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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Denise528 on January 11, 2002, at 8:55:52
Does anyone know how ECT works? Does it effect the neuro transmitters or does it work in a different way?
Denise
Posted by bob on January 11, 2002, at 16:51:39
In reply to How does ECT Work?, posted by Denise528 on January 11, 2002, at 8:55:52
Denise:
Like all psychiatric intervention, including therapy, no one "knows" how it works. Look at the monograph for any psychoactive compound and you will see wording like, "the exact mechanism of action of this drug is unknown". Well, as far as I know, the same thing is true for ECT. It is accepted that the induction of a seizure in the brain somehow "resets" the balance of amines and hormones. It is the seizure which is the necessary and therapeutic component of ECT. More specifically, it is thought that only seizures affecting the centrencephalic structures of the brain, including the hyphothalamus and pituitary gland are truly beneficial. One view is that this activity increases the availability of important amino acids and peptides in the cerebrospinal fluid, thus making these important compounds/hormones more available to the brain tissue.
If you are interested in ECT, you might want to read Max Fink's book, Electroshock. It is reasonably up to date. Chapter 9 deals with the theories of how ECT might work. The major theory he puts forth he refers to as "The Neuroendocrine View".
Coming back to my original point, however... it's all theory. What is apparent, however, is ECT's ability to bring people "back from the brink". What is also apparent is that it's level of effectiveness is different for each individual, including such things as amount of memory loss, and duration of effectiveness. In the short term, there seems to be no other treatment that works so quickly for so many people.
Bob
Posted by Blue Cheer 1 on January 11, 2002, at 18:19:29
In reply to Re: How does ECT Work? » Denise528, posted by bob on January 11, 2002, at 16:51:39
> Denise:
>
> Like all psychiatric intervention, including therapy, no one "knows" how it works. Look at the monograph for any psychoactive compound and you will see wording like, "the exact mechanism of action of this drug is unknown". Well, as far as I know, the same thing is true for ECT. It is accepted that the induction of a seizure in the brain somehow "resets" the balance of amines and hormones. It is the seizure which is the necessary and therapeutic component of ECT. More specifically, it is thought that only seizures affecting the centrencephalic structures of the brain, including the hyphothalamus and pituitary gland are truly beneficial. One view is that this activity increases the availability of important amino acids and peptides in the cerebrospinal fluid, thus making these important compounds/hormones more available to the brain tissue.
>
> If you are interested in ECT, you might want to read Max Fink's book, "Electroshock". It is reasonably up to date. Chapter 9 deals with the theories of how ECT might work. The major theory he puts forth he refers to as "The Neuroendocrine View".
>
> Coming back to my original point, however... it's all theory. What is apparent, however, is ECT's ability to bring people "back from the brink". What is also apparent is that it's level of effectiveness is different for each individual, including such things as amount of memory loss, and duration of effectiveness. In the short term, there seems to be no other treatment that works so quickly for so many people.
>
> Bob
I wouldn't spend money on Dr. Fink's _Electroshock: Restoring the Mind_. It's available in many bookstores, and the few chapters worth reading can be read in less than one-half hour. I once asked Dr. Fink in an email if he thought ECT would "total" me. His reply: "Probably not." Well, thanks! :) No one knows the mechanism of action in ECT, but there are *many* who know its consequences. Try searching online for the 60 Minutes II broadcast on ECT, and then read some of the posts in response to it.Here's one person's experience in an article I read today in a local weekly:
http://www.philadelphiaweekly.com
Once you have it, it can't be undone -- that's for sure.
Posted by OldSchool on January 11, 2002, at 18:53:44
In reply to Re: How does ECT Work?, posted by Blue Cheer 1 on January 11, 2002, at 18:19:29
> > Denise:
> >
> > Like all psychiatric intervention, including therapy, no one "knows" how it works. Look at the monograph for any psychoactive compound and you will see wording like, "the exact mechanism of action of this drug is unknown". Well, as far as I know, the same thing is true for ECT. It is accepted that the induction of a seizure in the brain somehow "resets" the balance of amines and hormones. It is the seizure which is the necessary and therapeutic component of ECT. More specifically, it is thought that only seizures affecting the centrencephalic structures of the brain, including the hyphothalamus and pituitary gland are truly beneficial. One view is that this activity increases the availability of important amino acids and peptides in the cerebrospinal fluid, thus making these important compounds/hormones more available to the brain tissue.
> >
> > If you are interested in ECT, you might want to read Max Fink's book, "Electroshock". It is reasonably up to date. Chapter 9 deals with the theories of how ECT might work. The major theory he puts forth he refers to as "The Neuroendocrine View".
> >
> > Coming back to my original point, however... it's all theory. What is apparent, however, is ECT's ability to bring people "back from the brink". What is also apparent is that it's level of effectiveness is different for each individual, including such things as amount of memory loss, and duration of effectiveness. In the short term, there seems to be no other treatment that works so quickly for so many people.
> >
> > Bob
>
>
> I wouldn't spend money on Dr. Fink's _Electroshock: Restoring the Mind_. It's available in many bookstores, and the few chapters worth reading can be read in less than one-half hour. I once asked Dr. Fink in an email if he thought ECT would "total" me. His reply: "Probably not." Well, thanks! :) No one knows the mechanism of action in ECT, but there are *many* who know its consequences. Try searching online for the 60 Minutes II broadcast on ECT, and then read some of the posts in response to it.
>
> Here's one person's experience in an article I read today in a local weekly:
>
> http://www.philadelphiaweekly.com
>
> Once you have it, it can't be undone -- that's for sure.
You dont sound like you ever had really severe clinical depression before.Old School
Posted by OldSchool on January 11, 2002, at 18:59:33
In reply to How does ECT Work?, posted by Denise528 on January 11, 2002, at 8:55:52
> Does anyone know how ECT works? Does it effect the neuro transmitters or does it work in a different way?
>
> DeniseECT works by causing a massive generalized seizure. In a nutshell thats how it works. No seizure induced from the electricity equals no antidepressant effect. When the seizure occurs massive amounts of brain neurotransmitters are released like serotonin, dopamine, etc. Serotonin actually has anticonvulsant properties in addition to antidepressant qualities. Its like a super MAOI. It also raises your seizure threshhold, creating a strong anti-convulsant effect. When you have ECT, it makes it harder to have more seizures. When you get shocked and have a seizure, its like the brain says "whoa there, another seizure is probably coming so I better start making some changes." The changes include automatically raising the seizure threshhold and creation of a strong antidepressant effect.
Posted by Blue Cheer 1 on January 11, 2002, at 23:16:58
In reply to Re: How does ECT Work?, posted by OldSchool on January 11, 2002, at 18:53:44
> > > Denise:
> > >
> > > Like all psychiatric intervention, including therapy, no one "knows" how it works. Look at the monograph for any psychoactive compound and you will see wording like, "the exact mechanism of action of this drug is unknown". Well, as far as I know, the same thing is true for ECT. It is accepted that the induction of a seizure in the brain somehow "resets" the balance of amines and hormones. It is the seizure which is the necessary and therapeutic component of ECT. More specifically, it is thought that only seizures affecting the centrencephalic structures of the brain, including the hyphothalamus and pituitary gland are truly beneficial. One view is that this activity increases the availability of important amino acids and peptides in the cerebrospinal fluid, thus making these important compounds/hormones more available to the brain tissue.
> > >
> > > If you are interested in ECT, you might want to read Max Fink's book, "Electroshock". It is reasonably up to date. Chapter 9 deals with the theories of how ECT might work. The major theory he puts forth he refers to as "The Neuroendocrine View".
> > >
> > > Coming back to my original point, however... it's all theory. What is apparent, however, is ECT's ability to bring people "back from the brink". What is also apparent is that it's level of effectiveness is different for each individual, including such things as amount of memory loss, and duration of effectiveness. In the short term, there seems to be no other treatment that works so quickly for so many people.
> > >
> > > Bob
> >
> >
> > I wouldn't spend money on Dr. Fink's _Electroshock: Restoring the Mind_. It's available in many bookstores, and the few chapters worth reading can be read in less than one-half hour. I once asked Dr. Fink in an email if he thought ECT would "total" me. His reply: "Probably not." Well, thanks! :) No one knows the mechanism of action in ECT, but there are *many* who know its consequences. Try searching online for the 60 Minutes II broadcast on ECT, and then read some of the posts in response to it.
> >
> > Here's one person's experience in an article I read today in a local weekly:
> >
> > http://www.philadelphiaweekly.com
> >
> > Once you have it, it can't be undone -- that's for sure.
>
>
> You dont sound like you ever had really severe clinical depression before.
>
> Old SchoolActually, I've had numerous episodes of severe bipolar depression and have considered ECT for myself on occasion. It's my opinion that the risks outweigh the potential long-term benefit, and that excepting certain life-threatening circumstances, ECT should be a *fully* informed decision. I've personally witnessed patients (in prestigious university hospitals and elsewhere) being coerced and literally hounded around the ward by eager residents in order to have them sign the informed consent form.
I'd recommend an advanced psychiatric directive (there's one available at www.bazelon.org) for anyone who has reservations about ECT.
Blue
Posted by Dr. Bob on January 11, 2002, at 23:25:31
In reply to Re: How does ECT Work?, posted by OldSchool on January 11, 2002, at 18:53:44
> You dont sound like you ever had really severe clinical depression before.
Please don't jump to conclusions about others or their experiences, thanks.
Bob
PS: Follow-ups regarding civility should be redirected to Psycho-Babble Administration.
Posted by bob on January 12, 2002, at 1:36:16
In reply to Re: How does ECT Work?, posted by Blue Cheer 1 on January 11, 2002, at 18:19:29
Blue Cheer:
I only suggested Fink's book in this case because of the suggested theory put forth in chapter 9 about how it might work. I did read the book, however, and don't see your problem with it. I think there are many situations where it is necessary. I'm not going to get involved in anybody's decision to have it though, and I also don't know about people being forced into it.
Also, the link you refer us to was for a woman who had ECT in the 1960s! ECT has made enormous strides since then, and Fink points out in his book. He specifically points out how oxygenation before and during the procedure reduces memory loss greatly. Memory loss is still a problem however, but it seems that extraordinary situations take extraordinary measures, and risks are naturally involved.
I don't agree with everything Fink says, but if one is to inform themselves on a subject, the book should probably not be ignored. It's probably not the only thing that should be read. Another book, Undercurrents, by Martha Manning might be something Denise would want to read. It is an excellent description of Mannings experience of ECT in the early 90s, I believe. She attributes it to bringing her back from the edge. There are people who have had ECT, and are not against it.
Posted by Dinah on January 12, 2002, at 4:51:46
In reply to Re: How does ECT Work? » Blue Cheer 1, posted by bob on January 12, 2002, at 1:36:16
I have no special knowledge in this area, but I suspect that when neurologists finally figure out what happens in at least some of the "mental illnesses" we'll discover that seizures play a more important role than we now realize. Perhaps a different type of seizure than we now understand. The mood stabilizers, Klonopin, all are anti-epileptics. And on a purely subjective level, some elements of my mood cycling transitional stages and my OCD feel oddly seizure-like.
I'm not really explaining myself well, and I may be completely off base. My thoughts are more intuitive than logical at this point. So if all scientific research shows my theory to be wrong, I won't be at all offended.
Posted by Mr. Scott on January 13, 2002, at 21:01:07
In reply to Re: How does ECT Work?, posted by Dinah on January 12, 2002, at 4:51:46
Hello Dinah,
My psychiatrist always talks about Seizures and anticonvulsants, and I'm like "but doc I'm just depressed and Anxious", He thinks I like benzos like Klonopin for their anticonvulsant effect and not the Anto anxiety effect.
I don't know about that, but obviously your not alone in your theory.
Scott
Posted by Mitch on January 14, 2002, at 9:43:07
In reply to Re: How does ECT Work?, posted by Dinah on January 12, 2002, at 4:51:46
> I have no special knowledge in this area, but I suspect that when neurologists finally figure out what happens in at least some of the "mental illnesses" we'll discover that seizures play a more important role than we now realize. Perhaps a different type of seizure than we now understand. The mood stabilizers, Klonopin, all are anti-epileptics. And on a purely subjective level, some elements of my mood cycling transitional stages and my OCD feel oddly seizure-like.
> I'm not really explaining myself well, and I may be completely off base. My thoughts are more intuitive than logical at this point. So if all scientific research shows my theory to be wrong, I won't be at all offended.
I think you are onto something, too. Whenever I get hypomanic I have a lot of symptoms of temporal lobe epilepsy. It is also interesting to find that benzos like clonazepam and lorazepam work as good or better as antimanic agents (for me) than antipsychotics do.Mitch
Posted by Mr. Scott on January 14, 2002, at 22:02:24
In reply to Re: How does ECT Work? » Dinah, posted by Mitch on January 14, 2002, at 9:43:07
Do you think Clonazepam has long term utility for bipolar? One doctor I saw a while back claimed he gave one of his floridly manic patients who refused to take mood stabilizers 1mg of Klonopin twice daily and that 13 years later she never again had a manic episode. Sort of answers my own question, but what do you think.
Scott
Posted by Mitch on January 14, 2002, at 23:32:45
In reply to Hey Mitch! I gotta question for you? » Mitch, posted by Mr. Scott on January 14, 2002, at 22:02:24
> Do you think Clonazepam has long term utility for bipolar? One doctor I saw a while back claimed he gave one of his floridly manic patients who refused to take mood stabilizers 1mg of Klonopin twice daily and that 13 years later she never again had a manic episode. Sort of answers my own question, but what do you think.
>
> ScottHi Scott,
Wouldn't surprise me at all if he was being completely honest with you. I am looking at increased hypomanias over the next few weeks (until my late June-start of another seasonal depressive episode). It is kind of like being on a treadmill and some Russian gangster is smoking a cigarette and cranking up the treadmill rate without my permission!
Anyhow, all I usually need to do is double up on my Klonopin for a day or two (maybe popping in 125mg of Depakote here and there, too), and that usually takes care of the high spots (which are usually only a few days long at most).Mitch
This is the end of the thread.
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