Electroconvulsive Therapy

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NPR interviews Kitty and Michael Dukakis

In an interview with Kitty and Michael Dukakis, journalist Katia Hauser explores the benefits and risks of electroconvulsive therapy (ECT) in treating depression. Kitty shares her first hand experience with ECT and the ways it changed her life, and Michael provides the perspective of a family member.

Dukakis interview

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Making our way through the questions on ECT – Top 3 Reasons for Being an Advocate

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?

fancy

Ooh La La!

So much fun to play dress up! When I was a scrub, a solid big boned unkempt of the Cleveland National Forest bordered lemon groves, when I walked barefoot, disappeared for the entire day in the rattlesnake infested chaparral, when I followed my brothers around like a desperate child, I still liked to play dress-up. I would sneak into my mother’s long closet, a dressing room really, with folding doors. I could hide behind her dresses, or climb up onto her shelves and be nothing more than luggage. But mostly I remember staring at her clothes and shoes. I remember one of her all time best outfits – a blue knit bell-bottomed jumper. A wide white belt with a hand-made gold buckle was an excellent accent. Yes, it would drag down below, but all the better to cover my brown feet.

When I think of my top three reasons for being an advocate for ECT, I think of dress-up. There are so many great options to put on, and I can and do exchange them with aplomb, as Fancy Nancy would say. That’s a French word for poise. It’s fancy. If you catch sight of my brown feet here and there, well, you can’t take the hills out of the psychiatrist I guess.

For today, Reason Numero Uno, (Fancy for #1, in honor of the second language I wanna-be speak):

  • It works most consistently, and most quickly of any treatment available. One must pick her fights after all, mustn’t she?

Reason Ithnān, (Arabic for two, in honor of my fancy mother):

  • It doesn’t touch “the body,” i.e. metabolics. Clean.

Reason Trois, pronounced I think like, twa, (Fancy Nancy’s favorite language. Need anyone explain? “French is fancy”):

For example, just by requiring someone to help with transportation, it’s built in. That thereby inherently increases community awareness of mental illness, something we rarely speak of with each other.

Then there is the medical staff. Our nurses are every patient’s advocate. Our masseuse increases oxytocin and other healing neurotransmitters when the patient’s get their massage waiting for treatment and then when in recovery. Our anesthesiologists are knowledgable, see the patient in their “whole person,” often picking up other issues that then will get the patient to receive treatment and improve the patient’s quality of life (QOL); such as hypertension, obstructive sleep apnea, etc…

There’s more, but basically in ECT, none of our patient’s are alone. That stands.

Question: What are the top three reasons you prefer the treatments you engage in? 

Self-care Tip: It is always helpful to write out why you are doing what you are doing, when it comes to medical treatments.

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Making our way through the questions of ECT – Memory Loss

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?

memory loss

1. Cognitive and memory impairments:

There is no brain damage done with ECT. One way to understand the memory loss is with our own not so fond memory of carbon paper and credit card receipts. It’s not too ago that we made manual credit card receipts. We used, what was essentially, a machine that held the card in place, while we rolled over a two-part receipt, including one surfaced with ink. When rolling over the card, the ink pressed into adjacent paper the outline of the card face.

Inevitably, whenever I had one such interaction, the carbon paper was used up. There would be little patches of ink left on it, but in all the wrong places. People would try to move the carbon paper around to maximize its usefulness. And we’d roll over it multiple times, using repetition to get a good enough copy, when the carbon-paper had gone almost white. Roll. Roll. Put your weight into it. Roll.

The machine hasn’t changed. The machine isn’t broken or damaged. There just isn’t enough ink on that paper.

This is a rough analogy of what happens in our cells.

When we get new experiences, our cells try to “imprint” those memories into another area of our brain for storage and later use.  We use the intracellular “ink” to do this. However, a seizure dumps that ink, the neurotransmitters, chemical messengers, hormones, ions, and all those good ingredients needed to lay down new memories. It squirts the intracellular ink nearly completely out when we are stimulated, like squeezing a bag.

ECT is a stimulation treatment. It uses electricity to stimulate, toward the effort of healing. There are other stimulation therapies that we have discussed already – magnetic and chemical. Not all stimulation therapies result in a seizure. We don’t know why a seizure is needed for such a dramatic benefit, but so far, in our 80+ years of experience with ECT, it is needed for this magnitude of healing. The seizure is the event that “tips the ink-well.”

Our cells will naturally refill if left alone, after being “tipped over” and emptied. What brings about the memory loss is that in the beginning, in the ECT index trial, we don’t. The proximity of the treatments to each other is more frequent than what will allow for the cells to refill adequately for new memories. We stimulate, Monday, then just as they start to refill, we stimulated again Wednesday. And then again Friday. Then we do it again the next Monday, and so forth.

This is only in the index trial though, the first part of ECT that we do in order to get healing. Once the first 2-4 weeks, approximately, are done, treatment response is achieved, and we progress to a maintenance program of ECT to keep those benefits. Just as with medication therapy, if we stop treatment, if we stop the pills, if we stop the stimulation therapy, often, we will relapse and become ill again.

In maintenance ECT, we treat as infrequently as once a week to once a month or more. By allowing our cells to refill with “ink” between stimulus events, the difficulty imprinting new memories goes away. Those memories of events that happened during the index treatment, (the 2-4 weeks when we first start ECT,) may never come back. But we wouldn’t expect them to, necessarily, because there wasn’t enough ink to imprint them at the time. Like a carbon copy paper without ink on it, no matter how many times we roll over it, mechanically, we don’t have the ability, the ink, the ingredients, or whatever you want to call that stuff needed to save the memory of an experience permanently.

I’m not going to go into the obvious juxtaposition of this with what happens cognitively with brain disease untreated, or with other treatment options toward brain health. I hope you do though. Because there’s so much there and it’s fun, liberating, and increases our personal freedom to choose.  Keep on.

Questions: What do you think about not being able to keep the memories of your life for a brief time? What is the cost benefit ratio to you, when you think about this? Please tell us your story.

Self-care tip: Be as careful as you can in your accounting, book-keeping, of your risk-to-benefit ratio of treatment.

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Questions From Someone Important – On ECT

Hi. I was hoping I could ask you a couple questions about ECT for a research paper I am writing.

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?
My thesis statement is:
Although there are many different treatments for Bipolar Disorder, Electroconvulsive Therapy (ECT) has proven to be the most effective therapy, treating both mania and depression.
Thanks in advance,
Priscilla

Good morning Friends!

What would you answer to Priscilla?  Do you have personal experience with ECT, primary, secondary, etc? Where did your beliefs and attitudes about ECT come from?

Last week I almost lost control of my functions when my patient told me about his sister’s comments.

Frank, my patient, had called up his sister, asking her to help drive him to ECT in the morning. Frank’s sister hadn’t even known Frank was getting ECT. She was alarmed but didn’t say anything until they were in the car together, a California dawn and sleep in their eyes for context.

Is this for real Frank? Where are we really going?

Frank was straight faced in his pragmatic style.

She thought maybe we were either going to doughnuts or the devil.
I don’t want this to sound bad or anything, but you know how people go, like to TJ, Mexico, to get some sort of cancer therapy that makes their skin fall off, that’s what she thought. Or we were going to get the psychiatry equivalent of a coat-hanger abortion in someone’s garage.
Don’t judge me for peeing a little.

One of my secretly favorite comedians, Amy Schumer, has a way of taking the worst negative biases in our community and denuding them w/o remorse. She did this with “rape.” The internet exploded that, demonstrating that sure enough, our community doesn’t get it. We don’t understand what rape is!

Then Schumer did it again with women. The idea is that we lose value because of age. Sure enough, the world started talking. For example, a few someone’s noticed when Maggie Gyllenhall was told she was too old, at 37, to get the role of a 55 year-old man’s girlfriend.

I wish Schumer would do a skit on electroconvulsive therapy, (“ECT.”) I wonder what she’d play with. Because there is awesome material there!

…

First introduction to ECT, some people wonder where the leather straps are. Dr. Schumer, in her white coat would say, “Oops! I forgot them at home.”

And what do you wear in an operating room, really? Scrubs for spine surgery. Scrubs for gastrointestinal procedures. And psychiatry?

Dr. Schumer, psychiatrist: “I’m a surgeon!”

Funny how you celebrate things you would otherwise not…”Hey, what a great seizure!” (High fives all around.) Never Say say, “I just push a button.”

Adding to the list of things not to say in the operating room (“OR”):

  • My Bad
  • Who is this?
  • Whoops!
  • I hope this works

ECT patient: “I want to be the placebo guy.” Patient (an older man:) Lifted his head, slightly, after the procedure was over, and asks, “Can I still have children?”

Patient: Being wheeled out of the OR (operating room) on the gurney, she stares up at the ceiling and mutters, “I can see why I need a driver.”two steering wheelsHow do People learn how to drive a gurney?! I just touch the thing and it’s like solid objects appear everywhere. The patients get nervous. One said, “Doctor, there can’t be two steering wheels.”

Dr. Schumer: “I want to reduce staff work load, and since I’ve proven to be an unsafe driver of gurneys… I now control the Tylenol. I am a physician and I hate it when people say that I just ‘push a button.’ They can hardly trust me not to shock myself…. But the Tylenol, the Tylenol is mine!”

Anesthesia: “Versed isn’t really an abused street drug—if you have a good time using it. You don’t remember anything anyway.”

Dr. Schumer: “Yes, I’ve put vaseline on my nipples to help with chaffing.” (Patient: In his ‘twilight’ sleep…we thought, bursts out laughing.) Dr. Schumer: “Yeah, try and not picture your doctor in pasties… It’s not good for your healing.”

Patient to Dr. Schumer: “You’re pretty good at this.” Dr. Schumer: “I’ve watched this on the Discovery Channel.” (Then, all of a sudden, she realized “I am not perfect. Such a shame.”) Dr. Schumer: “I really don’t do a whole lot in the OR… In fact, can we just get another gurney in here so that I can lie down?”

Cheap medical service, do you really want that?

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Trying to explain, temporary memory loss in ECT

rain gauge

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.

Tower-of-Babel Syndrome

COMPLETION-OF-THE-TOWER-OF-BABEL-GENESIS-XI9-2-Q6503

From time to time, I hear complaints that someone’s brain illness got better with medications and/or ECT, but just came back when they stopped. This almost always happens when a patient never transitioned to maintenance ECT and/or medication therapy.

I dub this, the Tower-of-Babel Syndrome.  We all suffer from it at some point in life, trying to be like God.  Or maybe a lesser god?  During this Tower-of-Babel Syndrome, after we have paid the price, after we have complied with the many hard tasks, after we have built ourselves up into something glorious, we are cured from illness. Right? Once we stop perceiving it, illness that is, we are closer to God, more like Him/Her, perhaps more perfect, when we feel better and do not need medical care. Little gusts of wind are all it takes to fill our wings and off we go, living life free from disease laden earth.

But this is a mistaken expression of freedom.

The number one reason for relapse is…? You remember.  Treatment noncompliance. Is relapse most often due to life stressors? There are so many. No. All those reasons for why we think we feel what we feel and do what we do, all those forces acting on us from the outside in, they are not the reasons we relapse most often.

There is something like a super-bug growing amongst us who engage in treatment on and off. We do it four or five months out of seven. We skip here and there and do not “over-react” if we do. “They don’t control me, after-all.” We apperceive the situation. We think we, by not being consistent with medical treatment, demonstrate our freedom. We are free when we engage in medical treatment or when we do not. We are free because we are human.

The super-bug in brain illness is a progression of disease process heightened and sharpened by treatment noncompliance. A growing resistance to treatment and an acceleration of our falls, how long it takes for us to drop into a relapse and how hard and far we fall.

Let us work together to take away barriers to consistent treatment.  You may laugh when you hear about the Tower of Babel.  You can laugh.  A bonus.

The Tower-of-Babel Syndrome is familiar to those of us who stop any variety of medical treatments on our own, excluding our treatment team members, (such as our physician, Wink! Wink!) in our decision to end treatment.

By stopping medical treatment, many of us have this sense of eliminating the reason we started in the first place.  Take treatment.  Disease continues.  Stop treatment.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You are gone.  Turn back.  You reappear.  Turn.  And just like that, you have been eliminated.  Even now, remembering it delights me.

Not so cute however, is disease relapse.  Maintenance ECT and/or medication therapy has a protective effect on the brain, prophylactic against further insult. It does not increase the distance between Me and God.  It does not increase a mislabeled dependency on treatment.  Maintenance therapy is part of our life journey.  It is part of our ability to be present with ourselves.  It is friendly.

Questions:  What keeps you in treatment?  Do you feel more diseased when taking maintenance therapy?  How do you manage that?  Please tell us your story.

Self-Care Tip:  Stay in maintenance therapy.

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More videos showing ECT and discussions around the globe

The Mayo Video uses a cartoon to show the procedure

MSNBC… not a full treatment, but a “demonstration”

Here is a VERY dated video… but it includes Max Fink (the master) the the full procedure

I often recommend this TED Talk to patients.  It doesn’t show the procedure. “Sherwin Nuland:  How electroshock therapy changed me.”

The BBC in the UK showed this video of a real patient getting ECT.

Questions:  What is your evolving opinions about treatment options for brain illnesses?

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Value Yourself

tiger cat

The room is dark, shades drawn for hours. Sandra stays unwashed in her blanket.  Around her are gathering piles of laundry and stale air.  Pictures have fallen over in their frames.  Sandra hears her daughter, “Mommy, please get up now.  Let’s get up Mommy.  I want you to get up.”  Sandra’s body feels like a bag of concrete and she tries to explain this to her seven-year-old.  “I’m just so tired, Honey.  You go play.”

Days and then months go by, like this.  Some of them, Sandra is up and functioning.  But mostly just.  She finds her thoughts are not clear.  It is hard to find words, let alone anything around the house.

“Who is this person?” Sandra thinks about herself.  She wonders if her husband will leave her.  He is trying to have sex less and less.  They do not talk and she is pretty sure her last real orgasm was a year ago, Thursday.  She cannot believe he even likes her when she dislikes herself so much.

Sandra is not treating anyone very well.  She has lost what was in her bank and cannot account for her own value.

Our value is not a very politick thing to celebrate, to speak of, or to put at the front of the line, but we, individually are worth it.  Sandra is worth it.

You are worth it.

Sandra was having trouble like this.  She had been missing more and more work, for “sick days” and she was worried she would be replaced.  “Who are these people?” she wondered about her colleagues, whom she used to enjoy, joke with, and compete with.

It occurred to Sandra, at last, that everything that was worth living for was only insecurely hers.  She thought, if she lost them, she would die.  She needed to get better.  She wanted to get better.  All the way better, back to herself, funny and sexy and showered.  That would be real nice.

Sandra took, what for her felt like, a desperate action.  Sandra went to see a psychiatrist.  It was not easy understanding her treatment options but basically they came down to, medications, psychotherapy, and stimulation therapies of which electroconvulsive therapy, or ECT, is the gold standard.

To grasp what these options meant, Sandra needed to think about how long it takes to respond to treatment, the chance of responding to treatment compared with not responding, either at all or only partially, and side effects.  Because of knowing she was about to lose “it all,” (home, marriage, employment, possibly parenting rights, and more,) she decided she needed treatment that was the most likely to work and work fast. (ECT can be up to 90 percent effective in reducing the severity of symptoms.)  Sandra did not want to gain weight.  “I would rather die,” she said.  And she did not want to get other medical problems from trying to treat another.  (We call these iatrogenic, when a medical treatment causes another disease, such as an antidepressant causing obesity.)  Because ECT allowed for all these, Sandra launched her ECT index treatment.  She started in treatment even before she started having hope.  Sandra took the action she was able to, toward her value.

This a a short story about Sandra, but her story goes on in a much richer, and pleasure filled way.  I wrote her story to give you an idea of how someone who has never tried medication therapy may decide on choosing ECT as their first treatment effort when struggling with brain illness.  Because of her value.  Because of our value.

Question:  When you explore your value, what would you like to do that more directly honors you?  What does valuing yourself do for those you value outside of yourself?  How can you show that you value others but caring for yourself?  Please tell us your story.

Self-Care Tip:  Care for yourself to care for others.

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Treating Depression with Electroconvulsive Therapy

mcfadden-moMaureen McFadden, a two time Emmy Award winning journalist, at WNDU.  In November 2007, she documented a winning medical series called Rewiring the Brain. 

  See part of the Emmy award winning story on a local man’s path to a better life in the series “Rewiring the Brain.”

I am sharing my response to Ms. McFadden with you, my friends, colleagues, and community, because I choose you for company.  Thank you for that.

Hello Ms. McFadden,

Thank you so much for your work increasing community awareness of ECT and diminishing social stigma.  Thank you for having a life-work, such as this, for obtaining a powerful voice that people want to listen to, and doing what you have done to get attention.  Your influence, hard-earned, is collateral and that you spent it “here” is huge.  I am so grateful.
I am a psychiatrist.  It is difficult for me to work with these, community awareness and social stigma.  I am not special in this difficult experience, of course, and I know that the bummer feeling that I am “alone” in it is a distortion.  Thank you for your company and illuminating presence.  Keep on.
Sana Johnson-Quijada MD
Related articles
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Nurse tells her experience – Suicide

Guest Post

by, Leslie Oneil, RN

Nurse extraordinaire! Person to know. More.

Nurse extraordinaire! Person to know. More.

In The Ring

I sat at a table in a large meeting room watching Dr. as she stood in front of the room. She stood in front of us with poise…armored with stories, analogies, statistics, and invisible red boxing gloves to match her red dress. She was ready to defend mental illness, and fight for its proper place in medicine and in the spot light where it belongs…right next to the heavy hitters: cancer, heart disease, diabetes.

Dr. delivered the statistics….”1 in 5 people suffer from depression.” She counts the room, “1, 2, 3, 4, depressed. 1, 2, 3, 4, depression.” She continued, “Put all of the depressed people in a room, and look around. 1 in 15 of those suffering from depression will go on to commit suicide.” It’s dramatic. The room was silent. It usually is. I am not comfortable with the topic anymore than I was the first time, but I am getting used to hearing the same phrases, the same statistics, and responding to the same questions from the audience. I am now familiar with the language of mental illness.

Last Friday, as I stood in the middle of the PACU, our eyes met. It felt intense. it was an emergency, and an emergency in behavioral health means…

Then I heard Michael Buffer, the master of ceremonies, in my head. He introduced the statistic to the ring. Dramatic music played, and before I had the chance to raise my gloves, the statistic nailed me…First with a left hook, then went below the belt. I was knocked out. Speechless with my face in my hands. Gloves were off.

 

Your patient committed suicide.

 

No amount of training prepares you. No power point presentation. No book. No doctor.

TKO.

I never even imagined how I would handle the news. I was weak in the knees and shook.

The patient was starting electroconvulsive therapy in 3 days. The patient had just called me. The patient denied any suicidal thoughts. The patient…….It doesn’t stop.

The gravity of what I do hit me. It hit me hard.

As I drove home I thought, “Have I entered a losing battle? I’ve wanted to be a nurse to comfort people, advocate for them, care for them, and try to help improve their quality of life if possible.” If possible are the key words.

Am I okay with, “We did everything we could. Stop. Time of death….”

 

My question to you: “Do you find gratification with the result or with the process?”

You think you know the answer…until you’re in the ring.

 

Leslie Oneil, RN, is a ECT specialist nurse.  She writes at a blog worth following, A Very LOshow.

 

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Answering Jim, professionally and personally – ECT

A few days ago, Jim, from blog, “I Don’t Want To Talk About It,” asked in his comment to my blog post,

What is your educated opinion about this?  A friend of mine is seriously considering this.

Jim was asking regarding ECT – electroconvulsive therapy.

021 Side Effect

021 Side Effect (Photo credit: Jester Jay Music)

Responding to a question that asks me to answer both personally and professionally is a little uncomfortable but this is my best effort.

…Alright, Provocateur Jim, I have been chewing my cheek on this, wanting to say something profound, considered “educated,” 🙂 yet not to turn anyone off with an up-tilted schnoz.

I do love ECT as a treatment option.

ECT is not for everyone of course, as nothing is, but consider it if you are looking for a treatment to work quickly and effectively .

Quickly is important.

  1. Can be life-saving, (“Timing is everything,” they say)
  2. Brain health short and long-term
  • less dementia,
  • less onset of other brain illnesses that come when one brain illness is not fully treated,
  • easier to respond to any future necessary treatments when we get more rapid and full treatment response to current illness episode,
  • ECT (as with medication therapy) that is done earlier in illness episode has a more robust response,
  • relapses are less severe, and we do not drop as rapidly when treatment is obtained more quickly for current illness episode

3. Quality of life,
4. Halt the damage to interpersonal relationships,
5. Diminish financial demise secondary to disability of brain illness,
6. Minimize side-effects,
7. Minimize medications.

Efficacy… do we really need to even say that the goal is to use a treatment that works?  ECT works more often and more thoroughly than any other treatment options.

Furthermore, we suffer less illness relapse when ECT is continued in maintenance.

Treatment response is much more robust when ECT is combined with medication.

Side Effects:

The side effects can only be measured on an individual basis, as qualified by the person going through them.

First off, there is no brain damage done by ECT, as seen in medical studies. This is a common fear.

Neither does ECT go through the body systems, it is not metabolized, and does not touch our body organs.  Yay, right!?  Medication side effects are a huge pill-dotted elephant in the room.  ECT does not touch the body (i.e. It is not a substance ingested or entered materially into the body,) all related potential side effects never happen.

The number one reason for relapse in brain illness is medication noncompliance.   This is due to many reasons, such as intolerable side-effects and the cascade of subsequent related issues.  Even dry mouth can lead to root canals.  We do not think of osteoporosis from serotonin agents.  Not taking our medication daily can be for more obvious reasons, like not climaxing during orgasm.

Zoloft Side effects in women

Zoloft Side effects in women (Photo credit: Life Mental Health)

Plus, it is just hard to remember.  Even the most consistent of us generally miss one to two days of medication a week or a month.  It is tough to be consistent.
ECT is less difficult to remember and maintenance ECT is much less frequent than taking pills every day.  Even when the ECT is combined with medication, if a day or two is missed, at least the ECT will be consistent as it has the support of the community of ECT staff and the transportation person to and from the surgery center.

In these regards, ECT has fewer barriers to treatment compliance that the majority of us suffer with medication therapies.  That is a big deal.

The side-effects of ECT are generally headache and temporary memory loss.

During index treatment, (about the first 3-4 weeks,) it is common to experience difficulty imprinting/recording memories. This typically takes about five weeks after the index treatment to return toward baseline. 80 years of data do not demonstrate that there is other memory loss but there are individual complaints of that.

Headaches are common for the the first couple treatments until the anesthesia becomes customized to the individuals experience. Generally after the first few treatments, the personalized anesthesia medications are able to resolve these from causing too much suffering. Not universally of course, but generally. Then once the maintenance treatments get going, memory loss and headaches are not common complaints.

…Big breath…

Did I do it?  Any questions about this diatribe?  🙂  Thank you for your patience.  I am trying…  Please let me know.  Keep on.

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Past week, latest on ECT on the web

  1. Shock therapy used to treat depression video from wzzm13.com community
  2. Wrong Planet Autism Forum Index -> Bipolar, Tourettes, Schizophrenia, and other Psychological Conditions
  3. Why are we still using electroconvulsive therapy?
  4. By Jim ReedBBC Newsnight
  5. PLOS ONE  :  Electroconvulsive Therapy Induces Neurogenesis
Cured by Electroshock Therapy,  Wall Street Journal

And, refreshing our memory… from http://www.FriendtoYourself.com, Related:
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another answer to ECT questions

Yesterday, we discussed seven bullet points on ECT.  I disclosed that I have a personal agenda in pursuing knowledge and community awareness about ECT.  (Maniacal laugh! j/k)

In my questions at the end, I asked for ways to continue to improve in this effort, and happily, Nance responded with these scintillating questions!  I’m listing the questions in her words, and responding to them one at a time because really, they are what I hear asked about so often from many others that it’s a no-brainer.  We have to talk about it.  🙂

Good looking lady

1.  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?

Studies demonstrate, as does the collective opinion of physicians anecdotal experience, that ECT memory loss is temporary.  Some mild memory loss happens during treatment of course because of the seizures, (also known as convulsions.)  Within a few weeks of the index treatment course ending, the memory returns to normal.

When we have seizures, it is typical, whether artificially induced, such as with ECT, or because of pathology, for us to feel sleepy, not remember events surrounding the seizure and even possibly disorientation.

After a seizure, the brain has a period of “quiescence,” or becomes quiet, when its natural electrical activity rests.  During this time, (the index treatment,) it makes sense therefore, that we will not imprint memories well.

ECT starts out with what we call the index treatment – around four weeks of ECT dosed generally three times a week, on Mondays, Wednesdays and Fridays, for a total of twelve treatments.

Index treatment = 3 ECT treatments/week x 4 weeks = 12 treatments total

This is not set in stone and some people have fewer or more.

Furthermore, most people say that within fifteen days of initiating ECT, memory is actually better!  That’s pretty cool.  It ties in with our understanding that our perception of how we concentrate and remember things is worse with brain illness.  However, in many brain illnesses, it stops there.  It is just our perception, when in reality, our memory is just fine.

Soooo, connect that with what we said yesterday about ECT taking about 1-2 weeks to start working, (i.e. round 15 days!)  And, when the brain illness is healing, the symptoms of the brain illness, (in this discussion it is memory loss,) is better.  Yay!  The term to describe this kind of perceived memory loss is “pseudodementia” because there really is no memory loss in the first place.

2.  How often, after the couple of weeks that you mention, would ECT be necessary?

ECT, like most treatments for brain illness, is not a cure.  Healing does happen, but the genetic predisposition remains.  Most of the time when people c/o that their illness got better with ECT but just came back when they stopped, it is because they never transitioned to maintenance ECT.

After the index treatment is done, we need to taper the ECT doses down slowly, monitoring all the while for symptoms of brain illness resurfacing.  When we decide that the symptoms are just starting to come back, we stop the taper and continue the ECT treatments at that frequency.  For example, if you Nance were at this point getting one ECT treatment every three months, we’d continue you with that.  Every three months you would get one ECT treatment and we would monitor to see that your brain illness remained fully treated.

If you relapsed, we would increase the ECT dosing again until you responded fully and then try to taper down again.

3.  Would it completely replace the need for medication or talk therapy?

ECT works alone, as does medication treatments and talk therapies.  However, any of these work best when used together.  We know that our goal is full treatment response and not just – “Ah, she’s better.  That’s great!  We’ll just see how she does for now.  She soooo much better than she was after all.  We should just be glad and not complain.”

Our goal is not to only improve the illness some, but get it fully responding to treatment and allow for maximum brain health.

Leaving a brain illness only partially responding to treatment equals leaving the disease to progress.  When we fight for full treatment response, we are fighting for our brain health fifteen years from now.

One of the beauties about ECT is that is gets us to this great place where we are giving ourselves a healthier brain in our futures.  For example, we know that there is more dementia and earlier onset of dementia if brain illnesses are not fully treated.

Thank you Nancy for these questions and opportunity to further discuss this important, underutilized treatment option for brian illness!

Thank you readers for joining us in this discussion.  Let us connect with our community, increase community awareness and decrease stigma together.

Everything starts and ends with Me.  Keep on.

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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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Marcos and his brain illness

Man portrait

Man portrait (Photo credit: @Doug88888)

He had always been a small man with wizened lines, a moguled nose that sloped over a deep philtrum and two ears that flew like flags on the sides of his head.  Looking at Marcos has always been a study of human terrain.   For someone with so much activity and exchange with just being seen by others, it was an apparent contrast to how disconnected he remained emotionally.  Brain illness had harmed Marcos.  It was as if he had been scooped out in places.

Marcos and I had worked together for ten years in psychotropic and psychotherapeutic remedies with only partial treatment responses that curved up toward an imagined healthy baseline on currents of hope.  His improvements however, never reached where he would call himself, “well,” and too soon they drifted down despite our cumulative efforts.

About that time, I had returned from Duke University for an update in training on electroconvulsive therapy, (ECT,) and had just opened up a new outpatient ECT surgery treatment center.  When Marcos and I discussed this as a new option, (new for our living location,) he wanted it without contest.

The evidence for efficacy as compared with the side-effect profile in ECT is dramatic.  When I tell patients about it, ECT might sound too good.  However, it has been around for so long that it celebrates itself. Marcos wanted in.

It has been a year already since we started ECT together but I still remember the way he leaned back in his chair that day in my office, animated almost for a change.  His scrubber eye brows were like punctuation marks around his eyes.  “Yes.  I want it.”

Marcos has not been able to taper down ECT at this point in his treatment to less than one treatment every two weeks.  He and his wife argue for it.  We have tried many times to taper down but every time we do, his symptoms come back.  He and his wife ask me separately and together, “Why doctor?  What is the point of decreasing treatments?  I do not understand?  When they work so well and we are not having any problems from them, why are we trying to reduce them?”  So, for now, he maintains one ECT treatment every two weeks.

His wife tells me he is better than he was on their wedding day.  She has never known him to be doing this well and they both think he is closer to whatever that baseline is for brain health he has always thought he was never going to get.  More connected with her, their sex life is having a run.  More connected with their kids, everyone feels like he has become a giver and the kids grades are even getting better.  By taking, Marcos became more of a giver; taking time, courage, emotional energy, even a ride there and from ECT, Marcos took and then was able to give.

Marcos is reading everything he can get his hands on about ECT; personal biographies, scientific articles, he has become his own advocate.  He could not read before ECT.  His concentration was too poor.  Now, with improved focus and attention, he perceives his memory is better.  Marcos believes he is interesting because he is interested in himself.  He is more aware of how others see him and smiles back when he catches the looks he gets just by wearing that face.

ECT is not a cure, but it is a treatment option.  It leads to brain healing, quality of life and improved connections.

Questions:  Have you struggled with quality of life?  How do you describe quality of life?  Please tell us your story.

Self-Care Tip:  Consider changing treatment paradigms to improve brain health.

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Medical Therapies Are Like Old or New Rugs

English: Physician of Rome During the Empire -...

The older I get, the more reputation I accumulate.  I am an old rug.

Have you ever seen a child – their smooth, unblemished skin like marsh-mellows;

their eyes, cupcakes, (my children’s are chocolate);

the way they look at the world open-mouthed swallowing flies;

the way the world looks at them?  Both sides hungry.

We say about these kids in contrast to us old property, “They have it all.”  They have it all because they just have not been around for very long.  They do no have a bunch of mistakes accumulated, crafted and woven into their lives; mistakes that could not be outed.  

Children do not have a limited supply of first beginnings.  When you have been around a while like us, first beginnings seem like they have changed their constitution.  On this side of the freeway, even though we have the freedom to start over at any point in our lives, starting over means something different when you have been around.  

It is not a matter of value.  Being around does not devalue Me.  It does not take away our worth.  It does not improve our worth – the Me we speak of.  Perhaps it will improve our worth in other ways or lessen it – but it won’t touch Me.  

There is nothing like a veteran office staff who knows how to do everything that your office needs.  That person is different from somebody out of high school.   Better for the position – yes, but not a better Me.  There is nothing like having a physician who has practiced for ten or twenty years and seen patients walk out angry, has seen patients die, has seen in action which treatments do what.  There is nothing like a physician who has worked with a medication long enough to know the inside of it; that there is good and there are things that happen that are not so good and that when you cannot unravel those things from that therapy, you try to see it together.  A more valuable physician for the job, but not a more valuable Me.  

The office staff, the physician and the child have reputations.  Those who have been around would take up more ink.  

Treatments are like that too.  The longer they have been around, the more reputation they have.  It is like being at a party and you see somebody who has been to all of the parties.  Somebody who has been the first to come and the last to leave, who has hurt people and been hurt and who has gossips surround them.  When you see that person, you walk in the door and think, “Oh boy!”  Or, “Yes! the party girl is here.”  But no matter what you think of them, there is something to say about them lasting as long as they have in these circles.  There’s a reason they keep getting invited and a reason they weren’t taken off lists.  

A treatment that’s been around a really long time, that has gotten a bunch of heat and perhaps even been referred to as “barbaric,”  has remained in circulation for reasons worth knowing.  If it didn’t offer lasting and unique benefits, if it’s benefits weren’t considered greater than the risks and potential negative outcomes, if people’s lives weren’t improved more than they were damaged – that treatment, like so many others, would have extinguished on their own much earlier in history.  

Questions:  What do you think when you see the treatment that you have been offered.  Has it been around long enough to get a reputation.  Or is it the new kid, the new child with velvet for skin?  Their eyes have not woven in shards of particled light that tangled the loom perhaps?  You with reputations, who are older than this and still around, tell us your story.

Self-Care Tip:  When considering treatments, consider their age as you consider their reputation.  Be a friend to yourself.

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More on ECT – TV Episode happened upon

Hello Friends.  I don’t know if you’re interested or not, but we’ve opened discussion on ECT (electroconvulsive therapy) in the past and because it remains open, I wanted you to know that I just ran across this TV episode online that is done surprisingly well.  Check it out and let us know what your thoughts are.  Keep on.

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Generic Patient Information on ECT

What is ECT? Electroconvulsive therapy (ECT) is a treatment for severe episodes of psychiatric disorders, especially major depression, mania, and some types of schizophrenia. It involves use of a brief, controlled electrical current to produce a seizure within the brain. This seizure activity is believed to bring about certain biochemical changes which may cause your symptoms to diminish or to even disappear. A series of ECT treatments, generally 6 to 12, given at a rate of 3 per week, is required to produce such a therapeutic effect; although sometimes a smaller or larger number may be necessary.

How is ECT administered? ECT is usually given three times a week, on Monday, Wednesday, and Friday mornings. It can be provided on either an inpatient or outpatient basis. You will not eat or drink after midnight the night before each treatment. Your ECT doctor will tell you what medications to take that morning. Before the treatment, a small needle is placed in a vein so that medications to put you to sleep and relax your muscles can later be given. The treatment itself is given in a special ECT Treatment Suite, where it is administered by a team of doctors and nurses with specialized training and experience. You will be brought into the Treatment Room and asked to lie down on a comfortable stretcher, after which blood pressure cuffs will be placed on your arm and ankle and a number of electrodes will be placed on your scalp, chest, and finger, so that brain waves (EEG), heart waves (ECG), and body oxygen levels can be monitored and so that the electrical stimulus can later be given after you are asleep. You will also be provided oxygen to breath by mask, and any pre-ECT medications, if indicated, will be given, followed by the anesthetic medication itself, which will put you to sleep.

Within a minute after the injection of the anesthetic medication, you will be asleep, and the medication to relax your muscles will be given. Within one to three minutes, your muscles will be relaxed. A controlled electrical stimulus, lasting a fraction of a second to eight seconds, will then be applied across the two stimulus electrodes, which will typically be placed either on both temples (bilateral ECT) or on the right temple and top of the head (unilateral ECT). As will be described later, unilateral ECT has less effect on memory than bilateral ECT. However, some reports suggest that it may not be as effective or rapid in all patients. The electrical stimulus triggers a seizure within the brain, which typically lasts around a minute. Because of the muscle relaxant drug given prior to the stimulation, very little body movement usually occurs.

Within a few minutes after the seizure, when you are breathing well on your own, you will be moved to a nearby room, where you will wake up within 5 to 10 minutes. Because of the anesthetic drug and the effects of having had the seizure, you will temporarily feel somewhat groggy. Usually within 20-30 minutes after leaving the treatment room, you will be brought back to your room (if you are an inpatient), or, if you are an outpatient, you will go to another area of the Treatment Suite, where you will wait till you are ready to leave the hospital (typically about an hour or more).

Is ECT effective? Although there have been many advances in the treatment of mental disorders in recent years, ECT remains the most effective, fastest and/or safest treatment for some individuals, particularly when alternative treatments, usually medications, are either not effective or not safe. Your doctor will discuss with you why ECT is being recommended in your case and what alternative treatments may be available. ECT is most effective in severe clinical depression (major depressive disorder), where it has a strong beneficial effect in 50-90% of patients, depending on the case. Still, there is no guarantee that ECT, or, for that matter, any treatment will be effective. In addition, while a series of ECT (or an alternative treatment) may bring an episode of illness to an end, it will not in itself prevent another episode from occurring weeks, months, or years later. Because of this situation, you and your doctor will need to consider additional treatment to follow any ECT that your receive. Such treatment generally consists of medication, psychotherapy, and/or additional ECT (given as an outpatient at a much less frequent rate and called “maintenance ECT”).

Is ECT safe? All treatments have risks and side effects, even no treatment at all. Prior to ECT you will undergo a medical, psychiatric, and laboratory evaluation to make sure that the treatments can be administered in the safest, most effective manner possible. Your medications may also be adjusted to minimize the risk and maximize the effectiveness of the treatments. For most patients, the side effects of ECT are relatively minor. The risk of death is very rare, about 1 per 10,000 patients for typical cases, but higher in those with some types of major pre-existing medical problems. Serious complications, which are also quite rare, include temporary or permanent heart abnormalities, reactions to the medication used at the times of the treatment, injuries to muscle, bones, or other parts of the body, and greatly prolonged seizures or seizures occurring after the treatment. More common side effects involve headache, muscle soreness, nausea, confusion, and memory difficulties. Headache, muscle soreness, and nausea are usually mild and can be prevented or at least diminished by medications.

Memory problems often build up over a course of ECT, but diminish as soon as the treatments have stopped. However, because of the harmful effects that mental disorders themselves often have on memory function, some patients successfully treated with ECT actually report an improvement in memory. When memory problems occur, they vary considerably from patient to patient, but are usually greater for larger numbers of treatments or when both sides of the head are stimulated (bilateral ECT). Because of the possibility of memory loss, it is recommended that important life decisions be postponed until any major negative effects of ECT on memory have worn off (usually within a week or two following completion of the treatment course).

ECT-related memory problems can be of two types: a difficulty remembering new information, and a loss of some memories from the past, particularly the recent past, e.g., during and just prior to receiving ECT. In this regard, the ability to learn and remember new information returns to one’s usual level over a period of days to weeks after ECT. The ability to remember material from the past, i.e. prior to ECT, likewise tends to return to normal over a similar time period, except that in this case, some memories from the recent past, mainly days to months prior to the treatments, may be delayed in recovery or even permanently lost. Some patients have reported longer gaps in memory. However, patient surveys have indicated that most patients receiving ECT are not greatly disturbed by memory effects and would have ECT again if it was felt to be indicated.

Other information on ECT: Please feel free to ask your doctors or nursing staff any questions you have about ECT. A variety of types of information are available concerning this type of treatment, including videotape material. You should understand that ECT is a treatment for which you (or your representative, if applicable) must consent on a voluntary basis, and that consent for future treatments can be withdrawn at your (or your representative’s) request at any time.