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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by ryanz on January 14, 2007, at 2:07:47
Not sure if this has been posted on here already:
http://www.medicalnewstoday.com/medicalnews.php?newsid=59631
Posted by halcyondaze on January 14, 2007, at 10:33:49
In reply to ECT causes permanent cognitive deficits + amnesia, posted by ryanz on January 14, 2007, at 2:07:47
> Not sure if this has been posted on here already:
>
> http://www.medicalnewstoday.com/medicalnews.php?newsid=59631
<< http://ajp.psychiatryonline.org/cgi/content/abstract/164/1/73 >>A recent study in AmJPsych showed that ECT actually causes less cognitive deficiencies, sometimes even improving cognition, than RTMS and is far more effective. They speculated that perhaps responders experience less cognitive problems with ECT than non-responders.
Sorry I can only post the abstract; I have a hard copy of the journal and the methods all make sense; there was no stretching the data to make it fit in this case.
Posted by Phillipa on January 14, 2007, at 11:28:54
In reply to Re: ECT causes permanent cognitive deficits + amnesia, posted by halcyondaze on January 14, 2007, at 10:33:49
But that's just a comparison between the two which I think said the ECT was better. Love Phillipa
Posted by linkadge on January 14, 2007, at 12:34:15
In reply to Re: ECT causes permanent cognitive deficits + amnesia » halcyondaze, posted by Phillipa on January 14, 2007, at 11:28:54
I'd be more inclined to believe the negative study. It was larger and followed patients for longer.
Linkadge
Posted by Karen44 on January 14, 2007, at 21:13:39
In reply to Re: ECT causes permanent cognitive deficits + amnesia, posted by linkadge on January 14, 2007, at 12:34:15
> I'd be more inclined to believe the negative study. It was larger and followed patients for longer.
>
> LinkadgeBe careful about buying hook line and sinker what Sackeim says. He has not been upfront about many things and has in the past not reported data that did not support his position. Even with this study, many of the measures he used are not the best from neuropsychology. Added to this he is now advocating right unilateral ECT at levels six timesand more above the seizure threshold level. He found effectiveness for treating depression at that level but even with his shoddy measures, he found cognitive impairments at such a high level of stimulus intensity. He was, however, inclined to gloss over this fact. Added to this, he advocates the three times per week which then means does not allow the brain a rest from such high stimulus intensities. Sometimes I wonder if the man is a sadist and then has so many psychiatrists following his lead. There is no good reason for three times per week unless someone is on the verge of suicide, and even then I think there are other alternatives. Many countries use twice per week and even once per week treatment. It's a primarily U.S. thing to administer ECT three times per week and is partly related to what the insurance companies want--fast and over with. Just something to keep in mind. Study results are often couched in terms the researcher wants one to take away from the study. RE rTMS, I would suggest as well looking more closely at the available literature thus far. We just don't know yet if it is safer or better than ECT. It looks as if that might be so, but there have also been some problems with this as well such as seizures and strokes. What does it mean for the brain depending upon where one does the treatment? This is still unanswered.
Karen44
Posted by blueberry1 on January 15, 2007, at 5:49:40
In reply to ECT causes permanent cognitive deficits + amnesia, posted by ryanz on January 14, 2007, at 2:07:47
Personally I would only trust studies that followed up patients for 3 to 12 years. What does ECT do in the longterm? Longterm is not 6 months or 18 months. I seem to have leveled off at a certain level of minor cognitive dysfunction that is not getting worse or getting better, but is definitely a notch below where I was before ECT. Just to be able to think as clearly, remember as clearly, plan as clearly as pre-ECt, I need a stimulant like Ritalin or Provigil. Basically ECT created partial ADD and partial alheimerzs when none existed.
Posted by Karen44 on January 15, 2007, at 17:19:39
In reply to Re: ECT causes permanent cognitive deficits + amnesia, posted by blueberry1 on January 15, 2007, at 5:49:40
> Personally I would only trust studies that followed up patients for 3 to 12 years. What does ECT do in the longterm? Longterm is not 6 months or 18 months. I seem to have leveled off at a certain level of minor cognitive dysfunction that is not getting worse or getting better, but is definitely a notch below where I was before ECT. Just to be able to think as clearly, remember as clearly, plan as clearly as pre-ECt, I need a stimulant like Ritalin or Provigil. Basically ECT created partial ADD and partial alheimerzs when none existed.
Blueberry; I appreciate your input on this matter, and I am sorry they did bilateral on you. Shame on them! Anyway, I saw my pdoc today, and he gave me samples of Provigil to try. This makes some sense anyway since I do have sleep apnea. So, perhaps I have put the "shock machine" on hold for now or for forever. I am going ahead with seeing two different doctors ahead of time,though, to address my conditions for ECT. If neither can or will accomodate me, then I will keep looking and hope I don't get so bad that I have no choice but to accept "their" conditions. Actually, I don't think I would.Karen44
Posted by med_empowered on January 15, 2007, at 23:10:18
In reply to Re: ECT causes permanent cognitive deficits + amnesia, posted by Karen44 on January 14, 2007, at 21:13:39
I dont think its really been a secret that ECT can cause brain damage. Back in the day (50s-70s), even Max Fink himself admitted as much. Now, after Thomas Szasz ("The Myth of Mental Illness") and attacks on (pretty crappy) psychiatric practices from everybody (minorities, women, gays, psychiatric survivors), Fink went along with the new story of ECT, which was that it somehow improved mood quickly and safely, without any of the trauma or brain damage one would expect from flooding the brain with high amounts of electricity. For whatever reason, the media and mainstream shrinks have largely played along with this, telling us all that "the new ECT" is somehow kinder and gentler that the "One Flew Over The Cuckoo's Nest" or Frances Farmer versions. Really, it isn't. They just added anaesthesia and muscle relaxers.
Anyway, its cool that this guy is finally admitting what has been pretty blatantly apparent since ECT hit the scene in the 30s: this treatment can cause brain damage. I don't know why he's coming forward with this--maybe he couldn't manipulate the data to go in any other direction--but I'm glad its finally happened.
I think it makes sense that ECT would cause brain damage. Think of what it is used for: mania, depression (non-psychotic), psychotic depression, schizophrenia, and apparently OCD (this from TMAP's website). I don't think there is one underlying abnormality in all these conditions that ECT could be rectifying. However, ECT does "help" all of them...my guess is that this is b/c "successful treatment" is synonymous with the degree of disorientation and disruption of normal thought patterns that ECT induces.
Posted by Karen44 on January 16, 2007, at 0:46:17
In reply to its about time, posted by med_empowered on January 15, 2007, at 23:10:18
My understanding is that Sackeim is becoming more interested in rTMS. This does not mean he is leaving the ECT field. Problem is he did manipulate the data even though he finds cognitive impairments. Nonetheless, he advocates even higher threshold levels be administered even if it causes cognitive impairements--he looks at it as okay because at least the depression is lifted. As a side note, both his master's thesis and doctoral dissertation were on the topic of deception. Interesting.
Karen44
Posted by invisiblemanpa on January 16, 2007, at 10:51:33
In reply to Re: ECT causes permanent cognitive deficits + amnesia » blueberry1, posted by Karen44 on January 15, 2007, at 17:19:39
I wholehartdly agree. I had it done this fall after going through the cycle of antid. meds., combos etc. with no change, except getting sick each time. My ECT left me more depressed, more anxious, and definately a few large notches down on the cognitive brain chain......It surprises me when I tell any health care professionals that and they just stare at me....they just hate to voice a negative opinion it seems like to any medical practice.....only people that have had it done seem to understand the terrible changes it leaves you with.........I wish I would of listened to the people that warned me about it......I am 4 months since my last treatment and they did both sides.....and I see no improvement in concentration, memory, writing things like this.........focus...all shot....memories of 2006 are gone......it like my hard drive was wiped clean.......good luck to all
Posted by Honore on January 16, 2007, at 10:53:21
In reply to Re: its about time » med_empowered, posted by Karen44 on January 16, 2007, at 0:46:17
Karen, I was thinking the same thing. I saw lots of articles where he's still advocating ECT-- but it seems he's now interested in VNS-- I think it was or one of the other newer brain stimulation technologies--so maybe he's found some new companies to consult for (?).
Not that I'm casting aspersions on his motives. Or anything.
Honore
Posted by linkadge on January 16, 2007, at 11:46:44
In reply to Re: its about time, posted by Honore on January 16, 2007, at 10:53:21
That is why Hemmingway shot himself. He wrote something along the lines of how the ECT took away the only think that he cherished and that was his cognitive abilities.
But, I suppose he doesn't know what he is talking about since he was depressed.
Linkadge
Posted by linkadge on January 18, 2007, at 20:13:28
In reply to Re: its about time » med_empowered, posted by Karen44 on January 16, 2007, at 0:46:17
>My understanding is that Sackeim is becoming >more interested in rTMS
I hope he is not changing his fincancial interests.
Linkadge
Posted by Karen44 on January 18, 2007, at 20:17:20
In reply to Re: its about time, posted by linkadge on January 18, 2007, at 20:13:28
> >My understanding is that Sackeim is becoming >more interested in rTMS
>
> I hope he is not changing his fincancial interests.
>
> LinkadgeMaybe he wants to get his hands into everything - ECT, rTMS, and VNS before he is sued up the river!!
Karen
This is the end of the thread.
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