The misunderstood consequences of electroconvulsive therapy
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That information can be found in the Code of Practice to the Mental Health Act. The code isn't law, but it describes the various acts, statutes, and case law and so a health care practitioner would have to ahve good reason to deviate from it.
https://assets.publishing.service.gov.uk/government/uploads/...
If you want to make it even harder for them to give you ECT against your wishes you can make an advance directive. Go see a lawyer that deals with mental capacity stuff and get one drawn up. Be clear and specific.
But, please do take note of what this woman has said:
> Despite the discomfort and the temporary memory loss it caused, I would have ECT again without hesitation. People voluntarily undergo much more invasive and damaging medical interventions to save or to prolong their lives—chemotherapy, radiation, open-heart surgery, blood transfusions, bone marrow transplants—and speak freely about those experiences, but continue to think about cancer and heart disease differently from mood disorders that can be equally deadly. In telling my own less than ideal story 30 years after the fact, I don’t want to discourage anyone from having this potentially life-saving treatment. What was difficult in my experience would now be unusual because the treatment protocol has improved over the years to greatly reduce the side effects. And my situation was extreme not only because of the perilous condition of my mind, but because my body was already hypersensitive and aggravated by drug allergies.
I know a few people who've had ECT and a couple of them hated it and are still angry it was done to them, but most of them are glad they had it done and would do it again.
It's hard to work out how much harm it causes because it's only used in people with the most severe depression, and that causes similar harms itself.
I've had depression for nineteen years, and because of it I have giant holes in my memory - I know that I went places and did things when I was growing up, but I have next to no memories of any of them. My short-term memory malfunctions a lot - I can go through an entire day, and have zero memories of it the next day. I suspect I'd lose a few more memories with ECT but, really, I would happily pay those memories for having a life where I could actually function.
They can force various antipsychotics down your throat like Olanzapine (https://en.wikipedia.org/wiki/Olanzapine) or Quetiapine(https://en.wikipedia.org/wiki/Quetiapine), with serious side effects, but ECT which has very little known side effects, and has been studied quite intensely, cannot be forced.
My wife suffered a psychotic manic episode (https://en.wikipedia.org/wiki/Postpartum_psychosis) after the birth of our first child, the opposite of post partum depression, which happens in 1/1000 births.
I witnessed her on antipsycotics for a week while attempting to persuade her to accept ECT. The effects of ECT were astonishing. She had the ECT treatment at 9:00 in the morning, and by noon she was back to normal. She had a few more treatments after that to make sure she didn't relapse, and that was the last we saw of it.
She's still without relapses 10 years later, and according to her, should it happen again she would accept ECT much sooner.
Edit: I should probably elaborate on the side effects she experienced. She suffered short term memory loss, which is a known side effect. When she went to the ECT treatment she recognized the driver, and they established where they knew each other from. It was surreal to witness the same conversation unfold with the driver that just unfolded 20 minutes ago before ECT. She had absolutely no recollection of having seen or talked to the guy before on that day.
She feels (now) that she has lost more memory, but as the conventional treatment for manic episodes is basically locking them up in a room with a bed, a table a chair, and some sheets of paper, and keeping them confined there for 2+ weeks, i bet most of us would be unable to keep track of time. Add the various drugs being administered to the equation, in doses that makes you lean against the wall and drool.
She has no memory problems today. The only "blank spots" are in the time surrounding her hospitalization, specifically the days her ECT treatment was administered.
I'm sure ECT can be misused by jerks on power trips, incompetent quacks, and grifters out to make a buck. I also appreciate that some people have suffered from awful side effects from ECT—and other treatments. I don't want to trivialize that at all.
Nevertheless, I want to emphasize that the vast majority of clinicians and researchers are doing the best they can. Depression can be very debilitating and the tools we have for dealing with it are not great. ECT is one of them. It works well for some people but not others, much like many of the drugs and behavioral therapies, and no one really understands why. We would love to have better options, and a lot of very smart, very hardworking people (and me!) have bene working hard to figure out how the brain works, how it can go wrong, and how to restore function when they do.
Much like the effects of having a seizure in those with epilepsy.
itt: people who don't know what they are talking about.
That ECT is still around after all this time, speaks to its effectiveness, despite some of the vehement comments on this page.
One of more credible theories about depression is that it occurs when the brain gets stuck in a "bad" state or cycle (like a local minimum or attracting state). If this model is correct, a treatment that nudges brain activity away from the depressed state and towards a less pathological one would help.
It's more akin to rebooting the computer than smashing it, if you will.
I ask because ECT seems to upregulate trophic factors, rather than downregulating them. Some sort of hippocampal injury does seem like it could explain memory-related side effects, but it apparently doesn't actually happen (e.g., https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...)
"ECT damage is easy to find if you look for it" https://www.nature.com/articles/35002188
Look, I’m not arguing that ECT is the best thing ever. The side effects are awful for some people, no one understands the mechanism, and so on. However, it sometimes works when other treatments—-which aren’t great either—-fail. Clearly, better therapies are needed all around.
What you are saying cashes out to the claim that depression can be overcome with sheer positivity and willpower, which is a view I really thought society had gotten over. Please post more responsibly.
To anyone reading this, if you think you're depressed, please seek out a qualified talk therapist (CBT has been shown to be effective in treating depression) and a qualified physiatrist for medication.
Not to mention the number of people who get heart complications from it or outright die during the procedure.
How can you say that "the alternative is unbearable"is beyond me, unless you're saying it's better to become mentally disabled than suffer from depression?
The argument that "this is not the same ECT" is also bogus. The difference is now they paralyze you so you don't convulse and break your bones while doing it. They also use a higher voltage (more damaging to brain cells) and higher frequencies with shorter, repeated bursts (also causes more brain damage and hemorrhaging). But it's "better" because the patient doesn't thrash around so much anymore. Give me a break.
Summary of the issues with ECT and associated studies: https://truthaboutect.org/ect-causes-brain-damage-a-review-o...
http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-Citi...
If not, then I want you to understand this: ECT is used to treat a lethal illness.
Would you take someone who is about to kill themselves and take a pair of live electric wires to their head to try to "cure" them? Because that's essentially what ECT is, despite all the supposed "new and improved" spiel which is marketing speak, that and they sedate you while doing it.
Inducing brain damage is not treatment.
Saying that is not denying the problems that some people are suicidal and need help. That's a very real issue.
But ECT is very real scientific fraud, often done without fully informed consent on the parts of the patients and family members, often done against and over the wishes of the person receiving ECT, and billed for thousands of dollars to insurance companies over and over again, with results that go away once treatment stops and side effects that remain for a lifetime.
ECT and ketamine, for example, are sometimes found to be effective for O(months) after initial more frequent treatment, while most of the psychiatric meds you run through earlier if you're pursuing that type of treatment take weeks to become effective (or not), weeks to stop, and the beneficial effects often stop much sooner than the side effects after taking them (...if they stop at all, in some cases).
ECT can and often does do lasting damage. It should not be used lightly. But singling out ECT for being a recurring treatment seems unreasonable when the other avenues of treatment, both behavioral and otherwise, have the same caveat.
By the time ECT is on the table, every other option is exhausted and the sufferer has been through multiple acute hospitalisations for suicidal ideation, if not unsuccessful attempts.
It is certainly fair to say the effect is not always permanent, that maintenance courses are a burden, and that their long-term efficacy does not justify the risks of the procedure itself or the anaesthesia it requires. Nonetheless, for someone who has been depressed for many years, plagued by crippling ennui and a nihilistic view of existence not even Schopenhauer’s grimmest passages can match, any respite is welcome. To deny them that option, with full knowledge of the risks, is to deny them agency.
"But he acquiesced when told that if he resisted, the hospital would seek a court order to overrule him."
Are you claiming they would do this, yet have the deeply depressed patient's honest agreement ?
I don't buy that. This was forced, under threat of force. To protect the hospital against having a successful suicide attempt on their record.
Symptoms return. Normal cognitive function does not. That tells you more than enough. This person is now (hopefully lightly) mentally handicapped, and this has been done to her under threat.
You might as well shoot the person. That has the same demonstrated effect. Seriously. Shooting someone with mental problems can fix those mental problems, many documented cases of that happening.
(edit: corrected language)
Clumsy language like this is a sign that you don't know as much about this subject as you think you do.
https://www.samaritans.org/documents/1/Samaritans_Media_Guid...
This is ludicrous hyperbole. The majority of people who receive ECT are successfully treated and go on to live fulfilling lives. ECT is an evidence-based treatment for a life-threatening medical condition.
Second, I resent psychologists using "evidence based" as a term. This, one might think, implies that they have proof. Well no, no proof. It doesn't mean that.
Ok, but surely it means that they have double blind statistical studies ? I mean, that makes "evidence" very misleading, but ... Yes, but those studies say there is no effect beyond placebo (in fact there are valid studies that say that all of psychiatry does not survive a double blind study). So statistical analyses actually says this does not work.
Ok, so what does "evidence based" mean ? Well, it means they have a few anecdotes of mostly temporary improvement (and lots of anecdotes of disastrous outcomes, conveniently left out). Which certainly exist for shooting depressive patients as well. Also they exist for not doing anything.
So why did the doctor force this treatment on her ? Well, to get her out of his clinic. You see, the way you get fired in a psychiatric department is to have a few patients commit suicide in the department. And observation and isolation only helps for so long. In practice, given 4-12 weeks of trying people successfully commit suicide, even under 24 hour observation with no tools in an isolation cell. This patient had gotten really close to doing that, as mentioned in the article (which, incidentally, would be the conditions this patient was held in prior to her getting asked if she'd agree to this treatment. Which of course also means she is mostly happy with the treatment because it got her out of an isolation cell, and still lives under threat of returning to those conditions. Reality of psychiatric patients).
So this is fact: this doctor forced permanent brain trauma on a patient because he was calculating that this trauma would temporarily prevent the patient from committing suicide, long enough so that she'd be out of his department before she actually succeeds.
So reality is simply that this patient was forced to get ineffective treatment that introduced permanent brain trauma against her wishes, with the decision made under extreme stress (introduced by this doctor), and under threat. That she got lucky and seems to be happy with it does not change that. PLUS she might merely be happy that it got her out of the isolation cell she was forced into for weeks/months before.
So let's go through your statement: > The majority of people who receive ECT are successfully treated If you don't count the permanent cognitive impairment, and the fact that most would have recovered without any help, then sure "successfully".
> and go on to live fulfilling lives.
Nope, most relapse. Unless you count redoing suicide attempts after ~4 months a sign of a fullfilling life. But of course, that's long enough to get them out of the hospital and let the doctor/hospital "not be responsible".
> ECT is an evidence-based
Nope. I know this term "evidence-based" is used in psychiatric literature, but that doesn't change the fact that it's bullshit, as explained.
> treatment for a
Nope. This is not a treatment by medical standards. For that to be the case there would need to be validation. This wouldn't even satisfy the standards for "experimental treatment", as that would require case-by-case review of an ethics board, which hasn't happened here.
> life-threatening
Nope. The vast majority of patients recover from this without any help. So it was not life threatening. Or at least, not any more
> medical
Nope, psychiatry is still not considered part of medicine by doctors.
> condition.
Well this is the only word in your sentence that was actually correct.
Psychiatry is a branch of medicine. Psychiatrists are medical doctors. Psychiatric disorders are recognised as diseases by the World Health Organisation in the International Classification of Diseases. The Merriam-Webster dictionary defines psychiatry as "a branch of medicine that deals with mental, emotional, or behavioural disorders". Psychiatrists are eligible for full membership of the American Medical Association, the British Medical Association and every other medical association I am aware of, because they are medical doctors.
The rest of your comment is just as wrong as this sentence and just as readily debunked. Due to the length of your comment and the sheer density of falsehoods, I am not inclined to debunk it point-by-point; I would suggest that anyone with an interest in the topic should consult the National Institute for Clinical Excellence's Technology Appraisal on ECT.
That doesn't mean it is considered medicine.
You still haven't explained why the threat of force (and thus force) was used against this patient ... to enforce an elective treatment that results in permanent cognitive damage. I am very curious how you'll explain that one.
(I would like to point out that any treatment that does not prevent death or long-term injury is one that's considered elective)
Medicine generally relies on “informed consent”: you have the right and responsibility to know and understand the treatments you are receiving and their possible effects.
Mental illness is tricky because the condition itself impairs patients’ ability to provide this consent. Maybe you’ve got extreme lassitude and refuse everything, for example, even contradictory options. Maybe you clearly do not understand the options presented to you.
Nevertheless, we also don’t want doctors making decisions unilaterally, so the next best thing is to involve a third party. If the patient has a guardian, it’s their call. If you don’t, a court can act as one temporarily, with the idea being that they’ll get you to a state where you can take over. Obviously, this isn’t ideal, but it’s not clear what would be a better approach.
The actual quote: "her husband was alarmed when the doctor suggested ECT. But he acquiesced when told that if he resisted, the hospital would seek a court order to overrule him." (note: author is talking about herself in the third person)
So I really do not "feel" force is mischaracterized. The threat was explicitly made AFTER the patient "was alarmed" (which means refused, let's get real). And threats are use of force, of course. (if I threatened to shoot you unless you did X, you would certainly call that force regardless of whether I actually shoot you, not even if I say "please". You would strongly disagree with me calling that "informed consent", rightly so)
And it's not just force. This is forcing a treatment that does permanent cognitive damage to the patient against their will. This was done knowing full well that given enough time, odds are pretty high it will disappear by itself (most suicidal patients "recover", very few actually commit suicide. I did a quick Google search and we're talking 4% apparently. Unfortunately, public opinion REALLY punishes any hospital where it happens. But that doesn't change that there was a 96% chance this patient would get cured without any action, never mind permanently crippling them)
Let's not pretend this is a moral grey area. It's not. This is far over the line.
How do you even know that this article isn't positive because the patient fears being readmitted (again with force) into the psychiatric facility and/or resumption of convulsive "therapy" ? (where she would be locked up in dismal conditions).
As I wrote above, I don't think ECT is great, but the evidence indicates it is one of the better options for drug-resistant depression. The side effects, especially for older approaches, can be pretty bad, but so is depression (and newer approaches seem to have weaker effects on memory).
I think you pretty much have to take her at her word here that she eventually appreciated the treatment. There's no way in hell someone is getting recommitted due to an article, especially not 30-40 years later.
The odds would be 99%+ that you would get better on your own (essentially nobody stays depressed, after all), BUT the process of getting better would involve 2 weeks nausea, painful pimples all over, and of course generally feeling very bad. You would need to be locked up during that time to prevent spread of the disease. In < 1% of cases it would feed back onto itself, and those weeks would repeat, progressively getting worse.
The treatment is amputation, say of a foot (because ECT does permanent cognitive damage). And, even though they can give you something to prevent you from remembering the pain or the process afterwards, they can't actually sedate you. This has a decent chance of making you better in a shorter time "without" (visible) pain/issues. They may need to redo it several times, taking off some more every time. Let's say they start with a few toes, but progressively they'll take off more, and you can reasonably expect to lose at least all your toes, with your entire foot being a possibility. Of course, there's also odds you'll lose your foot, but remain ill. (there is widespread disagreement on what those odds are, so let's leave it at "not zero, and not very small either, so >10%, but not 90% like some claim either"). And there's a tiny chance you die.
Would you still feel as positive about the treatment ? What if your parents got threatened while making this decision with having you taken away by social services and having this imposed on you ? (with some small odds of you never getting returned to them, ever)
The ethical issue is more complex than you present it. You conveniently leave out that it mutilates the patient, just not visibly. You leave out that there's extreme pain involved, and they can't sedate you (that would defeat the treatment, because the point is that the brain learns to associate absolutely extreme pain and stress with "the problem"), but they can give you the date rape drug (yes, really). You won't remember. You'll still be mutilated though. Cognitive impairment. You won't remember how it happened. Usually you won't, that is. There may be some lingering trauma, and PTSD. So there's a 10% chance (it's pretty high for ECT) that you'll have extreme (fear or violent) reactions to things you associate with the treatment room.
> I'm a little surprised at the lack of deference to her husband.
Really ? What do you think about the "doctor thinking of his career" explanation ? Can you at least agree it's pretty consistent, that some doctors might think like that ?
As in, can you at least agree that giving psychiatrists that option at all presents a "moral hazard" ?
Yes. My girlfriend who lived with me for several years.
> If so, is that truly a better outcome than undergoing ECT?
Yes, absolutely, for the reasons imperio59 and others have already described. You don't solve mental issues by injuring the brain until they the symptoms are no longer obvious to outside observers.
Also, using this type of emotional manipulation that presupposes the false dichotomy of "ECT or suicide" is highly offensive. There are many potential options, and you do not know what someone will do with or without any particular "treatment".
> We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in mild to moderate and severe depression, and in treatment-resistant depression? Which interventions reduce relapse rates? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS:
> We found 88 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
This meta analysis found that ECT was beneficial.
The point of ECT is not to act as a long lasting cure, it's to get someone out of a depressive episode so that they can engage in work to treat their depression - it's a life saving short term intervention that gives them time and space to do other work.
https://www.cambridge.org/core/journals/the-british-journal-...
Most people who would be considered eligible for ECT are actively suicidal; if they are released from hospital, they are almost certain to attempt suicide. Some are suffering from catatonic depression and are too depressed to perform even the most basic tasks, often including eating and drinking. The overwhelming majority are being held on secure psychiatric wards for their own protection. The alternative to ECT is usually death. If you don't understand this (or refuse to acknowledge it), then you don't understand why doctors continue to use ECT.
Chemotherapy is horrible. It makes you constantly and violently nauseous, it makes your hair fall out, it can cause lasting physical damage and the side-effects are sometimes fatal. It's horrible, but it's better than the alternative, which is dying of cancer.
The evidence is overwhelmingly clear that ECT is a life-saving medical intervention.
The first link you posted is a highly biased summary of evidence compiled by CCHR, a known Scientology front group; Scientology opposes all forms of psychiatry, largely because of the belief that its own (completely unproven) method of Dianetics is capable of resolving all forms of mental distress. Please see DanBC's comment for a more accurate summary of the evidence.
https://en.wikipedia.org/wiki/Citizens_Commission_on_Human_R...
https://en.wikipedia.org/wiki/Scientology_and_psychiatry
Your second link is to a citizens petition orchestrated by a law firm; the petition was rejected by the FDA on the basis of the evidence.
https://www.regulations.gov/contentStreamer?documentId=FDA-2...
The author of the article concludes: "Despite the discomfort and the temporary memory loss it caused, I would have ECT again without hesitation."
Much of psychiatry to me seems like an infant mad science but some of the stuff does have efficacy and if it's going to marginally improve the lives of people who can no longer exist normally in the world, then that's possibly the lesser of two evils.
You're not wrong that a lot of psychiatric medications are "this seems to work, who knows why" and experiments around testing mutations on those things to see if they're more or less effective, because we have so little visibility into the brain and cognition that we can't really gauge these things objectively v. well.
But for people with pathological brain problems, big unpredictable hammers can be a reasonable choice to try if you have an urgent need for mitigation (e.g. acutely self-destructive problems) and/or less invasive things like directed behavioral therapies have not proven sufficiently effective.
It wasn't a forced option, either - I wasn't in an environment where anyone was compelling me, directly or indirectly, to do it, or threatening to do something if I didn't, it was just another option presented to me.
I still don't think it's just a placebo - there's pretty good evidence that it's effective for a number of people, both in the small population of others I know who have had it done and outside of that, even though it wasn't helpful for me.
It also wasn't obviously deeply destructive for me, either - I don't remember the particular days that this was done well (and didn't even a few days after the fact), but I and others haven't noticed any memory or activity issues outside of that.
Do you have specific documentation of why you have these strong opinions?
I have personally witnessed a psychotic manic patient, who by her own account was _not_ sick, undergo treatment, and be completely free of mania and psychosis in 3-4 hours.
One problem with ECT is that many psychiatric medicines (e.g. lamotrigine) are also anticonvulsants so it requires stopping or reducing doses of those medicines which can cause problems.
People are so irrational in fearing the unknown "death" that they'll do something barbaric to themselves and where the outcome is creating a disabled version of their former self.
Humanity is really disgusting. First, we label people with "depression" a word denoting human expression built upon a pseudo practice named psychiatry and where the majority of people being depressed just suffered poor life events. Financial problems, divorce, child abuse, social & behavioural development problems, the list goes on and the professionals receiving funding "for these victims" will just try to numb the victim's brain; to medicate the problem away.
Now we say sadness and depression are diseases that must be medicated with drugs whose side effects (WRITTEN ON THE LABEL) include suicidal ideation and depression, and we wonder why the suicide rates are up?
The worst thing this country did was vote to allow pharmaceutical companies to advertise drugs on TV and in other media. Once that pandora's box was open, there was no going back. It's sad that we're only now waking up to the fact that things like the opioid crisis were actually fueled and manufactured by pharmaceutical companies to increase their profit margins... :/
Depression is different from sadness. If your father died/girlfriend left you/job laid you off, you should be sad about events like those, and frankly, it would be concerning if you weren't.
The patients who are candidates for ECT aren't just upset. Some are actively trying to kill themselves. Others have such lassitude that they can't work up the energy[0] to eat, drink, or bathe, let alone live a normal life.
I take your point that the US tends to 'medicalize' conditions, and we might be better off with fewer drugs and a more caring society, but these patients aren't going to be helped by a box of tissues and a soft shoulder to cry on. It is an illness
[0] The suicide bit is not as contradictory as it sounds. Depression is associated with very decreased activity levels. Some depressed people make plans to self-harm, but lack the energy to actually go through with it. As they recover, the energy often comes back first, so they get into a regime where they are still considering self-harm but have also recovered enough to actually go through with it. As an analogy, think about the 'danger zone' in food preparation. Frozen or cooked food is relatively safe from bacteria, but during thawing, food is warm enough for bacteria to thrive, but not hot enough to eliminate them.
The lawsuits are starting to come in and are of course beings settled out of court, because the manufacturers know they would lose in actual trial given the evidence against them is so blatant.
More details here https://breggin.com/huge-breakthrough-in-lawsuits-against-el... and here http://www.dk4law.com/blog/dk-law-group-news/other/ect-shock...