Posted by linkadge on July 6, 2008, at 12:44:09
In reply to Re: ECT response rate, posted by BGB on July 5, 2008, at 18:31:12
>was most likely treated for his symptom, >depression, rather than his true illness as it >was unknown to his physicians at the time. While >no autopsy was done at his time of death due to >his family's request, the disease is genetic and >runs rampant in his family. It is extremely >likely (although not confirmed) that he had the >disease, which would explain why his ECT >treatments failed.
That is a possability but I think the example is still a valid one. The point I was trying to make is that (for whatever reason) ECT often does not work yet can still leave the patient with the prospect of long term brain damage. People seem to restrict the deficits to memory. In animal models, ECT causes glutamatergic excitotoxicity.
It has the capacity to affect the operation of the enture brain. Some of the latest research on epilepsy shows how critical it is for brain health to get a prompt control of seizures. History of uncontroled seizures in epilepsy is positively correlated with cogniative deficits and cell loss. The long term and deleterious effects of seizures are well accepted. You basically see the same types of problems in epilepsy. Memory loss, hippocampal/temporal lobe damage, learning deficits, excitotoxicity, glial pathologies etc. The type of research poses a inconsistency that neurologists seem to be the most sensitive to.
Depression is a disorder with very heterogenious origins and we still don't really have any useful diagnositic predictors of ECT success. So, I really don't think it matters whether or not there is an identifyable reason for ECT failure. The point is that it doesn't always work.>Heart disease is also known to cause depressive >symptoms, and it is documented that Hemingway >had high blood pressure, extremely high >cholesterol levels, and severe aortal >inflammation.
Heart disease is highly comorbid with depressive disorders.
>Hemingway also survived not one but TWO plane >crashes, causing trauma to his head and crushing >his vertebrae, among other very serious >injuries. His head injuries were so severe that >he lost his vision and hearing on his left side >for a period of time.
Stress is a precipitating factor in many depressive illnesses.
>Such severe trauma to the brain could not only >explain his depression, it could also explain >his memory loss during ECT.
>Patients with severe head trauma are known to >experience greater memory loss with ECT than >typical patients.
ECT itself is a severe head trauma.
>Additionally, it is known that Hemingway was a >very heavy drinker his entire life, and became a >raging alcoholic in his final years. Not only >can alcoholism cause depression, but heavy >drinking is contraindicated with ECT treatment. >This could have played a HUGE role in his memory >loss.
Its easy to speculate. Depression can also cause alcoholism. Was he drinking in the waiting room or something?
>Furthermore, it is well accepted by physicians >that memory loss often reverses itself in the >days and weeks after ECT in many patients.
Some of more recent (and more comprehenisve) studies of pre and post ECT cognitive abilities do not suggest that the effects do fully "reverse themselves"
>Hemingway killed himself only a few days after >his last ECT treatment.
Obviously it was not lifting his depression.
>There are far too many extenuating circumstances >to proclaim that ECT caused Hemingway's death, >especially when you consider that his father, >two of his siblings, and his granddaughter all >took their own life.
I guess the bottom line is that patients should have a routene test for this iron overload disorder before having ECT, but they don't! Thats my point. Our understanding of why certain people are so depressed and refractory very ill defined.
Hemmingway was probably led to believe that ECT was his last option.>he was far too sick at the time to be able to >make clear and well-thought-out statements.
Exactly.
>I'm sure that he did feel as though ECT killed >him,
Well it certainly didn't save him.
Linkadge
poster:linkadge
thread:836941
URL: http://www.dr-bob.org/babble/20080706/msgs/838383.html