
The misunderstood consequences of electroconvulsive therapy - bookofjoe
https://lithub.com/the-misunderstood-consequences-of-electroconvulsive-therapy/
======
DanBC
In England a patient who is detained under the act can be given medical
treatment against their will, but the Mental Health Act includes an exemption
for ECT that makes it much harder for doctors to provide ECT against a
patient's wishes.

That information can be found in the Code of Practice to the Mental Health
Act. The code isn't law, but it describes the various acts, statutes, and case
law and so a health care practitioner would have to ahve good reason to
deviate from it.

[https://assets.publishing.service.gov.uk/government/uploads/...](https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/435512/MHA_Code_of_Practice.PDF)

If you want to make it even harder for them to give you ECT against your
wishes you can make an advance directive. Go see a lawyer that deals with
mental capacity stuff and get one drawn up. Be clear and specific.

But, please do take note of what this woman has said:

> Despite the discomfort and the temporary memory loss it caused, I would have
> ECT again without hesitation. People voluntarily undergo much more invasive
> and damaging medical interventions to save or to prolong their
> lives—chemotherapy, radiation, open-heart surgery, blood transfusions, bone
> marrow transplants—and speak freely about those experiences, but continue to
> think about cancer and heart disease differently from mood disorders that
> can be equally deadly. In telling my own less than ideal story 30 years
> after the fact, I don’t want to discourage anyone from having this
> potentially life-saving treatment. What was difficult in my experience would
> now be unusual because the treatment protocol has improved over the years to
> greatly reduce the side effects. And my situation was extreme not only
> because of the perilous condition of my mind, but because my body was
> already hypersensitive and aggravated by drug allergies.

I know a few people who've had ECT and a couple of them hated it and are still
angry it was done to them, but most of them are glad they had it done and
would do it again.

It's hard to work out how much harm it causes because it's only used in people
with the most severe depression, and that causes similar harms itself.

~~~
8fingerlouie
It's the same in Denmark.

They can force various antipsychotics down your throat like Olanzapine
([https://en.wikipedia.org/wiki/Olanzapine](https://en.wikipedia.org/wiki/Olanzapine))
or
Quetiapine([https://en.wikipedia.org/wiki/Quetiapine](https://en.wikipedia.org/wiki/Quetiapine)),
with serious side effects, but ECT which has very little known side effects,
and has been studied quite intensely, cannot be forced.

My wife suffered a psychotic manic episode
([https://en.wikipedia.org/wiki/Postpartum_psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis))
after the birth of our first child, the opposite of post partum depression,
which happens in 1/1000 births.

I witnessed her on antipsycotics for a week while attempting to persuade her
to accept ECT. The effects of ECT were astonishing. She had the ECT treatment
at 9:00 in the morning, and by noon she was back to normal. She had a few more
treatments after that to make sure she didn't relapse, and that was the last
we saw of it.

She's still without relapses 10 years later, and according to her, should it
happen again she would accept ECT much sooner.

Edit: I should probably elaborate on the side effects she experienced. She
suffered short term memory loss, which is a known side effect. When she went
to the ECT treatment she recognized the driver, and they established where
they knew each other from. It was surreal to witness the same conversation
unfold with the driver that just unfolded 20 minutes ago before ECT. She had
absolutely no recollection of having seen or talked to the guy before on that
day.

She feels (now) that she has lost more memory, but as the conventional
treatment for manic episodes is basically locking them up in a room with a
bed, a table a chair, and some sheets of paper, and keeping them confined
there for 2+ weeks, i bet most of us would be unable to keep track of time.
Add the various drugs being administered to the equation, in doses that makes
you lean against the wall and drool.

She has no memory problems today. The only "blank spots" are in the time
surrounding her hospitalization, specifically the days her ECT treatment was
administered.

------
andy_ppp
If you haven’t watched this beautiful first person account, by Sherwin B.
Nuland, who believes his life was saved by ECT, it’s very much worth watching:
[https://www.ted.com/talks/sherwin_nuland_on_electroshock_the...](https://www.ted.com/talks/sherwin_nuland_on_electroshock_therapy/up-
next?language=en)

~~~
rhombocombus
Dr. Nuland saved my aunt's life in the '80s. He has contributed a great deal
to humanity and I am grateful that ECT saved his life.

------
mattkrause
This is _almost_ too obvious to be said but... The brain is _REALLY_ _REALLY_
freaking complicated.

I'm sure ECT can be misused by jerks on power trips, incompetent quacks, and
grifters out to make a buck. I also appreciate that some people have suffered
from awful side effects from ECT—and other treatments. I don't want to
trivialize that at all.

Nevertheless, I want to emphasize that the _vast_ majority of clinicians and
researchers are doing the best they can. Depression can be very debilitating
and the tools we have for dealing with it are not great. ECT is one of them.
It works well for some people but not others, much like many of the drugs and
behavioral therapies, and no one really understands why. We would _love_ to
have better options, and a lot of very smart, very hardworking people (and
me!) have bene working hard to figure out how the brain works, how it can go
wrong, and how to restore function when they do.

------
jpovenden
ECT has been shown numerous times to improve cognition in the short-term with
little to no long-term decline from baseline.

Much like the effects of having a seizure in those with epilepsy.

itt: people who don't know what they are talking about.

------
kristianp
This is the most readable webpage I have seen for a while. The combination of
background colour, black font, font face and line height make for an extremely
readable page. Far better than the popular but varyingly unreadable white
background and gray text.

That ECT is still around after all this time, speaks to its effectiveness,
despite some of the vehement comments on this page.

~~~
Hydraulix989
It's effective just like taking a hammer to your computer is when there is a
bug in your code. You can't have a bug if you don't have a working computer.

~~~
mattkrause
Obviously, you're being sarcastic, but....

One of more credible theories about depression is that it occurs when the
brain gets stuck in a "bad" state or cycle (like a local minimum or attracting
state). If this model is correct, a treatment that nudges brain activity away
from the depressed state and towards a less pathological one would help.

It's more akin to rebooting the computer than smashing it, if you will.

~~~
Hydraulix989
The other credible theory is that by damaging your brain cells, they can no
longer fire in ways that regulate your mood towards depression.

~~~
mattkrause
Got some references for that?

I ask because ECT seems to _upregulate_ trophic factors, rather than
downregulating them. Some sort of hippocampal injury does seem like it could
explain memory-related side effects, but it apparently doesn't actually happen
(e.g.,
[https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...](https://jamanetwork.com/journals/jamapsychiatry/fullarticle/481657))

~~~
Hydraulix989
Nature, for one:

"ECT damage is easy to find if you look for it"
[https://www.nature.com/articles/35002188](https://www.nature.com/articles/35002188)

~~~
mattkrause
That’s an unreviewed letter to the editor, not an actual research report.

Look, I’m not arguing that ECT is the best thing ever. The side effects are
awful for some people, no one understands the mechanism, and so on. However,
it sometimes works when other treatments—-which aren’t great either—-fail.
Clearly, better therapies are needed all around.

------
raxxorrax
As long as it stays voluntary...

------
justtopost
The most dangerous placebo. Please never allow yourself, or your loved ones to
be subject to this. You have power within yourself.

~~~
Analemma_
Your comment is dangerous and irresponsible. This is not the 40’s, ECT is not
used lightly; it is the treatment of last resort for severe depression when
lifestyle changes, medication and therapy have all failed. The side effects
are well-understood and patients who choose ECT do so because the alternative
is unbearable.

What you are saying cashes out to the claim that depression can be overcome
with sheer positivity and willpower, which is a view I really thought society
had gotten over. Please post more responsibly.

~~~
imperio59
Sorry but there are dozens of studies and hundreds of reports of people
basically losing memories of entire portions of their life and the ability to
do simple things like tie their shoelaces or do simple math after just one
round of ECT. How this is still not banned by the FDA is beyond me.

Not to mention the number of people who get heart complications from it or
outright die during the procedure.

How can you say that "the alternative is unbearable"is beyond me, unless
you're saying it's better to become mentally disabled than suffer from
depression?

The argument that "this is not the same ECT" is also bogus. The difference is
now they paralyze you so you don't convulse and break your bones while doing
it. They also use a higher voltage (more damaging to brain cells) and higher
frequencies with shorter, repeated bursts (also causes more brain damage and
hemorrhaging). But it's "better" because the patient doesn't thrash around so
much anymore. Give me a break.

Summary of the issues with ECT and associated studies:
[https://truthaboutect.org/ect-causes-brain-damage-a-
review-o...](https://truthaboutect.org/ect-causes-brain-damage-a-review-of-
the-literature/)

[http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-
Citi...](http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-Citizen-
Petition.pdf)

~~~
depressed
Have you ever had someone close to you commit suicide? If so, is that truly a
better outcome than undergoing ECT?

If not, then I want you to understand this: ECT is used to treat a lethal
illness.

~~~
imperio59
I'm sorry but that's the equivalent of saying "This person is about to kill
themselves, so let's take a bat and hit them over the head with it so they
can't do that now. See, now they're doing fine, they're not killing
themselves."

Would you take someone who is about to kill themselves and take a pair of live
electric wires to their head to try to "cure" them? Because that's essentially
what ECT is, despite all the supposed "new and improved" spiel which is
marketing speak, that and they sedate you while doing it.

Inducing brain damage is not treatment.

Saying that is not denying the problems that some people are suicidal and need
help. That's a very real issue.

But ECT is very real scientific fraud, often done without fully informed
consent on the parts of the patients and family members, often done against
and over the wishes of the person receiving ECT, and billed for thousands of
dollars to insurance companies over and over again, with results that go away
once treatment stops and side effects that remain for a lifetime.

~~~
nickbarnwell
There is a both a large and strong evidence base for the usage of ECT in cases
of severe, treatment resistant depression. Many aspects of modern medicine can
be made to sound barbaric with the right framing; those who disparage ECT are
not so quick to characterise chemotherapy as “poison by any other name” or
dialysis a “vampiric ball and chain”.

By the time ECT is on the table, every other option is exhausted and the
sufferer has been through multiple acute hospitalisations for suicidal
ideation, if not unsuccessful attempts.

It is certainly fair to say the effect is not always permanent, that
maintenance courses are a burden, and that their long-term efficacy does not
justify the risks of the procedure itself or the anaesthesia it requires.
Nonetheless, for someone who has been depressed for many years, plagued by
crippling ennui and a nihilistic view of existence not even Schopenhauer’s
grimmest passages can match, any respite is welcome. To deny them that option,
with full knowledge of the risks, is to deny them agency.

~~~
candiodari
And yet from the article ...

"But he acquiesced when told that if he resisted, the hospital would seek a
court order to overrule him."

Are you claiming they would do this, yet have the deeply depressed patient's
honest agreement ?

I don't buy that. This was forced, under threat of force. To protect the
hospital against having a successful suicide attempt on their record.

Symptoms return. Normal cognitive function does not. That tells you more than
enough. This person is now (hopefully lightly) mentally handicapped, and this
has been done to her under threat.

You might as well shoot the person. That has the same demonstrated effect.
Seriously. Shooting someone with mental problems can fix those mental
problems, many documented cases of that happening.

(edit: corrected language)

~~~
jdietrich
_> You might as well shoot the person. That has the same demonstrated effect._

This is ludicrous hyperbole. The majority of people who receive ECT are
successfully treated and go on to live fulfilling lives. ECT is an evidence-
based treatment for a life-threatening medical condition.

~~~
candiodari
If it truly was, then why was that person threatened into doing it ? If what
you're saying is true, then what possible motivation could the doctor have to
threaten his patient into accepting this treatment ? (I get that someone else
had to say "yes", but that doesn't change the situation)

Second, I resent psychologists using "evidence based" as a term. This, one
might think, implies that they have proof. Well no, no proof. It doesn't mean
that.

Ok, but surely it means that they have double blind statistical studies ? I
mean, that makes "evidence" very misleading, but ... Yes, but those studies
say there is no effect beyond placebo (in fact there are valid studies that
say that _all_ of psychiatry does not survive a double blind study). So
statistical analyses actually says this does _not_ work.

Ok, so what _does_ "evidence based" mean ? Well, it means they have a few
anecdotes of mostly temporary improvement ( _and_ lots of anecdotes of
disastrous outcomes, conveniently left out). Which certainly exist for
shooting depressive patients as well. Also they exist for not doing anything.

So why _did_ the doctor force this treatment on her ? Well, to get her out of
his clinic. You see, the way you get fired in a psychiatric department is to
have a few patients commit suicide in the department. And observation and
isolation only helps for so long. In practice, given 4-12 weeks of trying
people successfully commit suicide, even under 24 hour observation with no
tools in an isolation cell. This patient had gotten really close to doing
that, as mentioned in the article (which, incidentally, would be the
conditions this patient was held in prior to her getting asked if she'd agree
to this treatment. Which of course also means she is mostly happy with the
treatment because it got her out of an isolation cell, and still lives under
threat of returning to those conditions. Reality of psychiatric patients).

So this is fact: this doctor forced permanent brain trauma on a patient
because he was calculating that this trauma would temporarily prevent the
patient from committing suicide, long enough so that she'd be out of his
department before she actually succeeds.

So reality is simply that this patient was forced to get ineffective treatment
that introduced permanent brain trauma against her wishes, with the decision
made under extreme stress (introduced by this doctor), and under threat. That
she got lucky and seems to be happy with it does not change that. PLUS she
might merely be happy that it got her out of the isolation cell she was forced
into for weeks/months before.

So let's go through your statement: > The majority of people who receive ECT
are successfully treated If you don't count the permanent cognitive
impairment, and the fact that most would have recovered without any help, then
sure "successfully".

> and go on to live fulfilling lives.

Nope, most relapse. Unless you count redoing suicide attempts after ~4 months
a sign of a fullfilling life. But of course, that's long enough to get them
out of the hospital and let the doctor/hospital "not be responsible".

> ECT is an evidence-based

Nope. I know this term "evidence-based" is used in psychiatric literature, but
that doesn't change the fact that it's bullshit, as explained.

> treatment for a

Nope. This is not a treatment by medical standards. For that to be the case
there would need to be validation. This wouldn't even satisfy the standards
for "experimental treatment", as that would require case-by-case review of an
ethics board, which hasn't happened here.

> life-threatening

Nope. The vast majority of patients recover from this without any help. So it
was not life threatening. Or at least, not any more

> medical

Nope, psychiatry is still not considered part of medicine by doctors.

> condition.

Well this is the only word in your sentence that was actually correct.

~~~
jdietrich
_> Nope, psychiatry is still not considered part of medicine by doctors._

Psychiatry is a branch of medicine. Psychiatrists are medical doctors.
Psychiatric disorders are recognised as diseases by the World Health
Organisation in the International Classification of Diseases. The Merriam-
Webster dictionary defines psychiatry as "a branch of medicine that deals with
mental, emotional, or behavioural disorders". Psychiatrists are eligible for
full membership of the American Medical Association, the British Medical
Association and every other medical association I am aware of, because they
are medical doctors.

The rest of your comment is just as wrong as this sentence and just as readily
debunked. Due to the length of your comment and the sheer density of
falsehoods, I am not inclined to debunk it point-by-point; I would suggest
that anyone with an interest in the topic should consult the National
Institute for Clinical Excellence's Technology Appraisal on ECT.

[https://www.nice.org.uk/guidance/ta59](https://www.nice.org.uk/guidance/ta59)

~~~
candiodari
Psychiatrists are medical doctors because they need to responsibly prescribe
medication. That's all.

That doesn't mean it is considered medicine.

You still haven't explained why the threat of force (and thus force) was used
against this patient ... to enforce an elective treatment that results in
permanent cognitive damage. I am very curious how you'll explain that one.

(I would like to point out that any treatment that does not prevent death or
long-term injury is one that's considered elective)

~~~
mattkrause
“Force” is a mischaracterisation.

Medicine generally relies on “informed consent”: you have the right and
responsibility to know and understand the treatments you are receiving and
their possible effects.

Mental illness is tricky because the condition itself impairs patients’
ability to provide this consent. Maybe you’ve got extreme lassitude and refuse
everything, for example, even contradictory options. Maybe you clearly do not
understand the options presented to you.

Nevertheless, we also don’t want doctors making decisions unilaterally, so the
next best thing is to involve a third party. If the patient has a guardian,
it’s their call. If you don’t, a court can act as one temporarily, with the
idea being that they’ll get you to a state where you can take over. Obviously,
this isn’t ideal, but it’s not clear what would be a better approach.

~~~
candiodari
This article VERY clearly states that the patient REFUSED, and then was forced
to let it happen under threat of force:

The actual quote: "her husband was alarmed when the doctor suggested ECT. But
he acquiesced when told that if he resisted, the hospital would seek a court
order to overrule him." (note: author is talking about herself in the third
person)

So I really do not "feel" force is mischaracterized. The threat was explicitly
made AFTER the patient "was alarmed" (which means refused, let's get real).
And threats are use of force, of course. (if I threatened to shoot you unless
you did X, you would certainly call that force regardless of whether I
actually shoot you, not even if I say "please". You would strongly disagree
with me calling that "informed consent", rightly so)

And it's not just force. This is forcing a treatment that does permanent
cognitive damage to the patient against their will. This was done knowing full
well that given enough time, odds are pretty high it will disappear by itself
(most suicidal patients "recover", very few actually commit suicide. I did a
quick Google search and we're talking 4% apparently. Unfortunately, public
opinion REALLY punishes any hospital where it happens. But that doesn't change
that there was a 96% chance this patient would get cured without any action,
never mind permanently crippling them)

Let's not pretend this is a moral grey area. It's not. This is _far_ over the
line.

How do you even know that this article isn't positive because the patient
fears being readmitted (again with force) into the psychiatric facility and/or
resumption of convulsive "therapy" ? (where she would be locked up in dismal
conditions).

~~~
mattkrause
When I was an infant, I (apparently) struggled valiantly to avoid getting
shots or having blood drawn. It hurt and the benefits of (e.g.) vaccines don't
really make sense to a kid who has just learned to string a few words
together. Nevertheless, my parents forced me to get them, and, as an adult who
does _not_ have several debilitating diseases, I'm glad for it. The idea is
pretty similar here: the patient herself can be in a state where she's (not)
making decisions that their unaffected self would. I'm a little surprised at
the lack of deference to her husband, but 'alarmed' can cover a lot from "NO,
NEVER" to "My God, is it really that bad?"

As I wrote above, I don't think ECT is _great_ , but the evidence indicates it
is one of the better options for drug-resistant depression. The side effects,
especially for older approaches, can be pretty bad, but so is depression (and
newer approaches seem to have weaker effects on memory).

I think you pretty much have to take her at her word here that she eventually
appreciated the treatment. There's no way in hell someone is getting
recommitted due to an article, especially not 30-40 years later.

~~~
candiodari
Would you feel even remotely the same if the treatment was not vaccination,
but let's say you already had the measles. A bad case.

The odds would be 99%+ that you would get better on your own (essentially
nobody _stays_ depressed, after all), BUT the process of getting better would
involve 2 weeks nausea, painful pimples all over, and of course generally
feeling very bad. You would need to be locked up during that time to prevent
spread of the disease. In < 1% of cases it would feed back onto itself, and
those weeks would repeat, progressively getting worse.

The treatment is amputation, say of a foot (because ECT does permanent
cognitive damage). And, even though they can give you something to prevent you
from remembering the pain or the process afterwards, they can't actually
sedate you. This has a decent chance of making you better in a shorter time
"without" (visible) pain/issues. They may need to redo it several times,
taking off some more every time. Let's say they start with a few toes, but
progressively they'll take off more, and you can reasonably expect to lose at
least all your toes, with your entire foot being a possibility. Of course,
there's also odds you'll lose your foot, but remain ill. (there is widespread
disagreement on what those odds are, so let's leave it at "not zero, and not
very small either, so >10%, but not 90% like some claim either"). And there's
a tiny chance you die.

Would you still feel as positive about the treatment ? What if your parents
got threatened while making this decision with having you taken away by social
services and having this imposed on you ? (with some small odds of you never
getting returned to them, ever)

The ethical issue is more complex than you present it. You conveniently leave
out that it mutilates the patient, just not visibly. You leave out that
there's extreme pain involved, and they can't sedate you (that would defeat
the treatment, because the point is that the brain learns to associate
absolutely extreme pain and stress with "the problem"), but they can give you
the date rape drug (yes, really). You won't remember. You'll still be
mutilated though. Cognitive impairment. You won't remember how it happened.
Usually you won't, that is. There may be some lingering trauma, and PTSD. So
there's a 10% chance (it's pretty high for ECT) that you'll have extreme (fear
or violent) reactions to things you associate with the treatment room.

> I'm a little surprised at the lack of deference to her husband.

Really ? What do you think about the "doctor thinking of his career"
explanation ? Can you at least agree it's pretty consistent, that _some_
doctors might think like that ?

As in, can you at least agree that giving psychiatrists that option at all
presents a "moral hazard" ?

------
bellerose
My opinion is suicide being the better outcome than electroconvulsive therapy.

People are so irrational in fearing the unknown "death" that they'll do
something barbaric to themselves and where the outcome is creating a disabled
version of their former self.

Humanity is really disgusting. First, we label people with "depression" a word
denoting human expression built upon a pseudo practice named psychiatry and
where the majority of people being depressed just suffered poor life events.
Financial problems, divorce, child abuse, social & behavioural development
problems, the list goes on and the professionals receiving funding "for these
victims" will just try to numb the victim's brain; to medicate the problem
away.

~~~
imperio59
We used to offer support and accept that sadness and sorrow were a part of
life and that sometimes people needed to grieve, or people went through rough
patches, and eventually got themselves out of it with the help of others.

Now we say sadness and depression are diseases that must be medicated with
drugs whose side effects (WRITTEN ON THE LABEL) include suicidal ideation and
depression, and we wonder why the suicide rates are up?

The worst thing this country did was vote to allow pharmaceutical companies to
advertise drugs on TV and in other media. Once that pandora's box was open,
there was no going back. It's sad that we're only now waking up to the fact
that things like the opioid crisis were actually fueled and manufactured by
pharmaceutical companies to increase their profit margins... :/

~~~
mattkrause
Ugh.

Depression is different from sadness. If your father died/girlfriend left
you/job laid you off, you _should_ be sad about events like those, and
frankly, it would be concerning if you weren't.

The patients who are candidates for ECT aren't just upset. Some are actively
trying to kill themselves. Others have such lassitude that they can't work up
the energy[0] to eat, drink, or bathe, let alone live a normal life.

I take your point that the US tends to 'medicalize' conditions, and we might
be better off with fewer drugs and a more caring society, but these patients
aren't going to be helped by a box of tissues and a soft shoulder to cry on.
It is an _illness_

[0] The suicide bit is not as contradictory as it sounds. Depression is
associated with very decreased activity levels. Some depressed people make
plans to self-harm, but lack the energy to actually go through with it. As
they recover, the energy often comes back first, so they get into a regime
where they are still considering self-harm but have also recovered enough to
actually go through with it. As an analogy, think about the 'danger zone' in
food preparation. Frozen or cooked food is relatively safe from bacteria, but
during thawing, food is warm enough for bacteria to thrive, but not hot enough
to eliminate them.

------
imperio59
The ECT industry is on par with the Purdue Pharmas of the world, they've lied
about the terrible side effects of ECT, neglected to report to the FDA the
side effects patients have experienced, and generally engaged in fraud and
cover ups for the fact that ECT's purported "effectiveness" goes away once the
treatments stop, while the very terrible side effects can be permanent,
including amnesia, loss of motor function, etc...

The lawsuits are starting to come in and are of course beings settled out of
court, because the manufacturers know they would lose in actual trial given
the evidence against them is so blatant.

More details here [https://breggin.com/huge-breakthrough-in-lawsuits-against-
el...](https://breggin.com/huge-breakthrough-in-lawsuits-against-
electroconvulsive-therapy-ect-manufacturers/) and here
[http://www.dk4law.com/blog/dk-law-group-news/other/ect-
shock...](http://www.dk4law.com/blog/dk-law-group-news/other/ect-shock-
treatment-class-action-case-update-april-2018/)

~~~
phren0logy
Is this a Scientology account?

~~~
imperio59
Why is that even relevant to the discussion? Sounds like you're trying to
distract from the actual issues at hand.

~~~
rhombocombus
What issues? Lawsuits != research. Most clinical research suggests ECT has
high efficacy with fewer side effects than many pharmacological interventions.
Your baseless claim is mental illness shaming and treatment shaming.

