Comment by fragcula | Hacker News Reader

Comment by fragcula | Hacker News Reader

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Oh I see.

No ECT is most certainly the most efficacious treatment for depression we have.

Talking therapies have a respone rate in depression of circa 40% [0], probably just slightly higher for antidepressants up to about 50% and faster [1], ECT respone rate is well over than even for those with treatment resistance but as high as 90% [2]. Vitally, the reposnse to ECT is fast and is often under 10 days.

The fact that ECT is burdensome, limited in availability and stigmatizing (which is why it's got so much legislative structure around it) is not relevant for it's efficacy.

This is spelled out relatively well in the UK's Royal College of Psychiatry statement on ECT [3]

> ECT IS A FIRST-LINE TREATMENT FOR PATIENTS ... where a rapid definitive response for the emergency treatment of depression is needed

This is because it works quickly and reliably to treat depression.

[0] https://onlinelibrary.wiley.com/doi/full/10.1111/acps.13335

[1] https://journals.sagepub.com/doi/pdf/10.1177/070674371005500...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650296/

[3] https://www.rcpsych.ac.uk/docs/default-source/about-us/who-w...

I think we're just disagreeing on different interpretations of the word effective.

If something works, but has so many negatives that you only use it when other negatives outweigh those, then it's effective in some sense of the word, but I'd maybe not phrase it as "the most effective treatment".

Kind of like pre-emeptive mastectomy for breast cancer, it's effective and it's the recommended treatment for people likely to have problems due to specific genetic factors, but saying "pre-emptive mastectomy is the most effective treatment for breast cancer" is missing a lot of important nuance and can sound extreme, even though it could be defended as a true statement.

> I think we're just disagreeing on different interpretations of the word effective.

That's likely. I'm using the word in the sense of clinical efficacy, i.e. how likely an intervention is to produce the intended outcome. In this case the response rate to the intervention in those with depression [0].

Preemptive double mastectomy is the most effective way to date to prevent breast cancer [2] (~95% reduction). This is important for those at heightened risk, for example those with pathological variants of BRCA 1 & 2 which each independently increase the risk of breast cancer 5 fold (up to 70%!)[1]. Coupled with other factors some women are statistically almost certain to get breast cancer if they live long enough.

We can't mince words with peoples lives. People with severe depression deserve to know that ECT is a safe treatment and the most effective treatment available. And there should not be stigma in any treatment.

Similarly, pre-emptive mastectomy the most effective prophylactic intervention available for preventing breast cancer. And important for those who are at very very high risk.

[0] https://www.collinsdictionary.com/dictionary/english/clinica...

[1] https://www.cancer.gov/about-cancer/causes-prevention/geneti...

[2] https://www.macmillan.org.uk/cancer-information-and-support/...

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