In the deepest despair, electroconvulsive therapy offers hope
psyche.co
psyche.co
Disclaimer: Not for everyone. I am not a doctor. Do not eat fungi you find in the wild unless you are a trained mycologist.
In England (where the author works) ECT really is used for people who are very severely ill. They will have been through several different types of medications first. When psychedelics get approval those will go into the roster of things to try before ECT.
It's possible for someone to write an advance directive that says they want ECT to be used, so I guess there's some people for whom it's not used as a last resort.
That's a sizable proportion.
"But there are other patients who claim that the long-term side-effects have been severe enough to stop them from working, and have had a catastrophic effect on their lives."
How many patients report such catastrophic symptoms? The author doesn't say.
And please note that psychiatrists lie. Technically it may be the truth what they say, but it is a disgusting lie through deception. Yes it is quite rare for a single ECT treatment to cause permanent memory loss or "severe" loss of function. What they "forget" to tell you is that an ECT regimen is not one treatment, but 7 to 20 individual sessions. Mathematically you can say that (1-(1-p)^20) is a hell of a lot larger than p. Intuitively you can say that it only works BECAUSE it does damage. So without at least some loss of function there is no benefit to it at all). It is also not so rare for the treatment to be abandoned, by the way, because the particular loss of function has medical consequences.
They also say it doesn't hurt, except that is patently false. When you have a medical operation doctors will use 3 sedatives, not just one. They use something akin to GHB that prevents the formation of memories, a muscle relaxant (prevents you from moving) and something to actually sedate (depress neural activity). For ECT they use a muscle relaxant and GHB. So ECT doesn't hurt in the sense that afterwards you don't remember. They would use a sedative, except with those it doesn't work. The working principle of ECT seems to be extreme pain and trauma, and they merely prevent you from remembering that. They explicitly don't prevent extreme pain. We know it's extreme because it used to be done without any sedation at all, so there's no shortage of patient testimonies on the subject.
Psychiatrists still want to use it because it is effectively the only medical treatment that can result in permanent change in behaviour. Nearly everything else (or let's say everything legal/moral) only results in change while the treatment continues, like antidepressants. If the treatment is stopped (voluntarily or not, say because of money issues) all effects stop in a matter of hours to weeks.
And yes, I think it should be outlawed. Also the modern forms. That psychiatry has no answers for problems is not new.
Depression kills people. ECT has serious side effects but it is also has proven efficacy and, if administered properly, is never fatal. All medicine involves this sort of cost-benefit analysis and in cases of severe drug-resistant depression, where there is a high risk of the patient dying in the short term, ECT is the only alternative.
That ain't how I interpreted the above comment.
> but it is also has proven efficacy
Right, but at what cost? It seems very much like something that just replaces one problem with another, at best (and at worst, introduces more problems while the existing ones don't go away).
But hey, as long as it's voluntary, who am I to judge?
If we are talking about very severely depressed you can't trust them to weight the risks and benefits in their own favor, so the physicians have so big overwhelming influence on their decision that it can't be argued otherwise.
And when applied to more debilitating conditions like schizophrenia, "consent" is even more wibbly-wobbly.
However it's important to keep in mind that
1) Memory loss is often very short term, or temporary.
2) losing the ability to hold down a job is a non-issue for patients who may end up out of work on disability
3) Many antipsychotics and mood stabilizers come with their own memory issues and other side effects... There's always a trade off.
4) We need better treatment methods. To say ECT is a shotgun approach is an understatement. It's a scorched-earth approach where you hope the ashes end up fertilizing a new crop.
5) It's a tragedy that many of our best and brightest STEM minds pursue an education that leads them to jobs optimizing ad-tech or hustling for an exit plan to get rich. Theranos duped so many people in part because everyone wanted to believe big tech could be more than this. Which at least means that if you're in it for the big payoff then you should find something with the same potential for human impact only, you know, not a massive fraud. If you do that, you'll bank a lot more money than in finding the next SaaS that provides an incremental improvement on an existing product category.
In general, deeply depressed people interpret and perceive even language and visuals differently, in more negative and cynical lights, its hard to consciously teach yourself to constantly perceive the opposite or think in a more positive way, perhaps just stimulating ALL nuerons helps calibrate paths that otherwise were not favored other neuronal pathways highly utilized by depressed people.
To be honest, I've seen more people in my life die from going from antidepressents to street heroine than I have people from ect. I am not ready to say ect is safer than antidepressants. It's also to be noted antidpressants its a multibillion dollar industry of which a very few very rich families make a ton of money and also sell the same drugs for heroine overdoses, many heroine addicts of which came from being cut off from abusing antidepressants, 1/3rd of all heroine addicts actually so...
when you compare ect therapy to a massive opioid epidemic that makes a few people rich, and all of the violence that has encompassed the heroine drug dealing industry, I would say ect is potentially a safer option.
It has a stigma because of how it was originally used.
I would still though be interested in psychadelics over ect but shrooms can cause permanent damage and impacts everyone differently as well so both are hard to streamline I imagine.
This is why I label ECT scorched earth. It risks significant self-damage in what is often a last resort. I'm not dismissing it as a useful treatment, I'm saying it is broad and unfocussed as a result of our inability to do any better, to come up with a better tactic that doesn't risk wholesale destruction of the person. If it was a real war, perfect knowledge of the enemy might allow a less destructive strategy: the same applies here. But there are no medical treatments that don't carry significant risks. It's all a balance, with escalating risks taken when less risky options don't work.
Many smart people choose ICT because of freedom it offers. Although biological/medical research looks interesting, i would not want to do it because things like this:
https://slatestarcodex.com/2017/08/29/my-irb-nightmare/
(even trivial questionnaire research is plagued by impossible board reviews)
The story you linked to is exactly this situation. They showed up on the doorstep with nothing but a vague idea and no clue on how a project like this was supposed to be organized-- details they could have learned in an hour or two.
Research with human subjects is not something you can approach with an MVP, move fast and break things approach. (Also a resident doctor is still literally in training. Needing someone above that level to oversee the process is by no means unreasonable, and a PI is not the same as giving that person credit for the research: The person that wrote this blog could still have received first author placement.)
I've had to work with IRBs and I've heard the same committeee described as a nightmare to work with, or a breeze. The difference I've notice is that people who are organized about it do fine. The rest get basic things wrong, raise those red flags, and have a hard time as a result. If you do not, for example, fully describe the data you will use and how it will be used in your initial submission then an IRB must be conservative and assume a general lack of care for such things.
Stakes are much higher. There are no "build it in a weekend" projects with human research subjects. You need to be willing to put in at least a few weeks of lit review, proposal organization before you get ready to submit something for review. If a person doesn't have the discipline for that then no serious project they undertake in any profession should be trusted, even when that isn't required.
Do you think closing a VC deal would be any less stringent? Would you show up on their doorstep without even knowing how their pitch process worked and expect to be welcomed with open arms? Of course not.
It's also possible the memory loss is partly a treatment effect and not a side effect. It might be weakening some of these learned patterns is what helps shake loose the depression.
"Put these two lines of research together and you get something like: synapse density increases over the course of the day, then sleep prunes it down again. Depression is associated with low synapse density. So it would make sense that depression gets better over the course of the day (including the extra-long artificial days of sleep deprivation) and then gets worse again after sleep."
Very plausible but imo very dangerous, a lot of your emotions are rooted in your memories and weakening the network could very much lead to loss of self or incoherence.
This is entirely subjective but I suspect there might be something else at play than anything mentioned in that blog post. (edit: that is, when it comes to sleep deprivation vs depression.)
I've had to go through depression myself, and also noticed that my mood is different when I'm sleep-deprived. The mood when sleep-deprived would often be elevated, assuming I didn't have to force myself to do something that required concentration. I'm not sure that state is so much an absence of depression as it might be a slightly hyper mood. (I once read someone's comment on the topic somewhere that it seems like the depression gets replaced by some kind of a hypomania-like state rather than a normal, non-depressed mood. I don't even remember where that comment was and it was also just speculation, but it rang a bell.)
I've noticed that kind of slightly hyper mood has also happened when sleep deprived outside of a depressive episode. (Perhaps it is in compensation for feeling tired when you for some reason psych yourself to still staying active, or something.)
It might feel preferable to a depressed state but I'm slightly sceptical of the idea that something with a similar mechanism could be used directly to return to a normal non-depressive state.
I don't know about ECT though.
The only side effects are mostly headaches and nausea, which are usually managed by just ramping up to full strength at the beginning. If you needed stronger pulses, I could imagine it being fairly uncomfortable. But no seizures means no anesthesia and no memory loss. Really, the main drawback is that it's time-consuming, and it's still not quite as effective as ECT. A typical course is 36 treatments administered 5-6 times per week. And insurance won't cover it unless you've tried a bunch of other stuff. Out of pocket, it costs a few grand.
I've started to feel it helping me, but the real test will be when I try to go off my antidepressants.
Who knows... maybe there's some difference?
"NICE has looked carefully at the evidence and has recommended that ECT should only be used for the treatment of severe depressive illness, a prolonged or severe episode of mania, or catatonia if the conditions described in the following paragraphs are applied. ECT should be used to gain fast and short-term improvement of severe symptoms after all other treatment options have failed, or when the situation is thought to be life-threatening. A risk–benefit assessment for the individual should be made and documented. It should include the risks associated with the anaesthetic, whether the person has other illnesses, the possible adverse effects of ECT (particularly problems with memory), and the risks of not having treatment."
https://theconversation.com/no-evidence-that-ect-works-for-d...
This can also be accomplished with magnesium (l-threonate) and l-theanine before bed.
https://pubmed.ncbi.nlm.nih.gov/15581403/
https://www.neuroscience.cam.ac.uk/publications/download.php...
The thing with most nootropics though is that the effects aren't big, the side effects of chronic usage aren't well known, and the basics such as exercise/sleep have a bigger effect.
Out of the two mentioned above (magnesium and l-theanine) - many people are deficient in magnesium due to modern diet, and there's some evidence that l-theanine works well with caffeine to aid concentration (it's found in green tea but not coffee). I have no idea about the neurogenesis claims though.
To someone with no knowledge about your claim (me included), it seems like an extraordinary claim with no extraordinary evidence, or really any information at all, to back it up.
To someone with knowledge of your claim, assuming it is a true one, it adds nothing to what they already know. So maybe it's obvious to an expert, but then they don't need to be told.