Posted by SLS on May 12, 2000, at 9:02:26
In reply to Re: ECT literature search, posted by Blue Cheer on May 10, 2000, at 1:00:15
Hi Cam. Hi Blue Cheer.
> > ECT is the treatment of choice in pregnant women with major depression.How prevalent is the practice of choosing ECT as the first treatment? Is there any difference in the rate of ECT usage between different countries? Sometimes, the treatment of choice of clinical researchers is not the treatment of choice of the local practitioner.
> > The high levels of cortisol in a pregnant mom's blood stream do more damage to the baby than either ECT (and it's prep meds) or the SSRIs.
Does ECT exert a greater effect on HPA function than do antidepressants?
> > but I am told (especially by the people with refractory bipolar disorder that I have presented to)
Is success rate of ECT as high for bipolar depression as it is for melancholic and psychotic depressions?
> > Fred, I am not trying to discount your experience, especially the part about 'forced treatment'. I have not heard of anyone in my area, who wasn't a danger to themselves and not refratory to all medication, to be forced to have an ECT. I actually have never heard of anyone being forced, but then again, I've never asked.
If someone is committed to a hospital for schizophrenia, psychotic mania, or psychotic or suicidal depression, is it not common for him to be forcibly treated with medication or placed in restraints? I'm not saying that this is a bad thing. Why would ECT be exempt from this sort of rationale? After all, it is effective. Neuroleptics are not without side effect liability, either temporary or permanent.
> ECT is arguably the most effective treatment in the history of psychiatry, but efficacy isn't everything. I've been hospitalized for mania and depression for over 30 years, and have taken 55 Rx psychotropic drugs (56 counting one dose of topiramate). I've read literally hundreds of articles on ECT, from Dr. Max Fink's _Convulsive Therapy_ to articles in _Good Housekeeping. =) In fact, I just read one in the current issue of _Psychology Today_ (p. 23 or 28?). It describes a treatment-refractory bipolar patient who underwent a series of 18 ECT treatments, and now has difficulty remembering where she lives if she strays farther than 4 blocks from her home.
How long has this condition persisted? This is not unusual with bilateral treatments, but is usually temporary. I experienced this for about a month after a series of 6 unilateral followed by 6 bilateral treatments. In addition, the period of time during which a course of treatments is given is sometimes lost from memory, similar to an alcohol "black-out".
> Also, I've witnessed the results of ECT in acute-care psychiatric facilities as recently as 1995, and in long-term facilities from the 60's through the 80's. ECT advocates claim an 80% improvement rate as opposed to a 65% improvement rate for drugs -- in depression. My experience has been that approximately one in five improve, and not without sequelae.
Non-response to antidepressants is a prognosticator of poor response to ECT.
> Although movies have depicted it as a barbaric assault, I'd rather weigh the risk/benefit ratio. Many treatments in medicine are theoretically unappealing (defibrillation of the heart), and not well understood, yet they can be life-saving, too. Although it's a powerful intervention in severe medicine-resistant mania, schizophrenia, and suicidal states (neuroleptic malignant syndrome, too), I'd only use it as a last resort for major depression.
I didn't know it was used for neuroleptic malignant syndrome. In what ways is it helpful? How long does the therapeutic effect last? Are maintenance treatments necessary?
> Even if it works, booster treatments are often required and sometimes fail. Then you're back to psychopharmacology -- square one.
This would not be square one if previous pharmacological intervention had not initiated a response. Often, it takes ECT to bring someone out of a pharmacologically treatment-resistant depression, whereafter, they can be maintained on the same drugs that they were previously unresponsive to.
> rTMS is an alternative and safer treatment. ~~~ Blue Cheer
rTMS has proved to be disappointing. On the other hand, vagus nerve stimulation (VNS) seems to be providing some impressive results. To me, this treatment seems very similar to the implanted portable defibrillators used for cardiac conduction disorders.
It is refreshing to encounter a discourse that is not polarized. (I am not in a position to cast the first stone). Thanks guys.
- Scott
poster:SLS
thread:32651
URL: http://www.dr-bob.org/babble/20000508/msgs/33280.html