4 ms·

I'm definitely not an expert, but my impression has been that ECT has been considered more likely to be effective at the severe or psychotic end of the spectrum

by Delk 6y ago

I'm definitely not an expert, but my impression has been that ECT has been considered more likely to be effective at the severe or psychotic end of the spectrum (so not really something to be considered in milder or even moderately severe cases), and more effective in acute cases of severe depression than in long-term chronic ones. I don't know if this could be one reason for differing views regarding efficacy, or if it's just more anecdata and noise. edit: better choice of words

YeGoblynQueenne 6y ago
Thanks. I'm not any kind of expert on the matter, either, and I'm going by what's in the article which claims there isn't enough evidence to conclude that ECT works.
- perl4ever 6y ago
  TMS (transcranial magnetic stimulation) is a thing these days, I believe. I don't know why, or how it compares. I met a woman once (between 10-15 years ago) who had had ECT. She was...not negative about it? I think she said it had helped her. But her affect was very flat and dull and made me involuntarily think of brain damage and lobotomies and such. To be fair, I didn't know her beforehand, so I was unable to compare. I wish it wasn't too much to ask for people to focus research efforts on tools to determine what is actually happening in the brain at the moment of experiencing depressive or psychotic thoughts. Rather than developing random treatments with nothing behind them. When's the last time you got frustrated with debugging a program and started making random changes? Did it work? I have kind of never stopped being horrified at reading about how drug companies test their medications for mental illness by giving people surveys on how they feel. They are using super sophisticated technology to make the treatments, and fancy statistics on the results, but they can't objectively measure what is happening. It's GIGO. We need more and better tools like https://en.wikipedia.org/wiki/Optogenetics https://en.wikipedia.org/wiki/Optogenetics.
  - Delk 6y ago
    Again going into non-expert territory, but AFAIK TMS is supposed to be slightly more effective than placebo. It doesn't work that much more often than placebo, but more often anyway, and even in some cases that haven't been helped by medication or other treatments, which AFAIK tend to be the cases that often aren't affected by placebo either. I don't know exactly how you'd do a placebo alternative of TMS, though. I don't know how it compares to ECT, though, and whether the cases potentially helped by each modality are the same or different. After all, depression is not a single coherent phenomenon. Individual cases can vary a lot, and it's quite possible that not all of depression is even the same disease with the same physical manifestations. I don't know exactly why TMS would work either. I'm under the impression that it somehow increases activity in parts of the brain at which it's targeted (or inhibits it in others, if done with different parameters).
    - perl4ever 6y ago
      Depression is a single coherent phenomenon, as much as cancer or diabetes or the common cold. Just because there are likely many causes doesn't mean there can never be an objective definition of it in biological terms. You can get a bruise from a million different things; that doesn't mean you can't measure it objectively as well as subjectively. There is an intermediate point on the causal chain that is useful to identify. Even just being able to determine mental state at a high resolution (temporally) would be incredible because then you can study treatments much better. Existing treatments tend to be like "ok take this for a month, now do you feel better" and people rationalize it by saying "well, maybe it's growing brain cells". Cause and effect just dissolve into murkiness when you can't do experiments with rapid turnaround.

by Delk 6y ago

YeGoblynQueenne 6y ago

Thanks. I'm not any kind of expert on the matter, either, and I'm going by what's in the article which claims there isn't enough evidence to conclude that ECT works.

perl4ever 6y ago
TMS (transcranial magnetic stimulation) is a thing these days, I believe. I don't know why, or how it compares. I met a woman once (between 10-15 years ago) who had had ECT. She was...not negative about it? I think she said it had helped her. But her affect was very flat and dull and made me involuntarily think of brain damage and lobotomies and such. To be fair, I didn't know her beforehand, so I was unable to compare. I wish it wasn't too much to ask for people to focus research efforts on tools to determine what is actually happening in the brain at the moment of experiencing depressive or psychotic thoughts. Rather than developing random treatments with nothing behind them. When's the last time you got frustrated with debugging a program and started making random changes? Did it work? I have kind of never stopped being horrified at reading about how drug companies test their medications for mental illness by giving people surveys on how they feel. They are using super sophisticated technology to make the treatments, and fancy statistics on the results, but they can't objectively measure what is happening. It's GIGO. We need more and better tools like https://en.wikipedia.org/wiki/Optogenetics https://en.wikipedia.org/wiki/Optogenetics.
- Delk 6y ago
  Again going into non-expert territory, but AFAIK TMS is supposed to be slightly more effective than placebo. It doesn't work that much more often than placebo, but more often anyway, and even in some cases that haven't been helped by medication or other treatments, which AFAIK tend to be the cases that often aren't affected by placebo either. I don't know exactly how you'd do a placebo alternative of TMS, though. I don't know how it compares to ECT, though, and whether the cases potentially helped by each modality are the same or different. After all, depression is not a single coherent phenomenon. Individual cases can vary a lot, and it's quite possible that not all of depression is even the same disease with the same physical manifestations. I don't know exactly why TMS would work either. I'm under the impression that it somehow increases activity in parts of the brain at which it's targeted (or inhibits it in others, if done with different parameters).
  - perl4ever 6y ago
    Depression is a single coherent phenomenon, as much as cancer or diabetes or the common cold. Just because there are likely many causes doesn't mean there can never be an objective definition of it in biological terms. You can get a bruise from a million different things; that doesn't mean you can't measure it objectively as well as subjectively. There is an intermediate point on the causal chain that is useful to identify. Even just being able to determine mental state at a high resolution (temporally) would be incredible because then you can study treatments much better. Existing treatments tend to be like "ok take this for a month, now do you feel better" and people rationalize it by saying "well, maybe it's growing brain cells". Cause and effect just dissolve into murkiness when you can't do experiments with rapid turnaround.