The good folks over at the Committee for Truth in Psychiatry (a national organization for people who’ve had electroconvulsive therapy – ECT) wanted me to remind you that the U.S. Food and Drug Administration (FDA) is seeking comments on the safety and efficacy of electroconvulsive …
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if it weren’t for the ECT treatments that i received, i honestly don’t know if i would be alive today. anyone can say that, but living with biploar, ocd & ptsd is sometimes debilitating. after months of deep depression, we tried therapy & meds. Nothing. then ECT, and it worked.
yes, there are side effects. memory loss, the obvious. well, i think that it is an even trade. most people don’t even suffer from long-term loss. i did, because i had over 50 sessions. being suicidal & hopeless before, i would DEFINATELY have the ECT, again.
and, i highly recommend it to people who are good candidates for this treatment. get your life back.
we need to focus on today, not the past.
It is a little odd to read this article along-side the articles by Therese expressing support for ECT, although I guess that this just demonstrates the independence and freedom of writers on this site, which is surely a good thing.
I have heard contradictory accounts of ECT. I recently heard a lecture from a psychiatrist, as part of my social work course, in which he said that ECT was only used in cases of very serious depression in which the patient would die if they didn’t receive it, that the electric charge used was minute, that the patients were well treated afterwards and give a cup of tea to drink (this is England!), and that it was very effective.
I had no doubt whatsoever that he was coming from a motivation of compassion and was very impressed by his lecture and his explanation of this point. Although the brain damage and memory loss causes is regrettable, psychiatric drugs have side-effects too, and even moderate alcohol consumption causes kills off brain cells, so I think that we have to look at things in context.
Still, Dr John’s point – that it should really be tested and evaluated, like every thing else – is a pretty strong one.
The anti-ECT sentiment is strong is this article.
I’ve worked with and observed first hand the benefits of ECT in a number of patients. If the argument goes that ECT should not be used since we don’t know how it works, then we might as well throw out pretty much all the psych meds that exist, since we don’t really know how those work either.
As with any intervention, there is bound to be side effects. I have yet to work with any ECT recipient who has had long-term memory loss, permanent or temporary. Most had short-term loss of memory proceeding and following the treatment (which may actually be a good thing since its a pretty invasive treatment).
A lot of emotion around ECT still remains based on old school ECT treatment and Hollywood dramatization. Before anyone comments on ECT, they should at least see first hand how it is performed. I’ve sat in on a number of treatments and the first time I saw it, was like “thats it?”. It was nothing like what is portrayed in the media.
While not a first line of defense, a lot of people will say that they have benefited from it. A lot of research has been conducted on ECT (uni and bilateral) and granted, more research is needed. However, the benefits are there. Do the risks outweigh those benefits? For those who have benefited, the answer is yes. For those suffering from the treatment, no. More funding is needed to develop larger scale studies.
It will be important for folks who actually received ECT (whether positive or negative experiences) to share their feelings with the FDA. I’m afraid too many people will share irrational and unsubstantiated concerns with the FDA through this feedback. Hopefully, the FDA, in all its governmental sanity, can see past the garbage comments and take a look at the meaningful ones, again regardless of whether those comments relay positive or negative experiences.
On a side note – not all proponents are investors. That’s just a silly comment.
Hmm… I can’t imagine why there might be some anti-ECT sentiment here. After all, we’re talking about a procedure that’s been performed for decades, with the first few decades it being done with little research and with little regard for patient safety, human respect or even basic dignity. Add to that that many of the strongest research articles demonstrating ECT’s “effectiveness” or “safety” are authored by researchers who have a vested interest in the companies who make ECT equipment. Gosh, I can’t imagine why a treatment that has such an interesting history would have such a bad reputation.
Indeed, not all researchers of ECT are investors — most are not. Indeed, not all ECT treatment — especially the modern forms performed nowadays — is bad. Some people have claimed that ECT has saved their lives, which I completely understand and accept.
What I do not understand nor accept is the fact that these machines — which still very much have the capability to inflict serious neurological damage if misused — have never undergone any type of formal FDA testing nor approval. That may have been acceptable at one time, but knowing what we know nowadays, it is completely unacceptable.
The last fact also remains — even with modern ECT treatment, no doctor can tell a patient with any certainty what kind of memory loss they will suffer. And that’s a significant “side effect” that patients are not always fully informed of going into this, because many practitioners of ECT minimize it (“Oh yes, you may experience some memory loss, but usually it’s just around the time of the ECT treatment itself.”) Very few are honest and say, “We cannot predict what kind of memory loss you will experience. Most people do not experience any significant memory loss. However, some people do. We won’t know what category you fall into until after you being your ECT treatments.”
Honesty. Transparency. Researchers who don’t have an invested interest in the companies their research supports. That’s all ordinary folks like myself are looking for…
The Wikipedia article on electroconvulsive therapy has a section on the “controversy over long-term effects on general cognition.” And it’s good. I recommend that people take five minutes to read it.
John: Have enjoyed many of your articles but think you have reached a topic beyond your knowledge limits. I have worked with many patients who have received ECT and many psychiatrists who perform it. It is very safe and very effective. There are many procedures in medicine that have not received FDA approval. ECT is not unique in this aspect.
Thank you for this article. I had ECT three years ago, and I am one of the people who have lingering memory problems and cognitive damage since then. My problems were very severe when I first came home – I couldn’t remember how to use the stove or cook a meal, or other simple things like how to take a shower or do the laundry….much less get from one place to another around my town. I couldn’t think of words (which has gotten better but is still a problem) and I couldn’t recognize words when I was reading. I lost the ability to do crossword puzzles and other pencil games, which I had previously enjoyed greatly. I had been a Greek scholar, and lost all of my knowledge of Greek. I lost so much memory is so many different areas. So yes indeed, ECT can cause significant damage. I regret ever having the treatments, and for all of that, it did not help with the depression – at least in my case.
Thanks for this article, and I will write to the FDA about my experience. I think the should study ECT therapy, and at the minimum, regulate it better, and perhaps even eliminate it as a therapy. I believe it is much more damaging than most physicians will tell their patients.
Take care,
Erin
while an argument damning the motivations of ETC researchers because those who advocate the therapy–and it is a therapy– participate economically in its development might seem cogent, it is more a damnation of the cpitalist system of medicine than of ect.
medical procedures–aren’t they evaluated by different standards than experimental drugs with an unknown back history? they certainly should be since we know a lot more about the long term effects of ect than you allege because we have living waking patients to interview over a long timeline.
ECT is not a one-sided success however. i remember being in a famous hospital that performs this procedure and some individuals faked recovery so that they would have the opportunity to kill themselves later on and did do so.
I am not a big fan of insurance companies but if their evaluations sugest that they need to pay for ECT than ECT is probably very useful for the kinds of cases insurance companies will fund. the verdict is already in.
there are many drugs that are grandfathered without clinical trials because of their history of effectiveness too. aspirin comes to mind as an example despite the fact that one can poison themselves with aspirin. (please delete this paragraph if you think it is too provocative for this website)
“requiring ECT devices to meet the same minimal safety and efficacy requirements made of any modern medical device or medication.”
I wonder if you need a bachelor in law and a bachelor in science or to be QA engineer and ISO certified auditor who had had to deal with such kind of problems to understand that any DEVICE has to meet requirements regarding safety and efficacy!
I understand that the method of treatment (electroshocks) has had some success; but how could you know that the failures are due to the method and not to the devices? How can you develop a better way to apply a method without better devices when you do not have minimal requirements for them??
Is the electroshock still used for resuscitating the heart? Is that device tested before using and then checked in time? Do your plugs and electric devices work for ever? Or it’s enough the doctor to say that he has used the device on patients “I have worked with many patients who have received (…) It is very safe and very effective.” Maybe the method is! But does a doctor, psychiatrist, psychologist have knowledge to check and assure the requirements and the maintenance of the technical devices? He/ she knows about patients and the treatments that might work.
Therefore the doctors have to ask for the right devices… It could be over my knowledge but the heart and brain are connected and the method seems to work in both cases.
Bill – “I have worked with many patients who have received ECT and many psychiatrists who perform it. It is very safe and very effective.”
Bill, with all due respect, this is not a logical rejoinder to the argument that medical equipment used to alter the brain should be FDA approved. As you can read for yourself in this thread, for as many people who have been helped by ECT, there are also a number of people who have been hurt by ECT. The research literature has hundreds of studies done on ECT, and you can find many that demonstrate that patients suffer from retrograde amnesia after treatment (for example, Harvard researchers O’Connor et al, 2008). Even “modern” ECT treatments can suffer from the memory side effect.
pi – I don’t disagree that the problems with ECT and research interests are limited to ECT. There’s a lot of “dirty” research in the literature, and very few journals who are interested in doing anything about the problem retrospectively. It’s all fine and well journals are finally cracking down on some of these conflicts now, but what about the past 40 years’ worth of research?
More reading on enforced ECT
http://www.irishtimes.com/newspaper/ireland/2009/1207/1224260241511.html
Memory Loss from ECT “my life is ruined”
http://www.irishtimes.com/newspaper/ireland/2009/1207/1224260241533.html
As a psychiatrist who has practiced for more than a decade, while not a provider of ECT services though, I have seen more good than bad with this intervention. So, like much of life, the treatment is a gray intervention, and I am tired of those who want to paint this matter with black and white brushes. ECT providers should be sure to fully evaluate candidates when referred, and go over the risk/benefit profiles with patient and invested collaterals involved with the patient. One point I would like to make: in my travels with patients who I sense are more characterologically disordered than mood disordered, there seems to be more post treatment sequelae than in primarily mood disordered patients. Also, I think some providers are too quick to go to bilateral lead placements. The treatment is faster acting than meds, but, with insurance so focused on “treat em and street em mentalities”, maybe unilateral placement for 4 to 6 treatments might yield a response in the two week period it would take.
Tell you one thing, it is nothing less than impressive when a patient returns to your office in 3 weeks and presents so much better after the treatment. You don’t see that with meds!
Joel: “You don’t see that with meds!”.
No, Joel, you don’t. But you do see it with sham-ECT. Why don’t you read Colin Ross’s review of the sham ECT literature. And while you’re at it, why don’t you read the Wikipedia article on effectiveness and adverse effects, and watch the Sackeim video clip that’s linked to on that page. Most recently, we have a 2008 Duke university study showing that post-ECT, patients have substantial cognitive impairment that they aren’t even aware of. And why is it that a 2004 study found that 42% of patients report that ECT results in lasting loss of intelligence, and that consumer studies on the benefits of ECT don’t reach the same positive findings as the clinical studies? What happens after you factor in the people who aren’t aware of their own deficits? Are any patients being told about the Sackeim and Macqueen studies on the negative effects on long-term cognition? No, they’re not.
In response to Steve, so you quote articles and statistics that support your position that ECT is not more beneficial than harmful. So another reader can quote different articles and statistics that show it to be mostly effective. Hey, step out of the black and white world and join the gray. If the procedure was so overwhelmingly detrimental, it would be lost as an option. When you see more people than not have a positive response, I am not going to bash it. And yes, sir, I see people respond more dramatically from ECT when it is effective than I see with medication in 3 weeks or less. Sorry you don’t see it. Have you ever seen a black swan? If you haven’t, you are going to tell me it doesn’t exist? How narrow minded. Sorry if the procedure has done you or someone close poorly. But, it has a place. No one bats 1000! “Only a Sith lord thinks in absolutes” Gotta love Star Wars’ quotes!
1955 was the year my sister had a nervous breakdown. She was five years older than me and we were very close. She agreed to be admitted to a state hospital where she remained for six months. Insulin therapy and ECT were administered daily. She was completely out of touch with reality, especially after the ECT treatments. When visiting her, I saw a result of this, whereby she was stripped of all dignity. She was released a fearful, emotional clone of a human being with memory loss and to this day will not discuss ECT. She really was never the same. I personally don’t care how this treatment is administered today in a so-called more humane fashion. I am totally against this method of treatment!
I have to put my 2 cents in. Like Erin above I have had MUCH memory loss from ECT. I went into a severe depression after having a miscarriage. I entered the hospital one month later. By week two of my stay they said I needed ECT- the medication wasn’t working. My husband was brought in to discuss this – he has no medical background, I was so deeply depressed that I became like a zombie- stand in line, pop a pill, repeat three times a day. I had my first ECT (unilateral) three weeks after entering the hospital. The memory loss was not around the ECT- I had clear memory of everything (including waking up -not once but TWICE- before the paralytic wore off). 12 treatments later I was discharged (I didn’t feel any better, just couldn’t take the hospital any more).
Less than 6 months later (after short repeated stays), when I was re-admitted, my outside provider said that she no longer wanted to treat me. My care was transfered to the local community health center- the new Doc reviewed my record and decided that I should have bi-lateral ECT- he met me ONCE! I had no choice, if I didn’t agree I would go to the state hospital. Six ECTs; My memory loss was profound- nurses who cared for me daily for weeks were like strangers. Finding words was difficult (still is at least three times a day). I have lost memories of my son as an infant. They continued the ECT for three more times- until my husband said I had to refuse. He was visiting and asked me about something- I looked at him like he had three heads- I didn’t remember that we had moved two years before, I told him where to locate something in our old place!
I have terrible memory loss! I look at pictures and have to ask my husband to remind me of what was going on.
While I know my ECT wasn’t done with the movie portrayl equipment, I do have to wonder what really happened to my brain- the best medication for me is an anti-seizure one; until I went onto this one I could not be out of the hospital except for short periods of time. I discourage anyone from getting ECT- there is too much unknown.
As to the comparison of a shock to the heart- They can map the electrical current in the heart and see exactly what happens when it short circuts, and AED devices have a extensive maintenance record.
“If the procedure was so overwhelmingly detrimental, it would be lost as an option.”
How many times in history can we point to a procedure, drug, what have you– and find that its performance was suspect for many years and yet it still retained “believers” even after proof of inefficacy was provided? Bloodletting was done for centuries and drugs have remained on the market for years until they were pulled. Having the FDA look into this matter is prudent, and hopefully can shed light on some of the personal and anecdotal “evidence” put forth by the users and recipients of this controversial treatment. I have no doubt that observations of people “feeling better” from this type of treatment are accurate, but the reasons behind the improvements may be as simple as someone “forgetting” their depression, placebo effect or not wanting to undergo the trauma of treatment a second time. If any of those circumstances exist, ECT is hardly a long term solution for the problem of mental illness.
Thalidomide was not seen as a viable medication after the birth defect incident in the 1960s, but yet today is used in oncology. Maybe not the most applicable analogy to this topic, but, if the FDA is looking for a 90% success rate with little to no risk issues, then they should be banning antipsychotic medications too. Actually, some of them they probably should!
I have no problem with the FDA evaluating this procedure. I have problems with people who paint the matter as only wrong. Again, ECT should be evaluated on a patient to patient basis, which it is by responsible providers.
Happy Holidays and New Year, and good mental health!
I have had 3 separate courses of ECT. Every one has been successful. My last series was the end of May and since then I have had maintenance treatments every other week. My memory loss is minimal and when I am reminded about something I can then recall it usually. I have been treated professionally and received excellent care. My treatments are now dropping down to every three weeks and I expect to go to once a month within a few months. I believe ECT to be beneficial for many people. Unfortunately, people who have had negative experiences are more likely to write than those with positive experiences.
Hi Doc Grohol,
“The biggest problem with ECT is that nobody can tell you whether your memory loss will just be around your ECT treatment itself, or whether you’ll lose memories of your childhood, your family, or other memories you hold dear. And while that’s a risk some people with serious, chronic depression may be willing to take, it’s a risk too often glossed over by the doctors who offer ECT treatments (for obvious reasons, as it reduces the numbers of people willing to undergo the procedure).
ECT may indeed have a place the realm of depression treatment, but it should — at minimum — have the same kinds of research studies we now require of antidepressant drugs. And of course, patients who consider undergoing ECT treatment should be fully informed of all of the risks associated with such treatment.” — John M Grohol PsyD
The biggest problem as I see it is not with ECT but with Psychiatry in general. There are simply no guarantees of efficacy from any treatment or therapy nor is there any definitive or quantitative diagnostic means to determine these illnesses or can one establish who will or will not encounter potentially serious side-effects. In fact the reality boils down to a term which I coined some four decades ago; “The Trial and Error Approach to Wellness.
Nor did you address the memory loss and challenges confronting patients suffering from sever mood disorders absent of any ECT.
Add to which it seems to me your lowering your level of professionalism to that of the lay persons I often encounter on blog forums by statements such as “…it’s a risk too often glossed over by the doctors who offer ECT treatments…” All those physicians attending to my spouse through the years have not glossed over anything nor have they not been forthright and open to the best of their knowledge as it applied to ECT and other psychiatric relevant matters. So please stop generalizing; it has not been our experience.
I am much in agreement with you as to minimum standards, requirements and testing of ECT equipment along with all medical equipment as well as studies for safety and efficacy but please also don’t delude your readership into thinking that research studies into antidepressants are seemingly satisfactory or the answer. I think we both know better on that subject.
Incidentally, ECT has proven a quick and effective treatment option on those occasions and when needed to quickly abort my spouse’s suicidal ideations with minimum to no side-effects.
Warmly,
Herb
VNSdepression.com
Hi Herb – I share my opinion based upon my experiences. My experiences in hearing first-hand from other people who’ve undergone ECT in the past few years and had some side effects like memory loss minimized leads me to the statement that some doctors do indeed “gloss over” some potential side effects. You don’t have to like it, but nobody is doing anyone any favors pretending it isn’t happening.
Unlike other psychiatric and psychological treatments (save, perhaps, the use of atypical antipsychotics), ECT side effects are life-long and possibly life-altering. Dry mouth goes away when you stop taking Paxil. Those memories a person lost to ECT may never come back.
Indeed, treatment resistant depression — what ECT is most commonly prescribed for — is a challenge and a tragedy I would wish upon no person. And ECT can be an effective, helpful treatment.
But it needs to undergo the same basic FDA modern standards we ask of all of our psychiatric treatments, that’s all.
Doc Grohol,
Before I forget let me extend best wishes to you and yours and your entire readership for wellness and a belated Happy Chanukah and a forthcoming Merry Christmas and a Healthy, Happy, Peaceful and Prosperous New Year.
“Unlike other psychiatric and psychological treatments (save, perhaps, the use of atypical antipsychotics), ECT side effects are life-long and possibly life-altering. Dry mouth goes away when you stop taking Paxil. Those memories a person lost to ECT may never come back.” — John M Grohol PsyD
May I also remind you that untreated MDD is “life-altering” too and that suicide is a “life-altering” death for the patient and a life-long hurtful memory for the surviving loved ones? I’ll also add and paraphrase a comment made to me by my spouse’s attending psychiatrist when discussing ECT and other therapies, “What other alternatives would you suggest” when nothing is working?
He also pointed out to me after attending a lecture some months back the comment made by the lecturer that in all the studies reported, the “n=” (number of study subjects) as in i.e. “n=250” all that truly is important is “n=1”, that being the patient in front of the physician at that very moment.
The point being that while you cite Paxil and dry mouth and ECT and lost memories I can report that my spouse has through “The Trial and Error Approach to Wellness” repeatedly taken numerous psychotropic medications and ECT and despite the study literature and anecdotal reporting on forums she has experienced few side-effects. More amazingly is the fact that through the years she has also stopped cold-turkey or withdrawn rapidly from those very same psychotropic medications without ill effect or addiction contrary to the horror stories I do read. The keyword I read in many studies through the years and now from your statement amongst other keywords is “may” which brings me back the “n=1” or the very patient in front of you.
I’ll also note that while the FDA may have approved a number of therapies CMS (Centers for Medicare and Medicaid Services) has denied insurance coverage which in effect financially prevents most patients from accessing the therapy of their choice and that of their attending physician as is the case with VNS Therapy for Depression although the use of the therapy is covered by health insurance for Epilepsy. CMS in rendering their decision for VNS Therapy for Depression also established the fact that there is no such recognized medical term in the DSM IV as “TRD” (Treatment Resistant Depression) although they do recognize chronic and recurrent depressive illness. I’ll omit my thoughts as to the less than scientific aspects of that manual.
When talk therapies and medications etc are ineffective for the “n=1” patient experiencing chronic, recurrent and pronounced suicidal ideations, “What other alternatives would you suggest?”
Warmly,
Herb
VNSdepression.com
look, dry mouth might go away after one stops taking paxil, but the patient’s teeth are already rotted because of the long term changes in the fauna of a patients mouth. and dentistry isn’t covered for the poor who take these meds.
and the psychotic individual who is expected to take haldol for life finds the idea of his intelligence coming back to be moot unless he intends to be non-compliant.
so i don’t think these distinctions are defensible. there is a bit of poison in every medicine. i agree with the doctor who wants us to ‘accept the grey.’
and i don’t want us to have ect the way it was administered in the distant past, according to the anecdotes here. i want to see newer safer ect based on magnetic fields which do not require an anesthetist become widespread.
as an aside about medieval bloodletting and doctors swearing by it, they should! leeches contained a blod thinner to continue the letting. we spend a lot of money today on drugs like cumedin and lasix to create the same effect. it was the best heart patients could hope for centuries ago.
He said, she said. I am not willing to risk what ever is left of my brain function after more than 40 years of TRD to so called treatment by electrocution. Why would I want to trade one form of suffering for another. That is crazy.
hello, i suffer with severe major depression the treatment resistant type. i’ve been on just about every med there is for depression, everything from ssris’ to snris’to tricyclic to tetracyclic to anxiolytic to anticonvulsants to lithium to antipsychotics and combinations of the above and also amantadine with NO success with these medications. then i spent 23 days on a psych ward getting ect, 12+ treatments and so far another 12 possibly more i haven’t been counting but if it weren’t for ect i would have blown my brains out by now or taken a massive overdose, so far ect has kept me walking on this globe, i still have my occasional crisis’, but that’s the nature of depression. ect is not perfect but it works, try to find a treatment for depression without side effects, that would be rare. thank-you ect, i pray they never remove it because it’s all i have to keep me alive.