5 ms·

"At least a third of patients experience memory loss after ECT." That's a sizable proportion. "But there are other patients who claim that the long-term side-

"At least a third of patients experience memory loss after ECT." That's a sizable proportion. "But there are other patients who claim that the long-term side-effects have been severe enough to stop them from working, and have had a catastrophic effect on their lives." How many patients report such catastrophic symptoms? The author doesn't say.

ca98am79 6y ago
My father had this for suicidal depression. After each ECT he would expect my mother to be taking him home, but he had to be reminded that they were divorced. He forgot. It was not a pleasant experience and didn't seem to help him with his depression.
- meepmorp 6y ago
  Did he remember his being divorced, eventually? Not the fact of being divorced, but the memories and feelings around it.
- racecondition 6y ago
  ect helps about half of patients. that is known from the get go
candiodari 6y ago
ECT: permanent mental impairment for temporary change in behavior.
- meepmorp 6y ago
  You're lucky to never have been at a place in your life where that sounds like it's worth trying.
  - candiodari 6y ago
    Maybe it's just me but I think I'd actually prefer suicide over the "possible" (but quite common) mental handicap that ECT will cause. And please note that psychiatrists lie. Technically it may be the truth what they say, but it is a disgusting lie through deception. Yes it is quite rare for a single ECT treatment to cause permanent memory loss or "severe" loss of function. What they "forget" to tell you is that an ECT regimen is not one treatment, but 7 to 20 individual sessions. Mathematically you can say that (1-(1-p)^20) is a hell of a lot larger than p. Intuitively you can say that it only works BECAUSE it does damage. So without at least some loss of function there is no benefit to it at all). It is also not so rare for the treatment to be abandoned, by the way, because the particular loss of function has medical consequences. They also say it doesn't hurt, except that is patently false. When you have a medical operation doctors will use 3 sedatives, not just one. They use something akin to GHB that prevents the formation of memories, a muscle relaxant (prevents you from moving) and something to actually sedate (depress neural activity). For ECT they use a muscle relaxant and GHB. So ECT doesn't hurt in the sense that afterwards you don't remember. They would use a sedative, except with those it doesn't work. The working principle of ECT seems to be extreme pain and trauma, and they merely prevent you from remembering that. They explicitly don't prevent extreme pain. We know it's extreme because it used to be done without any sedation at all, so there's no shortage of patient testimonies on the subject. Psychiatrists still want to use it because it is effectively the only medical treatment that can result in permanent change in behaviour. Nearly everything else (or let's say everything legal/moral) only results in change while the treatment continues, like antidepressants. If the treatment is stopped (voluntarily or not, say because of money issues) all effects stop in a matter of hours to weeks. And yes, I think it should be outlawed. Also the modern forms. That psychiatry has no answers for problems is not new.
- nicklecompte 6y ago
  Saying depression is a “temporary change in behavior” is like saying pneumonia is a “temporary change in respiration.” It’s insulting and dismissive and indicates you don’t really care very much about this issue. Depression kills people. ECT has serious side effects but it is also has proven efficacy and, if administered properly, is never fatal. All medicine involves this sort of cost-benefit analysis and in cases of severe drug-resistant depression, where there is a high risk of the patient dying in the short term, ECT is the only alternative.
  - kerblang 6y ago
    While the parent comment isn't all that helpful, I suspect they meant "...in exchange for a temporary change..."; in other words, not that that depression is temporary, but beneficial effects of ECT are.
  - yellowapple 6y ago
    > Saying depression is a “temporary change in behavior" That ain't how I interpreted the above comment. > but it is also has proven efficacy Right, but at what cost? It seems very much like something that just replaces one problem with another, at best (and at worst, introduces more problems while the existing ones don't go away). But hey, as long as it's voluntary, who am I to judge?
    - deleted 6y ago
      [deleted]
    - type0 6y ago
      > But hey, as long as it's voluntary, who am I to judge? If we are talking about very severely depressed you can't trust them to weight the risks and benefits in their own favor, so the physicians have so big overwhelming influence on their decision that it can't be argued otherwise.
      - yellowapple 6y ago
        That's kind of what I was underhandedly getting at, yeah. And when applied to more debilitating conditions like schizophrenia, "consent" is even more wibbly-wobbly.
- vernie 6y ago
  Suicide is a temporary change in behavior.
ineedasername 6y ago
This is why ECT is not a first-line treatment. It's where you turn when you've pretty much exhausted the alternatives. However it's important to keep in mind that 1) Memory loss is often very short term, or temporary. 2) losing the ability to hold down a job is a non-issue for patients who may end up out of work on disability 3) Many antipsychotics and mood stabilizers come with their own memory issues and other side effects... There's always a trade off. 4) We need better treatment methods. To say ECT is a shotgun approach is an understatement. It's a scorched-earth approach where you hope the ashes end up fertilizing a new crop. 5) It's a tragedy that many of our best and brightest STEM minds pursue an education that leads them to jobs optimizing ad-tech or hustling for an exit plan to get rich. Theranos duped so many people in part because everyone wanted to believe big tech could be more than this. Which at least means that if you're in it for the big payoff then you should find something with the same potential for human impact only, you know, not a massive fraud. If you do that, you'll bank a lot more money than in finding the next SaaS that provides an incremental improvement on an existing product category.
- racecondition 6y ago
  are we sure it's a scorched earth approach? I thought we don't exactly know WHY ect works. its possible calibrating neuronal stimulation is good for the brain and helps calibrate neuronal connections that otherwise were not as excercised as much as the ones very depressed people have. In general, deeply depressed people interpret and perceive even language and visuals differently, in more negative and cynical lights, its hard to consciously teach yourself to constantly perceive the opposite or think in a more positive way, perhaps just stimulating ALL nuerons helps calibrate paths that otherwise were not favored other neuronal pathways highly utilized by depressed people. To be honest, I've seen more people in my life die from going from antidepressents to street heroine than I have people from ect. I am not ready to say ect is safer than antidepressants. It's also to be noted antidpressants its a multibillion dollar industry of which a very few very rich families make a ton of money and also sell the same drugs for heroine overdoses, many heroine addicts of which came from being cut off from abusing antidepressants, 1/3rd of all heroine addicts actually so... when you compare ect therapy to a massive opioid epidemic that makes a few people rich, and all of the violence that has encompassed the heroine drug dealing industry, I would say ect is potentially a safer option. It has a stigma because of how it was originally used. I would still though be interested in psychadelics over ect but shrooms can cause permanent damage and impacts everyone differently as well so both are hard to streamline I imagine.
fossuser 6y ago
I thought this was pretty interesting and goes into a hypothesis of why ECT might be effective (in the context of sleep deprivation being effective) https://astralcodexten.substack.com/p/sleep-is-the-mate-of-death https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d... It's also possible the memory loss is partly a treatment effect and not a side effect. It might be weakening some of these learned patterns is what helps shake loose the depression. "Put these two lines of research together and you get something like: synapse density increases over the course of the day, then sleep prunes it down again. Depression is associated with low synapse density. So it would make sense that depression gets better over the course of the day (including the extra-long artificial days of sleep deprivation) and then gets worse again after sleep."
- agumonkey 6y ago
  > It's also possible the memory loss is partly a treatment effect and not a side effect. Very plausible but imo very dangerous, a lot of your emotions are rooted in your memories and weakening the network could very much lead to loss of self or incoherence.
- Delk 6y ago
  > I thought this was pretty interesting and goes into a hypothesis of why ECT might be effective (in the context of sleep deprivation being effective) https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d... This is entirely subjective but I suspect there might be something else at play than anything mentioned in that blog post. (edit: that is, when it comes to sleep deprivation vs depression.) I've had to go through depression myself, and also noticed that my mood is different when I'm sleep-deprived. The mood when sleep-deprived would often be elevated, assuming I didn't have to force myself to do something that required concentration. I'm not sure that state is so much an absence of depression as it might be a slightly hyper mood. (I once read someone's comment on the topic somewhere that it seems like the depression gets replaced by some kind of a hypomania-like state rather than a normal, non-depressed mood. I don't even remember where that comment was and it was also just speculation, but it rang a bell.) I've noticed that kind of slightly hyper mood has also happened when sleep deprived outside of a depressive episode. (Perhaps it is in compensation for feeling tired when you for some reason psych yourself to still staying active, or something.) It might feel preferable to a depressed state but I'm slightly sceptical of the idea that something with a similar mechanism could be used directly to return to a normal non-depressive state. I don't know about ECT though.
Eric_WVGG 6y ago
David Foster Wallace resorted to ECT, sounds like it didn't do him any favors. https://www.tandfonline.com/doi/full/10.1080/00111619.2017.1398712 https://www.tandfonline.com/doi/full/10.1080/00111619.2017.1...

ca98am79 6y ago

My father had this for suicidal depression. After each ECT he would expect my mother to be taking him home, but he had to be reminded that they were divorced. He forgot. It was not a pleasant experience and didn't seem to help him with his depression.

meepmorp 6y ago
Did he remember his being divorced, eventually? Not the fact of being divorced, but the memories and feelings around it.
racecondition 6y ago
ect helps about half of patients. that is known from the get go

candiodari 6y ago

ECT: permanent mental impairment for temporary change in behavior.

meepmorp 6y ago
You're lucky to never have been at a place in your life where that sounds like it's worth trying.
- candiodari 6y ago
  Maybe it's just me but I think I'd actually prefer suicide over the "possible" (but quite common) mental handicap that ECT will cause. And please note that psychiatrists lie. Technically it may be the truth what they say, but it is a disgusting lie through deception. Yes it is quite rare for a single ECT treatment to cause permanent memory loss or "severe" loss of function. What they "forget" to tell you is that an ECT regimen is not one treatment, but 7 to 20 individual sessions. Mathematically you can say that (1-(1-p)^20) is a hell of a lot larger than p. Intuitively you can say that it only works BECAUSE it does damage. So without at least some loss of function there is no benefit to it at all). It is also not so rare for the treatment to be abandoned, by the way, because the particular loss of function has medical consequences. They also say it doesn't hurt, except that is patently false. When you have a medical operation doctors will use 3 sedatives, not just one. They use something akin to GHB that prevents the formation of memories, a muscle relaxant (prevents you from moving) and something to actually sedate (depress neural activity). For ECT they use a muscle relaxant and GHB. So ECT doesn't hurt in the sense that afterwards you don't remember. They would use a sedative, except with those it doesn't work. The working principle of ECT seems to be extreme pain and trauma, and they merely prevent you from remembering that. They explicitly don't prevent extreme pain. We know it's extreme because it used to be done without any sedation at all, so there's no shortage of patient testimonies on the subject. Psychiatrists still want to use it because it is effectively the only medical treatment that can result in permanent change in behaviour. Nearly everything else (or let's say everything legal/moral) only results in change while the treatment continues, like antidepressants. If the treatment is stopped (voluntarily or not, say because of money issues) all effects stop in a matter of hours to weeks. And yes, I think it should be outlawed. Also the modern forms. That psychiatry has no answers for problems is not new.
nicklecompte 6y ago
Saying depression is a “temporary change in behavior” is like saying pneumonia is a “temporary change in respiration.” It’s insulting and dismissive and indicates you don’t really care very much about this issue. Depression kills people. ECT has serious side effects but it is also has proven efficacy and, if administered properly, is never fatal. All medicine involves this sort of cost-benefit analysis and in cases of severe drug-resistant depression, where there is a high risk of the patient dying in the short term, ECT is the only alternative.
- kerblang 6y ago
  While the parent comment isn't all that helpful, I suspect they meant "...in exchange for a temporary change..."; in other words, not that that depression is temporary, but beneficial effects of ECT are.
- yellowapple 6y ago
  > Saying depression is a “temporary change in behavior" That ain't how I interpreted the above comment. > but it is also has proven efficacy Right, but at what cost? It seems very much like something that just replaces one problem with another, at best (and at worst, introduces more problems while the existing ones don't go away). But hey, as long as it's voluntary, who am I to judge?
  - deleted 6y ago
    [deleted]
  - type0 6y ago
    > But hey, as long as it's voluntary, who am I to judge? If we are talking about very severely depressed you can't trust them to weight the risks and benefits in their own favor, so the physicians have so big overwhelming influence on their decision that it can't be argued otherwise.
    - yellowapple 6y ago
      That's kind of what I was underhandedly getting at, yeah. And when applied to more debilitating conditions like schizophrenia, "consent" is even more wibbly-wobbly.
vernie 6y ago
Suicide is a temporary change in behavior.

ineedasername 6y ago

This is why ECT is not a first-line treatment. It's where you turn when you've pretty much exhausted the alternatives. However it's important to keep in mind that 1) Memory loss is often very short term, or temporary. 2) losing the ability to hold down a job is a non-issue for patients who may end up out of work on disability 3) Many antipsychotics and mood stabilizers come with their own memory issues and other side effects... There's always a trade off. 4) We need better treatment methods. To say ECT is a shotgun approach is an understatement. It's a scorched-earth approach where you hope the ashes end up fertilizing a new crop. 5) It's a tragedy that many of our best and brightest STEM minds pursue an education that leads them to jobs optimizing ad-tech or hustling for an exit plan to get rich. Theranos duped so many people in part because everyone wanted to believe big tech could be more than this. Which at least means that if you're in it for the big payoff then you should find something with the same potential for human impact only, you know, not a massive fraud. If you do that, you'll bank a lot more money than in finding the next SaaS that provides an incremental improvement on an existing product category.

racecondition 6y ago
are we sure it's a scorched earth approach? I thought we don't exactly know WHY ect works. its possible calibrating neuronal stimulation is good for the brain and helps calibrate neuronal connections that otherwise were not as excercised as much as the ones very depressed people have. In general, deeply depressed people interpret and perceive even language and visuals differently, in more negative and cynical lights, its hard to consciously teach yourself to constantly perceive the opposite or think in a more positive way, perhaps just stimulating ALL nuerons helps calibrate paths that otherwise were not favored other neuronal pathways highly utilized by depressed people. To be honest, I've seen more people in my life die from going from antidepressents to street heroine than I have people from ect. I am not ready to say ect is safer than antidepressants. It's also to be noted antidpressants its a multibillion dollar industry of which a very few very rich families make a ton of money and also sell the same drugs for heroine overdoses, many heroine addicts of which came from being cut off from abusing antidepressants, 1/3rd of all heroine addicts actually so... when you compare ect therapy to a massive opioid epidemic that makes a few people rich, and all of the violence that has encompassed the heroine drug dealing industry, I would say ect is potentially a safer option. It has a stigma because of how it was originally used. I would still though be interested in psychadelics over ect but shrooms can cause permanent damage and impacts everyone differently as well so both are hard to streamline I imagine.

fossuser 6y ago

I thought this was pretty interesting and goes into a hypothesis of why ECT might be effective (in the context of sleep deprivation being effective) https://astralcodexten.substack.com/p/sleep-is-the-mate-of-death https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d... It's also possible the memory loss is partly a treatment effect and not a side effect. It might be weakening some of these learned patterns is what helps shake loose the depression. "Put these two lines of research together and you get something like: synapse density increases over the course of the day, then sleep prunes it down again. Depression is associated with low synapse density. So it would make sense that depression gets better over the course of the day (including the extra-long artificial days of sleep deprivation) and then gets worse again after sleep."

agumonkey 6y ago
> It's also possible the memory loss is partly a treatment effect and not a side effect. Very plausible but imo very dangerous, a lot of your emotions are rooted in your memories and weakening the network could very much lead to loss of self or incoherence.
Delk 6y ago
> I thought this was pretty interesting and goes into a hypothesis of why ECT might be effective (in the context of sleep deprivation being effective) https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d... This is entirely subjective but I suspect there might be something else at play than anything mentioned in that blog post. (edit: that is, when it comes to sleep deprivation vs depression.) I've had to go through depression myself, and also noticed that my mood is different when I'm sleep-deprived. The mood when sleep-deprived would often be elevated, assuming I didn't have to force myself to do something that required concentration. I'm not sure that state is so much an absence of depression as it might be a slightly hyper mood. (I once read someone's comment on the topic somewhere that it seems like the depression gets replaced by some kind of a hypomania-like state rather than a normal, non-depressed mood. I don't even remember where that comment was and it was also just speculation, but it rang a bell.) I've noticed that kind of slightly hyper mood has also happened when sleep deprived outside of a depressive episode. (Perhaps it is in compensation for feeling tired when you for some reason psych yourself to still staying active, or something.) It might feel preferable to a depressed state but I'm slightly sceptical of the idea that something with a similar mechanism could be used directly to return to a normal non-depressive state. I don't know about ECT though.

Eric_WVGG 6y ago

David Foster Wallace resorted to ECT, sounds like it didn't do him any favors. https://www.tandfonline.com/doi/full/10.1080/00111619.2017.1398712 https://www.tandfonline.com/doi/full/10.1080/00111619.2017.1...