Posted by: thealienist | August 5, 2011

An Analysis of “Anatomy of An Epidemic”: Part III

Chapter 3 of Robert Whitaker’s book, Anatomy of an Epidemic, is fairly short and begins his discussion of the history of psychopharmacology and the changes it brought to the practice of psychiatry.  Much of this section seems to revolve around the concept of the “magic bullet.”

Mr. Whitaker begins his chapter by recounting the discovery of early antibiotics and the realization that medications could be created that had more toxicity some cells and less for others.  He quotes Ehrlich with what I assume will be his definition of a “magic bullet”:

“If we picture an organism as infected by a certain species of bacterium, it will be easy to effect a cure if substances have been discovered which have a specific affinity for these bacteria and act on these alone.  (If) they possess no affinity for the normal constituents of the body, such substances would then be magic bullets.”

Now, what are we to make of this idea?  We need to see if Mr. Whitaker believes that magic bullets exist as described by Ehrlich or if he harbors some doubt.  We may be able to poll people and quote those who are “true believers” in such things, but is there any factual evidence that these exist in any area of human experience?

Mr. Whitaker cites salvarsan as the first “magic bullet.”  How does it stack up?  It is an organic derivative of arsenic that was able to kill the organism causing syphilis.  So far, so good.  But did it really have “no affinity for the normal constituents of the body?”  Not really, salvarsan had significant toxicity that worsened on exposure to air.  The Merck Index simply says, “It is poisonous!”   It is no longer used therapeutically.  It does not seem to be much of a “magic bullet” though it was indeed an advance for its time.  The next “magic bullet” mentioned is sulfanilamide, a member of the class of medications called the sulfonamides, which found it usefulness in treating bacterial infections.  It also worked well to kill bacteria, but the sulfonamides are also known to cause kidney damage, anemias, hypersensitivity reactions, hepatitis, hypothyroidism, arthritis, and various neuropsychiatric disturbances (Goodman and Gilman’s The Pharmacological Basis of Therapeutics).  These are not all common side effects, but they show that this medication does have effects on the “normal constituents of the body.”  The third “magic bullet” mentioned is penicillin.  This comes closest to the idea of a “magic bullet” due to its usefulness in treating infections, but even it is not without potentially harmful effects on the body (most frequently allergic reactions).  Mr. Whitaker points out that as more and more medications were synthesized, society became more optimistic about conquering more and more types of diseases.  The “magic bullet” was about to change psychiatry.

But have we ever found any medication that meets Ehrlich’s definition of a “magic bullet?”  Do any of Mr. Whitaker’s examples suffice?  It is telling that Mr. Whitaker uses examples of antibiotics for his “magic bullets.”  If there were ever to be one discovered, it would be among the medications that target non-animals (even better — noneukaryotes, i.e. bacteria) that affect animals (eukaryotes).  This is Mr. Whitaker’s best chance, but he cannot find a medication without some risk to the host.  How, then, are we to understand the idea of the “magic bullet?”  It is not a real thing — it is an ideal.  We do not criticize a drug for not being a “magic bullet,” but we can assess how close it comes to this ideal.

As Mr. Whitaker tracks drug development into the field of psychiatry, he notes the progress of mental health treatment through the “moral therapy” era and into an era of “physical treatments.”  Contrary to Mr. Whitaker’s statement on page 43, moral therapy was not viewed as a “failed form of care” but became impractical and financially unsupported, leading treaters to seek new forms of care that fit with the cultural forces of the time.  Still, Mr. Whitaker notes several forms of treatment that range from the head-scratchingly bizarre (tooth extraction) to inexplicably successful (electroconvulsive therapy).  He also notes the shortsighted foray into the frontal lobotomy.  His description of the state of some mental hospitals of the time is well-designed to elicit sympathy and horror.  Against this backdrop, Mr. Whitaker quotes various influential people expressing the great need for mental health care and with great hopes for psychiatric treatments.  His last quote is from Dr. Howard Rusk who said, “We must realize that mental problems are just as real as physical disease, and that anxiety and depression require active therapy as much as appendicitis or pneumonia.  They are all medical problems requiring medical care.”  With this, Mr. Whitaker sets up the argument that he intends to knock down.

So, why is this chapter in the book?  What purpose does is serve in Mr. Whitaker’s argument?  It seems to do a few things such as

1.  Set up the idea of the “magic bullet” as a tool with which to criticize psychiatric medications;

2.  Show that historically psychiatrists have provided treatments that over time have been repudiated; and

3.  Blur the lines between opinion and fact.

The first point is rhetorically useful, but intellectually problematic.  If you want to convince people that something is flawed, it is often better to compare your subject to a very high standard.  This makes it stand out more in stark contrast.  A more nuanced and realistic approach may not be nearly as motivating to your audience once they realize that the flaws you are pointing out are not unique.  Such is the case with the “magic bullet.”  No matter where you get your treatment or what kind of treatment you get, there will always be risks of side effects.  There is no treatment that ONLY treats what you aim it at and has no other effects on the person.

The second point is valid and is a sober reminder of the need for responsibility in ALL fields of medicine.  The point is not unique to psychiatry.  The emotional content of the section dealing with this point, however, is apt to be misused to discredit psychiatrists in particular.

The third point may or may not be widely accepted, but here is why I think it plays a role in this chapter.  Almost all of the quotes that Mr. Whitaker uses in the later part of this chapter are OPINIONS.  As opinions, I may choose to agree with them or not, with no harm to logic or meaning.  If I read the last part of this chapter as opinion, then the chapter winds up saying something like, “Infectious disease doctors have cool drugs, and some people hope that psychiatry gets drugs that rival the ideal qualities of antibiotics, though they may not.”  If I read the same section as fact, however, then I wind up believing that “infectious disease doctors have cool medications, and successful psychiatric medications will have the same ideal qualities as the antibiotics.”  It’s not much of a difference, but being disappointed in the opinion reading is less motivating and attention-getting than feeling lied to with regard to the fact reading.


Responses

  1. Perhaps Whitaker derails magic bullet train. He should have said that the temptation to declare the discovery a magic bullet for ANY disease is a constant in the history of medicine. Just read the health wires.

    The sadder, wiser history of magic bullets is that they usually fail in spectacular fashion. Did you know that the weight of the literature does NOT favor the use of antibiotics in the treatment of acute otitis media? Most people, INCLUDING PEDIATRICIANS, don’t know this either. Don’t take my word for it. Check out Cochrane, or the work of my colleague David Newman. So much for antibiotics as magic bullets.

    The history of psychiatry is sadder still. Truly heinous “therapies” scar the history of madhouses in the 18th century. It’s interesting that you say that the frontal leucotomy has been repudiated. Too bad it hadn’t been repudiated by 1949, when its inventor, Egaz Moniz, was awarded the Nobel Prize in Medicine for the discovery. Not effective? To the contrary! It was spectacularly effective! It stopped crazy people from bothering their families and communities.

    As for ECT, that you refer to as “inexplicably successful”: John, you’re a neuroscientist. Let me ask you: why do we stop seizures? Don’t seizures kill brain cells? If you can’t come up with a better explanation for the “success” of ECT, might you consider that the mechanism of action is similar to that of the frontal leucotomy, except that it takes more whacks to achieve the desired effect?

    Finally, back to your critique. Perhaps Whitaker’s criticisms can be generalized to medicine writ large. Fair enough. But Whitaker’s book is about psychiatry, not medicine full stop. Arguing “Tu Quoque” (roughly translated “Yeah? Well so’s your old man!”) is a hell of a bad way to win an argument.

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    • Rob,

      I actually know about the use of antibiotics in otitis media, but I am not trying to critique other medical practices. I’ll let folks like you (pediatricians) police your peers.

      Regarding the frontal lobotomy, it was effective in a narrow sense, but the cost was too great. Again, as I tell my patients, “I can make you stop doing or feeling anything — it’s called general anesthesia, but that’s not going to make you better.”

      As for ECT, it is the most effective treatment for depression. In many, it has very mild and tolerable side effects. Certainly, its potential for significant side effects means that we do well to use it judiciously. The comparison to the effects of frontal lobotomy is unjust. Talk to the many people who have benefited from its use. It’s effects are truly “inexplicable” but for many they are very welcome.

      Finally, I don’t see the problem with encouraging people to see that psychiatry is dealing with the same problems that other health care providers are. This is not to bring others down but to say that it is not fair to set up a standard that no branch of medicine can attain and then complain that psychiatry does not meet it. If we are going to criticize psychiatry, let’s at least use a reasonable standard.

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      • John,

        What exactly is “unjust” about the comparison of ECT to frontal leucotomy? If you will claim not to understand ECT’s mechanism of action, why do you dismiss out of hand the notion that ECT acts by degrees of neuronal killing? Do you claim not to understand how leucotomy “worked”?

        Are there any studies comparing ECT to placebo? I expect such studies are difficult to do well. How do you have a patient wake up with confusion and memory loss without actually shocking him?

        And as for testimonials: you don’t expect us to accept testimonial as a criterion of truth, are you? If we did, we should all be taking the snake oil they advertise on infomercials!

        Finally, as to judging all of medicine by the same standard: please don’t call the kettle black, John. I never claimed that medicine was NOT rife with fraud and coercion. If you had had the benefit of reading me stuff back in my own blogging days you’d have no issue with my bona fides as to hammering pediatrics. It simply won’t do to defend psychiatry with Tu Quoque.

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      • Rob,

        ECT has a long history of returning people to full functioning. It is very clear that this is very different from what the lobotomies were doing. It is also clear from autopsies that any neuronal damage from ECT is very limited. The damage from frontal lobotomy was definitely not.

        I do not know of comparisons of ECT to placebo, but I am aware of success with ECT in patients who have not responded to many different types of treatment. This is highly suggestive that the ECT effect is not a placebo effect.

        As for the testimonials, I accept them for what they are. Just like those who tell of treatments with bad effects for themselves, there are those who tell of ECT with very good effects for themselves. This, along with the research showing ECT’s efficacy in treatment-resistant depression leads me to believe that it can be a very important means of treatment for some patients.

        Finally, I’m not really sure why you are being so defensive about my call for a reasonable standard by which to judge medical treatments. We are talking about a book that singles out psychiatry for criticism and uses infectious diseases as a standard for treatment. Is it not reasonable to point this out and say that this is an unfair way to argue this point? I have made no comments about your “bona fides.” I am worried that you are taking this too personally. There is no “Tu Quoque” argument going on here.

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      • Sorry to double dip. I want to address your plea for a reasonable standard. It is precisely here where psychiatry fails.

        Since the dawn of scientific medicine in the 17th century, starting with Virchow, disease were defined not by phenomenology, but by pathology. Even today, even putatively medical entities such as irritable bowel syndrome and fibromyalgia do not yet merit standing as true diseases. Why? Because neither entity is associated with pathology, to say nothing of etiology or pathophysiology. That we nevertheless pretend (in the sense that I used the term last time), displays the same degree of folly that we display when we pretend to treat mental illnesses.

        Want to bring up seizures disorders or other entities for which we cannot identify gross pathology? Fine, but seizures are associated with objective findings (abnormal EEGs)

        How’s this for a reasonable standard: objective, measurable, and reproducible diagnostic modalities? Do any medical entities fail to meet the standard? Yup, you bet. In my book, they don’t merit the designation “disease”. The problem with mental illnesses is that they ALL fail to meet the standard.

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      • Rob,

        No problem on the double dip. As long as you have something productive to add, feel free.

        I’m not sure if we are going to be able to agree on this topic, Rob. I’m also not sure why you are so hung up on the word “disease.” Sure it is a great ideal to know enough about the physical basis of a particular kind of suffering that it ranks as an official disease, but does a mere word make the suffering more treatable or less distressing? Does it make the medications work better? We know a lot about mental illnesses, but our knowledge is largely not of the same kind as in the general medical illnesses. We may not yet know the anatomical pathology of many of the illnesses we treat, but we know an increasing amount about the psychopathology of the illnesses that we treat. What we know about the physical effects of our medications may not be sufficient explanations of their mental effects, but their behavioral effects are clear enough to justify careful therapeutic use. (But our knowledge of the physical effects of our medications is necessary to improve our understanding of, prevention of, and monitoring for unwanted effects.) With additional research, we should continuously improve our skill in our use of medications, electromagnetic stimulation, and psychotherapy to address the emotional and behavioral disorders we encounter.

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      • Thanks, John, I’d go looking for refs on autopsy data s/p ECT, but if you have cites, that would shorten my journey considerably.

        I see your point about infectious disease and psychiatry. What I’m proposing, a reasonable definition of a disease, clearly differentiates psychiatry from medical disciplines.

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      • Rob,

        See below. This is a quick survey. I know some of the authors, but not all. I think that these give a realistic view of ECT in that they contain both positives and negatives. Note: Not all are human studies (though most are). I’m not sure how many of the full texts you have available on-line. I hope this is a helpful start.

        Electroconvulsive therapy, brain-derived neurotrophic factor, and possible neurorestorative benefit of the clinical application of electroconvulsive therapy. By Taylor SM, The Journal Of ECT, 2008 Jun; Vol. 24 (2), pp. 160-5

        Practitioner review: electroconvulsive therapy in adolescents. By Walter G, Rey JM, Mitchell PB, Journal Of Child Psychology And Psychiatry, And Allied Disciplines 1999 Mar; Vol. 40 (3), pp. 325-34

        Increase in hippocampal volume after electroconvulsive therapy in patients with depression: a volumetric magnetic resonance imaging study. By Nordanskog P, Dahlstrand U, Larsson MR, Larsson EM, Knutsson L, Johanson A, The Journal Of ECT, 2010 Mar; Vol. 26 (1), pp. 62-7

        Unaltered neuronal and glial counts in animal models of magnetic seizure therapy and electroconvulsive therapy. By Dwork AJ, Christensen JR, Larsen KB, Scalia J, Underwood MD, Arango V, Pakkenberg B, Lisanby SH, Neuroscience, 2009 Dec 29; Vol. 164 (4), pp. 1557-64

        Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. By UK ECT Review Group, Lancet, 2003 Mar 8; Vol. 361 (9360), pp. 799-808

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  2. I just want to sum up how I feel about psychiatry from a patient’s perspective. This will be my last post here.

    I think the best comparison to draw is that psychiatry is remarkably similar to Washington now in its delusion and disconnect from the greater reality of the average citizen (or, as the case may be, psych patient). For over a decade borrowing ballooned in Washington and the debt racked up into the trillions. And yet those in Washington just kept on spending and borrowing, ignoring the alarm bells from people like Ron Paul, Paul O’Neill, Noriel Roubini and others. The political gridlock and sheer nonsense of it all peaked with the debt ceiling debacle which had no real outcome other than raising the debt ceiling yet again.

    Then S&P came along and did the right thing and spanked the US for its toxic idiocy and downgraded our credit rating. It has come to this historic measure to send a message.

    Using the Washington analogy, I honestly think Whitaker, Kirsch and other critics of psychiatry (but NOT those who are “anti psychiatry” — there is a difference) are the S&P of psychiatry. Psychiatry has been in denial for a long, long time about the all-out corruption of its profession. Yes, I could cite seemingly endless flawed and corrupted studies by poisoned psychiatrists like Biederman and Nemeroff and the undying legacy of the “chemical imbalance theory” (which is still being used by Dan Carlat and at least one prominent webmd psychiatrist), but for the sake of my analogy I’ll cite the fact that none other than ghostwriter extraordinaire and Stanford University conflict of interest golden boy Alan Schatzberg is APA PRESIDENT. And Tom Insel, who has been suspected of being instrumental in getting Charles Nemeroff (the OTHER ghost-writer extraordinaire and conflict of interest wunderkind) appointed as chair of psychiatry at the University of Miami after he was forced to resign as chair of Psychiatry at Emory over conflict of interest disclosure issues, is the director of the NIMH!

    In my opinion, this is quite similar to Henry Paulson being tapped by Bush to be Treasury Secretary in 2006 even as the subprime market was nearing crisis levels and Paulson was a chief architect of this meltdown due to his aggressive support of deregulation. A news report even said this in April of 2007: “All the signs I look at” show “the housing market is at or near the bottom,” Paulson said in a speech to a business group in New York. The U.S. economy is “very healthy” and “robust,” Paulson said.”

    But even with such toxic nonsense, at least Paulson (and Greenspan, another prime suspect in the meltdown) admitted they were wrong. You’ll get no such admittance from Schatzberg, Nemeroff, Insel, etc.

    And ultimately it took people like Kirsch and Whitaker to spank psychiatry into a much-needed dialogue. Yes, their arguments are intense and all their points may not be confirmed in hindsight, but when psychiatry chooses not to police itself, it doesn’t get to choose what those who bring it to justice accuse it of. It can only offer counter arguments, and so far they’ve been pretty weak: back-peddling about the chemical imbalance theory (“well, it’s been a discredited theory for quite some time now,” or, “there’s a difference between theory and fact,” yet neither of these points address why this theory is still used by many psychiatrists to get their patients to take meds), the “everyone else is doing it, so why can’t we?” defense that claims such corruption is endemic in all of medicine (that may be true, but if such an argument didn’t work on our parents when we were kids, how can we expect it to work as grown-ups?), and the tortured logic behind claims that psychiatry is, indeed, like other medical specialties (forever the grand hope of the medical model of psychiatry!) by saying many other diseases such as cancer and hypertension have unknown etiologies. Well, that may be true, but I think Marcia Angell’s point is well taken that even though we don’t know what causes something like arthritis, we at least know a fair amount about the underlying mechanism and how the treatments (anti-inflammatories) work. Psychiatry knows neither about underlying biologic mechanisms of mental illness or how its treatments work, yet it still claims to be a medically-based profession.

    But the ultimate counter-argument is evidence. What evidence is there that clearly shows the long-term efficacy (and safety) of antidepressants? I don’t know of any. Unbiased, longitudinal (I’m talking at least five years, and ten years would be that much better) outcome studies comparing antidepressants to placebo and other therapeutic modalities like CBT and other talk therapies are vitally needed, but I don’t hear anyone but Whitaker crying out for such studies. I think it’s quite telling that in the 25 years since Prozac was introduced, only one such study, the STAR*D trial, was conducted, and it wasn’t exactly a rollicking success for antidepressants. Even if it was indeed a sloppy study, that’s even more reason to conduct a fresh longitudinal study with lessons learned from the STAR*D trial, but I don’t see psychiatry advocating for that.

    in In fact, the only one I see actively taking steps to begin unbiased psychiatric studies and to disseminate unbiased information is Whitaker, who set up his foundation expressly for those purposes.

    In conclusion, I will quote the psychiatrist at oneboringoldman.com, who has neatly summed up how I feel about psychiatry and the direction it should take in the future:

    “Dr. Angell writes a stinging indictment of Psychiatry and the modern turn to psychopharmacology. She sees psychiatry as way off base right now. In ‘The Illusions of Psychiatry': An Exchange, several prominent Psychiatrists acknowledge the problems, but go on to defend the specialty and its current directions. I think that’s a mistake. While I agree that some of the anti-medication current in many recent writings may go too far, in my opinion, it’s not the place of psychiatrists to defend anything right now. That’s for later, if and when we’ve restored some credibility to our scientific processes and literature, when our evidence is based on genuine science. Right now, right-thinking psychiatrists need to focus on clearing out the forces among us that have made our specialty a target of mockery.

    I’d rather join forces with the efforts…to end ghostwriting and insist on transparency in our scientific literature. With the likes of Nemeroff, Schatzberg, Biederman, and many others prominently in our midst, we haven’t got a leg to stand on in defense of anything…”

    Like

    • Psychtruth,

      Thanks for your input into the blog. I’m sorry that you are deciding to stop posting. I hope that over time the science will come around to answer the questions that you have brought up.

      Like

  3. Oops. Triple dip. Era of
    Scientific medicine is 19th century. Fat thumbs? Or wishful thinking?

    Like

  4. Thanks for the cites, John. The study in monkeys is fairly persuasive. If they truly reproduce ECT conditions, then the data show no evidence of neuronal damage. I like that they included a negative control group. A positive control group would have made their paper stronger, but it was good enough to publish.

    I was unable to get more than an abstract from the Lancet. I’m willing to pay for it but I’d prefer the cheap route if you have a pdf. Would we be violating copyright laws if you emailed it to lindeman@natickpediatrics.com? No worries if you can’t. I’ll get it myself. I’m particularly interested in the placebo groups in these studies. If ECT causes no measurable change in brains whatsoever, then the contribution of placebo effect becomes extremely important. I confess I’m not as interested in articles published in the Journal of ECT, for reasons that should be obvious.

    I’m getting an education here. But I have more questions: If ECT is more effective than medications (and the data certainly support this contention in the Lancet abstract – which is to say absent an active-placebo effect, there does not appear to be much therapeutic effect of anti-depressants, particularly in long-term studies), then the question is begged: why aren’t all depressed people prescribed the most effective therapy?

    Is the putative therapeutic effect of ECT specific to depression? And if so, why?

    Like

    • Rudorfer, MV, Henry, ME, Sackeim, HA (2003). “Electroconvulsive therapy”. In A Tasman, J Kay, JA Lieberman (eds) Psychiatry, Second Edition. Chichester: John Wiley & Sons Ltd, 1865–1901.

      A comprehensive review of ECT from an on-line textbook. They are rather effusive regarding ECT in depression (“the evidence is overwhelming”).

      There was an interesting section on theories of mechanism of action, all dead-ends. Even more fascinating were the sections on use of ECT in schizophrenia (they claim efficacy, although so nuanced as to suggest that they don’t believe the result), and even in neurological diseases such as Parkinson’s Disease!

      At the end of the chapter, one is left wondering why ECT is not used for any and ALL diseases, particularly first-line in depression. The authors appear to have succumbed to the syndrome of “when you’ve got a hammer, the whole world looks like a nail.” I hope the Lancet is more circumspect.

      Like

      • Rob,

        Yes, the Lancet seems much more focused in their review of studies. I’ll see what I can do to get you a copy.

        (By the way, that is one of my favorite sayings…”When all you have is a hammer, everything looks like a nail.”)

        Like

    • Rob,

      Those are good questions. While I was reviewing some literature, I came across some references to very good results of ECT in bipolar disorder, but I seem to recall that they were from old studies, so I’m not quite sure how to take them. More recently I was taught that the treatment is more particularly sought for Major Depression than Bipolar Depression. I’m sorry I can’t say more than that right now. I’ll continue to look into it.

      I thought that the cites from Journal of ECT probably were not the most pursuasive but were interesting nonetheless. You don’t really expect that journal to specialize in negative reports on ECT.

      As for the reason behind the use of ECT as a last resort treatment, I think that there may be several reasons. First, it has a scary history. Early ECT, which was done without neuromuscular blocks and deep sedation, was really pretty ugly. This was widely published and resulted in a reasonable anxiety about the procedure. Second, while it is safe for many, there are those who have had prolonged problems with memory following treatments. The perception that medications have fewer long-term side effects (though debatable by many) led the more “invasive” treatments to be withheld as “last ditch” options. Third, as you might well expect, when ECT is used involuntarily, it is a potentially horrifying intrusion into the life of a patient. This leaves a reduced pool of potential patients — those who have the ability and desire to consent to the procedure (i.e. not too sick) who have also tried all the less scary treatments and failed. Fourth, there is a need for preventive treatment following ECT. Many are put on antidepressants in an effort to prevent relapse. Some few get maintenance ECT. Most other treatments can easily be continued as maintenance, but there is very little data on the use of long-term maintenance ECT. Most psychiatrists would prefer to induce remission and continue maintenance with the same type of treatment. Finally, the Scientologists and their associated lobbying groups have done a very thorough job at legislating restrictions on ECT in many states.

      Like

  5. I wouldn’t be happy to see ECT used more. I lost almost all my memories from 2008 (maybe more) because of 7 treatments that did not help one bit.

    The whole experience was traumatizing. I DO remember the terror of not knowing where I was or what was happening after the procedure. Apparently, one time I tried to run away and they had to tackle me and inject me with Haldol.

    I was told such memory loss was rare. I do have severe depression that is ongoing, so I was an appropriate candidate. The price of so many lost memories was too high even if the treatment had “worked.” If it had worked, I would have had to keep going back to that terrifying experience month after month for maintenance ECT. I did not know it would be so frightening.

    This treatment is terribly expensive, also. And you have to line up a family member to take care of you for a month. Damned if I could remember where the flour was kept, or the mixing spoons. That kind of memory did return after treatment.

    (As an aside, on antipsychotics, I made frequent errors such as lay a dishtowel next to a burner and set it on fire, or grab a cookie pan out of the oven without remembering to use a potholder, run into doors etc).

    It just isn’t practical to use ECT a lot more often, imo.

    Like

    • Cats,

      Your experience with ECT is important for others (doctors and patients) to consider. Even though it can be safe for many, ECT certainly is not for all. There is research being done to try to tell who is at the most risk for memory side effects from ECT. This is very important and will hopefully be able to spare others what you experienced after your ECT. Thanks for sharing.

      Like

  6. Hmm, the effects of ECT don’t seem minor to me.

    Electroconvulsive Therapy Causes Permanent Amnesia and Cognitive Deficits, Prominent Researcher Admits

    http://tinyurl.com/3usdwle

    In a stunning reversal, an article in the journal Neuropsychopharmacology in January 2007 by prominent researcher Harold Sackeim of Columbia University reveals that electroconvulsive therapy (ECT) causes permanent amnesia and permanent deficits in cognitive abilities, which affect individuals’ ability to function.

    “[T]his study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings,” the study notes.

    For the past 25 years, ECT patients were told by Sackeim, the nation’s top ECT researcher, that the controversial treatment doesn’t cause permanent amnesia and, in fact, improves memory and increases intelligence.

    Psychologist Sackeim also taught a generation of ECT practitioners that
    permanent amnesia from ECT is so rare that it could not be studied. He
    asserted that most people who said the treatment erased years of memory
    were mentally ill and thus not credible.

    Link to the study

    http://www.nature.com/npp/journal/v32/n1/pdf/1301180a.pdf

    By the way, I realize this article is from 2007 but I think that admission is stunning. Many people claim it doesn’t go far enough but that is another post.

    Like

    • AA,

      You linked to a good article. If you look carefully at the data, it shows that cognitive performance is worsened immediately after ECT but is improved by 6 months following the treatment. The effect of impairments in autobiographical memory can persist, but appears to depend on the placement of the stimulating electrodes and the form of stimulation delivered. This indicates that we should be able to limit the amount of amnesia experienced. Overall, the data you referred to shows that for most people who receive ECT with electrode placement and stimulation type chosen to reduce side effects (right unilateral electrode position and non-sine wave stimulation current) the effects on cognition are largely helpful. This study should be reassuring for those who feel that they need this treatment to address their depressive symptoms.

      Like

  7. …still you gotta give Sackheim credit for having the cojones to publish this

    Like

    • Rob,

      Why did it take him 25 years to publish this study when people who had ECT were complaining for years of memory loss?

      And please don’t tell me there wasn’t enough evidence to do an earlier study. Psychiatry has a history of blowing off patients when they complain about side effects as they are deemed not credible due to their “mental illness” label.

      Alienist, you’re right, I didn’t read the study carefully. Unfortunately, due to brain fog, which I partially blame psych meds for, I haven’t been able to go back and focus long enough to really study it more carefully.

      Regarding animal studies and ECT, I would be very skeptical as I feel no matter what your position is, that they have several weaknesses. Even if I find an animal study that seems to support my position on an issue, I don’t feel it proves anything one way or another.

      Like


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