Controversy – ECT machines and the FDA

Hello Friends,

Once again, ECT is being bullied and manhandled by stigma, using fear instead of science, to steer people away from a lifesaving treatment. In this instance, they are targeting the ECT machines as an angle to keep others from having access to treatment. Science and life example clearly states the efficacy and success rates with ECT. The machines, …really?

The best way to diminish stigma is to tell others your own story.

Tell others here:


Please post your comments to the FDA website: , as soon as possible.

To post comments for the proposed rule:!submitComment;D=FDA-2014-N-1210-0001

To post comments for the draft guidance document:!submitComment;D=FDA-2014-D-1318-0002


A colleague, whom I tremendously respect, responded to this elequently. I wanted to share it with the world. He has so many years of practice, a deep skill set in the art of medicine, and in these short paragraphs, captured much of the beast in ECT stigma. Thank you Dr. Guerra!

Electroconvulsive therapy is a treatment for potentially fatal illnesses including major depression, bipolar disorder (manic, depressed, mixed, rapid cycling), catatonia, and schizoaffective disorder. It has a remarkable rate of success. Many patients only remain well with continuation or maintenance ECT. In more than forty years of practice, I have seen hundreds of lives saved and hundreds of my patients restored to productive lives.
ECT remains the most rapidly effective form of treatment for those who have not responded to psychotherapy and/or medication. For the acutely suicidal or catatonic patient the risk of mortality may be equal to that of a ruptured aortic aneurysm.  
As we in psychiatry and medicine are trying to fight the stigmatization of the mentally ill, a few points demand attention:
Among the treatments for potentially fatal illnesses (chemotherapy, radiation, surgery), ECT has the highest rate of success with the least physical damage. In fact, while cognitive difficulties occur with ECT, they are generally short-lived and are not the result of physical damage to the brain. By contrast, treatments for other life-threatening conditions, like cancer, often leave patients permanently damaged in the service of saving lives. Treatments such as those for cancer are embarked upon (with consequent debilitating effects) even when the likelihood of remediation or cure is low. In all cases, clinical judgment and the consent of family and other stakeholders are involved before a decision to treat occurs. Such informed consent is the standard for the practice of ECT as well.

An agreement regarding the safety of ECT machines is reflected in the decision to change their classification. Restricting the clinician’s ability to apply his or her clinical skills and knowledge does not improve the safety of ECT machines. It only communicates that the safety of the ECT apparatus is of concern for some diagnostic categories by not of concern for others. Furthermore, restricting the ability of clinicians to apply treatments according to a set of guidelines does nothing the make the apparatus safer.
Having determined that the machines are safe for some, they must be safe for all. Their use must be left to the discretion of the treating physician.

The restrictions being imposed do not seem logical to me. They tie the hands of clinicians, promote stigma, and will foster diminished access to treatment for those most desperately in need.

Frank Guerra, MD, DLFAPA, FACA
Medical Director
The Guerra Fisher Institute
Boulder, Colorado
Clinical Professor of Psychiatry and Anesthesiology
University of Colorado School of Medicine
Past President
Colorado Psychiatric Society

Bilbo and Me, trying to get to the Smoky Mountain


Imagine, a young father playing basketball with his buddies on a Sunday in the gym, joking around, slapping each others butts, (because, help us, that’s what they do!) Sweat is rolling down his face. Call him Jake. He’s heavier after three kids, but he’s trying to lose the baby weight. His wife has to wear earplugs to sleep, he sounds so loud in their bed. Jake has been playing hard for about thirty minutes. He’s feeling good. He never lost his touch. He’s with his same buddies from high school. They stay in contact. They’ve got each other’s backs. They’re running down the court. He’s guarding Tom and everyone’s diverted, running, heaving and breathing hard. Tom makes the shot and they’re all slapping each other’s butts. They are throwing the ball back into play and someone laughs at Jake. “Hey Jake! Get up!”

Obstructive Sleep Apnea (OSA) is a leading cause of early heart attack.

I wrote this out in what may seem almost tasteless detail only because this is how it happens. I wish it didn’t and I want it to stop. It is as horrible as you imagine. Jake dies. His wife and gorgeous kids are left to live life without his laughter and counsel and noisy snoring that his wife would do anything to have again. Jake’s community is man-down. Obstructive sleep apnea is a deadly sleep disorder.

CPAP is 99% effective when used to treat OSA. It works. It is just not always the easiest treatment to tolerate for many reasons. But it is worth fighting for. The fight for CPAP might look something like multiple visits to your primary care practitioner to get that referral to go through to your sleep lab. A referral is made, and silence, then made again, silence, then finally by the third or fifth try, it goes through. Or multiple visits to your sleep specialist, exchanging one sleep mask after another and then another until you finally find one that keeps a good seal on your face through the night. There are truly a mountain of barriers to compliance that you will trek across, more barriers than Bilbo encountered heading toward Smaug, and you’ll need as much courage.

Keep on!

Questions: To start with, how is your breathing, or your loved one’s? Did you know that you might have to walk such a circuitous trail toward being your own friend? Who else will do this for you?

Self-Care Tip: When you are deflected, when you get stuck in the moment of loss, pull back into the big picture. You are your own friend and it starts with Me.

Diary Of a Shock Nurse – Blog

Source: Diary Of a Shock Nurse – Blog


Great post. Check it out and speak. Keep on!

My husband interviewed by NPR #gratitude

Obstructive Sleep Apnea and Not Watering the Plant


Ownership of plants is an exercise. For some, their bread won’t ever rise. (Um, me.) Others, apply maschera like a windshield wiper. (Those people. Um, me.) Me, these are true, along with the exercise of owning plants, which is essentially expensive composting. They never live long.

These are different in my book than trees. I’ve got some duplicity here, I realize. Yes trees are plants but I think of them differently. More human. I classify leafy potted things as “plants.” If there were “Plant Protective Services,” (PPS), some social worker somewhere would have thick files on me. I’d never make it out of court.

But even I, plant abuser that I am, know that if you don’t water a plant it will “wilt”. Yup. Bookmark this post. Words of wisdom.

Marvelous as that pearl is, being a brain doctor and all, I can’t help but parallel that the brain will wilt without oxygen.

There is a disease called Obstructive Sleep Apnea which describes this very misery. What generally happens is the tube through which air goes from your mouth to your lungs, called the pharynx, collapses for any number of seconds, over and over throughout your sleep. Over time, the brain cells change, and diseases develop, secondary to “anoxia.”

The story goes something like this. The brain senses that there isn’t enough oxygen. As oxygen is carried on red blood cells to the brain, just like it is to any and every cell in your body, the brain interprets this as not getting enough red blood cells. As red blood cells are pumped to your brain from the heart, the brain tells your heart to “Get working! Pump harder! Pump more oxygen-carrying red blood cells. We’re wilting over here!” The heart dutifully pumps, like a champion.

What is the heart? Mostly muscle. What happens to a muscle when it gets worked is, …It gets sexy! Right? Venice-Muscle-beach type of sexy. Ding! …Um, or just muscly.

Every cell in the body, requires oxygen to live. Even muscle. Even heart muscle. So heart muscle has it’s own arteries that bring oxygen-carrying red blood cells to it’s muscle cells to live. The oxygen “perfuses” the muscle and the muscle is healthy, not like my potted plants. But when that heart muscle gets extra work-outs, like any body builder, the muscle wall of the heart grows thicker. The heart wall however was given arteries to perfuse a wall thickness less robust than that and eventually the heart wall gets too thick for it to get its own oxygen. Compost. You got it. After time enough, the heart wall will die. That thickened muscle won’t get enough oxygen, and it will die. Obstructive Sleep Apnea is a leading cause of early heart attack.

And, oh yes! there’s more! If this isn’t bad enough, boys can’t keep their erections. Wilted.

Related problems are happening everywhere in this body. Brain cells are dying. Any variety of brain diseases develop, including early dementia, depression, anxiety, and more. Day time sleepiness happens, and Boom! You’re falling asleep while driving. And you’re eating more. Yup. Good news after more good news.

When we don’t get enough oxygen at night, we don’t get enough sleep. During the day, therefore, our brain is falling asleep on and off throughout the day. Our eyes may be open, but we are actually in the early stages of sleep. Then, our subconscious tell us to eat. No respect! We can’t catch a break! That’s because food and eating release stimulating hormones and we wake up a bit more. But,… we also get more fat. The fat then pushes down harder on our poor suffering airway at night and our disease, obstructive sleep apnea, worsens! Round and round like that lovely Krispy Cream Doughnut, we go. Eating, obesity, obstructive sleep apnea, eating, more obesity, and more apnea. Burp.

Now why would the pharynx collapse? What is it’s problem, anyway?! Generally it’s because it just can’t stay open under all that weight. We’re too fat and heavy. Those poor oxygen molecules are out of luck spelunking through that tunnel.

The brain, is super tired after all this. All night, it’s been rudely and repeatedly awakened, gasping sounds like fog horns through the night herald the body’s cry for oxygen. Nobody can get any sleep around here, not even you. All night your brain is waking you up, even if you don’t know it, to get a deeper breath of air. You’re constantly being pulled out of a deeper sleep into a state where your pharyngeal muscles can take over again, push open, and allow yourself to breath.

Because you aren’t fully conscious when this is happening, the best way to discover this is to get a sleep study, called a polysomnogram. During this study, you have a type of electroencephalogram, where specialists study your brain activity, as well as your different levels of oxygenation, and more.

After this lovely post, it may surprise you that bucket loads of people avoid getting a sleep study, but they do. There are many barriers to getting treatment in obstructive sleep apnea, that on paper, seem tiny. Today, let’s breathily say, they’re there, they’re real, and we acknowledge them. We are just trying to understand some of the, “why?,” your psychiatrist keeps saying you need oxygen to have a healthy brain. Go figure.

Self-care tip: Everyone deserves a sleep study. Please consider.

Question: What are your barriers to getting a sleep study? What are your barrier toward getting other medical studies? Please tell us your stories. We know the barriers are real. We know the barriers are common. Please speak out!

Keep on!

“Daylight Savings Time – Oooops”

Photo post by @dagostino07.

Source: “Daylight Savings Time – Oooops”

Start Over


Muscled and gorgeous, he came in, like dessert, main course, and appetizer. Some people just carry themselves that way. It doesn’t work if they dress low, chest hair accentuated by opened buttons and glimmering chains. It doesn’t work if it’s their agenda, checking to see if you noticed, a finger hovering over the acoustic applause button. No. Attire must be intact, normal, not baptized in cologne. In fact, attire must be worn as if it is completely a non-issue. Attitude of a jack-rabbit, who never thought about his muscled legs. Those legs just hop because that’s what they do. That is the kind of attitude-ingredient to this kind of presence-recipe.

How would a mother name such a son? How could she know he would turn out this way? Greg is an essential name for this elixir to work, as essential as “Fabio” is to its destruction. Everything else may have been in place, developed over years, like a bonsai tree groomed under the tender ministration of Father Time, and caboom! “Fabio.” The bonsai becomes a paint-can-frosted Christmas tree. Greg’s mother named him ‘Greg’, in fact, because it was the dullest name she could think of, not wanting him to grow up to be anything like the sort of philandering infidel his good-for-nothing pig father “Fabio” was. Greg told me this. I didn’t come up with it. He knew it because his once beautiful mother, who worked seventy hour weeks, told him whenever he messed up, “I named you Greg! This is not supposed to happen!”

In came Greg, after three years of absentia. And it was like I had just seen him yesterday. His mother couldn’t believe that the name Greg would hold such a man, an addict. Yep. Greg hadn’t seen me for three years for a reason. There I was. Chirpy as ever.

Greg! Where you been?

Whenever a patient comes to see me, I believe in him or her. I believe. In part, because I believe in Me. I believe in my value. Wink. But I also believe in them because I believe in Love, and because I’m simply wired to. There are more reasons why we behave and feel the way we do, more than colors in your crayon box. It’s not just a moral issue, biology, or an adjustment to our human condition. Heck. His name may have even had something to do with it. “Greg,” is quite a name. But I did believe, more than I disbelieved, that he hadn’t been in to see me for reasons other than relapse. Maybe his primary doctor was filling his meds, and he was so stable he didn’t need psychiatry anymore! Yah! That’s it!

(This is inside information folks. You can’t tell anyone. My patients can’t know this about me. It could ruin my career! I don’t want them to be any more afraid of disappointing me than they already are. It’s hard enough to be honest in these places, and I do my darndest not to project my Pollyanna-agenda’s on them. They don’t deserve that. They deserve the hard-earned poker-face I screw into place when my heart gets broken. I purchased it with ten-years of my life from some magic spiders I quested in a cliff off distant shores. Bargain.)

Greg! (I said,) It’s great to see you!

Every patient wants to please their doctor. And every doctor wants to please their patient. And we all get our hearts broken at some point.

I was really glad to see Greg, after all. And he was looking good. But then I noticed he had more weather in his face, some clouds, lines, and gutters. And I noticed he wasn’t as glad. He had an aura of melancholy and self-loathing rolling off of him.

His little boy was with him, too, (Fabio. …J/K! Gotcha! Good ‘ol “cycle.”)

Greg sat there, thunder in his sorrow shaking his frame, and we reviewed his story. You may know Greg’s story. Greg may be your friend too. Or brother, husband, dad, or You. And you know the high from this addiction feels better than everything, until it doesn’t.

The best line ever spoken in this context is, “Relapse is part of Recovery.” That is from the God of Hope. That is what makes sense in every illness, like Charles Dickens is to literature, timeless and universal content, man. When Bob reaches for that doughnut, when Harriet rolls the dice at Pechenga, when Fabio uses porn rather than intimacy in a meaningful relationship, when Myrtle has to pull over on the freeway in a panic attack, this is when we ask, “Why am I alive?” and demand to start over for that answer.

I’ve asked that question fifty-plus times a week for fourteen-some years, and every time I ask it, I listen for an answer. I’m curious too. We all are, right?! It’s a marvelous question. Every time I ask, I wonder about the magic that keeps this beautiful creation in our community. I listen, because every answer is something that crescendos into the room, the words explosive, the best part of the atom.

I have a daughter. She needs me.

My dogs. Nobody loves me more than my dogs.

I want to know what it is to live without this.

I’m too scared to die.


I just don’t know why.

Oops! Wait. “I just don’t know why,” isn’t good enough. Figure it. Finger it. Cradle it, and answer. What do you want to stay alive for? Because this thing! This thing is part of your recovery. Another day will come.

Greg left our appointment with options for treatment and a commitment to treatment. I’ll see him again and he’s one of the reasons I love life. Can’t wait.

Questions: Why are you alive? Please give us your answer. It will explode into the universe and someone out there needs to hear it.

Self-care Tip: Answer the question and start over.