I have a (depressed) family member who has had his Doctor bring up the idea of ECT treatment. Have any Dopers any opions to share, or experiences? I know it is not the One Flew Over the Cukoo’s Nest version. I have checked a few of my college texts as well as the internet. A few personal opinions might add dimension to my fact-gathering. So far the legitimate medical community seems to be making a pretty good case for it.
If your family member has tried the various other alternatives and they have all failed there may be cause to try ECT. Still the new ‘anti depression pacemaker’ http://www.msnbc.msn.com/id/6903265/ might be worth looking into before trying ECT. As you have allready researched ECT is still considered beneficial for some forms of depression http://www.medicinenet.com/electroconvulsive_therapy/article.htm . Good luck to your depressed family member.
In my psych nursing days it was always the course of last resort and only a tiny number of patients received ECT but it was certainly effective more often than not. I recall one patient who appeared to be greatly troubled by his short term memory loss during the initial treatments but he was very depressed anyway. As his depression lessened so did his worry about the post treatment memory loss.
I have seen it awaken people from an ashen, zombie-like depressive state when everything else failed. It is one of the most potent treatments for depression but it also has serious side-effects - most importantly memory loss.
It really does work and it is not quakery if that is what you are asking. It should also not be taken lightly. The newer methods are much better than what you saw in One Flew Over the Cukoo’s Nest.
There is plenty of information on the web. Here is a brief summary of ECT.. There is even www.ect.org for other information.
A colleague of mine, a physician, had ECT. His depression was so severe, and absolutely nothing else had worked. It was the treatment of last resort, frankly. He certainly could no longer live the way he had been living.
And it worked. The depression lifted, and he’s been happy and successful as a husband, father, and physician. He’s never regretted it, and speaks very gratefully of being able to get the treatments.
ECT needs to remain available so it can be used when indicated. But it shouldn’t be indicated often.
Hey thanks! This is the sort of the thing I had been picking up from the research. I had heard about the pacemaker, but did not know it had been approved. I will tell him to check with his Doctor about it, mabey it is something to try first. (will insurance pay for it? Probably not). I agree about the serious side effects. Still, I can see where the depression messes up his memory, or at least his ability to attend tasks and focus.
No personal experiences, here, but I’ve met consumers who do use and swear by their ECT treatments - not that they get them often, mind you - but as a treatment of last resort it’s been effective for them.
A friend of mine was convinced it would help him with his depression and OCD. It kinda worked. He became a rage-a-holic instead. None of the memories that caused him trouble did not go away. Memories from months and days ago became disjointed. He’d remember doing something and think he did it a few does ago, when in fact it was last month. A lot of things were permanently on “the tip of his tongue”. He sat around the house a lot because he no longer remembered to do the routine things he’d normally do everyday. He stopped going to the movies because although he understood what they said, he couldn’t react to the scenes like the audience was supposed. He had a flat affect. And as his short-term memories returned he got progressively angrier and angrier. His new psychiatrist told him, that he would never have suggest to him ECT because although he is chronically depressed, he was still overall functioning. The temporary loss in the ability to do every day tasks which you know you were able to do with barely a thought made him feel worse than before.
On the bright side, he lost weight.
Most of the info I’ve heard on ECT says that all of its efficacy is short-term; that it causes permanent brain damage and a temporary lightening of the mood which is a direct and physiological side effect of the brain damage itself; and that, while it doesn’t hit every patient that way, it is capable of causing profound and permanent memory loss.
NYOrg press release from last month::
One person whose opinion on electroshock you should definitely hear is Linda Andre. Linda Andre, like Peggy Salters, was subjected to electroconvulsive therapy and, like Salters, lost enough of her memory to be unable to continue in her profession. Andre has made activism on the subject of ECT her remaining life’s work.
You should know a bit about what ECT consists of. First they wheel you in and administer a muscle paralyzer based on curare, which so completely paralyzes the muscles of the body that you cannot breathe on your own. Medical technicians will be squeezing what is called an Ambu bag, forcing air into your lungs until you recover from the curare compound. While you are in this condition, pads for conducting the electricity are placed on your temple, and then enough electricity is run through your brain to prompt a seizure. The reason for the curare compound is to lessen the otherwise-powerful muscle spasms of convulsion and keep you from breaking any bones.
Many patients experience this moment of actual shock as horribly traumatic, although they generally remember it in disconnected snatches afterwards.
Then, a short interval of days later, you repeat the process. Electroshock,. you see, is administered in a series. They don’t hit you once and then wish you luck, you get zapped 20 times, 50 times, 75 times. Survivors of ECT have described it as being like you’re walking down the street and someone jumps out and hits you over the head with a baseball bat and you wake up dazed and confused and then they take you back to the street and you know you’re goin to get hit again.
Don’t take my word for it, google it, and go to the library and read up on it.
The proponents will say things like “We don’t know exactly how it works but it seems to do some patients a lot of good when nothing else is working”. And they will say “It is much safer now, because of the curare meds and because we’ve changed the electrode placement”. And they will dismiss the reports of permanent brain damage and memory loss as rare and concerns about it as “alarmist”.
You should also, however, google Dr. Peter Breggin and read his take on it.
A good friend used ECT as a treatment of last resort, and it did wonders for him. It wasn’t a cureall, and there certainly were some memory related side effects, but it served to snap him out of a downward spiral and allow him to take control of his life again.
It’s not for everyone, and it’s certainly not a treatment to take casually, but in the right situation it appears to have lasting and beneficial results.
The bottom line is fully informed, nonpressured fully volitional consent. If the family member, upon reading the different takes on the issue, the pros and the cons as laid out by the advocates in favor of it and the activists who are against it (including in both cases the tales from those who have been through it), and then says “I’ve decided I want to try ECT”, that’s one thing.
It’s another thing (an intolerable and horrid thing in my opinion) if the doctor threatens perpetual involuntary incarceration unless the family member agrees to ECT, or the rest of the family says “You’ve got to do this, we’ve talked with the doctor and this is what’s best for you”, or the staff at the mental hospital simply place the family member in restraints and impose ETC on an involuntary basis.
Everything I know about it makes me think ECT is a singularly bad idea, but I don’t think it should be illegal, just confined to fully informed unpressured consent.
That would be nice but it doesn’t allow for reality. I did a mental health prac a few months ago and there was a guy on the ward whose diagnosis was basically crazy. He had treatement resistant schitzophrenia and basically spent his days muttering to himself and smoking, and that was it.
His mother was terminally deluded as to his condition, she kept kidnapping him from the medium secure mental health ward he was on and trying to get him jobs and the like and somehow was convinced that he wasn’t really crazy but was just feeling useless because he couldn’t remain employed.
The psychiatrists handling him were discussing using ECT as a last ditch resort; literally every single drug they’d tried him on had failed to work.
How are they supposed to get informed consent out of him or his family?
They aren’t. They don’t know what the fuck they’re doing (and they admit it — they claim ECT helps some people some of the time but they have no validated explanation for what causes the conditions they purport to treat, nor for how ECT could be doing anything to help those alleged conditions).
The fact that someone has severe problems doesn’t justify someone else trying anything that they think might help (even when it has been demonstrated to do damage to a significant portion of the population on which it has been tried so far) and imposing it on the suffering person on an involuntary basis, and then claiming they did this “for their own good”.
They should not even be able to incarcerate him involuntarily. If he doesn’t want to be there and his mom is willing to let him live at her place, well, arrest him if he commits a crime, otherwise the crazy people have as much right to liberty as the noncrazy.
Frankly her attempts to treat him as a person who might have a future with employment and so forth sounds like a course of treatment with a much better long-term prognosis than keeping him psychiatrized and electrocuting his brain cells.
Um, they don’t? Consent is not a brass ring to be won. You may look at that situation and see it as tragic, but it’s a small price to pay for living in a society where YOUR medical decisions are respected. Because if they’re able to give ECT to that guy, then the floodgates have opened. There is no reason why they can’t give it to the next guy in a same or similar situation, and then they give it to someone who is more lucid and maybe actively protesting against it “for his own good,” and then they give it to every third person that comes in the door. Besides, from what I’ve read ECT doesn’t have that great a track record when it comes to schizophrenia, its main “successes” are depression patients.
Personally, I find ECT to be barbaric. I don’t see how controlled irreversible brain damage can ever be considered a good idea, and I really don’t think the procedure has changed that much since Cuckoo’s Nest days. Maybe the reason people don’t care about their memory loss is that they’ve lost enough intellectual capacity that they forget how important it is to have a remembered past (i.e. been transformed into drooling idiots). There is no reason otherwise someone wouldn’t be destroyed by a damaged memory.
Please read AHunter3’s posts to other threads to put his comments in context. He is anti-psychiatry on all fronts because he has had bad personal experiences with the mental health profession.
Dr. Peter Breggin is a psychiatrist who makes a lot of money by writing popular anti-psychiatry books like Toxic Psychiatry.
As always, it is important to understand the background and underlying motivations of the sources of information.
He’s not “anti-psychiatry” in the sense that he thinks it should be illegal; the only thing he’s consistently advocated is informed consent. He hasn’t said ECT should be illegal; he explicitly stated the opposite.
It’s fascinating that you’re not bothering to factually refute his claims, and instead attack his motivations and crassly writing off his position by attributing it to bad experiences with the mental health profession.
So what? Does making money off a position mean that the position is invalid? I guess all the psychiatrists that make money off ECT’s and all the drug companies have an invalid position, then.
It’s vastly more important to understand the information.
And, to answer the OP, and bearing in mind that this is IMHO, I would not consider ECT if I was severly depressed and had a choice. I think that the psychiatric establishment downplays the harmful side effects and overstates the efficacy.
If I was severly depressed, and I have been in the past, I’d try to figure out what environmental factors were causing the depression and address those, with the help of friends, support groups, or counselors (and if I went the counselor route I’d shop very carefully).
Who am I to argue with a recommendation that all of my topically related posts be read? 
Well, not exactly. That is, yes, I’ve had bad personal experiences with the MH profession, but I’d have to say I’m anti-psychiatry because I’ve been in several very large rooms chock-full of people who have had bad personal experiences with psychiatry.
And because the profession lies — claiming to know with great precision and scientific detail all about the human emotional and cognitive conditions they claim to treat, when in fact their understandings are murky, mostly hypothetical or conjectural, and quite often reverse-engineered from deciding that they like the effects of a treatment on a population of patients, therefore whatever the treatment does obviously needed doing.
And because the profession and its evil twin the pharmaceutical industry lie also about the specificity, efficacy, and safety of the treatments they dole out. Most of it isn’t particulary safe, and patient experiences vary from “thank you doctor you saved my life” to “if you ever get within twenty feet of me with that fucking drug on your person I’m gonna show you ‘danger to others’ in a way you’ve only had nightmares about”, not to mention “I think I was better off when I had feelings and thoughts, even the unplesant ones, not to mention a body that didn’t misbehave on me so badly that I can’t be seen in public”.
But mostly, first and foremost, because the profession has coercive powers, and when all of the above is linked to the power to coerce treatment, it’s really bad news. To voluntarily take stuff that might make you feel better or might fuck up your brain — well, ultimately your business. To take such stuff voluntarily after having been lied to about its safety and effectiveness — well, that sucks and should fuel lots of successful lawsuits, but caveat emptor, no one should blindly trust their doctors and not do their own medical research, whether the doctor be psychiatrist, cardiologist, or phlebotomist. To have such stuff imposed on you against your will? Just like rape. Your thoughts and feelings are the most personal of that which is yours, perhaps more so than your body, and to have those chemically modified against your will is a horrid form of violent assault.
[QUOTE]
Dr. Peter Breggin is a psychiatrist who makes a lot of money by writing popular anti-psychiatry books like Toxic Psychiatry.
There are very few authors who make lots of money writing unpopular books. It’s the popular ones that sell. Breggin writes books that are harshly critical of psychiatry. He’s a good writer, he backs up his claims, and people do buy his books.
True. The underlying motivations of the psychiatric profession are convoluted and murky and in places self-contradictory. Historically, they have been charged with removing disturbing people from society first and foremost, and, having done so, to see if they can do something with or about these people. Historically also, they work from a medical model dating to the 1800s, a time when ailment after ailment was yielding to the microscope or the laboratory, along with other impressive strides in science — a medical model that assumed with hopeful optimism that what plagued “these people” would soon also be understood in etiological terms. (And some were: one widespread dementia turned out to be a symptom of late-stage syphilis, several other patterns turned out to be epilepsy in one or more variants, another pattern came to be understood as hypothyroidism and so on. Problem was, once they were understood, these ailments were generally removed from the authority and domain of mental health by internists and neurologists and endocrinologists, and psychiatry was left with the ones that did not yield themselves up to straightforward medical-model explication. Psychiatry remained a medical ghetto for a long long time. And mostly it still ‘contains’ the diseases that 250 years of study haven’t been able to explain in convincing medical-ailment terms) As a consequence of that, within the larger medical profession psychiatrists have long sought more legitimacy, more of a sense of being based on medical science than they had long been perceived as being.
The genuine suffering and truncated life-opportunities of the patients had definitely motivated many to get into the profession, to try to really do something for us, to help us. Meanwhile, as a profession in which there does exist a great deal of power to weild over largely helpless patients with little recourse, the mental health profession does attract a frightening sprinking of folks who, like the famous Nurse Ratched, apparently get a solid emotional thrill over having that power and using it to manipulate people who are placed in their care.
The threat of lawsuits and political fallout from anyone that they have seen & treated committing violent acts in the community is a motivation, not only for doctors and psychiatric hospital administrators but also for judges who rule in commitment procedures and related hearings.
As a profession, psychiatry is and has been very heavily courted and wooed with great ardor and expense by the pharmaceutical industry, whose underlying motivations are simpler and easier to understand.
Insurance companies to whom mental health practitioners submit claim forms like specific diagnoses and a conventional “default treatment” schema whereby there is an appropriate medical response to each diagnosis and a number of visits and pills and so on that they are prepared to cover.
“Family” advocacy groups such as NAMI, also heavily courted by the pharma companies, have a historical taint of Freudian-inspired blame-the-parents stigma that tends to cause them to embrace the medical model of mental illness with great fervor, while a desire to see their loved ones get better mixes with the modern western notion that for any illness there must be a fix, a pill or a procedure to make everything all right again.
Political policy makers need to deal with voters, who include NIMBY-esque folks who don’t want to ever run into the Crazies, the beforementioned NAMI folks, and patients-rights folks like the group that I’m a part of.
It’s not a simplistic and uniformly Evil Snakepit Practice but it sure isn’t the Modern White Clean Miracle of Mental Health either.
Thank you for providing the the pro and con arguments. It is not my choice to get or not get the treatment, but I am not going to push either way, I want him to have maximum knowledge. (I am prone to depression myself, but electroaversive as all get-out. )
[OK, slight hijack here.] Doctors threatening involuntary incarceration? Staff placing people in restraints and imposing ECT involuntarily?
Excuse me, but what country do you live in? Every single one of the United States has very specific laws governing involuntary treatment of mentally ill people. In none of them can that treatment decision be made by a single treating physician, or by a consensus vote of the relatives, or by any single relative unless that relative has a power of attorney that specifically authorizes consent for psychiatric treatment.
To obtain a court order in Michigan (where I practice), two different physicians must perform evaluations, and then one of them and one lay petitioner must testify before a circuit court judge that Patient is in imminent danger of harming himself or someone else, or that the person is so incapacitated by his disease that he isn’t able to perform even basic self-care. Evidence supporting those three opinions has to be provided to the judge, who can question any of the witnesses. The patient can speak to the court and introduce any evidence he may have. He also is represented by an attorney, who can and does examine any of the witnesses at whatever length he deems necessary. If the judge decides that hospital treatment is necessary, he can order it for a maximum of thirty days, or until the patient is no longer an imminent danger, whichever time is shorter. If he decides to mandate outpatient treatment, he can authorize no more than ninety days.
ECT requires a separate court order, supported by clear evidence that no less invasive treatment has worked, again with an attorney to represent the patient’s rights.
Details differ from state to state, and it’s been a few years since I took the forensic psychiatry exam, but I don’t recall any other states giving more leeway to the physician. Some allow considerably less.
Involuntary incarceration, my foot. Involuntary administration of treatment, my other foot.
Concern for the patient’s right to determine his own treatment has led to increasingly stringent laws limiting the power of doctors or relatives to treat involuntarily. Violation of the law carries criminal penalties (battery, unlawful imprisonment) and civil ones as well (high money damages and angry malpractice insurance carriers). [/hijack]
Back to the OP’s question: If I ever develop a depression so bad it’s keeping me from my job or my life, and if medication can’t pull me out of it, then I want ECT. No question about it. I have not seen any convincing evidence of brain damage or personality change resulting from it. Even if it meant giving up more memory than that of the days of actual treatment, I would choose that if it gave me the chance to get back to myself.