![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 46. This is the beginning of the thread.
Posted by Nancy on May 10, 2000, at 15:18:15
Has anyone received ECT? If so, what was it like? Why did you participate? What were the effects before and after? Would you recommend one to have ECT?
Nancy
Posted by tina on May 10, 2000, at 16:30:24
In reply to ECT, posted by Nancy on May 10, 2000, at 15:18:15
Nancy: There's a thread higher up on this board that you will find informative but you will also notice that ECT is an extremely touchy topic here. Beware of angry responses and remember the babble motto---Your mileage may vary. www.mental-health.com has info you might find useful. Never been through it myself. take care---Tina
> Has anyone received ECT? If so, what was it like? Why did you participate? What were the effects before and after? Would you recommend one to have ECT?
> Nancy
Posted by stjames on May 10, 2000, at 17:52:31
In reply to T Nancy--Re: ECT: sensitive topic, posted by tina on May 10, 2000, at 16:30:24
James here...Also search the archives using "ECT", we discussed this alot at one point. To me ECT is an option if you have really tried all the meds and combos. As there are 25+ AD's now, a trial of 2-4 meds does not scratch the surface.
I would never think of ECT as a first line treatment but for the chronic or people getting bad fast, i.e. those who have to be locked up and watched 24/7 lest they kill themselves, ECT makes sence to me.
james
Posted by Greg on May 10, 2000, at 18:14:20
In reply to Re: T Nancy--Re: ECT, posted by stjames on May 10, 2000, at 17:52:31
I read the earlier postings about ECT but didn't involve myself in the conversation because, quite honestly, I didn't know what it was. I just returned from educating myself at a website and all I can say is....OH MY! This certainly would have to be a last line defense for me.
Greg
>
> James here...
>
> Also search the archives using "ECT", we discussed this alot at one point. To me ECT is an option if you have really tried all the meds and combos. As there are 25+ AD's now, a trial of 2-4 meds does not scratch the surface.
>
> I would never think of ECT as a first line treatment but for the chronic or people getting bad fast, i.e. those who have to be locked up and watched 24/7 lest they kill themselves, ECT makes sence to me.
>
> james
Posted by quilter on May 11, 2000, at 1:28:30
In reply to Re: T Nancy--Re: ECT, posted by Greg on May 10, 2000, at 18:14:20
I posted about my ECT experiences before but had to tell you that the only reason I considered the treatments was the possibility of a lethal error finally taking care of the depression. Nothing else had. When encouraged to try it again recently, I declined because I now have information I want to keep.
Please feel free to e-mail me for more details.
Posted by Mark H. on May 12, 2000, at 19:12:45
In reply to ECT, posted by Nancy on May 10, 2000, at 15:18:15
First, I should say that I have not experienced ECT nor would I try it in its current form. Although resistance to its use is often amped by shocking depictions in popular culture, there is also a battery of anecdotal evidence suggesting that electrical jolts to the brain in fact cause damage. I had a fit when I first read about induced seizures, but after conducting some research I switched my opinion. Attenuating my beliefs somewhat transformed my capacitance for holding alternating points of view. ECT as a topic clearly carries a charge for some of us, and we need to insulate our feelings while grounding these lines of discussion in fact. Shock therapy can generate controversy, as we’ve seen.
Mark H.
Posted by Mark H. on May 12, 2000, at 20:08:23
In reply to Re: T Nancy--Re: ECT, posted by quilter on May 11, 2000, at 1:28:30
Dear Nancy,
I started my last response with an unintentional double-entendre and then just got carried away.
I think that in the future, some highly selective form of direct-application electrical therapy will replace ECT, which is outrageously crude in its present application. As with chemo-therapy and other forms of "nineteenth century veterinary medicine" that get applied to people, ECT is akin to driving a finely drawn needle with a fifteen-pound sledge hammer. It may do the job, but at what price?
That said, subjectively, I have always experienced my madness as a storm building in my frontal lobes, longing to arc across the gap in a flash of lightning-like release, leaving me clear and free of the multiple streams of thought that I associate with the "storm" and the slide into deep depression.
When I was in my mid-twenties, I could accomplish that release with alcohol sometimes, believe it or not. I would come home from the University on a hot summer day and quickly drink two icy bottles of cheap champagne on an empty stomach and put myself to bed. In the morning, I would awaken refreshed, renewed, and without 3, 4, or 5 thought-streams all going at once (and no hangover). This salubrious effect would sometimes last for a few weeks. (Kids, don't try this at home.)
I have longed to find a medication that will accomplish the same thing, since I stopped using alcohol altogether more than 18 years ago. I think we'll see an effective pharmaceutical product long before we find an efficient and simple way to apply direct current to the brain.
However, in the not-too-distant future, I suspect that TENS-type units for the brain will exist and be used effectively, rather like pacemakers are used today. I would welcome the ability to give myself a "clearing shock" while waiting at a traffic light, making me a safer driver and a more clear and focused employee.
Mark H.
Posted by SLS on May 12, 2000, at 21:56:13
In reply to Re: To Nancy--Re: ECT, posted by Mark H. on May 12, 2000, at 20:08:23
> However, in the not-too-distant future, I suspect that TENS-type units for the brain will exist and be used effectively, rather like pacemakers are used today. I would welcome the ability to give myself a "clearing shock" while waiting at a traffic light, making me a safer driver and a more clear and focused employee.
What is a TENS unit?
You seem wonderfully focused today. You write some really, really smart stuff. Please write some more. Just go to work every now and then.
Regarding pacemakers for the brain (that was one hell of a "brainstorm" you had there), check out vagus nerve stimulation (VNS). I'm sure you'll get a charge out of it.
- Scott
Posted by Mark H. on May 12, 2000, at 23:27:50
In reply to Re: To Nancy--Re: ECT, posted by SLS on May 12, 2000, at 21:56:13
> What is a TENS unit?
Hi Scott,
I believe it's a transcutaneous neural stimulation unit -- basically, if you've ever seen those suitcased-size devices that Soviet bodybuilders used to develop certain muscle groups with electronic muscle stimulation (EMS) using modulated DC to stick-on electrodes, then a TENS unit is a 9v transistor radio sized, belt worn, lower-powered equivalent that is widely used in chronic pain management, the theory being that a mildly irritating, pulsed shock at the pain site or along the nerve path will mask or override the perception of the more serious chronic pain. It works for probably less than half of all people who use them, but when effective it's a great alternative to medication for chronic pain.
Thank you for your kind thoughts and encouragement.
Much love,
Mark H.
Posted by Adam on May 16, 2000, at 21:28:26
In reply to ECT, posted by Nancy on May 10, 2000, at 15:18:15
I have received ECT. I got eight successive treatments over a span
of about two weeks.Where I got treated (Mass. General Hospital), it was like being in
an assembly line. They wheeled us all to the OR, which was this
enormous room filled with multiple stations, like maybe it could be
used to do tens of surgeries simultaneously if there was a huge
disaster. There was only one doctor and anaestesiologist performing
the proceedure, however, so we had to wait our turn, many of us
even spilling a bit into the hallway outside.I wasn't supposed to, but one time, when I was in the OR, I sat up
and looked over. I couldn't see much, but from my perspective, the
person receiving the current barely moves. Hardly remeniscent of
the Hollywood depictions.I was injected with a general anaesthetic and muscle relaxants. They
burned when they entered my arm, and that was the extent of the
discomfort (besides lying there for what seemed like an eternity with
nothing to do but stare at the ceiling while others ahead of me got
their treatments). Later on I woke up with a bit of goop in my hair
from the gel they use to aid conductance from the electrodes. I
usually woke up without any obvious difficulties. One time, though,
I did, shortly after regaining consciousness, develop a vicious
headache that took a really big hunk of ibuprofrin to relieve. The
attending remarked "Jeez, everybody's got a headache. They must have
really turned up the juice today."After about the fifth or sixth treatment, I felt remarkably better.
It was astonishing. I had been through a terrifying episode that I
still find difficult to explain, and suddenly I was feeling happier
and calmer than I had in years. I think my mood could even approach
elation soon after I finished. Strangely, I felt I had a "normal"
range of emotions. By that I mean I felt "alive" and able to be happy
and sad, scared and at ease, all in the right measure. I wondered if
this was what "normal" people felt like.Shortly afterward I was discharged as an inpatient, and started to
attend the Hospital's "Partial Program" sessions, which are part of
the transitional period post-hospitilization.It was during this time I started to notice the memory lapses. I was
asked at one point the name of my last psychiatrist (who had kind of
dumped me after I entered MGH), and couldn't come up with his name.
It was just gone. I had a difficult time recalling what the date was
that I entered the hospital, even though I had written it on various
forms about a gazillion times. I had absolutely no recollection of a
conversation I had with another one of the inpatients, several days
earlier, when we had made plans to meet after we both were discharged.
To my utter suprise I had her address in a notebook, and she asked me
for mine again, since she had lost it. It was like I was seeing that
page for the first time. A couple weeks later I was at my parent's
house. My sister was talking about meeting me down in Boston, and asked
me if there were any good restaurants. "How about that Italian Place
we went to in the North End?" my mother chimed in. I had no clue what
she was talking about. She had to take me aside later and ask if I
remembered the night my parents visited me in the hospital and we all
went out to eat. I remembered them visiting, but as far as the great
meal I had goes, I didn't remember anything about it, and still don't.Later, I think some of the memories came back, or, rather, things I would
encounter triggered feelings of recognition that were so powerful it
sent chills down my spine, but I had no clue why I was reacting in such
a way. A short while after my visit to my parents' place, I was strolling
around the neighborhood where I had apparently eaten out with them, and
passed a restaurant I had "never" been in. I was transfixed by the room
I saw through the window, and stood there for a good five minutes trying
my hardest to bring back something. I could not, except that I felt
rather than knew I had been there, and that this must have been the place
my parents and I had eaten. I still don't know for certain, since they
couldn't remember the name themselves, and only vaguely could describe
the location.All of this was, in a word, creepy. As I mentioned above, to this day
there are things I just don't remember about that time, and my memory for
some things (especially names and directions) is so poor these days I
confess I have wondered if there were long-term effects, despite the
reams of scientific papers discounting claims of permanent dammage from
ECT. From my own experience, I hope these studies are correct, but I do
have my doubts at times. I just don't feel I've been the same, but
there could be many other reasons for what I am experiencing.The positive effects of ECT didn't last. After a failed trial of Celexa
and a more prolonged, also unsuccessful trial of Remeron, I was again
quite depressed. I'd say the real benefit lasted from three to five
weeks and then just faded.I am glad ECT is there. I know, if all else fails, I responded to that,
and can go back to it if I have to. There is certainly something to be
said for an utter lack of persistant physical side effects coupled with
the positively wonderful change in mood. However, I found the amnesia,
and the fears of more lasting effects on memory, to be quite distressing,
and I'd rather not experience that again. If I were to receive similar
treatments on a monthly basis, I can imagine I would have to keep a
diary, because otherwise I would forget so many things people around me
would start to think I was demented.It's a useful way to treat depression. For some, it's the only effective
and/or tolerable way to deal with their illness. When one has hit rock
bottom, I can't imagine a better way to accelerate their recovery than
ECT. But in my oppinion its use should be limited to those special cases.
It may not have any permanent effects, but I really do have to wonder. I
don't want it again, unless I absolutely have to have it. Some may feel
differently.I hope this is helpful.
> Has anyone received ECT? If so, what was it like? Why did you participate? What were the effects before and after? Would you recommend one to have ECT?
> Nancy
Posted by bob on May 16, 2000, at 21:40:40
In reply to Re: ECT, posted by Adam on May 16, 2000, at 21:28:26
Adam,
Thanks for the detailed and even-handed account. I found it quite informative. It's still a bit disquieting for me, since your experiences confirm both the "good" and the "bad" of modern ECT.
But I guess we never get any clear, unequivocable answers in our field anyway.
cheers,
bob
Posted by Adam on May 17, 2000, at 23:07:19
In reply to Re: ECT, posted by bob on May 16, 2000, at 21:40:40
You're welcome. I honestly do feel it's a useful means of treating the
illness, and the actual procedure is a breeze. I've had more unpleasant
dentist's appointments. I must confess I actually like the feeling of
succumbing to the effects of anaesthesia. Of course, at the time, being
unconscious was as close a thing to true bliss as I could imagine.But, as I said, the after-effects were both wonderful and frightening.
If I were back where I was then, I'd do it in a heartbeat. Brain dammage
seemed worth it. I even asked the attending and the head resident how
much damage I could expect, and their answer was an emphatic "none!" I
do remember posting here before that the principle investigator of the
transdermal selegiline study I was in called ECT "the cat's pajamas."ECT has a lot of supporters. I've combed the literature for clear
evidence of ECT-related damage to the brain, and could find nothing that
seemed incontrovertable. Nearly every major journal in psychiatry has
published at least a couple of review articles on it, and all of them,
not for want of looking, claim unequivocably that there is no credible
evidence in support of permanent harm from ECT. Some papers I have
encountered even have claimed ECT protects the brain from the negative
effects of stress hormones, etc.I hope they are correct. My memory difficulties are not my imagination,
though. I've recently self-administerd some tests that would indicate
some deficits, based on a high IQ combined with some specific difficulties
with verbal and numerical memory. These deficits, however, have also been
identified in persons with OCD, and it has been hypothesised that we OCD
sufferers are a bit "constipated" when it comes to some mental tasks,
essentially because we ruminate too much on the particulars, and thus
score poorly on certain tests with time limits. I am thinking of seeing
a specialist (I met her at a party, actually), who is both a diagnostician
and a counselor for cognative disorders.I'm hoping I can get some answers. It could be age. It could be
selegiline (though the suggestion has been met with incredulity by my
doctors). I suppose it could even be that nearly a year of intense,
sometimes mind-numbing depression terminating in a period of quivering
frenzy did its own damage.I don't know. I do know that, well, I don't remember having such a hard
time remembering some things. It seems to be a fairly recent problem. I
do find myself being afraid of the few reports, published in peer-reviewed
journals, that suggest ECT is not so benign. It may not be a reasonable
fear, but I have it all the same.
>
> Thanks for the detailed and even-handed account. I found it quite informative. It's still a bit disquieting for me, since your experiences confirm both the "good" and the "bad" of modern ECT.
>
> But I guess we never get any clear, unequivocable answers in our field anyway.
>
> cheers,
> bob
Posted by Chris A. on May 18, 2000, at 12:58:53
In reply to Re: ECT, bob, posted by Adam on May 17, 2000, at 23:07:19
Adam,
Your account is similar to mine, except for the waiting in line part. Here, ECT is done in the PACU (recovery room) and there is a lot of privacy. Basically no one is around at 6:00 a.m.! Tomorrow I am having my nineteenth RUL treatment since the end of January. They've all been on an oupatient basis, except for two. My concerns over memory and cognition are similar to yours. The retrograde amnesia and temporary confusion go with the territory and are expected. Two months post treatment we are all supposed to test as well or better than we did prior to treatment. I realize the severity and length of my depression can interfere with memory and cognition. If one doesn't want to be alive, why would one care to think? My pDoc and I have discussed this repeatedly (how repeatedly, I wouldn't remember in my current fog). He does say there is evidence that some people lose random foci of memory permanently, which I have (over forty treatments total since 1977). Loss of specific memories is not equated with brain damage. When I had bilateral treatments in '92 with a high stimulus intensity, the confusion and immediate memory problems were severe, but the depression seemed to remit. When the confusion abated and my memory improved, I relapsed into depression, despite pharmacological treatment. My consultant's advice was to do the treatments farther apart over a longer period of time to avoid cognitive and memory problems. He also suggested using Aricept (donzepil) to minimize those problems. It may be helping some. The problem is that I am still extremely depressed 90% of the time and at points get really desperate. My pDoc and I are planning to make a decision whether or not to continue ECT or not on Tuesday. Do you by chance have the references to the peer reviewed articles you mentioned? It would be nice to review them prior to making a decision. There was an excellent article in the New England Journal in '93 that I was reviewing just a couple of days ago (again, as I didn't remember even having a copy of it until going through my papers). Following one treatment I had temporary aphasia (two - three hours). That was scary, but it is discussed in the literature. Word finding seems to be my most apparent cognitive difficulty otherwise. There is no doubt in my mind that my stints on Topomax and Tegretol were capable of producing real damage. One would have to come up with very solid evidence to convince me that there is any irreversible brain damage with ECT - no flawed studies allowed. People with complaints are usually still depressed. I understand being a bit scared of the memory loss and possible cognitive problems, but agree with you that the procedure itself is a piece of cake. There is probably no point in doing maintenance treatments if there are no results to maintain, though. That poses the question of what to do next. Today I am not currently down, but that is definitely due to sleep deprivation, the results of which are not sustainable. It's like playing with fire for those of us who are bipolar. One of my concerns about the portrayal of ECT on the net is that it is made to look extremely dangerous and misused. I don't believe that is the case at all in the US currently. The stigma surrounding it is probably costing lives that could have been saved (speaking from a public health standpoint). It is less risky than the vast majority of medical procedures and the reason it is used more for depression in the elderly and pregnant women is because there is less risk involved. Meds are not benign. In the back of my mind I wonder if I would have ever had a hypomanic/mixed epsisode if I hadn't taken Prozac. They say the bipolar is lurking...but, I still have always wondered if it would have been better to stick with the desipramine even though it didn't completely cause the depression to vanish. Of course my docs were concerned that I might ingest too much desipramine at some point and turn up dead, a reasonable concern. That is water under the bridge. Paxil and Effexor caused clear manic symptoms and Wellbutrin caused intense irritability (my poor Hubby). Subtle signs of TD started showing up with minimal use of neuroleptics and I certainly don't want to go there. I'll take the ECT any day - I just wish it worked for me. If you have those references available, I'd be grateful.Thanks for sharing and please forgive my rambling.
Chris A.
P.S. I completed my MA with a 3.5 after having had over twenty treatments total. Perhaps my subjective perception of cognitive impairment and the hard facts are not the same. Who knows. I don't. The procedure was not quite as refined when I started in '77.
Posted by boBB on May 18, 2000, at 18:33:42
In reply to Re: ECT, bob, posted by Adam on May 17, 2000, at 23:07:19
I have a question of purely editorial concern. It seemed your post offered two conflicting assessments of the available, peer reviewed literature regarding ECT.
You wrote:
> Nearly every major journal in psychiatry has published at least a couple of review articles on it, and ALL OF THEM (emphasis added), not for want of looking, claim unequivocably that there is no credible evidence in support of permanent harm from ECT.> I do find myself being afraid of THE FEW REPORTS, PUBLISHED (emphasis added) in peer-reviewed journals, that suggest ECT is not so benign.
Maybe I damaged my memory some other way, like falling off my skateboard while improperly acting like a teenager, and comparing your two apparently contradictory assessments does require that I remember the one while I read the other. Are you saying that peer reviewed suggestions "that ECT is not so benign" do not undermine unequivocable claims that there is "no credible evidence in support of permanent harm from ECT"? If so, I guess your assessment is consistent, at least with itself.
I understand that reports from people who awake from anesthetized ECT experiences with broken bones, or reports of long-lasting post-ECT memory loss do not carry water, scientifically, unless they are verified and published in peer reviewed literature. The question remains, however, whether informed consent implies only information published in peer reviewed publications, or whether it also implies access to case record of malpractic litigation, summaries of practitioners' records in adverse cases and access to reports compiled by public health agencies and other governmental bodies.
The discussion of informed consent can also include discussion of the potentially prejudicial role of an authority figure who is supplying the information. If the clinical caregiver stands to gain from collection of Medicaid payments with little oversight concerning the efficacy of the treatment, which often seems to be the case, at least in the administration of ECT, we might want to consider whether the caregiver themself can be relied upon as a fair arbitrer of what information is sufficient to qualify the consent of the ECT subject. My perception of informed consent is that it refers to information provided to the subject of a therapy, who then consents, rather than information shared by scientists who then consent to allow or require a particular therapy.
Anyway, I agree that waking from anesthesia ROCKs. (but that is a subjective, un-peer-reviewed assessment). AND, my sister had pretty good luck dressing up cats, but I have experienced ferocious resistance attempting to put pajamas on feline subjects.
Posted by bob on May 18, 2000, at 22:53:53
In reply to Editorial Concern, Too, posted by boBB on May 18, 2000, at 18:33:42
boBB, I share your concerns over the objectivity not just of ECT research reports but, in the academic climate these days, ANY research reports from studies that uncovered data contrary to what either a source of funding or the professional body of that field of study might want to hear. A fairly modern example out of physics is string theory, which was slammed as sham science for more than fifteen years because it proposed ideas contrary to the general model of the time (which in those fifteen years was poked through with experimental holes to the point of transparency). It also required an understanding of a branch of mathematics that most physicists knew nothing about, and did not care to learn in order to be better critics of the theory. Or, at least, so goes the story as I've heard it told....
That being said, there is a great deal of difference in a scientific research report between what can be supported by statistical inferences based on hard evidence and what researchers will speculate upon in the conclusions section of their papers. Adam's statements are not necessarily self-contradictory. Findings of no permanent harm from ECT due to a lack of credile evidence sounds like a statistical argument that any data demonstrating some permanent damage is not common enough in controlled studies to rule out random chance or any other number of factors as the cause of that damage. "Suggestions" in journal articles are often speculations on anomalous data or trends (i.e., non-statistically significant results that the researchers want to discuss anyway -- more an indication of researcher bias than of good scientific practice) that can often either appease editorial board members with an agenda or make the article a little "sexier" and atractive as a publication.
It's not how all science is done, but it certainly is how a lot of science gets reported.
Consider also the source for such publications -- usually large university-based research and teaching hospitals. Within those sites, not everyone who receives treatment will be included in any study. And not everyone who receives treatment will get it at a place where research on ECT is being done. Combine that with the fact that over the thousands of people who receive ECT each day/week/month/whatever, very few will respond really well to it, most will have some good results and some side effects, and another few will have extremely horrible responses to it. That this only happens to a few people does nothing to mitigate the damage done, but portraying their stories as what potentially awaits every individual undergoing ECT is IMO more scientifically irresponsible than relying on statitistical models to fill a gap in our understanding of brain function.
Not being scientists, we don't necessarily have to base our own decisions on what science finds support for -- you may not value their standards of "truth". But doctors don't ethically or professionally have that option of disregarding scientific evidence out of hand.
[well, unless they're up for tenure somewhere and they REALLY NEED those pubs on their vitas]
cheers,
bob
Posted by Cam W. on May 18, 2000, at 23:34:31
In reply to Re: Editorial Concern, Too, posted by bob on May 18, 2000, at 22:53:53
A fairly modern example out of physics is string theory, which was slammed as sham science for more than fifteen years because it proposed ideas contrary to the general model of the time (which in those fifteen years was poked through with experimental holes to the point of transparency). It also required an understanding of a branch of mathematics that most physicists knew nothing about, and did not care to learn in order to be better critics of the theory. Or, at least, so goes the story as I've heard it told....
bob - I have followed the superstring theory for the past 12 years, at least. Actually, I like the offshoot, "superrings" theory, but using elipses of the rings rather than circular rings (all these terms being relative, of course), believing (in my naivety) that this will clear up some of the mathematical conundrums. I try to avoid most of the math as much as possible, though. It gives me a pain in my M-branes. Want to share structure of universe theories via e-mail? - Cam
Posted by bob on May 19, 2000, at 0:29:07
In reply to Re: Editorial Concern, Too - off topic to bob, posted by Cam W. on May 18, 2000, at 23:34:31
> Want to share structure of universe theories via e-mail?
Well, I've been out of the loop (hah!) for a while, but I can give you my own theory on the structure of the universe. Back as an undergrad, I solved the "missing mass" problem you see. You know how a single sock out of a pair will disappear from the dryer with no explanation whatsoever? Or how you often see a single shoe lying along the side of the road, the other one no where in sight? Plus, I've heard from smokers that cheap plastic butane lighters have a tendency to disappear into thin air -- vanished without a trace! Well, the place that all this stuff goes to is where all the missing mass is ... one or more of those other 11 or 15 dimensions that are supposed to exist somewhere.
Anyway, there are some rather disturbing implications of this theory. While locally, here on earth, things like socks and butane are far more common than their cosmic distribution would suggest, we generally dismiss how rare free hydrogen is. Cosmically speaking, tho, hydrogen makes up 90% or so of the matter in the universe. So, logically, 90% or so of the missing mass should be hydrogen, right?
Well, what if some well-meaning but ignorant person should go in search of that sock or lighter? What if he or she actually FINDS it? I mean, besides all that hydrogen, there are all those other socks and probably a lot of dust bunnies.
Do you realize what would happen in the case of any static cling with those socks? Or what if someone flicks their newly-found Bic? Doesn't anybody remember the Hindenberg?
Yep ... we'd have ourselves another Big Bang.
So the moral of the story is that somethings that are lost should stay lost. Finding them just isn't worth the price.
cheers,
bobNow, wasn't there an item about ECT somewhere around here? ....
Posted by Cindy W on May 19, 2000, at 9:16:19
In reply to Re: Editorial Concern, Too - off topic to Cam, posted by bob on May 19, 2000, at 0:29:07
> > Want to share structure of universe theories via e-mail?
>
> Well, I've been out of the loop (hah!) for a while, but I can give you my own theory on the structure of the universe. Back as an undergrad, I solved the "missing mass" problem you see. You know how a single sock out of a pair will disappear from the dryer with no explanation whatsoever? Or how you often see a single shoe lying along the side of the road, the other one no where in sight? Plus, I've heard from smokers that cheap plastic butane lighters have a tendency to disappear into thin air -- vanished without a trace! Well, the place that all this stuff goes to is where all the missing mass is ... one or more of those other 11 or 15 dimensions that are supposed to exist somewhere.
>
> Anyway, there are some rather disturbing implications of this theory. While locally, here on earth, things like socks and butane are far more common than their cosmic distribution would suggest, we generally dismiss how rare free hydrogen is. Cosmically speaking, tho, hydrogen makes up 90% or so of the matter in the universe. So, logically, 90% or so of the missing mass should be hydrogen, right?
>
> Well, what if some well-meaning but ignorant person should go in search of that sock or lighter? What if he or she actually FINDS it? I mean, besides all that hydrogen, there are all those other socks and probably a lot of dust bunnies.
>
> Do you realize what would happen in the case of any static cling with those socks? Or what if someone flicks their newly-found Bic? Doesn't anybody remember the Hindenberg?
>
> Yep ... we'd have ourselves another Big Bang.
>
> So the moral of the story is that somethings that are lost should stay lost. Finding them just isn't worth the price.
>
> cheers,
> bob
>
> Now, wasn't there an item about ECT somewhere around here? ....
Bob, enjoyed your post. But there's one thing you need to consider...those lost socks are responsible for the superstring structure of the universe (they unravel when they leave the dryer).--Cindy W
Posted by Adam on May 19, 2000, at 23:49:32
In reply to Editorial Concern, Too, posted by boBB on May 18, 2000, at 18:33:42
I don't think there's anything contradictory about what I have said. I have merely stated
that when one peruses the literature on ECT, especially the publications from the last
decade or so, you see virtually no evidence in support of claims that ECT does permanent
harm to the brain. I have seen, rather rarely, and not much recently, articles in respected
journals suggesting (especially in the case of geriatric patients and some individuals who
may be at risk for siezures) that there can be prolonged, unwanted effects.I have just wondered, of those who have experienced persistant adverse effects due to ECT,
are these people just rare cases, indicating, at most, that perhaps better screening of
candidates for ECT should be developed, or are these people are a sort of "canary in a
coal mine," whose relative sensitivity gives the more tolerant the first sign of danger.
The danger may be subtle, and normally escapes detection.This is just speculation, of course. At any rate, it's not easy in science to always say
that two opposing views or claims are necessarily contradictory, even when they appear
to be on the surface. If alternate claims both appear credible, it probably just means
that more research needs to be done, and the differing conclusions result from the way the
investigators approached the subject. Often what one finds in science is that the question
is a lot more complicated than you first thought, and the answers may take a lot of hard
work to find.I'm not as cynical about science as bob is, though there are egos and idiocy to be had in
abundance in the field, just like any human endeavor. I do believe, though, that modern
psychiatry does need to find a balance between rather sweeping claims of safety and
efficacy (this goes for drugs, psychotherapy, you name it), and the rather alarmist claims
of a vocal minority, that many or our current psychiatric interventions are unacceptably
dangerous and are pushed on us by scheming capitalists. I think there may be real dangers
for some people, for any given treatment. Those who support psychiatry often minimize
the claims of adversity to the point that the victims and their concerned physicians are
accused of dissemblance. Those who don't give their support can sometimes blow isolated
cases out of all realistic proportion.I think the uncomfortable truth is likely to be that for treatment X, the odds are in your
favor that it will be safe for you. Unfortunately, if you are the one-in-large-number-N
who shouldn't use said therapy, not only is there no good way to screen for your
vulnerability, no one of any use to you may believe you when you complain of adverse effects.Statistics gives us a valuable set of tools, but I think maybe sometimes they are misapplied
in clinical research. Or maybe I should say, the tools we really need in addition to the
statistical analyses of heterogeneous populations are only just begining to show tangible
promise. When you think about it, the jump from the animal model of a drug trial, for
instance, to clinical studies doesn't involve any radical changes in analytical tools, even
though the expected polymorphisms in the group to be studied "in the real world" could be
orders of magnitude more frequent than what one finds in the lab. There's a big difference
between getting statistical data from a colony of Sprague-Dawley rats, which are highly
inbred and thus about as genetically alike as you can hope for without being total
Frankensteins, and, say, a group of 100 caucasian males, between the ages of 18 and 45,
non-smokers, with no known illnesses besides (your disease here).I imagine genomics, and the subsequent correlation between genetic differences and various
diseases will provide us with another piece of the puzzle. Hopefully with this information
we will be able to get a clearer picture of how these differences interact with environment
to yeild the observed syndrome. Then we'll do a better job of screening candidates for
various treatments. In defense of all that preceded such advances, that vital information
just wasn't available before, so we had to make do.What I find rather disturbing and unscientific about the attitudes taken by many practicing
or researching in the field of psychiatry (we'll call them the authorities on the subject, or
the credible ones), is that they seem to often react to the likes of Dr. Breggan and Dr.
McMullen with a response that is in polar opposition. No, ECT does not cause brain damage.
No, people don't commit suicide because they are taking an antidepressant. Why not respond
with something like "There may be many explanations for the symptoms described. We, as of
yet, have no statistically significant evidence to support contrary claims, but we must
remain open to the possibility that for some individuals, certain unacceptable risks may
exist, and as of yet, we do not know how to positively identify such rare individuals.
Given the cost-benefit analysis, we feel that (treatment) is safe for the vast majority
of the poulation, but that patients should still be closely monitored." It's wrong to go
around saying "Prozac KILLS! Lily is run by Nazis!" but it might be equally wrong to say
"Any such claim that (treatment) caused X is patently absurd." I don't see how we could
have enough information to make such a definitive statement.I suspect the lack of a moderate public stance on many of these issues has more to do with
politics and economics than science (which means we shouldn't impugn science, just those
who don't practice it with due dilligence or exaggerate pseudoscientifically). The trick
is figuring out how to approach various treatments safely and sanely without exposing
ourselves to unnecessary danger, or denying ourselves a useful treatment. I'd wonder, myself,
if the story with ECT is this: "For most people, it's quite safe. For some, it's not. We
have no idea if you fall into the former or the latter, just that the odds are in your
favor." I don't want to be in the latter catagory, and yet, I don't want to be suicidally
depressed either. ECT helped me in many ways. Did it hurt me? Can anyone say for certain
one way or the other? Are any of my fears and supicions valid? It's an uncomfortable and
unahppy position to be in, to not have any real answers, just "schools of thought." It's all
cost-benefit analysis at this point, just playing the numbers. And I don't like that. I also
know I have no real alternative approaches at this point. Nothing better to work with.> I have a question of purely editorial concern. It seemed your post offered two conflicting assessments of the available, peer reviewed literature regarding ECT.
>
> You wrote:
> > Nearly every major journal in psychiatry has published at least a couple of review articles on it, and ALL OF THEM (emphasis added), not for want of looking, claim unequivocably that there is no credible evidence in support of permanent harm from ECT.
>
> > I do find myself being afraid of THE FEW REPORTS, PUBLISHED (emphasis added) in peer-reviewed journals, that suggest ECT is not so benign.
>
> Maybe I damaged my memory some other way, like falling off my skateboard while improperly acting like a teenager, and comparing your two apparently contradictory assessments does require that I remember the one while I read the other. Are you saying that peer reviewed suggestions "that ECT is not so benign" do not undermine unequivocable claims that there is "no credible evidence in support of permanent harm from ECT"? If so, I guess your assessment is consistent, at least with itself.
>
> I understand that reports from people who awake from anesthetized ECT experiences with broken bones, or reports of long-lasting post-ECT memory loss do not carry water, scientifically, unless they are verified and published in peer reviewed literature. The question remains, however, whether informed consent implies only information published in peer reviewed publications, or whether it also implies access to case record of malpractic litigation, summaries of practitioners' records in adverse cases and access to reports compiled by public health agencies and other governmental bodies.
>
> The discussion of informed consent can also include discussion of the potentially prejudicial role of an authority figure who is supplying the information. If the clinical caregiver stands to gain from collection of Medicaid payments with little oversight concerning the efficacy of the treatment, which often seems to be the case, at least in the administration of ECT, we might want to consider whether the caregiver themself can be relied upon as a fair arbitrer of what information is sufficient to qualify the consent of the ECT subject. My perception of informed consent is that it refers to information provided to the subject of a therapy, who then consents, rather than information shared by scientists who then consent to allow or require a particular therapy.
>
> Anyway, I agree that waking from anesthesia ROCKs. (but that is a subjective, un-peer-reviewed assessment). AND, my sister had pretty good luck dressing up cats, but I have experienced ferocious resistance attempting to put pajamas on feline subjects.
Posted by bob on May 20, 2000, at 0:44:14
In reply to Re: Editorial Concern, Too, posted by Adam on May 19, 2000, at 23:49:32
> ... It's wrong to go
> around saying "Prozac KILLS! Lily is run by Nazis!" but it might be equally wrong to say
> "Any such claim that (treatment) caused X is patently absurd." I don't see how we could
> have enough information to make such a definitive statement.That's because you're not cynical enough about scientists. ;^)
Call it skepticism instead, and you'll wind up with a hallmark value of Science-as-we-know-it. My problem isn't with Science, but how it's practiced.
> I suspect the lack of a moderate public stance on many of these issues has more to do with
> politics and economics than science...It also has a lot to do with the difference between medicine and public health. Doctors deal with individuals. Good ones know that statistics do not apply to individuals (they apply to populations), and so statistical results are a guide and not a rule. On the other hand, public health DOES deal with populations. Well-documented and replicated stats are the law, not the rule. I've known smokers who lived out their long lives to succumb to something totally unrelated to their habit. I know long-time recreational drug users who haven't ruined their lives. I've known teens who've had unprotected sex and managed to avoid both pregnancy and disease. But if I was some public health official, do you think I'd publically admit to any of that?
Not on your life!
(well, on anyone's life for that matter, since that'd be a threat to, well, public health.)
cheers,
bob
Posted by Chris A. on May 20, 2000, at 0:53:56
In reply to Re: Editorial Concern, Too, posted by Adam on May 19, 2000, at 23:49:32
Adam,
It appears to me ECT didn't touch your intelligence. You may have lost a memory or two, but your input is rational, well informed and well written. I agree with you 100%. I'm a bit foggy, as I had a treatment this a.m. Fortunately I'm feeling pretty good. The memory difficulties are hard for me to deal with, but as you say, suicidal depression is not always easy to vanquish.Best,
Chris A.
Posted by Elizabeth on May 22, 2000, at 3:29:44
In reply to Re: ECT, bob, posted by Adam on May 17, 2000, at 23:07:19
> I hope they are correct. My memory difficulties are not my imagination,
> though. I've recently self-administerd some tests that would indicate
> some deficits, based on a high IQ combined with some specific difficulties
> with verbal and numerical memory. These deficits, however, have also been
> identified in persons with OCD, and it has been hypothesised that we OCD
> sufferers are a bit "constipated" when it comes to some mental tasks,
> essentially because we ruminate too much on the particulars, and thus
> score poorly on certain tests with time limits.Yeah, I doubt that can be attributed to ECT. I have the same sort of problems (I think you and I have even discussed this, though it could have been someone else), and I've never had ECT.
> I suppose it could even be that nearly a year of intense,
> sometimes mind-numbing depression terminating in a period of quivering
> frenzy did its own damage.Don't scoff so readily at this possibility! I've wondered about that myself.
Posted by Adam on May 23, 2000, at 19:19:10
In reply to Re: ECT, bob, posted by Elizabeth on May 22, 2000, at 3:29:44
> > I suppose it could even be that nearly a year of intense,
> > sometimes mind-numbing depression terminating in a period of quivering
> > frenzy did its own damage.
>
> Don't scoff so readily at this possibility! I've wondered about that myself.Actually, I was kind of serious about that. Cortisol, etc. Not a pleasant
thought.I think it's wrong to jump to too many conclusions about ECT, as tempting as
it is. However, I used to be rather convinced that nefazodone may have had
something to do with some of that "mind numbing frenzy", which, no matter how
bad my depression or obsessions got, was something quite beyond my experience.
The idea was repeatedly discounted by all my doctors.But I read, and read, and found some references, to mCPP, a major metabolite
of nefazodone. I first came across that chemical in my reading about OCD
and the serotonin receptors implicated in that disease, and mCPP is used quite
a lot to probe receptor binding, relieve OCD-like symptoms with chronic use
(at least, in animals), and acutely as an anxiogenic. The connnection to
nefazodone I stumbled on quite by accident.As it turns out, in some instances, prescribing nefazodone can be problematic
for some patients, because it can precipitate intense anxiety, as well as some
other distressing, almost hallucinogenic symptoms. Primarily this occurs when
those either genetically deficient in CYP450-2D6, or those who have recently or
are being prescribed a drug that inhibits 2D6, also take nefazodone, since 2D6
is the primary metabolizer of mCPP.As it turns out, I was also being prescribed clozapine, which is well known to
have a host of potential drug interactions, including and especially those drugs
which interact with 2D6. This may have been a particularly ill-concieved combo.,
since clozapine has never been convincingly shown to have any special benefits
for OCD sufferers (the reason I was told to take it). Meanwhile risperidone, which
has far lower potential for drug interactions, had been shown to be helpful for
some OCD patients at low doses, with statistical significance, in open-label
trials as early as 1995. What I describe above took place in late 1998, early
1999.
Anyway, I was at first suspicious, came to doubt myself after professional
reassurances, and now not only suspect nefazodone again, I have some real evidence
supporting that suspicion, with other cases of adverse reactions to such a combo.
documented, and a sound mechanistic explanation.My confidence has been shaken again and again by professional reassurances. I do
appreciate the fact that while the potential mCPP connection is well-documented,
any such claims about ECT and permanent damage are far less so. But when I have
doubts or suspicions, it's not so easy to brush them off as it used to be. I was
once dold Zoloft wasn't causing my weight gain, but when I took it I gained 30
pounds, and when I stopped taking it, I lost weight. What should one think under
such circumstances? I could only advise others to read. A lot.
Posted by Dave A on May 23, 2000, at 19:42:43
In reply to Re: ECT, bob, posted by Adam on May 23, 2000, at 19:19:10
Hi,
Not sure I'm doing this right, this is my
first time on this site.I have had bilateral treatments in the
past, but have trouble waking up all
confused and disoriented immediately
after a treatment. I was told unilateral
was easier.Has anyone had both? If so, can you describe
the differences in waking up? If anyone
has had just unilateral can you describe
what that is like. Confusion? Do you know
where you are? Delirium? For how long
after awaking?Thanks,
Dave A
Posted by Noa on May 24, 2000, at 16:53:50
In reply to Re: ECT, bob, posted by Adam on May 23, 2000, at 19:19:10
I think there is a discussion in Dr. Bob's Tips about this, and a suggestion that some people are genetically predisposed to experiencing bad effects from the metabolite. I think this could be an interesting avenue of research to pursue, not just for the question about who will respond favorably or unfavorably to this med or others, but perhaps identifying such genetic vulnerabilities can give more clues to the actual mechanisms causing the psychiatric symptoms in the first place.
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