The hard work of being friendly to Me – talking about ECT

i take drugs

i take drugs (Photo credit: the|G|™)

I give a lot of talks in my community on understanding electroconvulsive therapy, (ECT,) as a treatment option for brain illness and I am finally able to bullet point most of it.  It has been and continues to be a long love-labor I am honored to be involved in.  (It looks so simple! – Not!) These seven points, believe me or don’t, represent many hours of research, training, practical experience and time looking into my own motives of interest.

Even here! everything starts and ends with me.  Ah.  So sweet.  😉

drum-drum-drum-drum… rollllllll!

Number 1.  20% more effective than medication at any point in treatment.

In other words, if it is a first episode or fifth episode of brain illness, ECT is 20% more likely to get a positive treatment response than psychotropics.

Number 2.  It starts working in 1-2 weeks, versus medication therapy takes 6-8 weeks.

Number 3.  It does not touch the body systems – does not affect metabolism, heart, weight/appetite, sex drive/performance, cause dry mouth, or vomiting and diarrhea, life-threatening rash or anything else common or bizarre side effect to the body.

Name it, imagine it, confabulate about it but ECT does not do that to your body.  It does not touch the body except the brain where we are trying to make therapeutic changes.

Number 4.  It is the gold standard in pregnancy and peripartum for the same reasons – does not touch the body systems.

For the fetus – there really are not yet any psychotropics that are considered “safe.”  Even serotonin agents that once were the go-to pills for Ob-gyn physicians, are now known to risk increasing bowl irritability, lung function problems and possibly even heart disease.

Number 5.  It is the gold standard in the elderly for the same reasons – does not touch the body systems.

As we age, medications metabolize differently, interact more and cause a lot more life threatening side effects.  Even medications we’ve been safely on for years, one day, cause dizziness and falls.  Out of the blue, we start having nausea.  As if betrayed by an old friend, we don’t metabolize them well, our organs are sickened by them, we develop kidney disease.  Etcetera.  It goes on.

ECT does not.  ECT does not do any of this.  It does not touch the body systems.

Number 6.  ECT has been around for eighty years.

That is a big deal.  That is helpful if kept in mind when we consider if it is fad, a gimmick, secondary-gain driven procedure, motives for treatment and other concerns against its use.

So often in practice, we thrill at the medication samples in their shiny colorful boxes so well marketed with commercials on the television to support their use.  Our physicians pull their drawer out and present them as a new chance at treatment response, which they are.  These medications have been around for how long though?  Surely not eighty years.

How long does their patent last even?  Eight to ten years maybe.

What will we discover about study-medication-X over that amount of time?  Maybe nothing dangerous or too intolerable   How bout eighty years of time?  Still, study-medication-X might remain in a relatively safe category.   Maybe.  Or not.

Most medication trials, to get a medication legalized in the USA, are designed to study medications for about 8-12 weeks on any one patient.  Many trials are done over years, and they are compared with each other using complicated mathematical statistical analysis and governments.  It is not bad and I am grateful to be a part of this community of physicians who studies and prescribes medications from this pool of treatment options.  Still, I think how despite the huge number of persons who received this study-medication-X, none of them were individually treated with that compound for very long.

Deciding to launch a medication into the community is based on this.  Once it is on the market, data is collected and made transparent to the community progressively thereafter. But initially, we are making our decisions to use or not to use with this at our spine.

Shiny boxed pills with a few years gathered round them at most of information from individuals who probably used the study-medication-X no longer than several weeks total, verses, ECT that has eighty years of transparent data regarding what we want to know – side effects, efficacy and any other sense.

Can’t poo poo that.  Eighty years has its own kind of luminescence.

Number 7.  ECT works by changing how different parts of the brain communicate with each other.

ECT “turns down” those areas that have overreactive connection.

It turns out, this is similar with how medications work for brain illness, but without the medication side effects.

For a long time, stigma-related opinions about ECT exposed that we knew ECT worked but did not have studies demonstrating how.  That is no longer true.  This is an important milestone for the history of our treatment choices.

None of this is to say that one person’s choice of treatment is superior to another or not.  Rather, the import of this is that ECT is underutilized largely because of ignorance and stigma.  Not that it is qualified as better or worse.  Better or worse is the opinion of you and I with an informed consent.

Who are we to say that a side effect of ECT is more worth enduring than those of one medication or another?  Only the patient can say this and then how that side effect(s) compare for her against the benefits received from treatment.

However, psychiatry is not an area of medicine that yet has a huge array of treatment options.  To obscure one of this caliber, life-saving heroics and life-changing import is a huge loss.  ECT is another paradigm of treatment.  It is not an either/or.

Oh, but to share in what this does, mmmm.  That gives Me a sense of value, connection to you and improves the way I care for my professional and personal self.  Rich.

Gratefully,

Dr. Q

Self-care tip:  Share in what improves your sense of value, connections and the way you take care of yourself.

Questions:  I’d like to continue to improve this.  Any suggestions?

Does any of this ring a bell in your mind of something important to you?  Please tell us about it.

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8 thoughts on “The hard work of being friendly to Me – talking about ECT

  1. We have discussed the matter before and I am not qualified to dispute this clinical research and evidence. Seems just as barbaric as the way we treat cancer to me. But there is efficacy in results and we must use the tools we have as long as “we do no harm”. It is incumbent upon me, however, to admit and reveal that I have come to religious epiphanies having been struck by the lightening of our Lord.

  2. I like the way you have presented this, Sana, and I have to admit that I have never looked at ECT as a better treatment than meds for those of us who seem to react to any chemical substance we encounter. 😦 My doctors have all suggested it as a totally “last ditch effort” for me and all of them, except one, have said that, for me, at least, it would be a terrible thing to try. Their reasoning is that I suffer more from loss or fear of loss than anything else in my brain illness and losing my good memories would be more traumatic than the gaining the effects of losing the bad memories. You know that I, therefore, fear ECT for exactly those reasons. My husband fears ECT because he watched it being done fifty years ago and, even though he is an emotionally well-balanced, intellegent scientist, he doesn’t want me to ever go through the procedure that he remembers even though he realizes that a lot has changed in fifty years.

    All of the above to say, I like the way you have presented this but please add one more thing to it. Please help those of us who fear good memory loss to understand (or feel better, at least) how ECT is still a viable option. Is the good memory loss permanent? Will the bad memories come back? How often, after the couple of weeks that you mention, would ECT be necessary? Would it completely replace the need for medication or talk therapy?

    Maybe this is a whole new subject for a whole new post, and, if it is, that would be great. I don’t think I’m in a place now where I need ECT. Actually, I’m positive I’m not in a place now where I need it!! But, if I ever were again….??????

  3. ECT does work. If you have tried every medication and they failed and yourrdepression is going to kill you, then do ECT. Losing your short term and long term memories are a problem with ECT for me. I am currently reading your book. ECT did work right away for me and I felt great. My memory problems did start when I had the last 2 maintenance treatments. I never did get my short term memory back. If I want to remember I have to rehearse it to get it into my long term memory. I also lost some long term memories. I had a hard time with word recall before ECT, but now I really have a hard time. I initially quit ECT because of the blue O2 mask. I could not stand the smell and I would smell it on and off between sessions Reading has also help remembering. That is the bad side effect of ECT. ECT did save my life. I would love to feel great again, but losing my memory is too high of a cost right now. If I get to the point of life or death then I would do it. ECT did help me with lessing my depression so I can use the coping skills I have been taught. With me when I am severly depressed coping skills do not work, even if I do try. Now, occasionally I have suicidal thoughts, but I can counteract them with a coping skill. I still get moderately depressed and now I can do something about it. I am grateful for that. I haven’t had a treatment since Dec. 2012. In conclusion, ECT did save my life, for I am always grateful.

    • Hello Shiela. Thank so much for connecting and speaking out. What a journey worth talking about.
      Re: the memory loss, do you know if you received bilateral or unilateral ECT treatments?
      I’m sorry to hear this is an ongoing struggle but live that you are “on it!” 🙂
      Keep talking.

      • I had unilateral , but they were having a hard time invoking a siezure so they had to amp up the voltage. I did have the best team of doctors, nurses, and mental health workers. If I didn’t have such good support I might not have done it. I sure do miss them.

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