ECT aka ElectroShock Therapy for depression

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I'm glad it worked for the OP. The treatment sounds very crude to me though. Like trying to repair a clock by hitting it with a hammer. I can't help wondering what other memories the OP has lost without knowing it.

anybody ever hear of Eye Movement Desensitization & Reprocessing [EMDR]?

Don't think I could go through with such a procedure no matter how depressed I am, but I am glad you have found it to be helpful for you.

Well, I have been considering this, but my psychiatrist has said that I should try a few more things first.

This is only used on more serious conditions in the UK & it's more going towards the banned.

Has anyone came up"how ECT works" other than just theories? Long time since I looked at it.

Sure some people have had it, it comes back ( as it temp goes away ), or maybe it only works after you cause enough damage.

But it would be like sticking a modified tazer on a timed trigger to cause the seizure.

Sure they used to use drugs to cause seizures somewhere. Really nothing to do with the shock really. Isn't it?

( sorry not read everything yet, just part about it used in UK )

Edit:-

Only thingI would suggest is someone who knows you well to test you after each one. To make sure memory is ok & test your skills.

Last edited by TechnoDog on 10 Mar 2012, 5:28 pm, edited 1 time in total.

Too late to do anything about it then! If there is damage done to the brain it is unlikely anything can be done to undo it.

Not really depends on how much damage has been done. The brain has an interesting way of repairing itself. Been a while since I read into that research too "cellular pathway", so don't know where it is up to.

But stopping will prevent further damage from ECT

TallyMan: What is "the OP?" Is that me? Is that a term I should know?

TechnoDog: Correct. It's the seizure, not the electricity. Also, I have a social worker spend 3 hours a week with me in my home, and she tells me the difference is remarkable. Seems a bit overstated to me, but I'm the patient - I can't see this neutrally.

If you're into reading the scientific literature, here's a great review from 2011:
Segi-Nishida E. Exploration of new molecular mechanisms for antidepressant actions of electroconvulsive seizure. Biol Pharm Bull. 2011;34(7):939-44.

It's available in full text online at:
http://www.jstage.jst.go.jp/article/bpb/34/7/939/_pdf

This is one of many papers I read before deciding to go with ECT. (Sad to say, but I think I went into this more informed than most psychiatrists.) I actually felt so good after reading this review that I emailed the author to thank him. Neuroscientists and molecular biologists rarely have the opportunity to affect individual patients directly, and I wanted him to know his paper had allayed a lot of my fears.

There are several important things to keep in mind when discussing this topic. First of all, no one knows what causes depression in the first place. We know that mildly elevating serotonin and norepinephrine can provide relief of symptoms, but if we don't know the cause, we can't definitively state how any particular treatment actually works. Therefore, it's always preferable to use the least invasive (least risky) treatment that provides adequate relief.

ECT is fairly invasive, not because it uses ultra-brief (1/4 a millisecond) and rather weak electrical stimulation (1/2 a millicoulombe), but because it requires administration of general anesthesia, which can cause adverse pulmonary events (including aspiration pneumonia, pulmonary edema, respiratory arrest, and possible death) in one of every ~2,000 patients. (Some sources say one in every 1,600.) That's why I was glad to learn that an MD anesthesiologist would be handling my anesthesia. It's no small matter.

As invasive as ECT is, unlike VNS implantation it does not involve tissue destruction, a surgical wound, scarring, gliosis (like a kind of scarring of brain tissue), adhesions, infections, antibiotic use, cosmetic changes (scars or a lump where the control pack is kept), or exposure to iatrogenic infection beyond that associated with anesthesia, which itself is a slightly greater risk with VNS implantation because the implantation procedure requires more time under anesthesia. VNS implant patients need to recover in a medical surgery unit, whereas ECT can be done as an outpatient or in a psychiatric unit.

I think we also need to get together with our terminology. When we speak of brain damage, a neuroscientist like myself specifically means physical damage to brain tissue. That doesn't happen with ECT according to the latest papers I've read. However, certain neural functions can temporarily be impeded, such as a specific type of memory coding and recall known as long-term potentiation (LTP). I think some people here are considering that to be a type of brain damage. One common type of LTP involves placement of a magnesium ion in an ion channel that has the effect of blocking the ion flow except when the neural membrane reaches a certain voltage when glutamate is present. During ECT, many of these ions are scattered, making it hard for the brain to continue its LTP memory coding.

I know, this is complicated stuff to follow, but maybe thinking of it this way will help: The neurons involved are not damaged, but their LTP patterns can be interrupted temporarily. Think of it like a cassette tape. Putting a magnet on the tape won't damage it at all. It will still record and playback just fine. However, whatever signal had been on the tape before the magnet was placed on it will have been weakened, and the quality of the sound will be poorer. That's what this memory loss feels like. The memories are still there, just a little harder to find, and all the papers I've read say that the ability to code and recall via LTP will return to normal within a few weeks or maybe months. That's not brain damage, though it is temporary interference with normal brain function, but my brain was not functioning normally before ECT, and the function I've already gained seems to compare favorably to the memory I've lost.

The jury's still out though. Again, I'm not trying to defend ECT as a good & proper treatment for anyone else, not even for myself at this point. But I detest politicians trying to outlaw medical procedures based on their own fears rather than science. Outlawing ECT is in no way justified by the scientific evidence. Judicious use of ECT, certainly, but many people credit ECT for saving their lives, and I can certainly understand that. Politicians who have never been through the procedure and have never seen the effect it can have on someone they love should keep out of this.

In a possibly related story (to LTP and how ECT works to relieve depression), dietary magnesium supplementation might be associated with rapid relief from depression. For a free online review of this and other recent research on nutrition and depression check out this website:
http://www.ncbi.nlm.nih.gov/pmc/article ... ool=pubmed

It's a bit easier to understand than the Segi-Nishida paper I referred to above.

My bottom line:
I understand why feelings about ECT are usually very strong, but IMO that means we need to be all the more careful about learning the facts and making reasonable decisions regarding public policy and individual treatment choices. Hyperbole and misleading language like "brain damage" do a disservice to the truth.

If 80-90% of broken clocks were actually repaired by hitting them with a hammer, with the only consequence being they had to be reset to the correct time, your analogy would be perfect. It may sound very crude (I myself certainly agree with that statement), but crude or not, it remains the most effective antidepressant therapy known. It has withstood the scrutiny of rigorous scientific testing. We don't know how it works, but ECT has achieved scientific consensus that it does work. Science doesn't require that a mechanism be known for an idea to be supported.

Scientists have also demonstrated the value of an (IMO) equally ridiculous sounding treatment: acupuncture for chronic pain. Like ECT, the evidence for its effectiveness is so solid that many American health insurance companies will pay for acupuncture as a treatment for chronic pain because it works, and it's cheaper and less risky (less addictive - American insurance companies usually have to pay for addiction treatment as well as pain management) than the fancier analgesic medications.

However, after paying for acupuncture for years without knowing how it works, insurance companies now have good evidence for the mechanism of acupuncture analgesia. There is a certain kind of pain-sensing neuron called a substance-p receptor that only exists in deep tissues, typically muscles, but not in skin or more superficial tissues. Acupuncture needles penetrate deep into the tissues, activating substance-p receptors, and causing them to send deep tissue pain messages to the brain. The brain interprets these messages as serious injuries to deep tissues, and in response to the perceived injuries, the brain releases a flood of endogenous opioids (the body's natural pain killers: dynorphin, enkephalin, and beta endorphin), causing a dramatic reduction in pain, regardless of the cause.

We have a high degree of confidence that ECT is a very effective antidepressant treatment, in some cases the only effective treatment available. We are starting to understand why it's so effective, but for me, and perhaps for many others in my position, it is enough to know that it simply is very effective, though it also has serious (yet well known) side effects. With that information, I was able to make an informed decision, knowing the risks and the benefits.

If I had a broken clock, and I'd taken it to all the local repair shops, and none of them had been able to fix it, but then I learned about a very old technique that old-time clock makers had been using for a long time, I'd consider giving it a try, even if it simply involved using a hammer, as long as the method had a solid track record of success.

Oh yeah, I also want to agree with your point, "I can't help wondering what other memories the OP has lost without knowing it." (Again, what is "the OP?" does that refer to me personally, or is it a more general term?) It would be monumentally disingenuous for a scientist to disagree that we don't know what we don't know. I certainly can't say with certainty everything I've forgotten. If I could, then it wouldn't be forgotten. But I can say that I don't hate myself today. I don't wish I were dead. I actually did some cleaning and organizing yesterday, something my social worker said she hadn't seen me do on my own in the year or more since she's known me. So the things I do know look pretty promising, though the things I don't know are keeping me from judging this an unqualified success - at least at this point.

And thanks for caring enough to talk about this stuff, whatever your personal opinions. I feel a strong need to talk about my experience. It doesn't matter to me whether I talk about it with people who think I made the best decision, but it does matter that I talk about it with people who are genuinely interested in the discussion. If people actually care about me, then so much the better!

It is a common abbreviation for "Original Poster" i.e. the person who started a thread. The abbreviation comes in handy when people start doing a reply to a thread but by then have forgotten the name of the person who started the thread.

It sounds like you've done lots of research on ECT and I found your posts informative. I'd always assumed it was the electricity "frying" some brain nerve cell connections that had the effect - i.e. literally brain damage, but from what you state above the mechanism seems to be something else.

I suffer from bouts of severe depression myself, but ECT isn't something I'd consider. Having said that, there is no telling what long term damage anti-depressant medications cause anyway - they certainly mess with my brain functioning when taking them and have various unwanted side effects.

I have researched ECT pretty thoroughly. Something that seems so radical and so potentially risky wasn't something I was going to have done to my brain unless I was thoroughly convinced that its safety was a good balance with its effectiveness. I'm also fortunate enough to have chosen neuroscience as my profession, which gives me the ability to interpret the available research papers, and protects me to a great extent from most of the rumors on the subject.

It's true that the original goal of the developers of ECT was to fry, or ablate brain tissue that they thought was faulty. It was just a variation on the lobotomy. But over time some psychiatrists discovered that the benefits were more associated with the resulting convulsions, and the worst of the side effects were associated with the tissue damage itself. That's when everything changed.

Convulsions, or seizures, are something the brain does when it senses damage or dangerous internal conditions (such as high fever) that could cause damage. The convulsions themselves do not cause brain damage, though they can be the result of brain damage. It's possible, though I've not seen any data to support this, that convulsions are some sort of protective mechanism for the brain in response to injury, excess temperature, toxins, or other hazardous internal conditions. In a similar story, until recently we thought Alzheimer's disease was caused by amyloid plaques & tangles. We now know that the amyloid plaques are part of the brain's protective response against oxidative stress. That led to research showing antioxidants can help prevent Alzheimer's. We may one day also learn that convulsions, like amyloid plaques, somehow protect the brain from certain kinds of damage.

And you're right - all drugs have side effects, and drug side effects are not always well known. Remember Vioxx?