I’m trying to help explain, “Why temporary memory loss in ECT versus loss of memories prior to ECT?” It is “friendly” to understand our treatment options and dispel stigma, starting with “Me.” Please let me know if this effort is helpful in any way. 🙂
Community opinion of ECT, largely influenced by the media rather than data, has a very hard time believing that the memory loss is of new memories, (or imprinting memory, ) during the course of the index trial; not memories before ECT, not memories after the index trial is done, not memories when maintenance ECT is going on.
The best way I can explain this, (and this is my own Dr. Q effort,) is that the memory loss is related to mechanical issues, like a cork in a bottle. Think of a rain gauge, for example. After it rains, we see on the gauge that it rained 2.3 inches last night. We uncork it at the bottom, and all the rain water flows out until the rain gauge is empty. We let the water out. The rain gauge may fill again when it is recorked.
The electrical stimulus and subsequent seizure to a brain cell is like the process of uncorking the rain gauge. The natural process of the brain is to “recork” after a stimulus, be the stimulus pressure, magnetic, chemical, or in this case, electrical, and let the cell fill back up each time it happens. The recorking process happens all the time in our brain, (in vitro,) after natural stimuli act upon a cell, be those natural stimuli pressure, magnetic, chemical, electrical, or another.
ECT is a medical therapy that uses the basic recovery methods of our own physical design and perhaps, this is one of the reasons it is so effective.
Unless the cell has that inside content, it cannot lay down new memories. The stimulus and stimulus response does not damage the cell. They empty it. The response is mechanical.
This idea also works to help understand why the memory loss is most often temporary rather than long-term. The cells replenish between treatments. It is a cumulative effect, so the closer the treatments are, the more the degree of memory loss. As the time between treatments increases, the recovery time is so brief, that the patient doesn’t notice memory loss. The patient is able to imprint memories without difficulty. The rain gauge, we could say, has its cork in for longer periods of time.
Question: Have your choices toward treatment ever changed based on dispelling your own stigma? Has information and greater understanding of your treatment options ever specifically improved your self-care? Please tell us your story.
Self-Care Tip: Use information and greater understanding of your treatment options to improve your self-care. Keep on.
Dear Doc Sana,
While I do appreciate you’re trying to attempt a logical analogy and reasoning for what you refer to as “temporary memory loss in ECT” I would tend to differ with you first from the viewpoint as a very, very long-time support person and mental health advocate/activist for my spouse and others.
I think it improper for any mental health physician to attempt such reasoning at this time when discussing ECT with a patient and/or his/her support persons when in fact there are no definitive answers for the actual mechanisms of action for what I refer to as anterograde amnesia and the fact that the results may differ from patient to patient.
I’ll also remind you that up and until Dr. Harold Sackeim’s published study
http://www.nature.com/npp/journal/v32/n1/pdf/1301180a.pdf
physicians were telling their patients that ECT did not cause memory and cognitive issues despite patients strongly disagreeing with their physicians.
I’ll also point out as a former Board Member, President and facilitator of a local chapter of DBSA I sat through many a meeting listening to the narratives of ECT patients addressing the devastating effects of ECT on both their anterograde and long-term memories and cognition.
I think it more proper of a physician to answer “I don’t know” but if requested to offer up theories maybe do so while at the same time addressing the various modes of ECT treatments offering the least potential for memory and cognitive side-effects.
The problem as I still see it in most all psychiatric treatment is there are no guaranties as to who will or will not respond to any given treatment and the added potential for serious side-effects. In the case of ECT there are the very real potential serious side-effects of memory and cognitive issues. To which I coined a phrase some fifty years ago, “The Trail and Error Approach to Wellness.”
I apologize for taking your remarks to task but from my perspective and knowing that which I do I felt a need to respectfully express my views.
Sincerely,
Herb
http://www.vnstherapy-herb.blogspot.com
http://www.vnstherapy.wordpress.com
Thank you for your attention Herb. sounds like you are in the thick. Take care.
I completely applaud your willingness to discuss ECT as a viable treatment option for severe depression. It is very important for people to understand that most often the memory loss is temporary. I apologize for the shameless self-promotion, but my blog is the true story of a former patient of mine (who is a co-author) who ended up needing ECT in order to become stabilized after over a year of unrelenting depression. ECT contributed to saving her life, and at the point when she agreed to it she would have done anything to feel better…memory loss or not. She has had no residual memory effects, which is the case for everyone I have known who has had this treatment. Thank you for your very educational blog!
This was an amazing reply to me. Thank you. It is a touch, a sound, a thought, a site, all that come into an emotion of depth and width We r most grateful for. Keep talking, powerful voice that u r.
After triple by-pass I felt like early stages Alzheimer. I’d look at my check book ledger holding a pen and be a complete blank. Took 2 or 3 months to get OK but I still feel I am operating at 97% eight years later. So I can see a glimpse of what this is about but seems far less dramatic.
thank you for that carl. i appreciate the analogy. helps to understand. keep on.
I didn’t agree to do ECT not because of what I saw in the movies , but because I could not get my psychiatrist to discuss the risks. If I asked about the risk of permanent memory loss he started going on and on about how it’s not like One Flew Over a Cuckoos Nest (which I had never seen) and how the scientologists are putting out negative information, etc. etc. This was not helpful. I wanted him to discuss the risks (along with the benefits) but he only wanted to discuss the benefits. This is not informed consent, so I did not agree to do it.
Luckily, I ditched that guy and have a psychiatrist today who provides informed consent. He tells me before I take a medication what the risks (i.e. Vyvanse can cause cardiac problems) and benefits are, and then I decide. I take Vyvanse even knowing there is some risk. That’s informed consent. I can’t help but wonder if the reason there are so many people floating about on the internet angry over permanent memory loss from ECT is that their treating physician either minimized the risk or didn’t discuss it with them at all (like my first psychiatrist). There are plenty of people who are willing to risk permanent memory loss if they can get relief from depression, but there are others who do not feel that risk is worth it to them. It’s a very big decision and a very individual one. Informed consent is crucial.
awesome comment Kristen! Thank you so much for telling us about your experience w informed consent.
Let’s hear it for physicians who speak and patients who engage. keep on.
Also, it is consistent with my experience in practice, just as an aside. Most of the patients I work with, appreciate the benefits so much, they consider any perceived side effects to be acceptable. I have had those who haven’t, but as you say, these decisions are individual and we celebrate that.