We may be witnessing electroconvulsive therapy’s final days. This week, a U.S. Food and Drug Administration (FDA) panel will review whether there’s enough evidence to downgrade electroconvulsive therapy (ECT) devices into the Class II medical device category — that is, a medical device that carries only “medium risk.” Like a syringe.
That’s right, a device that can send electricity directly into your brain is being considered to be placed in the same medical device category as a syringe. And guess who doesn’t mind that reclassification? Why, the American Psychiatric Association, of course — they are right on board with this re-classification (PDF).
Currently ECT devices are classified as Class III devices — high risk. Yet they have never undergone the very basic safety and efficacy the FDA requires for all Class III medical devices and medications. Why not?
We’re told the devices were “grandfathered” into the Class III category because they’ve been around so long. That seems like an odd way to run an agency that’s supposed to be looking out for the public’s safety when it comes to medicine and medical devices.
In addition, the ECT devices that have been around so long are definitely not the ones in use today. Today’s ECT devices are reportedly much safer and even more effective — at least, that’s what the manufacturers claim! So given these are basically completely different devices, how could they have been “grandfathered” in?
The answer to that question is not entirely clear, although it may have something to do with taking the manufacturer’s word that the new “version” of a device is just an update, not a completely new machine. Yet, according to these same manufacturers — for instance, Dr. Conrad Swartz, one of the founders of an ECT manufacturer, Somatics — the devices are safer and better than ever:
Dr. Swartz […] said in an e-mail that any cognitive side effects from Somatics’ latest device “are distinctly less than they had been.”
The research base on ECT devices is much thinner than one would expect for a treatment that’s been available for over 70 years. Thinner — and full of the kind of bias that would make even today’s pharma-backed psychiatric researchers cringe. For instance, if you go back to some of the earliest research on the devices, you’ll regularly find researchers who had direct financial stakes in ECT device companies they were researching.
What this argument all comes down to is the usual — money. It has little to do with the actual safety and efficacy of the devices.
Professional associations like the American Psychiatric Association want to protect their members to be able to continue to “prescribe” such treatments because they are very lucrative to its members — according to the New York Times article, between $1,000 to $2,500 per session. As most patients get at least 8 to 12 ECT sessions, that’s between $8,000 and $30,000 — for just one patient.
But here’s the real kicker (for me, anyways) — the companies who’ve been raking in 70 years’ worth of profits from the sale of these machines suddenly claim they wouldn’t have the resources to do the basic safety and efficacy research the FDA would require if the devices remain classified as Class III medical devices:
“There is not nearly enough money in this industry to begin to pay for clinical trials that would be substantially larger than those already in the medical scientific literature,” Dr. Swartz wrote.
Well, then, perhaps if the device manufacturers can’t find a way to fund (or lobby the government to help fund) such studies, the devices are really not nearly as safe and as effective as they would have us believe. After all, if you really believed a treatment worked and was safe, why wouldn’t you pull everyone together and raise the money necessary?
It just seems kind of ridiculous for a company to claim that their very reason for being in business would suddenly become unaffordable if they were held to the same standards as any modern medical device manufacturer.
It is my opinion that ECT devices are neither particularly safe nor particularly effective (as I wrote 3 years ago here). Yes, of course they’ve worked for some people — every treatment works for some people. But they don’t seem to work for most people, and few doctors seem to give a very clear and complete picture of the device’s side effects. Especially when it comes to unrecoverable memory loss.
I’d love for ECT device manufacturers to prove me wrong. Go, do the basic 101 research that consumers should demand of any medical device that has the potential to turn their brain into the ultimate “living in the moment” organ. Show us all that the data support the use of these devices in a clinical setting.
Until then, the FDA should do its job and protect the public — not the professionals and the manufacturers — and demand the same minimal standard of safety and efficacy data that they demand of all modern medical devices and medications.
Read the full article: F.D.A. Is Studying the Risk of Electroshock Devices
71 comments
Why would that mean it’s final days? I’d think just the opposite..
Personalty, it scares the crap out of me. I’ve had it suggested before and said “no thanks”
While the testing and research may not be what it should, and though it is a high profit therapy, for some it has been a life saver. For those with medication resistant depression, it can make the difference, as in my son’s case. He says he would do it again, if he ever got back into the extremely deep depression that medications couldn’t touch. While ECT may not be an ideal frontline treatment, it is an excellent back-up plan.
Too bad you aren’t speaking from you own experience. At one point in my life I also gave electroshock credit, the drugs gave me brainfog and I was unable to see the clear picture, the end result of electroshock. Because the shocks did end so many years ago and I did get clean from the drugs side effects, I am able to realize how much of my life was destroyed. It isn’t fun to sit and listen while my children reminisce about their growing up years, while I am unable to participate in the conversation.
I can only hope it isn’t too late for your son. I trust most of his life is still ahead of him. I’m sorry for him!
angrykeyboarder…. Well, if the FDA maintains the ECT devices’ Class III rating, they will be required to do the minimal safety and efficacy studies the FDA requires for such devices (and medications). And the companies claim they can’t afford to.
Kim…. Indeed, I don’t disagree that it’s been a lifesaver for some. Many treatments are. But in the U.S., we require that medical devices all undergo the same testing to ensure they are both safe and effective — testing ECT devices have never undergone in the U.S.
I simply think it’s fair to ask that they do so.
Dear Sirs,
I wrote a novel against ECT and lobotomy in 2008 and I translated it recently. You could find the novel (The inheritance of the lobotomized man) on Amazon site.
May be this novel could be helpful for association against ECT and lobotomy.
Sorry for the mistakes in english grammar, I had not the means to ask a professional translator.
Best regards,
More regulation means more expensive, can’t repeal the laws of economics. I don’t know if ECT is the best tool for fighting depression, but ECT use should be based strictly on risk/benefit and expectation of efficacy in a particular case. The author seems to have an anti-ECT/anti-business bias.
Oh OK. I get it now. Thanks.
Reading your article pitted my husband and I against each other. I, being a former patient who underwent 20 ECT treatments, have mixed feelings about its safety. Having suffered from cognitive impairment after being treated with ECT while on lithium (a dangerous mix that few doctors will warn you about or are simply ignorant of), the experience did not leave me feeling “safe” by any means. On the other hand, disabling symptoms that had plagued me for years were completely eradicated. Cognitive impairment was a small price to pay to get my life back; a life that was nearly ended through several years of negligent prescribing practices.
My husband, however, specializes in Regulatory Affairs. According to him, “First of all – if you do not like the way the FDA is operating, tell the Republican Senators in Congress how you are feeling. The FDA has been underfunded for a very long time and will be even more so if the GOP budget cutters have their way. Fewer than 5% of medical devices out there have been tested under the 1976 Safe Medical Device Act due to the enormous cost of carrying out the necessary studies and proper PMA evaluations to fully review these “grandfathered” instruments. If you can convince the government to multiply the FDA’s budget about 20-fold, you may get the thorough testing that you speak of.
As far as ECT instrumentation is concerned, it has been around for decades and is constantly being improved (especially since we live in such a litigious medical environment). Many of these devices come from Europe and were tested under far more stringent conditions, where profit was of secondary importance. As a result, the devices themselves are reasonably safe, however, the technique of using ECT to elicit a brain seizure carries known risks. People with epilepsy often suffer similar cognitive impairment due to the effect that multiple seizures have on brain function. Maybe we shouldn’t place such stringent demands on the FDA, but rather upon the APA whose modus operandi is profits derived from the pharmaceutical industry, keeping patients addicted to complex chemical cocktails.
While ECT is not entirely safe, neither are the pharmaceuticals that are too widely prescribed for patients with severe intractable depression. In a side by side comparison, ECT is more (or less in some instances) effective and has longer lasting therapeutic efficacy. Many pharmaceuticals cause side effects ranging from cognitive impairment, weight gain, diabetes, heart damage, organ failure, and worsened or additional psychiatric disorders usually treated through polypharmacy which causes further complications. Drugs in many cases have not proven any more effective, and indeed, are less effective. Unfortunately, we still live in the Dark Ages of treatment, until a better solution is discovered, ECT is still a viable and effective therapeutic technique.”
In response to your reply to angrykeyboarder – As I stated before – FACT: Fewer than 5% of medical devices received this stringent testing that you claim. Your premise is incorrect.
Since most medical devices that are now marketed were NEVER tested under the FDA protocols following passage of the 1976 Safe Medical Device Act(SMDA), many of the newer devices are simply cleared for marketing through a process known as the 510(k) submission. This simply requires that the new device is compared to a predicate device and determined to be Substantially Equivalent. When devices are submitted to CDRH at the FDA they are ALL initially given a Class III assignment. Following the initial review, a panel of physicians and other educated professionals will then decide whether or not the device will be reclassified as II or I. If the device does not have a predicate, and is considered to carry a Significant Risk (SR), the manufacturer will be required to submit a much more extensive (and costly) Pre-Marketing Application (PMA) containing a significant amount of clinical trial data. Due to the FDA’s meager level of staffing and funding it is still an overwhelming challenge for the administration to keep up with the applications for new devices.
I beg to disagreeand will try to do so civilly. First there is a mass of well done research esp in the last 30 years of ECT the longest of which has been done by Dr. Max Fink of NY, and by the group at Duke and at MUSC Charleston, Dr. Charles Kellner. Second, the prices/fees quoted are ludicrous and untrue. Fees are tightly regulated by insurors and in my recent days of doing ECT till 2004, the fee averaged around $125 per treatment hardly the kind of fee that is implied to drive increased utilization. Third, ECT is tightly regulated in accredited hospitals and is utilized almost always in severely treatment resistant patients whose other treatments have failed to remit their depressions. Other indications are for the most severe manic delirium cases and anyone who has seen a supremely psychotically uncontrollable assaultive manic delirious patient respond to ECT will not dispute its life saving efficacy. The days of ECT being utilized willy nilly left us in DECADES ago and properly so.
i had over 80 ECT treatments between 2007 and 2009.
yes, they kept me alive those years. no, i had no life during those years, i was a mess. yes, i have severe memory loss of those years and of other things.
would i do it again? absolutely not.
my depression has returned, and i struggle through it the same way i deal with my childhood abuses and my various dx’s – i work hard, and i don’t give up.
“treatment resistant” is an interesting phrase. i was considered that once. but i can tell you that submitting to ect was the easy way out.
This is so upsetting! After reading Doctor’s of Deception, I just can’t see how this sort of “therapy” can be thrown in with SYRINGES!
PsychLounge… I’m not sure it’s fair to compare an ECT device — which, if used without proper training or with one setting in the wrong position, can cause serious and perhaps permanent damage — to “medical devices” like a breast pump or the light they used in surgeries. Thank you for illuminating us on the procedure.
fmillmd…. I disagree about the research base. There’s still a lack of studies using control groups and ones that measure the deleterious side effects that are of most concern (e.g., memory). It’s funny how, if you don’t measure it, you don’t have to worry about reporting on it. So while I respect all of the studies that only looking at improvement on depression scores at T1 and T2, I’m disappointed in researchers’ continued myopic view when it comes to the concerns that have plagued this treatment for decades.
Why is systematic study of this treatment so challenging?
What little good research is out there suggests a disturbing variability with regards to how it is administered — and a direct relationship to resulting cognitive deficits (the Sackeim et al. 2007 study):
This was just 3 years ago. After 70 years, we apparently still don’t know how to administer this treatment in a way to ensure the least amount of cognitive problems.
So yeah, I still have my concerns.
It must be something wrong with ECT if in Poland the consent of the patient or his family is required for this therapy and it is used almost in cases of severe depression or catatonia. I wonder, if America is much more backward in relation to the one of the poorest European country.
I heard that you “cure” with electroshocks one British, who was told that he has severe depression and who, when he come back to GB, was proved to be the stereotypical phlegmatic Englishman.
You used lobotomy when it was, for obvious reason, forbidden in almost all communistic (and very backward) countries with Soviet Union (where psychiatry was used against dissidents) ahead, so I think that you will still use ECT in every case. Pecunia non olet.
It is dismaying where so much is represented for mental health treatment representations for treatment effectivness and actual outcomes diverge so greatly. From the NY Times, “Dr. James H. Scully Jr., medical director and chief executive of the American Psychiatric Association, wrote the F.D.A. recently to say the treatment was ‘extremely effective and safe.’ It provides relief some 80 percent of the time, he wrote.” On the other hand, we have the statistics cited by Dr. Grohol in “A Love Letter to ECT.”
For depression treatment in general, we have those who regularly assert a treatment success rate of 80% while we also have the following which introduced an article in the October 2010 edition of the APA’s Psychiatric Services, “The problem with clinical depression is that treatment often is ineffective. Only 5.8% of patients with clinical depression have symptom remission within six months of treatment, according to a Minnesota study of 184 primary care and behavioral health clinics conducted by MN Community Measurement, the state’s public reporting agency.” (A New Direction in Depression Treatment in Minnesota, Psychiatr Serv 61:1042-1044)
Whether it be ECT or any other treatment, mental health consumers deserve a system where representations and reality intersect if we are to make intelligent decisions about our care. The same representations should not only reflect the outcomes realized by those receiving optimal care but “usual care” since this is the very care we usually receive.
If ECT is effective for some, why would we not use it for some? The figure I’ve heard is that “some” is 80 percent.
I have seen someone I know transform from catatonia to normal with ECT. Knowing what I have learned from this experience, how could I discourage its use?
Mark… I agree completely.
I will say I have reservations about the Minnesota study cited, because I couldn’t find it in the research literature. What you referenced was an awards announcement, which actually included no references, methods, etc. It was not a published study, and I could find no references to this treatment approach (DIAMOND) in PsycINFO.
Which isn’t to say that we couldn’t do better in depression remission rates across the board with more systematic and focused treatment efforts. If you look at individual, well-designed, robust CBT studies, however, you will regularly see 70 – 80% remission rates in < 6 months.
You can find more info on the DIAMOND program at the ICSI website: http://www.icsi.org/health_care_redesign_/diamond_35953/
Also, the “latest and greatest” ECT replacement, TMS, is not necessarily any more cost effective than ECT. Patients will spend $300-500+ on each treatment, which is supposed to be done daily for 4-6 weeks. With similar outcome successes, it still seems like ECT would be a viable option for some patients
What an interesting discussion. Far more informative than anything else I’ve seen on this topic!
Firstly, I’d like to say that I’ve been following you writing recently, and it never disappoints. Your responses to comments are also well worth reading.
One little point, and I’m not a medical professional :
An additional comment from you on the regulation and oversight of practioners who assess, and administer the treatment, with a review of their success rates/remissions, might also be of interest.
Dr. Grohol, The source document for the 5.8% depression remission statistic is the MN Community Measurement 2010 Health Care Quality Report and can be found on page 56 forward, Depression Care: Remission at Six Months (Clinic Level Results). http://mncm.org/site/upload/files/HCQRFinal2010.pdf
The grim reality is that many of us suffering from depression don’t have access to optimal care including CBT from a practitioner skilled in this approach. We receive that treatment the public mental health system affords us or we can afford. ECT would be used much less if more persons received that depression treatment which actually makes a difference.
[ECT may be the “Hail Mary” play of depression treatment, “This is your last chance. You’ve failed all previous treatment.” Too much consideration is given to the length of preceding treatment rather then its nature and quality. Perhaps the use of ECT reflects to one degree or another the inability of the mental health system to uniformly deliver high quality, outcome oriented depression treatment.]
I have seen ECT two ways. one as an RN years ago we had patients standing in line down the hall(28)years ago Then in my early upper 30’s- 40’s ( i can’t remember exactly)I was so depressed that nothing worked. That is when they did ECT on me and I was too depressed to say hey no way. I just did it. What was the outcome? I remained as depressed as before but had/have large parts of my long term memory erased and for some reason I lost the ability/interest in reading books. Formerly that was my favorite past times. It was not until Abilify arrived did I make real headway. I now take 5 meds daily and am no longer depressed. of course Abilify makers charges hundreds for the medicine. I have to order it from India four months for 76.00 dollars verse $800.00 for one month here. Ect was the worst & damaged me permanently. That it is still used is Barbaric.
The headline is somewhat misleading and is disconnected from the story. It would imply to the casual reader ECT may be banned by the FDA. Far from it, there will always be a place in medicine for ECT.
As a person who has received great benefit from ECT, if the choice did not exist, I likely would not be here. ECT will always exist as an option as it is remains the “gold standard” in depression treatment. No other treatment for depression maintains as high a response rate.
If I were ever to suffer again from deep dark depression where no other treatments were effective, I am happy I will be able to look upon ECT as a treatment to enable me to regain my life.
Always remember there are a significant number of folks out here who have been helped greatly by ECT and have experienced little to no negative side-effects. The vocal “anti” groups are those whom I believe will be “anti” everything with little thought into the negative consequences of those helped by ECT.
AS founder of Psych Central, I would have expected more.
just read your comments about the FDA and ECT 2011. I’m glad it worked for you. It didn’t for me and I now have significant memory and cognitive dysfunction including remembering my children growing up. My technical skills as a professional artist and writer are sorely damaged and in my art, I don’t recognise my own work. And I wasn’t depressed. I had a terrible reaction to an SSRI that I didn’t need. I just needed someone to talk me through a tense time. The doctor panicked and prescribed ECT x 66 times in 20 months, often against my will. I was threatened, physically forced into the ECT room and often begging them not to do it. It was a private hospital and as a psych patient I couldn’t sue. My opinion was that of a `sick’ person’ meaning it was unreliable.
So, now we know the machines were not accepted as class 11 and I hope you read the correspondence associated with that finding. I also hope you take the time to check the science to support your position. No evidence supports that any beneficial effects are very short lived. Days or weeks rather than months. In the few `good’ (well performed and honest), placebo trials real ECT vs. `Sham’ ECT, remission rates were the same or not statistically significantly different after a month. But the `sham’ people didn’t get brain damaged. Very few long term follow-ups have been done, but it is believed if retrograde autobiographical memory hasn’t come back in three months, it ain’t coming back. Talk to the neurologists, they know. Have a look at some of these mega-studies: `The Sham ECT Literature: Implications for Consent to ECT’ study by Colin Ross. – `The Effectiveness of Electroconvulsive Therapy: A Literature review’, Read and Bentall 2010- `Shock Treatment: Memory Loss and Brain Damage – Psychiatry’s Don’t Look, Don’t Tell Policy’, by Richard Warner, Email: [email protected]. There are others. And understand that whilst `some’ people benefit from it, as is constantly trotted out, `some’ 50+%, of other people’s lives are destroyed by it. In any long-term, (6 months +) only the damage remains. The depression will be back, possibly made worse because people now have realised what they’ve lost. Which `some’ people should we look after? Could there be other solutions to help depression? Take thalidomide, a fantastic anti-nausea drug; the terrible effects were limited to the first trimester foetus. So it shouldn’t have been taken by young women who were likely to become pregnant. ? % of the population but significant because of nausea in the first trimester. No problem with males or women past child bearing age. But off it came. The risks were too great. ECT causes noticeable, permanent brain damage in more than 50+% of recipients, and I am being generous. One in two. Not acceptable.
Mark… I know it’s in a report, but the report isn’t a peer-reviewed journal article. It’s evidence, but at a different level of a journal article. And here’s why you should question this particular data — they defined depression as a PHQ-9 score of greater than 9 and remission as less than 5. Yet the validation study for the PHQ-9 defined clinically significant change as a post-treatment score of ≤9 combined with improvement of 50%. So they used different cutoffs in order to obtain the low numbers they did. Remember, if you change the definition, you can make numbers show anything you want.
Fred………. As the Sackheim 2007 study demonstrated quite clearly, there is little to no regulations or controls on how practitioners actually use the equipment in the real world. And that’s where the problems really begin. Because there is no “standard of care” for ECT treatments (there are competing theories and techniques), different ECT treatment providers will use different techniques that will result in different outcomes and side effects.
But this is true throughout all medicine. Nobody is really watching over doctor’s shoulders until a complaint is filed with a medical board. Doctors and other healthcare professionals are loathe to report colleagues (as other studies have shown), so it’s usually up to the patient to complain.
And of course, some people dismiss patient complaints nearly out-of-hand because of the patient’s depression diagnosis. Especially if the patient’s treatment is forced.
Hello,
I can say that ECT has scared the hell out of me. I have read numerous studies about it and have talked to many who have had it done to find they don’t even remember who their children or husband are anymore. Some who were told they would only need it once, who then later came to find they would have to have a series done again every 6 months for the rest of their lives.
I have depression and PTSD. When I was in Albany New York I was admitted a few times due to self injury which can’t be solved in a 72 hour hold. It’s requires therapy. The doctor wanted to do ECT on me. He tried to have me declaired incompetent so he could do it. But thankfully I had a health care proxy that put my friend in control if I was for any reason unable to do for myself.
So he released me since the health care proxy was keeping him from doing the ECT. He pulled me aside just before I left and tells me “I don’t care about your health care proxy. If you are ever admitted here again, I WILL DO ECT on you”.
That next month I packed up my stuff and moved to California. As far away from Albany New York I could. And I choose California because right now, ECT cannot currently be forced onto you here. At least for now. The ADHD makes it difficult to remember things as it is. I can only imagine how much worse my memory would be if they did ECT on me. No thanks.
This is one thing that should be discontinued. The side effects from it just don’t make it worth the little benifit from it. And a benifit that seems to only last a few months before you have to do it again. The brain is not a computer. And even a computer hard drive can fail with enough restarts.
-Stanley
ECT saved my wife’s life, pure and simple.
*Nothing* was bringing her out of incredibly severe depression, and the hospital had already kept her for two months (one of which insurance would later refuse to pay even their 50% for). And of course they had nowhere else to send her, since the state hospitals have all been compassionately abolished.
ECT brought her out of it. Medication works … *now*.
Haven’t seen any cognitive deficits. Most memory loss was short term, and she says she frankly could have done without the memories that did come back. We’re not talking about a happy, functioning time.
I received ECT at the depth of my severe, treatment resistant depression. I was suicidal and willing to try anything. But it didn’t help me, what did help was a non-traditional mix of psych meds. THAT should have been tried first. I am convinced the ECT gave me an amnestic disorder, but I’ve found very little writings on that possibility – having searched my university’s scholarly databases. I wondered how there could be such a lack of studies!
YYZMAX……. If the FDA does not re-classify ECT devices as Class II devices, the ECT manufacturers have already said they cannot afford to do the research the FDA would require of them. Therefore, yes, ECT may be enjoying its last days.
It’s not clear whether the FDA would ban the use of existing devices. But even if they didn’t, those devices will eventually fail and need to be replaced. If there’s nothing to replace them, ECT as we know it today will be over.
Now I’m curious how you feel about TMS. I’m seeing more and more in the news about that. Do you feel like researchers are doing due diligence? Is it going too fast?
The side effect profile and efficacy of ECT are directly related to where and who completes the treatment. The dose has to be carefully titrated by starting with a very low dose and increasing the dose until a therapeutic seizure occurs. This is how the Mayo Clinic performs this procedure. The only places that are qualified to administer ECT are major research hospitals with a dedicated psychiatrist for ECT. To say that there is no valid scientific research done on ECT is ignorant. While I was receiving ECT treatments at the Mayo Clinic, I participated in three separate clinical trials. You say that past studies are not valid because they have not included a control group. Not treating someone with ECT who needs would be reckless and bordering on malpractice. ECT is not part of a long term treatment plan, it should and mostly is an emergency treatment. Before I received ECT at Mayo Clinic, I was an inpatient in the mood disorders unit. I heard what was described as ‘sirens call’ in another blog on this site. I was smarter than the nurses and they could not stop me from killing myself even while in a secured unit. After receiving the ECT treatments I was still very depressed but I no longer heard “sirens call”. Mayo clinic and its doctors would not do this treatment if it was not effective since the doctors themselves are not compensated based on the number of treatments given. I see on this site that you call yourself Doc John. You are not a doctor unless you have an MD behind your name.
I had 7-13 Ect treatments approximtely 8 years ago. The exact figures, I can not recall because of memory loss. I was not relieved of depression. I was not told that memory loss would be permanant. I now can not remember dates, or learn from a text books. It has disabled my life more than ever. Doctors tell me that this can not be true. I feel horrible that more patiets submit themselves to this procedure without being informed of the possible side effects.
Thank you all so much that spoke of memory loss. I feel no longer like a floundering ship. I know it hurt my memory but they swear it doesn’t. After the last ECT I told my doctor, it” is was not helping and it was making me dumb.” You know what I remember now. how did I forget? he said,” you are too intelligent to do more ECT’s. I am a doctor what the hell would have happened if I was deemed normal?
“If the FDA does not re-classify ECT devices as Class II devices, the ECT manufacturers have already said they cannot afford to do the research the FDA would require of them. Therefore, yes, ECT may be enjoying its last days.”
I pray this does not come to fruition. Severe mood disorders have been in my family for five generations (that I know of). My Great grandmother was diagnosed with dementia preacox (sp?) as was one of her daughters. In 1960 my mother was diagnosed with/as a catatonic schizophrenic which was later changed to manic depression, then later to bipolar. I, for years, was diagnosed with an agitated depression until at age 45, after 20 years of continued sobriety, I checked into a large teaching hospital in NYC. While there I was diagnosed with bipolar. My long lasting episodes of agitated depression were actually “mixed episodes” or dysphoric hypo-mania. Until that time I will guess that I had been on more than 40 different antidepressants. Some of them worked for a few months only to poop out after a year. Many of the medications and combination of meds were prescribed for me at extremely high doses for many months before switching. I am and have always been a compliant patient. Attending therapy and 12 step meetings have been constants in my treatment as well as other “alternative treatments” (yoga, acupuncture, nutritional counseling, psychic healing with crystals, meditation, exercise prayer, etc)Not only did these efforts not work, the end result was that I felt worse about myself BECAUSE they didn’t work. Nothing I tried was able to relive me from this debilitating depression. Finally, after arriving at the conclusion that the only way out of the excruciating psychic pain was suicide, I asked my psychiatrist if she thought ETC would help. By my second treatment, I felt calmer than I had in years. The end result was after a six treatment cycle, I felt better and clearer that I had in years!
Prior to the treatments I was very aware that loosing large chunks of my memory was a very real possibility but I didn’t care because there was nothing about my life I felt was worth remembering. (My mother had over sixty ECTs during the 1960s with permanent memory loss). I also knew that, as with any procedure that requires anesthesia, death was also a possibility. Deeply depressed, that was an idea I welcomed because through that lens, mine was a life worth very little. For me, ECT was nothing shy of a miracle as I had not even dared to dream I might feel that much better. ECT lifted a lifelong, intractable depression. In addition it gave me the gift of hope. The only thing I would do differently would be that I will NEVER allow myself to become so sick for so long.
Although in 2011 we have many antidepressants from which to choose, they do not work for 40 – 60 percent of the people who take them. ECT has an 80 percent efficacy. The people who get well the fastest and most dramatically are the folks who receive ETC.
Today I remain depression free with the help of low doses of an old fashioned tricyclic antidepressant and two mood stabilizers. I am back in school (at age 53), my world is getting bigger and I am forever grateful that ETC exists.
I have had ECT with maintenance sessions from May 2009 to Oct 2010. The ECT was done at our local hospital by my psychiatrist who has been trained in its use. I tried multiple medications and combinations of drugs during which time I had suicidal ideations and attempts. We finally tried ECT and I had relief very quickly. My sessions started at 3 times a week, moving to once a week, decreasing until it was once a month. I had minimal memory loss which returned when reminded of the event or person. I would return to ECT treatments without any reservations.
It has been shown that a only a third of people respond to antidepressants, causing a need to change medications until finding one that works (sorry, no reference but I have read that in articles, many on PsychCentral). For some people, no medication works just as ECT doesn’t work for everyone. ECT today is a safe procedure with little physical risk other than the use of anesthesia and some memory loss. My medications have extensive lists of possible side effects, some very serious. There are no treatments for mental illness that are without risks. Also, psychotropic medications are extremely expensive. My medications cost in excess of $1,700 a month. My ECT treatments cost between $800 and $1200 a session.
If you are truly interested in learning about ECT, I would suggest that a read Shock by Dukakis and Tye which takes a more positive view of ECT and cites many studies.
until recently i had not idea this brain butchery was still used.
I find it shocking that it helps for a little while a people are still willing to risk erasing their lifeworth of memories… and whom they are. I hope I will never be in such situation to even think about this option… but I guess I would chose death than being a shell of myself. Susana Kaysen pondered about quality and worth of human life in Girl, Interrupted… is life itself really worth anything… what is success anyways? I define it as being able to live full life and live up to their potential… not just not wanting to kill yourself.
I am pretty shocked too that some people speak of meds and ECT… but don’t mention psychotherapy, finding sense in life… brainfry will not give you a purpose in life and change your cognitive functioning in a good way.
Stanley, what you describe is scary and I know of a person who packed up and moved out of state for much the same reasons. I would never mental health care in NY or Minnesota after what they have forcibly done to people with ECT. No thanks.
They shut down the ECT program at a hospital in my state because the sudden surge in the 65 year old age group once they qualifed for Medicare and ECT was covered. Turning 65 must be a very depressing year for people.
It’s interesting to me, having had ECT without positive effects and suffering permanent memory loss – I don’t support the eradication of ECT. I know it works for some people, and when I agreed to have it I knew there were risks – not that I could lose my memories permanently, but I would have gone ahead with it regardless. I had tried so many meds and treatments and I didn’t care anymore what negative side effects might occur – I desperately wanted to die, but hated to leave my family in suicide. I was biding time, and partly figured if I tried everything to get better and it all failed, then I’d be more justified in killing myself. As I saw it, I had nothing to lose.
What I can’t stand is the lack of information available for those like me who do lose their memories permanently, and suffer other cognitive changes. I want the VALIDATION of a diagnosis, a recognized condition resulting from the treatments, e.g. 294.0 Amnestic Disorder Due to ECT…
Having observed ECT and learned about it from a local medical school, I know there is still a place for ECT. And the memory loss may be from bilateral treatments (instead of unilateral treatment on the non-dominant side of the brain). However, I’ve never seen an informed-consent form for ECT which addresses this. It also may be that people who complain of memory loss/interruption from it may also not remember how poorly they functioned before the ECT they later regret. I’ve also learned that ECT may “buy time” for people in the early stages of schizophrenia, & I believe I’ve witnessed this, too. Unfortunately other treatments which may help, especially psychotherapy, are too often provided by inadequate practitioners, leaving patients with fewer alternatives.
If the ECT came out now it would be subject to extensive testing. Just because it’s been around for 70 years, over-used and abused, and was developed in the dark ages of mental illnesses. It’s use should be stopped until it’s proven to be at least safe, as well as beneficial.
I have had ECT on and off for 12 years. If it weren’t for them I would be dead. I don’t know what I would do if they stopped giving them.
I really don’t see how this could be the end of ECT. Yes, manufactures are stating they would no longer be able to afford making them, and would there for stop, however I truely believe that to be an idol threat.
I support ECT treaments, they have truly made a huge difference in my life. Just recently, I was very suicidal. I made three attempts in a little over 90 days…yes, in the begining I was no way on the thought of ECT. However, when I was so deeply depressed I figured I had nothing and it has made huge difference, so I truly hope this is not the end of ECT treatments.
ECT changed my life, but not in the way I had hoped. Yes, it allowed me to leave the hospital and “live” for about 2 months. After I realized what I had allowed to happen, I ended up suicidally depressed,traumatized, and back in (a different) hospital. I do not remember events from that summer or even things that happened in the years surrounding it. I have even been to places that I was told I had been and still did not recognize it. I’ve looked back through old journals and medical bills to discover things that I have no recollection of. My children tell me stories of school events, but I cannot recall them. I was a licensed pharmacist and when I realized that memories were not going to come back, I decided that I no longer felt confident in my profession. I feel that ECT has had quite a negative effect on my life.
I don’t know that it should be stopped, some people are helped very much and some do need to continue it. If they know it works and don’t experience negative side effects, or are able to cope with them, then they should be able to continue. However, I believe that there should be more testing done, with follow up on everyone it is administered to. I also feel that the side effects need to be more clearly explained, including the possibility of severe memory loss and continuing cognitive dysfunction. The patient should know of this possibility and know ECT may have a great impact on their life, even affecting their self-perception. I feel I am no longer the person I was. I agree with the above responses that would like to see some validation of the cognitive disruptions. I never know how to explain to people that I have years that I cannot account for and am embarassed by how often I cannot get a full sentence out of my mouth without forgetting the words I wanted to use.
This topic makes me very emotional because I would never have submitted to ECT treatments had I known I would lose the memories of some of my children’s lives. I just wish I had had more information with solid data that I could have used in my decision.
This article seems over-extrapolated, and going in the wrong direction. This is what I see happening:
1. It is very doubtful the manufacturers do not have the money to run appropriate tests. Not wanting to spend the money and not having the money are two different things for it. Why take their word for it? Surely, they’d rather run tests than go out of business. If they remain at level 3, that will be all that will happen.
2. Psychiatrists are obviously lobbying on behalf of the manufacturers, in a shameless effort to do an end-run around the law and public consultation. It is disgraceful and corrupt.
3. Point 1+2 make it likely that the FDA will defer to psychiatrists recommendations. They will likely be domoted to class II.
4. Changing ECT machines to category II would make them more widely available, and, more importantly, would remove a level of stigma associated with them (and rightly so), so that it could become an easier sell on behalf of so-called “therapy” providers.
It will be a dark day for humanity if these get classified like a syringe. The notion of grandfathering anything in should not exist in medicine. Or else why not keep using leaches and bloodletting.
Electroshock is so unregulated, for 70 years in USA, it is the Bernie Madoff of mental health. Despite this lack of oversight some Americans get it over their reasonable expressed wishes, even on an outpatient basis. Google – MindFreedom forced electroshock – for more info.
I had 6 series of 3 “treatments” each sometime in 2008. I don’t remember exactly because ect took about 2 years of memory away from me. It’s taken a long time to get back to the level of sharpness in thinking I used to have, and I’m still not 100% yet.
I really think they shocked me because they didn’t really know what else to do with me, and simply saying “I don’t know how to help you” isn’t in the typical psychiatrist’s vocabulary. I think they also liked getting paid from my health insurance.
I hope the doctor that performed my ECT enjoys his McMansion, while I scrape by on disability.
IT’s so unfair what doctors get away with all because they have that ‘title’. Agree, they don’t know what else to do so they just decide to do the ECT as something to do.
Well, here’s some good news, at least for now…
An advisory panel to the FDA decided Friday that ETC devices need to be subject to the same testing as other medical devices now entering the market.
The FDA does not *have* to follow the advisory’s recommendations, but, it usually does. 🙂
A final decision from the Administration should come later this year.
Read the story here:
http://www.sparkpeople.com/resource/health_news_detail.asp?health_day=649384
Peace!
There are plenty of NIMH sponsored randomized control studies demonstrating the efficacy of ECT.
The treatment is not going anywhere.
What we should be talking about is better understanding who would benefit better by it and/or better training by those administering it.
Dear Dr. Wayne, There are plenty of well organised, honest and `transparent’ studies and reviews of the evidence from over 70 years of ECT’s use that say it is neither safe or effective and the FDA upheld that in 2011. My problem is why are you and your colleagues so insistent that there should be no investigations into its use? Could it be because you can’t? Try looking around without the blinkers. You might find the search very interesting.
It’s strange that the author has such a strong opinion against ECT, but provides no scientific evidence that the treatment does not benefit most of the patients who utilize it. Depression is so painful and debilitating it would be regretful to limit one of the effective weapons in the arsenal to combat it. I may be wrong, but it is my understanding that permanent memory loss is not a common side effect in current practice, at least not as common as tardive dyskenesia is in the treatment of psychosis, for example.
Curious… the research is in the articles we linked to, as we’ve provided the research in the past about issues with ECT. We don’t like to be repetitive on issues where there is little debate (e.g., ECT causes memory problems).
No one is arguing that depression isn’t painful. What I am arguing for is the same testing that you would demand of from the latest pharmaceutical drug — both of which have the potential to seriously make your life worse. Much worse than depression itself.
I would ask in return, Why the double-standard? Why wouldn’t we want such testing done on these devices?
Dr. Wayne, you said,
“There are plenty of NIMH sponsored randomized control studies demonstrating the efficacy of ECT.”
It is my understanding that that those studies are only for the short term. And that to avoid relapse, several maintenance treatments are needed.
Are there any studies that show the long term effectiveness of ECT for at least one year?
Thanks!
Dear AA, Why not? Because there aren’t any!
The lack of regulation with ECT was one of the reasons I didn’t agree to it. Many years later, I continue to be glad I didn’t do it.
I’m glad something is happening with this:
“Warning that patients could be at risk, an interdisciplinary group of multinational investigators is calling on the U.S. Congress and federal regulators to tighten a law that permits use of brain devices to treat rare neuropsychiatric disorders without supporting clinical trials or stringent patient oversight…”
http://www.medicalnewstoday.com/articles/215637.php
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