[HN Gopher] In the deepest despair, electroconvulsive therapy of...
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In the deepest despair, electroconvulsive therapy offers hope
Author : rbanffy
Score : 35 points
Date : 2021-03-29 18:01 UTC (5 hours ago)
(HTM) web link (psyche.co)
(TXT) w3m dump (psyche.co)
| jakeogh wrote:
| Nicotinic Acid is as safe as it gets, but does not get much
| discussion. It's worth trying.
| hypersoar wrote:
| I'm in the middle of a course of ECT's newer, kinder, gentler
| cousin: trans-cranial magnetic stimulation (TMS). The idea is
| similar. The brain is stimulated by magnetic pulses in place of
| electrodes, and there are no seizures. Every weekday morning, I
| go to a place where they strap on a helmet that hits me with a
| 2-second pulse every 20 seconds for about 20 minutes. They
| calibrate the power by testing your motor threshold. Mine was
| low, so I get relatively gentle pulses. Having declined the
| required offer of earplugs, I sit and chat with the tech and
| barely notice the knocking on my head. With chances for in-person
| socializing being hard to come by, I find my treatments to be
| rather pleasant.
|
| The only side effects are mostly headaches and nausea, which are
| usually managed by just ramping up to full strength at the
| beginning. If you needed stronger pulses, I could imagine it
| being fairly uncomfortable. But no seizures means no anesthesia
| and no memory loss. Really, the main drawback is that it's time-
| consuming, and it's still not quite as effective as ECT. A
| typical course is 36 treatments administered 5-6 times per week.
| And insurance won't cover it unless you've tried a bunch of other
| stuff. Out of pocket, it costs a few grand.
|
| I've started to feel it helping me, but the real test will be
| when I try to go off my antidepressants.
| newsbinator wrote:
| I'd be curious to test whether it works better or the same when
| attempting to concentrate or meditate during the stimulation
| vs. distracting yourself with conversation.
|
| Who knows... maybe there's some difference?
| neartheplain wrote:
| "At least a third of patients experience memory loss after ECT."
|
| That's a sizable proportion.
|
| "But there are other patients who claim that the long-term side-
| effects have been severe enough to stop them from working, and
| have had a catastrophic effect on their lives."
|
| How many patients report such catastrophic symptoms? The author
| doesn't say.
| Eric_WVGG wrote:
| David Foster Wallace resorted to ECT, sounds like it didn't do
| him any favors.
| https://www.tandfonline.com/doi/full/10.1080/00111619.2017.1...
| ca98am79 wrote:
| My father had this for suicidal depression. After each ECT he
| would expect my mother to be taking him home, but he had to be
| reminded that they were divorced. He forgot. It was not a
| pleasant experience and didn't seem to help him with his
| depression.
| racecondition wrote:
| ect helps about half of patients. that is known from the get
| go
| meepmorp wrote:
| Did he remember his being divorced, eventually? Not the fact
| of being divorced, but the memories and feelings around it.
| ineedasername wrote:
| This is why ECT is not a first-line treatment. It's where you
| turn when you've pretty much exhausted the alternatives.
|
| However it's important to keep in mind that
|
| 1) Memory loss is often very short term, or temporary.
|
| 2) losing the ability to hold down a job is a non-issue for
| patients who may end up out of work on disability
|
| 3) Many antipsychotics and mood stabilizers come with their own
| memory issues and other side effects... There's always a trade
| off.
|
| 4) We need better treatment methods. To say ECT is a shotgun
| approach is an understatement. It's a scorched-earth approach
| where you hope the ashes end up fertilizing a new crop.
|
| 5) It's a tragedy that many of our best and brightest STEM
| minds pursue an education that leads them to jobs optimizing
| ad-tech or hustling for an exit plan to get rich. Theranos
| duped so many people in part because everyone wanted to believe
| big tech could be more than this. Which at least means that if
| you're in it for the big payoff then you should find something
| with the same potential for human impact only, you know, not a
| massive fraud. If you do that, you'll bank a lot more money
| than in finding the next SaaS that provides an incremental
| improvement on an existing product category.
| racecondition wrote:
| are we sure it's a scorched earth approach? I thought we
| don't exactly know WHY ect works. its possible calibrating
| neuronal stimulation is good for the brain and helps
| calibrate neuronal connections that otherwise were not as
| excercised as much as the ones very depressed people have.
|
| In general, deeply depressed people interpret and perceive
| even language and visuals differently, in more negative and
| cynical lights, its hard to consciously teach yourself to
| constantly perceive the opposite or think in a more positive
| way, perhaps just stimulating ALL nuerons helps calibrate
| paths that otherwise were not favored other neuronal pathways
| highly utilized by depressed people.
|
| To be honest, I've seen more people in my life die from going
| from antidepressents to street heroine than I have people
| from ect. I am not ready to say ect is safer than
| antidepressants. It's also to be noted antidpressants its a
| multibillion dollar industry of which a very few very rich
| families make a ton of money and also sell the same drugs for
| heroine overdoses, many heroine addicts of which came from
| being cut off from abusing antidepressants, 1/3rd of all
| heroine addicts actually so...
|
| when you compare ect therapy to a massive opioid epidemic
| that makes a few people rich, and all of the violence that
| has encompassed the heroine drug dealing industry, I would
| say ect is potentially a safer option.
|
| It has a stigma because of how it was originally used.
|
| I would still though be interested in psychadelics over ect
| but shrooms can cause permanent damage and impacts everyone
| differently as well so both are hard to streamline I imagine.
| candiodari wrote:
| ECT: permanent mental impairment for temporary change in
| behavior.
| nicklecompte wrote:
| Saying depression is a "temporary change in behavior" is like
| saying pneumonia is a "temporary change in respiration." It's
| insulting and dismissive and indicates you don't really care
| very much about this issue.
|
| Depression kills people. ECT has serious side effects but it
| is also has proven efficacy and, if administered properly, is
| never fatal. All medicine involves this sort of cost-benefit
| analysis and in cases of severe drug-resistant depression,
| where there is a high risk of the patient dying in the short
| term, ECT is the _only_ alternative.
| yellowapple wrote:
| > Saying depression is a "temporary change in behavior"
|
| That ain't how I interpreted the above comment.
|
| > but it is also has proven efficacy
|
| Right, but at what cost? It seems very much like something
| that just replaces one problem with another, at best (and
| at worst, introduces more problems while the existing ones
| don't go away).
|
| But hey, as long as it's voluntary, who am I to judge?
| kerblang wrote:
| While the parent comment isn't all that helpful, I suspect
| they meant "...in exchange for a temporary change..."; in
| other words, not that that depression is temporary, but
| beneficial effects of ECT are.
| meepmorp wrote:
| You're lucky to never have been at a place in your life where
| that sounds like it's worth trying.
| vernie wrote:
| Suicide is a temporary change in behavior.
| fossuser wrote:
| I thought this was pretty interesting and goes into a
| hypothesis of why ECT might be effective (in the context of
| sleep deprivation being effective)
| https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d...
|
| It's also possible the memory loss is partly a treatment effect
| and not a side effect. It might be weakening some of these
| learned patterns is what helps shake loose the depression.
|
| "Put these two lines of research together and you get something
| like: synapse density increases over the course of the day,
| then sleep prunes it down again. Depression is associated with
| low synapse density. So it would make sense that depression
| gets better over the course of the day (including the extra-
| long artificial days of sleep deprivation) and then gets worse
| again after sleep."
| linuxftw wrote:
| This 'therapy' is often forced on patients, especially in state
| run hospitals. It's nothing short of medieval quackery, its only
| use is to destroy parts of the brain.
|
| Anybody that performs this nonsense on another human is a
| sadistic psychopath.
| bjt2n3904 wrote:
| What a funny story, linuxftw. Man is nothing more than chemical
| and electrical reactions, and we now have dominion over that.
| Now shh, let's "listen to the science"...
| rincebrain wrote:
| I don't know, I've had it done (by choice, not under
| involuntary commitment of any kind), and my brain feels pretty
| intact.
|
| It's possible that it has no useful effect on people and all
| the (mostly historical, for reasons the article mentions)
| studies of its efficacy are fundamentally flawed, but people do
| keep using it outside of involuntary contexts, when the
| desperation is strong enough and enough other treatments
| haven't worked, and some of them find it quite effective.
| tartoran wrote:
| Question. Did you try this as last resort treatment? Have you
| tried psychedelics/ketamine therapies and they weren't
| effective or this is what was available to you?
| rincebrain wrote:
| I had tried a great many things, including ketamine, though
| not (at that time) psychedelics.
| TheAdamAndChe wrote:
| Just another anecdote. A large dose of LSD reversed the
| course of my severe depression. I wouldn't necessarily
| recommend it, but there are lots of things that a
| depressed person can try, and believe me, it's worth
| trying.
| anyfoo wrote:
| Forgive me if I'm being simplistic and/or ignorant about
| it, but can psychedelics such as LSD not also result in
| somewhat of the opposite effect, e.g. psychosis? (Though
| it seems to me that if ECT is considered, calculated
| risks are on the table already.)
| Aerroon wrote:
| My theory is that any kind of strong mental effect _can_
| , but not necessarily will, help with depression. Be that
| very strong emotions, drugs, ECT, exercise etc. The
| trouble is that depression itself makes a person less
| likely to want to try these.
| mikepurvis wrote:
| I have a close friend for whom ECT has been a last resort for
| treatment-resistant depression, and who has found it very
| helpful.
| tartoran wrote:
| Do you have any references?
| [deleted]
| msla wrote:
| Better question: Do they have any references which don't
| ultimately come from the Church of Scientology?
| DanBC wrote:
| People in England who never want ECT should make an advance
| directive.
|
| https://www.cqc.org.uk/sites/default/files/documents/2012082...
| jamesgreenleaf wrote:
| Some people in this thread have mentioned that ECT is only
| considered when doctors have "exhausted all alternatives". Does
| that include the use of psychedelics? I don't know about you, but
| before electrocuting my brain I might be willing to try a
| particular mushroom that humanity has been using for thousands of
| years to alleviate feelings of despair and meaninglessness, and
| one which has shown serious promise in that regard in several
| recent studies. It's really too bad most governments saw fit to
| make it highly illegal.
|
| Disclaimer: Not for everyone. I am not a doctor. Do not eat fungi
| you find in the wild unless you are a trained mycologist.
| DanBC wrote:
| Psychedelics are still grinding their way through the testing
| and licensing processes. One of the reasons ketamine had so
| much buzz was because it was initially going to be used for
| this group of patients.
|
| In England (where the author works) ECT really is used for
| people who are very severely ill. They will have been through
| several different types of medications first. When psychedelics
| get approval those will go into the roster of things to try
| before ECT.
|
| It's possible for someone to write an advance directive that
| says they want ECT to be used, so I guess there's some people
| for whom it's not used as a last resort.
| [deleted]
| unixhero wrote:
| This treatment scares me to no end. I would never ever do it.
| Also I get sick to my stomach when movies speculate on its use.
| JPLeRouzic wrote:
| I had the same advice, then I saw someone in my family
| transformed from a frightening robot like state, to a warm nice
| person again. Truly astonishing!
| manjana wrote:
| There's a lot of myths associated with ECT, especially the
| procedure and equipment. I've seen the procedures carried out
| on people with schizophrenia and depression in documentaries
| and it's not the least bit scary to watch.
| Angostura wrote:
| For anyone interested. NICE - the UK's 'National Institute for
| Health and Care Excellence' has published its guidance on the use
| of ECT here: https://www.nice.org.uk/guidance/ta59/resources/the-
| use-of-e...
|
| "NICE has looked carefully at the evidence and has recommended
| that ECT should only be used for the treatment of severe
| depressive illness, a prolonged or severe episode of mania, or
| catatonia if the conditions described in the following paragraphs
| are applied. ECT should be used to gain fast and short-term
| improvement of severe symptoms after all other treatment options
| have failed, or when the situation is thought to be life-
| threatening. A risk-benefit assessment for the individual should
| be made and documented. It should include the risks associated
| with the anaesthetic, whether the person has other illnesses, the
| possible adverse effects of ECT (particularly problems with
| memory), and the risks of not having treatment."
| airhead969 wrote:
| FYI/PSA: treatment-resistant depression can be caused by sleep
| apnea, metabolic, or endocrine issues that psychiatric meds can
| only partially mask.
| jacques_chester wrote:
| Psychiatrists are medical doctors and will typically attempt to
| exclude these diagnoses. I've had all sorts of tests issued by
| psychiatrists.
| airhead969 wrote:
| In the US, mine is an MD too. Must be a different kind of
| psychiatrist because mine sent me to my PCP to narrow down
| health issues.
| aantix wrote:
| The whole point of ECT is to spur neurogenesis.
|
| This can also be accomplished with magnesium (l-threonate) and
| l-theanine before bed.
| anyfoo wrote:
| Consider the value of your comment:
|
| To someone with no knowledge about your claim (me included), it
| seems like an extraordinary claim with no extraordinary
| evidence, or really any information at all, to back it up.
|
| To someone with knowledge of your claim, assuming it is a true
| one, it adds nothing to what they already know. So maybe it's
| obvious to an expert, but then they don't need to be told.
| Aerroon wrote:
| I disagree. I think statements like that can capture people's
| interest and spur them on to look into it further on their
| own. It's kind of a reminder that X exists.
| throckmortra wrote:
| got any sources for that? I would think that any credible,
| conclusive evidence of nootropics actually doing anything would
| spur a great deal of fanfare
| prionassembly wrote:
| Does lithium count as a nootropic?
|
| https://pubmed.ncbi.nlm.nih.gov/15581403/
|
| https://www.neuroscience.cam.ac.uk/publications/download.php.
| ..
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