suicide.
poster:blueboy
thread:836941
URL: http://www.dr-bob.org/babble/20080626/msgs/837847.html