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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by bob on February 4, 2002, at 21:11:44
Well... what did everybody think of that Discovery Channel Program on ECT? I don't think it did the treatment modality any favors at all. Most of the hour long program was negative, in my view. Peter Breggin was on there every 5 minutes spouting doom and gloom about all forms of treatment that interefere with the brain's mechanisms, with ECT recieving the spotlight here. It seemed that every little positive thing they had to say was than squelched with a mountain of negativity. I think if I'd never done any reading about it, I'd get the impression that ECT was usually a failure, sometimes a disaster, and every once in a long while, a miracle occurs.
I don't know... maybe I just don't want to face the truth?
Posted by IsoM on February 5, 2002, at 0:55:55
In reply to Discovery Channel - Shock Therapy, posted by bob on February 4, 2002, at 21:11:44
I never saw the show. Canadian channels can vary in what they carry, but I have seen programs on ECT before & I have to agree with you -- most are very negative & discuss postive effects little.
The people who talk about it are usually those who have the old style treatment where you can really call it shock therapy. Those have sufferd far more & are vocal about it. I don't blame them. They suffered terribly with the old treatments. But nowadays, the current used is so low, treatment is more likely to be unilateral, muscle relaxants are given, & the course of treament is generally far less than before.
I'd still regard it as a last resort treatment but I've heard from doctors (& a couple of patients) that it's still the best & quickest means of treating strong suicidal feelings.
Posted by bob on February 5, 2002, at 14:58:39
In reply to Re: Discovery Channel - Shock Therapy » bob, posted by IsoM on February 5, 2002, at 0:55:55
For someone who doesn't know anything about it, I definitely think ECT did not come off very well at all in that show. They only really present two successes: a tympani player in an orchestra, and a girl that went completely rigid and catatonic around the age of 9 or 10. In the latter case, there was absolutely no other choice. Luckily, the treatments brought her completely out of whatever happened. They don't mention her being on meds. That leaves only the tympani player as someone who WILLINGLY sought treatment and is satisfied with the results. I don't remember him mentioning being on meds either. Curiously, he gets very little air time. I guess lack of controversy doesn't make for a good tv program.
The others are all "failures". One in particular I feel is quite inappropriate. It's an older man who seems to have received a rash of treatments when he was a child (thus placing him in the medieval era for ECT) and then stopped having them. He dwells on the insensitivies of the staff when he was being treated, and naturally attributes ECT to destroying his life. He may very well be right. I don't understand what this has to do with modern day ECT though. His treatments were probably 50 or more years ago. This, of course, gives another opportunity to show what ECT used to be like, file footage and all. Of course it's even more disturbing because he was a young child. They have a liberal dosing of ancient footage from the earlier part of the 20th century where, of course, no muscle relaxants or anesthia are used, so people are flailing and convulsing wildly. I'm not so sure why these type images always have to be shown with ECT. It seems people are very reluctant to let go of what the treatment used to be.
There is a woman who appears in her thirties who describes having had a psychotic episode of depression in the about 5 or 10 years ago. She underwent ECT treatment and is now on meds. She says if they had the meds then that they have now she wouldn't have had to do it (she apparently is taking a med that wasn't available then, although I wouldn't hazard a guess as to what that would be). I contend that the decision would have been no clearer today than it was then. Besides, ECT often changes how people respond to meds. It seems to me the ECT did do what no med apparently was able to for her. She said she has no "feeling" memory anymore, just factual, and that she wouldn't do it again.
The largest portion of the program is dedicated to a young mother who's depression began with a post-partum espisode and degenerated into chronic unremitting major depression about 5 years ago. She undergoes 6 or 7 treatments in the show, during the course of which, she remits for a short time (about 2 to 3 weeks). Then, she falls right back into depression and requests another treatment. There is no success and she stops. She experiences memory loss, but she says it wasn't major, was short term, and was well worth the chance to feel better for a few weeks. At least here, we get to see what going through an actual course of treatments is like, as they follow her through the procedures.
There is no discussion of maintenance ECT. In every example shown, it is implied or stated that a set number of sessions was given, after which no more were to be administered. I think it's pretty well understood now that ECT is not a cure, except in rare cases. There is also no mention of alternate placement of electrodes. The woman who they follow through treatment is obviously recieving bitemporal. No mention is ever made in the show of RUL, or BF placements. Brevital is used as her anesthetic, so this obviously leads to her confusion upon waking.
They do mention rTMS and show a short stint on that, immediately followed by one of Peter Breggins many appearances ranting about yet another form of "electrical lobotomy".
The show does raise a question for me:
If certain things are found to improve the Electroshock therapy, such as using certain anesthesia, or electrode placements (i.e. Bifrontal), why isn't this information immediately disseminated to all people practicing this therapy? It seems like the place at which the woman was receiving treatment was just blowing through the treatments using Brevital and good old fashioned BT placement. What about Dipravan? What about BF placement?Maybe the show is just revealing ECT treatment for what it is: an absolute last resort treatment for psychotic and/or severe suicidal depression/agitation? Or are there many, many cases out there where ECT is a very successful treatment? They do say that over 100,000 people per year reveive the treatment, and that it is on the rise. Are the vast majority of these 100,000 having their lives irreparably destroyed by these treatments? Breggin states that even the proponents of ECT readily admit that any remission will only be shortlived, and so he asks why we are putting people through this for something that ultimately will not be a solution.
The show raises many more questions than it answers.
Posted by Chloe on February 5, 2002, at 19:01:25
In reply to Discovery Channel - Shock Therapy, posted by bob on February 4, 2002, at 21:11:44
I tried to ignore the "negative" or "positive" aspects of the show. I don't know many tv shows that go out advertising such a controversial treatment as ECT.
The thing that interested me the most was how the women in her mid thirties reacted to ECT under general anesthesia along with muscle relaxants. I was really suprised how much she tensed her face and then became very flushed. I guess I thought the "new" ECT with meds on board meant that you just lied there and your brain convulsed but there was not outward evidence that something was sending an electrical shock through your brain.
So despite what the interviewed doctor's said, good or bad, about ECT, it still looks like a very invasive, traumatic way to "reboot" the brain. I also thought that the female patient really "appeared" worse, after her 7 treatments. Not better. Her affect was dull, she looked more blank, and just seemed more dispondent than before she began the ECT. But, this was just my impression of her post treatments.
I do think ECT has it's place, much as I thought before I saw the program. But I think it really should be a treatment of "last resort". If you are in a vegative depression (like that poor little 8 year old, for example), or uncontrollably manic/psychotic, I think it should be used. But for severe depression, I would really think twice. I don't think we *really* know on a case by case basis that there is NOT going to be any long term damage. Or any longer term recovery for that matter.
It is a very controversial subject. Life is a daily struggle for me, like it is for most of the folks on this board. But, I don't think there is a "magic bullet" that is going fix our brains in a few treatments. For most people, I think using a various conbination of meds, and therapy is the best that we can do right now. But this is just my humble opinion.
Hang in there, Bob
Chloe
Posted by bob on February 5, 2002, at 23:47:18
In reply to Re: Discovery Channel - Shock Therapy » bob, posted by Chloe on February 5, 2002, at 19:01:25
> I tried to ignore the "negative" or "positive" aspects of the show. I don't know many tv shows that go out advertising such a controversial treatment as ECT.
>I wasn't looking for them to sugar coat it, but I still think it was biased towards the sensational failure aspect.
> The thing that interested me the most was how the women in her mid thirties reacted to ECT under general anesthesia along with muscle relaxants. I was really suprised how much she tensed her face and then became very flushed. I guess I thought the "new" ECT with meds on board meant that you just lied there and your brain convulsed but there was not outward evidence that something was sending an electrical shock through your brain.
Yes, the face thing was a little disturbing.
> So despite what the interviewed doctor's said, good or bad, about ECT, it still looks like a very invasive, traumatic way to "reboot" the brain. I also thought that the female patient really "appeared" worse, after her 7 treatments. Not better. Her affect was dull, she looked more blank, and just seemed more dispondent than before she began the ECT. But, this was just my impression of her post treatments.
Yes, the treatments didn't seem to help her much. I would think that having a series of unsuccessful ECT treatments would leave someone more despondent.> I do think ECT has it's place, much as I thought before I saw the program. But I think it really should be a treatment of "last resort". If you are in a vegative depression (like that poor little 8 year old, for example), or uncontrollably manic/psychotic, I think it should be used. But for severe depression, I would really think twice. I don't think we *really* know on a case by case basis that there is NOT going to be any long term damage. Or any longer term recovery for that matter.
I think it depends on how severe it is, catatonia etc not withstanding. If someone is continually suicidal and does almost nothing from day-to-day for years, and has gone through many med trials, it may be time. If you can't work, and can't take care of yourself, and you've tried many meds, what do you do? I think people like the woman in the show come to a point where they feel it is worth the risk. Obviously there are people who win the lottery, like the tympani player. It just annoys me that so many in the mental health profession tout the high success rates for remission, and the show seemed so bleak. I know it doesn't last and that continued meds or maintenance ECT are necessary, but they didn't even discuss the follow-up for that woman. It leaves you with a bad taste. I guess it just reflects some of my dashed hopes.
> It is a very controversial subject. Life is a daily struggle for me, like it is for most of the folks on this board. But, I don't think there is a "magic bullet" that is going fix our brains in a few treatments. For most people, I think using a various conbination of meds, and therapy is the best that we can do right now. But this is just my humble opinion.Seems like you're right, and I feel that it may be that way for quite awhile.
>
> Hang in there, Bob
> Chloe
Posted by bob on February 5, 2002, at 23:53:25
In reply to Re: Discovery Channel - Shock Therapy » bob, posted by Chloe on February 5, 2002, at 19:01:25
By the way... did you see when the nurse tried to give her that shot when she woke up? She was so confused, you could see she wasn't comprehending what the nurse was saying. I'm quite suprised the nurse did that, and I could have told you there was a good chance she was going to hit the ceiling.
Posted by Chloe on February 6, 2002, at 19:34:55
In reply to Re: Discovery Channel - Shock Therapy » Chloe, posted by bob on February 5, 2002, at 23:53:25
> By the way... did you see when the nurse tried to give her that shot when she woke up? She was so confused, you could see she wasn't comprehending what the nurse was saying. I'm quite suprised the nurse did that, and I could have told you there was a good chance she was going to hit the ceiling.
Yeah, I saw that coming too! But I did find it disturbing to see her so disoriented and fearful when she awoke from her treatment. I was under the impression that ECT left the patient kinda like a "blank slate." Sort of erasing the mind of good and bad, hence the memory problems.
So it was suprising to me that she thought the nurse had a hostile intent toward her. Why didn't the patient have curiosity, or a confused wonderment about what was going to happen next? This women seemed to wake up in an uncomfortable, agitated state. I wonder if some other issue was going on with this patient that wasn't being treated by shocking her frontal lobes...
Again, JMO :)
Chloe
Posted by bob on February 6, 2002, at 23:17:30
In reply to Re: Discovery Channel - Shock Therapy » bob, posted by Chloe on February 6, 2002, at 19:34:55
I think the way this patient woke up is probably typical. They say you often have a pounding headache and need to crash for hours afterwards.
I'm not suprised by the reaction to the shot. If you are truly and completely confused and disoriented, I think any unexpected stimulus will lead to a fight or flight reaction. Your cognitive abilities have been, for the most part, taken off line - so basic emotions are taking over for awhile.
Like you say... JMO.
This is the end of the thread.
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