[Analemma_]

Your comment is dangerous and irresponsible. This is not the 40’s, ECT is not used lightly; it is the treatment of last resort for severe depression when lifestyle changes, medication and therapy have all failed. The side effects are well-understood and patients who choose ECT do so because the alternative is unbearable.

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.

[CoffeeInMyCup]

Thank you. I've seen the effects of severe depression first hand. It's not a matter of just needing to smile more, it's a serious medical condition that requires professional intervention.

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.

[imperio59]

Sorry but there are dozens of studies and hundreds of reports of people basically losing memories of entire portions of their life and the ability to do simple things like tie their shoelaces or do simple math after just one round of ECT. How this is still not banned by the FDA is beyond me.

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...

[DanBC]

https://www.ncbi.nlm.nih.gov/pubmed/21609510

> 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-...

[jdietrich]

>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?

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...

[depressed]

Have you ever had someone close to you commit suicide? If so, is that truly a better outcome than undergoing ECT?

If not, then I want you to understand this: ECT is used to treat a lethal illness.

[pdkl95]

> Have you ever had someone close to you commit suicide?

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".

[imperio59]

I'm sorry but that's the equivalent of saying "This person is about to kill themselves, so let's take a bat and hit them over the head with it so they can't do that now. See, now they're doing fine, they're not killing themselves."

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.

[nickbarnwell]

There is a both a large and strong evidence base for the usage of ECT in cases of severe, treatment resistant depression. Many aspects of modern medicine can be made to sound barbaric with the right framing; those who disparage ECT are not so quick to characterise chemotherapy as “poison by any other name” or dialysis a “vampiric ball and chain”.

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.

[candiodari]

And yet from the article ...

"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)

[jdietrich]

>You might as well shoot the person. That has the same demonstrated effect.

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.

[DanBC]

> successful suicide

Clumsy language like this is a sign that you don't know as much about this subject as you think you do.

[rincebrain]

Most forms of treatment, in terms of therapy, psychiatric medication, or more invasive options, cease to be effective when they're removed, eventually.

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.

[devoply]

Not particularly last resort. And apparently there is a large line-up in the system for people to get this therapy. They claim that there is a lot of efficacy... but apparently for many the symptoms return over time.

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.

[nickbarnwell]

It really is the last resort; even if you were able to find a psychiatrist willing to administer a course of it without extensive trials of multiple classes of psychotropic medication as an adjunct to psychotherapy, your insurer is definitely not going to spring for it. The NHS’ NICE guidelines outline what’s to be considered before ECT is even proposed (https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#seq...), and criteria are at least as stringent in the US.

[rincebrain]

A lot of medicine is rather more grey than black and white than we'd prefer, since we either find things out through long tails of researching lots of things and seeing what works better than placebo, or by verifying unexpected reported outcomes (several entire classes of medications have come from unexpected side effects - Rogaine and Viagra were blood pressure meds, the entire SS*I class of drugs was found when someone noticed by accident that a type of antihistamine seemed to improve malaise in some patients, ketamine is rather well known at this juncture as an anesthetic and party drug that got signoff as a novel antidepressant...), and observational evidence isn't necessarily predictive of how it happens on its own.

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.