Psychiatrists: glorified drug dealers?

[Scarf-Ace]

I've been seeing one of these fools on and off for a while now because I'm basically a loon, and have come to the conclusion that all they do is prescribe a drug they have access to and hope for the best.

The evidence that these sort of drugs work is thin on the ground and the trials are carried out by the companies that make them - what kind of assurance is that?

Of the three I have seen, they have little or no understanding of mental ill-health, preferring to think on the chemical level and ignoring social factors almost completely. If they do accept that the cause of your mental ill-health is primarily social, guess what? They want to treat you with drugs!

(Thats if you're lucky like me - real bad cases still get electrocuted which I find barbaric).

Worst of all, they don't even give you a tab like real dealers...

So has anyone had a good experience of psychiatrists? I'd like to know!

[Second Guest]

My short answer to the thread title: Yep.

Many years ago, I had a similar experience to what you've described. The psychiatrist saw me for twenty minutes every other week, wrote a prescription, and that was that. Long story short, the drugs nearly killed me--not as in an OD, but rather a nasty set of side effects that the doc failed to mention since "that hardly ever happens"--and once I'd recovered (and the temporary blindness lessened enough for me to find my bus stop unassisted), I went to her office and told her I wouldn't be back. That's when she started asking questions about my personal life. Too little, too late. She tried to tell me that I just needed a boyfriend (not by a long shot), and that I should give the drugs more of a chance to work.

Since then, I've handled life on my own. It's not great, but at least I'm functional. (And I can see!)

[Wolfian]

As a future "drug dealer" I can only hope not. From what I've learned in my two years of undergrad work, drugs are good, but you also must talk. There are a lot of idiots in my classes. Maybe you guys wound up with them. Sorry, but a psychologist/psychiatrist is the same is anything else: there are good ones and there are ones that suck.

Originally posted by Meta-Gumble
(Thats if you're lucky like me - real bad cases still get electrocuted which I find barbaric).

From what I can remember electroconvulsive therapy uses a jolt of electricity that is barely strong enough to run a microwave. This jolt lasts less than a second. Yes, there is Cuckoo's Nest style shaking (that's where the convulsive part somes in), but it does more harm that good by raising biogenic anime levels. Simply put, it gets you high and keeps you that way for about a month.

[Ringo]

Try a psychologist. Most of them will refer you to a psychiatrist for prescriptions if drug therapy seems indicated*, but they have only their wits to work with, and will thus engage you.

Good luck!


*_{I believe New Mexico is the only state that allows psychologists to prescribe controlled medication.}

[Doomtrain]

In my experience, since psychiatrists are MDs, they tend to be very quick to whip out the ol' prescription pad. YMMV, Some Assembly Required.

[Jonathan Chance]

Originally posted by Wolfian
From what I can remember electroconvulsive therapy uses a jolt of electricity that is barely strong enough to run a microwave.

While not really wanting to argue your point I just want to point out that a microwave draws a signficant amount of power. It's no small thing.

[Shagnasty]

I am seeing a psychiatrist and have had much the same experience that you had. However, I know a little about the system and know it is not really her fault. If the psychiatrist works for the hospital, then he or she is forced by the powers that be see as many patients in as short of time as possible. Get the patient in, make a diagnosis, write a prescription. Long term talk therapy is not usually the role of the psychiatrist although some do engage in it. If you want talk therapy, you should see a psychologist, a good counselor, or a social worker licensed in therapy. That is their job.
The job description of the psychiatrist is muddled in the public's mind and I believe sometimes in their own mind as well. I have a condition that all of the talking in the world won't fix. I need a psychiatrist to make that diagnosis, come up with the most effective drug treatment possible, and do long-term monitoring. As long as she does that, then that is her contribution to my care. I also have a Ph.D. psychologist that I see to talk about the social aspects of my condition. I want him to leave the drugs to her and her to leave the talk to him. That is the reason that they are two different jobs.

[Rasa]

In my rather extensive, intensive experience with psychiatrists and psychologists, I've found that yeah, some want to whip out the pad and give you drugs to make you better right off the bat, whereas others are more "let's try this, and if it doesn't help we'll get you on some meds."

Keep in mind that from their perspective, the chemical imbalances in your brain that are causing whatever you're seeking treatment for are what need to be addressed *first*. When my first shrink immediately said "Here, Zoloft. Take this." I went "Whoa, without any sort of therapy or anything else first?" His rationale was "We need to get you to a more 'normal' baseline from which to work with first." Makes sense I guess. But yes, some do first reach for the pad, where others recommend a psychologist.

My uninformed opinion is that a combo of the two are probably the best, in cases where meds are needed. Drugs + counseling seems the best way to go. The drugs will keep the chemicals in balance, but you still need to deal with the underlying issues.

I've never actually taken the antidepressants prescribed for me so I dunno, they may have been right.

[AHunter3]

The psychiatric profession is very, very heavily lobbied and wined and dined and favor-curried by the pharmaceutical reps.

I am hardly an apologist for psychiatrists, but in fairness to them they don't have much in their toolkit except medication. Their conferences are virtually sponsored by and catered by the pharma companies who distribute literature and samples and push the idea that their newest and greatest will do a better job than the dusty old pills of yesteryear.

wolfman

From what I can remember electroconvulsive therapy uses a jolt of electricity that is barely strong enough to run a microwave. This jolt lasts less than a second. Yes, there is Cuckoo's Nest style shaking (that's where the convulsive part somes in), but it does more harm that good by raising biogenic anime levels. Simply put, it gets you high and keeps you that way for about a month.

The jolt creates a seizure and does permanent brain damage, which is not an unfortunate side effect but is the means by which it "works".

You don't get wheeled in for "a" shock, incidentally. Shock treatment is done as a series. They electrocute your brain over and over, day after day, leaving you in an increasingly hazy fog of disorientation and scrambled memories. Then they release you (with permanent memory loss, impaired cognitive function, flattened affect, and nightmares about the experience) and then, as you say, you buzz along with the false euphoria generated by neural damage for a month or so before it wears off.

Oh, and they still do them on an involuntary basis.

Hardly an improvement over pharmaceuticals, even hideous ones like Prolixin and Haldol.

Then there's psychosurgery. Stick a wire down into the brain tissue and cauterize a bit of it. SO much more civilized than the old ice-pick lobotomies of the 1950s, don't you think? ::shudder::

[Wolfian]

AHunter3:

Thank you for the information. First off, its' Wolfian. Wolfman is a whole 'nother cat (pun intended). No problem, I get confused too sometimes.

I think there is a "new" version of ECT that does what I described. I think you are thinking of old school electroshock therapy. I could be wrong and/or my source maybe biased. It was a 200 level undergrad course. Maybe in grad school they will go into more side-effects.

As for psychosurgery, it is mostly used on seizure patients now and it does wonders. People who used to be paralyzed by shaking can now lead productive, non vegetable-like lives. Psychology has come a long way from the 1950s Cuckoo's Nest style where trouble-makers have their brains scooped out to spend the rest of their days in a Jimmy Carter-like calm (thank you, MST3K for that reference). Of course there are still problems, just look at the first two posters, but nothing is perfect.

PS Yeah, the microwave analogy seemed a bit off to me too. Maybe its' the lightbulb in the microwave. The point, its' a relatively mild shock.

[Ferret Herder]

Originally posted by Meta-Gumble
The evidence that these sort of drugs work is thin on the ground and the trials are carried out by the companies that make them - what kind of assurance is that?

As someone who works in medical research (some sponsored by drug companies, some by government grants), and participates in our medical center's institutional research review board, I will note that most of these studies have their data collected and analyzed not by the drug company, but by an independent data monitoring agency of some sort. Thus I feel pretty confident that it can be difficult for companies to lie about the effects that their drugs have.

[kambuckta]

Originally posted by AHunter3


The jolt creates a seizure and does permanent brain damage, which is not an unfortunate side effect but is the means by which it "works".

You don't get wheeled in for "a" shock, incidentally. Shock treatment is done as a series. They electrocute your brain over and over, day after day, leaving you in an increasingly hazy fog of disorientation and scrambled memories. Then they release you (with permanent memory loss, impaired cognitive function, flattened affect, and nightmares about the experience) and then, as you say, you buzz along with the false euphoria generated by neural damage for a month or so before it wears off.

Really? That's not how it worked for me. No memory loss (apart from immediate post-zap), no impaired cognitive functioning (actually, it was improved!), emotional affect was restored and not one nightmare. YMMV of course.

[greck]

I'd say if you say it about psychiatrists, you have to say it about the entire medical profession.
One of them quacks has my Dad hooked on blood pressure drugs, and some other crap to keep his diabetes under control.

But seriously.
We have seen a rise in the past few years of designer mood drugs. For some people they're life savers. For others they do no good at all.
If you're dissatisfied with the effects of the prozac or whatever the doc has you on, don't take it.

At least it's not as addictive as crack.

[techchick68]

I had an excellent psychiatrist in Denver that really helped me. We had a cocktail of meds going but soon reduced it to one, ritalin, that really helped me.

He did a lot for my mental thoughts, not just the chemical issues. Ask your primary physician for a doc he/she recommends, the medical community is pretty tight in most places so I assume your general practioner should be able to recommend one for you.

If not a psychologist (as suggested) can work with your primary physician to prescribe what is appropriate.

[The Man With The Golden Gun]

After I confessed to my parents that I wanted to commit suicide on Christmas Eve, 2001, they took me to a psychiatrist. He prescribed me some good drugs. They made me happy, and basically saved my life, despite the side effects.

So yes, I have had a good experience with a psychiatrist. In fact, if it wern't for one, I would likely not be posting this right now.

[Mirror Image egamI rorriM]

Hey, medication works for some people. Like me.

My life is not messed up, my parents are still married and I live with them, I don't do drugs or drink, I am not in an abusive relationship, I was never sexually, mentally, or pyhsically abused. However, I am clinically depressed, just because the chemicals in my brain are messed up.

Psychiatrists may prescribe drugs too often, but they were a god-send for me (I had just been diagnosed and was leaving for a family vacation in three days--which is enough to give someone a panic attack even if the are in good mental heath--and if I had not had anti-anxiety medication, I cannot imagine how hellish it would have been).

I'm an advocate for medication for depression, but if you want someone to talk to, definately get a psycologist.

[DoctorJ]

A few scattered points:

--Studies I've read have shown that in moderate to severe depression, drugs + counseling is a bit better than drugs alone, which is far better than counseling alone, which is somewhat better than no treatment at all. I'll try to dig up those studies.

What I deal with more often in primary care internal medicine is mild, chronic, long-term depression, often in older people. These are folks that never had a breakdown or thought about killing themselves or anything dramatic like that, but when you probe you find that they get little to no joy out of life, they feel hopeless all the time, etc. I think of this as "compensated depression", in that they have the tendencies that we refer to as clinical depression but they've had them for so long that they lead a tolerable, if not joyful, existence. My experience is that when these folks experience a major life stressor, like an illness or the loss of a loved one, they decompensate in a big way.

Can drugs help those people? For some of them, absolutely; I've seen several of them get a new lease on life after starting an SSRI. Then again, drugs won't help some of them feel better at all. Others may have some resolution of their depressive symptoms, but they've had them for so long that they're uncomfortable with the change, so they don't really feel any better.

Note: this is all my own clinical experience, and I'm rambling.

--Re: the "overprescription" of medications--would those who cry out about meds being overprescribed rather we went to the other extreme and refrained from giving meds to someone whose life would benefit greatly from them? Ideally, you'd just give medications to those who would definitely benefit from them, but it isn't reality.

Granted, the majority of the psychiatric pathology I see and treat is mild to moderate depression and anxiety, but if I think a patient's life might be improved significantly by a medication, and I feel the potential side effects are mild and self-limited, I will offer the medication. Why shouldn't I? The patient doesn't have to take it, and if it doesn't work, he can stop it.

So yes, I overprescribe psychiatric meds, and I wil continue to do so. The greater crime would be to underprescribe them.

--One of my best friends is a psych resident who has been known to lurk around here. I'll see if she's interested in popping in and offering her insight.

Dr. J

[Doomtrain]

Originally posted by DoctorJ

--Re: the "overprescription" of medications--would those who cry out about meds being overprescribed rather we went to the other extreme and refrained from giving meds to someone whose life would benefit greatly from them? Ideally, you'd just give medications to those who would definitely benefit from them, but it isn't reality.

I'm not advocating NOT prescribing them, they can be quite the help, especially if paired with counseling. What troubles me is the "Feeling a little blue? Have a Paxil!" attitude I've sometime experienced. I just have some qualms about messing with brain chemistry for things that could be treated otherwise.

[Zoe]

What troubles me is the "Feeling a little blue? Have a Paxil!" attitude I've sometime experienced.

I'm not questioning your experience, but over the forty years that I have had my struggles with clinical depression, I have never had that experience. Sometimes other physicians have been known to take a more casual approach.

Some anti-depressants take six weeks or so to take affect. So if you appear to have the symptoms, the psychiatrist will often get you started right away. (Clinical depression can be a terminal illness.)

My understanding is that if you are not depressed, the medication will not make you "overly happy."

I have had really truly totally rotten psychiatrists three times over the past four decades. But I have also had two who are excellent. I continue to see one of them once a month for twenty minutes. During that time he checks to see how my life is going and how I'm relating to people in the present. He has to shift my medications from time to time. The twenty minute session seems to be a trend, I think, in treating depressed patients.

But I had already had years of experience exploring my past. And that was helpful to me too. If you are not getting what you need from a psychiatrist, tell her or him and see what happens. If you don't get the talk therapy that you feel you need, look elsewhere. Sometimes medical universities can provide low cost psychiatric help. Also, talking with a psychologist can often do the trick, but insurance is not as likely to cover these sessions.

If you do decide to stop taking your medications, please do that only under a doctor's supervision. Going cold turkey can have a terrible effect.

I don't blame the OP for being wary given the circumstances. But I owe my life to a good psychiatrist and the appropriate medications.

Meta-Gumble, you refer to yourself as a "loon." I hope that you can stop being so derogatory about yourself. There are lots of us who need help and it takes courage to seek it. More likely than not, the disease you have is not your fault. Don't blame yourself and don't give up.

My experiences with ETC were forty years ago and similar to that of AHunter3. But I don't think that people these days have so much trouble with it.

[eunoia]

Originally posted by Wolfian
...by raising biogenic anime levels.

If I don't get some anime or manga every once in a while, I have fits of OCD.

[Scarf-Ace]

Wow - Second Guest that was a nasty experience! Although I am firmly against automatic medication, I have managed to avoid it despite the psychiatrists trying to shove it down my throat as I know my (rather limited) rights.

I know that drugs can help some people, but you have to do a thorough assessment first - surely if someone's condition (the chemical state of their brain) is a direct result of a bad social situation, then helping them to cope with this situation should be paramount.

Ahunter3 - a chilling description of practices we should be ashamed of, particularly the involuntary part. I'm deeply sorry that anyone should have to undergo such torture.

Zoe - thanks for the advice

Ferret herder - are you aware of the current investigation into SSRIs in the UK? It seems that some members of the "independant assessment board" turned out to be shareholders in the companies selling the drugs. Surprised? I'm not.

My game plan is to seek out talk therapy and take it from there, hopefully my probs (pretty minor compared to others) can be sorted out that way

Peace 2 all

[Wolfian]

Originally posted by eunoia
If I don't get some anime or manga every once in a while, I have fits of OCD.

Well played, my friend. Well played.

[occ]

Note that most of those with strong opinions here are the least informed, or have a known axe to grind. Are there problems with psychiatric treatment? Yes, much as there are with any medical practice. However, the degree to which detractors paint psychiatry as going beyond completely useless into the degree of intentional maliciousness is just ridiculous. The vast majority of those who see psychiatrists have mental illnesses that cause them much difficulty in their day-to-day lives. We aren't talking about people with psychological "issues"; we're talking about well-known, well-described, but unfortunately not perfectly understood medical conditions. The reason that psychiatrists use medicine to treat these conditions is because they are, as stated, medical conditions -- and our current best way of treating them is through medication. If there were a better way, it would replace the use of medication; this is how the science of medicine progresses.

On ECT ("electroshock" therapy): first, most of those talking about ECT have clearly gotten most of their information about the practice from watching One Flew Over the Cuckoo's Nest. ECT is a "last resort" procedure, and is only done in times of acute, serious psychiatric breakdown. We're talking about people who are going to kill themselves, or severely harm those around them, unless immediate action is taken. These are people who are completely unresponsive to medicine; obviously, other treatment is exhausted long before ECT is considered.

Also, the thing about ECT is that it *is* effective. The resultant neurological effects aren't caused by "brain damage", although the jury is still out on what ECT does from a physiological standpoint. For whatever reason, ECT acts to "reboot" the brain, and can cause improperly functioning portions of the brain to revert to more standard modes of function. Unfortunately, this will often not last, and ECT may need to be repeated. However, as said, we are talking about otherwise "lost cases".

Talk therapy: can be useful in getting people to change their behavior, but generally not effective in altering people's "feelings". Talk therapy will not make an OCD sufferer stop obsessing and ritualizing. It will not make someone with severe anxiety stop having panic attacks. It will certainly not make someone with schizophrenia stop hearing voices. Medicine is used because it *is* effective, in many cases.

On bad doctors: I've met plenty of shitty doctors in my life. In fact, I'd say that the medical profession has more crappy practitioners than you would expect for a field with such a long and difficult training period. However, when you get a bad doctor, ditch them! The internet is a great tool; you can look up online to see if a particular doctor has had complaints filed against them. You can compare medical advice or prescriptions you've received to what other people are getting by participating in discussions online; if your doctor is doing something that seems very non-standard, you would do well to get a second opinion.

On "overprescription": I have yet to see any numbers that cause me to believe this is a genuine phenomenon. Rather, this is something that everybody "knows" happens, and continues to repeat -- giving the illusion of legitimacy. Check the many threads here on "Should kids be given Ritalin?" and see how many people preface comments by saying "Now, everybody knows that Ritalin is overprescribed", or things to that effect.

On "wining and dining" by pharmaceutical reps: most of the extravagent perks that psychiatrists get from the pharm companies consist of trinkets like pens, pads, little refrigetor magnets, and so forth. Those of us who worked in the "dot-com" economy got bags of this crap as well. Obviously, there is marketing of pharmaceuticals, and obviously it must be effective up to a point or the companies wouldn't bother with it. Honestly, though, do you really think a rational doctor is going to immediately start pushing a drug to those who don't need it because someone gave him a little foam doodad and a few ballpoint pens? Or, for that matter, a "conference" and free meal? I know there are several MDs on the boards, and I'm sure they would tell you that the swag they receive from pharm reps isn't going to make them quit their day jobs.

Anyway, this is running a little long, but I do think someone has to balance out a few of the negative comments (and misinformation) I'm seeing here. Hopefully, this is a start.

Signed,

occ
Not a psychiatrist. Not working for a pharmaceutical company. Been in therapy. Used a number of psychiatric medications.
Have relatives who've been through ECT.

[AHunter3]

I would be one of those folks with the axe to grind. That axe would be the "involuntary treatment" axe, although it's a bit of a two-headed axe with the backside being about "informed consent", in contrast to which exists psychiatric treatment as it is generally described by the profession to those on the receiving end of it, which is generally far short of fully informed even when it is otherwise truly consenting.

On ECT ("electroshock" therapy): first, most of those talking about ECT have clearly gotten most of their information about the practice from watching One Flew Over the Cuckoo's Nest. ECT is a "last resort" procedure, and is only done in times of acute, serious psychiatric breakdown. We're talking about people who are going to kill themselves, or severely harm those around them, unless immediate action is taken. These are people who are completely unresponsive to medicine; obviously, other treatment is exhausted long before ECT is considered.

That isn't true. There are very few barricades to its use. There is absolutely no requirement that the recipient be a person who is suicidal or actively dangerous to others, even for its involuntary imposition. Do you wish to read the policies for the various New York State public bins that do ECT? We obtained them via FOIA and you can read them all here including the circumstances under which the institution is to seek judicial OK to impose electroshock against patients' will. There are a few circumstances under which they regard it to be contraindicated but a "treatment of last resort" is is, unfortunately, not. It should be.

Also, the thing about ECT is that it *is* effective. The resultant neurological effects aren't caused by "brain damage", although the jury is still out on what ECT does from a physiological standpoint.

Yeah. "We don't know how it works, but we're sure that the results we observe are not caused by the brain damage that we insist does not happen" is a line we' ve heard often. We've been pushing for long-term studies but the legislation we've sought has not been passed. Meanwhile, I find it difficult to defend concluding that running electricity through the brain doesn't do much damage without some evidence that it doesn't. There is certainly some evidence indicating that it does.

For whatever reason, ECT acts to "reboot" the brain

Oh please.

, and can cause improperly functioning portions of the brain to revert to more standard modes of function

But not vice versa, eh?

Unfortunately, this will often not last, and ECT may need to be repeated. However, as said, we are talking about otherwise "lost cases".

No we are not. This last link takes you to first person accounts, some by people who say they benefitted. Some by people who say it ruined their life. I dare you to dismiss them all as "otherwise lost causes"!

[phraser]

TBH, I have the exact opposite experience to most people here. My psychiatrist spends far too much time wanting to talk about my family, and is yet to prescribe me any drugs. I feel like I'm spending a lot of money and not getting much from it.

[Doomtrain]

I think it's just like any field. There are some good people and quite a few useless morons.

[occ]

That second link merely takes us to a registration form (since I assume you can't run a search without being a registered user). Similarly, ECT.ORG appears to be an advocacy website, although I may be wrong. I'm digging through it now to try to figure out what its about. Has ECT been used improperly? I'm sure that it has. However, how does it follow that the procedure thus has no merit?

Brain damage is generally defined as tissue death. To my knowledge, observable tissue death is not present after ECT. Are there negative effects of ECT? Certainly, much as there are risks when engaging in many "hardcore" medical procedures.

Also, I see that you are noting few barricades to the use of ECT on a legal level, and that you advocate for legal changes regarding the use of these procedures. While there may be few legal barriers to its use, that does not mean that there are few professional barriers to its use. A doctor who improperly administers ECT would be just as guilty of malpractice as one who performed unnecessary surgery.

[AHunter3]

Sorry, my fault with the link. I thought it would go directly to the "Show All" results.

You can do a search without being a registered user. If someone (e.g., Kambuckta) wishes to enter their own personal experience with being electroshocked, that person would have to register first. But there is a "list all" link on that page that the rest of you can use without registering, which will let you browse the stories of the ECT recipients, positive and negative.

Read the stories. ECT is most commonly administered to mental patients who have not responded favorably thus far to neuroleptic or antidepressant medication. Sometimes it is administered to mental patients for no apparent reason. On occasion it is even administered purely as punishment. The site with the stories is not an advocacy/activist web site, as attested to by the presence of stories from people who say ECT "saved their life".

I have no objection to the use of ECT on consenting patients who are fully informed. "Fully informed" includes being told that the procedure may cause permanent brain damage *. "Fully informed" includes being told that although it does not afflict everyone who undergoes the procedure, permanent memory loss, both short-term (time frame before and after procedure) and long-term (entire life's history of events plus acquired skills and knowledge etc) would appear to be a risk. "Fully informed" means being told that to the extent that it works (and results are mixed), it works through an as-of-yet unexplained mechanism and that it may be that the remission in depression symptoms cannot be separated from the memory loss, i.e., that (as one pro-ECT testimonial put it) "electroshock let me get past my depression by causing me to forget what I was depressed about".

These are things that have not been proven to be true by the research, but some of the research tends to support those conclusions and personal experiences as described by those who had had the treatment tends to bear that out.

Voluntary consent means just that: no quid pro quo arrangements such as "You don't have to consent to ECT but we won't release you if you don't".

Voluntary consent means by the patient, meaning no ECT for children who are "consented for" by administrative fiat. IMPO, children should not be electroshocked period, end of story.

* Yes, actual observable tissue death. Read what Dr. Peter Breggin has documented on it. Breggin is quite transparently an activist of course, but he does cite his research data. He quotes one researcher (Karl Pribriam) who (circa 1974), after seeing a series of brains in autopsy and comparing those of ECT recipients to nonrecipients, said the overall shrinkage and apparent tissue damage readily observable in the ECT victims was such that if he had to choose between receiving a small lobotomy and an ECT series he would go with the small lobotomy. Yes, 1974 was over a quarter century ago, but why should the burden of proof be on our side in this case? If someone stated that they had a new variation on a procedure that in its original form was known to be dangerous, and claimed that the variation is probably safer for this and that reason, wouldn't you normally respond with "OK, do you have clinical data analogous to the data on the original procedure showing that the variation does not cause the damage"?

Most of the changes implemented in ECT since circa 1950 can be summed up as follows: the shock is administered preferentially to one side of the brain instead of bilaterally, although they still do the bilateral type if they have trouble inducing seizures the other way -- the claim is that this is less dangerous and this may be true, although probably not so "true" as to make it 'safe'; and, second, the patient is paralyzed with a muscle-paralyzing agent (a derivative of curare) which turns the otherwise-violent muscle spasms from the terrifying sort that can break bones to much milder twitches and jerks. The paralysis is so strong that respiration ceases and patients must be artificially respirated during the procedure. Many people believe that far less current is now used than was used in the olden days. This is not necessarily true. They use a different "wave" called "brief pulse", for the most part these days, but the amperage has been increased and the actual amount of electricity passed through the brain, measured in joules, is actually more than was prevalent in the early years of ECT.

Finally, consider the presence of euphoria as it is noted to occur across the board in various brain-damaging events:
oxygen deprivation
vascular insufficiency / dementia (aka "hardening of the arteries")
general paresis (tertiary syphilis)
inhalation of volatile chemicals, "huffing"

So, here in the form of ECT, we have a procedure used predominantly to lighten up the moods of intractible depressives. It is known to correlate with permanent memory loss. It works by applying electricity to the brain, and research exists showing that the process does do brain damage. And the people who administer it say they don't know how it works, but it works (at least fairly often, at least in the short term). Doesn't that make you very very very suspicious that the way it works is by inducing a little brain damage and subsequent euphoria of that common sort?

I offer you folks the use of Occam's Razor on that one.

[Dr_Paprika]

For DoctorJ:

A 1997 meta-analysis concluded that interpersonal psychotherapy or CBT is as effective as anti-depressants for the treatment of mild depression. This was not the case for severe, recurrent depressions, in which a combination of psychotherapy and antidepressants was more effective than psychotherapy alone (Thase ME, Arch Gen Psych 54:1009-14, 1997). A 1999 mega-analysis found CBT as effective as anti-depressants for severely depressed outpatients. (DeRubeis RJ, Am J Psych 156:1007-13, 1999). I've often heard psychiatrists tell me that drugs and psychotherapy offer the biggest bang for the buck and am inclined to agree since not everyone responds to psychotherapy (especially if they don't identify with the doc, which is very hit or miss) or medicine.

Some psychiatrists are glorified drug pushers (the less they enjoy their job, the more they "push"). I think antidepressants have been a real boon. The independent research showing benefit could be better, but it isn't bad, and the benefits can clearly be seen in clinical practice on an awful lot of people. Some doctors would indeed give you a script of X for a free meal or game of golf. I see this all the time. Drug companies are a blessing and a curse to work with.

I have seen many people benefit from ECT. It is indeed linked with amnesia, and I agree with AHunter3 about the difficulties in informed consent. I have never seen anyone intubated following ECT, but the danger is there and an anesthetist is often on hand. That said, I think there are difficulties in defining "brain damage"... first of all, the brain is very plastic, and second ECT is generally used on psychotic depressives who are often a fair risk to themselves; some (I wouldn't) may say they already have "damaged brains". I have seen ECT work wonders on these people and am only slightly ambivalent about the procedure. I worry about the lack of understanding of psychiatric treatments in general, including the medicines, and wish there was some more neurology in the discipline. Which is why medicine is an art and not a science, I guess.

[AHunter3]

wish there was some more neurology in the discipline.

Amen to that!!