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Study: Electroshock therapy more successful for depression than ketamine

152 points by voisin 4y ago

Technetium 4y ago
Wow, this is genuinely one of the most horrific studies I've seen on HN. I wish from the bottom of my soul that ECT would be banned worldwide for everything except extreme seizure treatment with patient consent. I know 2 people that have been irreparably damaged from it. I want my friends back, and I'll NEVER EVER get them back because Swedish 'doctors' forcefully administered treatment. There will there NEVER be justice because they were essentially lobotomized, and as such no longer have the mental capacities to sue the facility. ECT has an EXTREMELY high incidence of brain damage, and you only have to do one Google Scholar search to find out. Of course this 'study' doesn't track anything other than memory loss and headaches.
downrightmike 4y ago
Yeah, but the history of the two are wildly divergent.
- operator-name 4y ago
  What are you trying to say here?
  - downrightmike 4y ago
    People will have a hard time accepting electric shock as a treatment.
stevenalowe 4y ago
“The side effect profiles of the two treatments differed, with ECT more likely to cause headaches, muscle pain and memory loss, while ketamine was more likely to cause dissociative symptoms, vertigo and double vision.” I’ll take milder effects over pain and memory loss, thanks. No mention of longevity of effect, or specific studies and who paid for them.
- Waterluvian 4y ago
  Without more information on likeliness, permanence, and magnitude, both sets of symptoms sound potentially intolerable.
  - arcticbull 4y ago
    People do ketamine recreationally; the symptoms really aren't intolerably bad, I'm led to believe.
    - saxonww 4y ago
      And the therapeutic dose in this case seems to be roughly 1/2-1/3 of what people do recreationally.
    - nibbleshifter 4y ago
      The worst side effect recreationally is usually mild nausea. The other "side effects" are generally part of its desirable properties ;)
    - elevaet 4y ago
      ECT on the other hand has very few recreational users. I imagine the physical effects of ECT must be very harsh and difficult for the body.
      - pyuser583 4y ago
        Are there any recreational users?
        elevaet 4y ago
        I was being a bit facetious, but surely in this world of ~8billion people there are some freaky recreational users out there.
  - deleted 4y ago
    [deleted]
warrenmiller 4y ago
aren't the side effects of ECT quite severe though? "loss of creativity, drive and energy. difficulty concentrating. loss of emotional responses. difficulty learning new information."
- pyuser583 4y ago
  Those are also the symptoms of depression.
- thrown_22 4y ago
  Those are also the side effects of severe depression so you're not missing out on much.
- andrewflnr 4y ago
  If you take away my creativity and ability to learn, you may as well just kill me. That sounds like a recipe for depression in itself.
  - operator-name 4y ago
    You're depressed, which has already destroyed your creativity and ability to learn. Nothing has worked. Your option is to ECT, which may help, or have adverse side effects. Would you try it? If you've not got much to lose, why not? It's not as if suicide is suddenly no longer an option afterwards.
    - generalizations 4y ago
      > which has already destroyed your creativity and ability to learn Don't think that's necessarily the case.
      - operator-name 4y ago
        Loss of focus and difficulty retaining new information are common symptoms for major depressive episodes.
chiefalchemist 4y ago
> All five of the studies independently found that ECT was more effective than ketamine at relieving *severe* depression symptoms. A keyword was left from the title / headline.
- rubatuga 4y ago
  Definitely a key factor since most psychiatrists reserve ECT for severe depression.
  - chiefalchemist 4y ago
    I think the article mentions that. That said, I would presume the Schedule 1 drugs are being approached with a conservative mindset. But they still mind have wider application once the med profession gets past the stigma. The point being, abandoning these new options should be given a fair chance even if there are intials findings like this one.
    - wnoise 4y ago
      Ketamine has been schedule III since 1999. https://www.dea.gov/sites/default/files/2020-06/Ketamine-2020_1.pdf https://www.dea.gov/sites/default/files/2020-06/Ketamine-202...
kingkawn 4y ago
This article completely neglects discussion of side effects. Ketamine has almost none, whereas ECT can cause horrible degradations to quality of life. Any discussion of efficacy that doesn’t include side effects is quackery.
- operator-name 4y ago
  I'll give you that it's a short article, but: > The side effect profiles of the two treatments differed, with ECT more likely to cause headaches, muscle pain and memory loss, while ketamine was more likely to cause dissociative symptoms, vertigo and double vision.
  - howinteresting 4y ago
    I mean the point of ketamine is dissociation. That's where a lot of healing happens. The vertigo and double vision last a little while, possibly the rest of the day. They're not long term or serious. The memory loss from ECT can be long-term for some people. I've personally found ketamine to help a lot with my mental health issues. It's great and I'd highly recommend at least giving it a shot in a therapeutic setting. I'm sure it's interesting recreationally as well, though I've never tried it that way.
  - irq 4y ago
    The way the article omits mentioning the ECT memory loss side effect is often permanent, and the way it omits that ketamine’s dissociative effects are always temporary, screams of quackery.
andy_ppp 4y ago
I absolutely love this talk by Sherwin Nuland, it’s beautifully told and always worth remembering that someone who seems so put together on stage can have had quite extreme troubles… electroshock therapy is surprisingly very effective in extreme cases. https://www.ted.com/talks/sherwin_nuland_how_electroshock_therapy_changed_me https://www.ted.com/talks/sherwin_nuland_how_electroshock_th...
- lotophage 4y ago
  Came to mention this! That is one of my all-time favourite TED talks. If nothing else, it's a fascinating story told well.
nvr219 4y ago
Yeah but ketamine is a lot more fun so I'm gonna stick with that.
- operator-name 4y ago
  This is a really strange mindset to me - if Ketamine is working why bother even considering switching?
  - fragmede 4y ago
    Tolerance. It's possible to build up a tolerance to ketamine, such that it stops working. For those for whom ketamine once every while is sufficient (eg once a month), there's little danger of that, but for those that need to take it every day (under doctor supervision), it's not sustainable.
larryliu 4y ago
Ketamine is a prescription medicine that can be taken oral, intranasal or IV drip. ECT is an inpatient procedure that need one anesthesiologist and one psychiatrist plus nurses to administer, two to three times weekly for three to four weeks. Who pays for the healthcare, definitely want to try the former and use the latter only if the former works poorly.
- RichardCNormos 4y ago
- operator-name 4y ago
  ECT, due to the potential side effects and Ketamine due to how recent it is are both near the "last lines of defence". IRRC both of them cannot compare to psychotherapy, which has far higher effectiveness at the cost of far more resources.
  - theGnuMe 4y ago
    In the beginning we only had psychotherapy and it was like 15-30% successful IIRC.. so no, not necessarily.
    - petesergeant 4y ago
      I think it's a reasonable assumption that psychotherapy has improved since the 1940s/1950s when alternative medicines came out.
  - richardjam73 4y ago
    ECT has the highest cost of resources.
    - olliej 4y ago
      I'm guessing this was a typo, but if you look at how unbounded the time for psychotherapy to work, I would not be surprised if it did actually end up being the most expensive.
operator-name 4y ago
It's really dissapointingly seeing the comments section do exactly what the article tries to avoid. There seems to be so much lack of understanding for the process of prescribing treatment for depression, and overreliance on endless anecdotes or other singular data points, directly at the antithesis of the study: > “Every single study directly reports ECT works better than ketamine. But _people are still skeptical of ECT, perhaps because of stigma_,” Rhee says, or negative depictions in films such as “One Flew Over the Cuckoo’s Nest” and shows such as “Stranger Things.” “_We need to improve public awareness of ECT for treatment-resistant depression_.” If we read the article carefully, we can see that the headline (as all headlines are) is lacking in nuance: > Most people diagnosed with depression are offered an _oral antidepressant (in combination with psychotherapy) as a first-line treatment option_. But _if oral antidepressants don’t help, or if the person is at imminent risk of hurting themselves_, there are other, more rapid treatment options: ECT, and more recently ketamine or esketamine. Firstly, oral antidepressants and psychotherapy are still the firstly line of defence, and for the majority of people enough. As it is, ketamine or esketamine is nowhere near close - has nowhere near enough evidence and longitudinal studies - to replace SSRIs and psychotherapy as the first line. Unfortunately modern medicine isn't advanced enough to fully understand what's going on with oral antidepressants (we have theories, but the majority evidence is simply statistics), let alone (es) ketamine and ECT. As a result, if oral antidepressants are not effective it can often be difficult to effectively prescribe treatment. Naturally a consequence of this is increased risk, from procedures that may not have much if any benifits, not even including the very real chances of a misdiagnosis! If we look at the cited paper's abstract, the message is even more clear > Question: Is ketamine as effective as electroconvulsive therapy (ECT) in patients with _major depressive episode_? > Findings: This systematic review and meta-analysis of 6 trials with 340 patients suggests that ECT may be superior to ketamine in improving depression severity. Findings also suggest that ketamine and ECT each have unique adverse effect profiles. > The overall pooled SMD for depression symptoms for ECT when compared with ketamine was −0.69 (95% CI, −0.89 to −0.48; Cochran Q, P = .15; I2 = 39%), suggesting an efficacy advantage for ECT compared with ketamine for depression severity. > Both ketamine and ECT had unique adverse effect profiles (ie, ketamine: lower risks for headache and muscle pain; ECT: lower risks for blurred vision, vertigo, diplopia/nystagmus, and transient dissociative/depersonalization symptoms). > Meaning: Although ECT may be more efficacious than ketamine in the acute phase, _treatment options should be individualized and patient-centered, considering different adverse effect profiles and patient preferences._ Both (Es)Ketamine and ECT are useful and sometimes literally life saving therapies for those with treatment resistant depression. Like any treatment some respond effectively and may never have to undergo future treatment whilst others may require constant support. The stigma around ECT and the uninformed experience and use of anecdotes is dangerous, and ignores the reality that there are no good answers, at least with our current medical knowledge. I would advise not drawing any conclusions from limited evidence, and if they want to see more personal anecdotes explore both the positive and negative comments at /r/ECT and /r/TherapeuticKetamine
tcj_phx 4y ago
My friend figured out for herself, when she was in her 30's, that she's a poor methylator who can't turn the food fortification folic acid into a usable form of Vitamin B-9. She once told me that adding L-Methylfolate to her routine was like flipping a switch from "depressed" to "not-depressed". But the doctors had already decided she was being "stabilized" by the anti-psychotic prescriptions they forced on her, so they just added this vitamin to their cocktail of prescriptions. Vitamin B-9 has to do with DNA synthesis... My source for physiology told me that even the mutants get enough Vitamin B-9 from an adequate diet, it's just poor methylators who rely on fortified food who are screwed. Deplin is the prescription form of Vitamin B-9. It's approved as an add-on therapy, for when patients don't respond well to the prescriptions that never work. Usually 'mental health' diagnoses are manifestations of stress: emotional stress is the big one, but malnourishment is often a factor too. Stressed brains use more energy thinking about the stress all the time. ECT should be retired from use. I heard once that brain damage causes the brain to increase production of the steroid allopregnanolone. The beneficial effect of the SSRI's seem to also be related to increased allopregnanolone, NOT to boosting serotonin levels. I wonder if my friend's guardian [0] could consent to her getting electrocuted. [0] https://news.ycombinator.com/item?id=33307982 https://news.ycombinator.com/item?id=33307982 Edit: She remembers being depressed for as far back as her memories go. Someone on twitter says food fortification didn't really take off until the 1980's. Before then you had to explicitly buy "wonder bread" to get fortified flour, now you can basically assume white flour is fortified white flour.
- chrsig 4y ago
  > But the doctors had already decided she was being "stabilized" by the anti-psychotic prescriptions they forced on her, so they just added this vitamin to their cocktail of prescriptions. Outside of very specific circumstances during hospitalization, doctors can't actually force you to take any medication.
  - kortex 4y ago
    Ehhhhhh depends a lot on the circumstances and the hospital/center. In theory, yeah, in practice, it's a lot harder for patients to refuse treatment, for one reason or another.
thornjm 4y ago
I found the origin of ECT quite interesting: depressed people with epilepsy had dramatic improvement in their symptoms following a seizure. They also discovered that the type and location of the seizures had varying levels of effect.
MangezBien 4y ago
I had ECT and it was absolutely life changing. Only thing that ever worked for me. Mild headaches with each treatment and my memories of the time of my treatment is fuzzy. But I think we probably should be investigating why it works so well.
- MangezBien 4y ago
  After reading the comments in this thread it is clear that people are not current with how ECT is administered in the modern era. 1. You are under general anesthesia 2. The dosage of electricity is very low when compared to how it was done before. 3. The electrical currents are far more focused Stuff like personality changes or loss of creativity is no longer a risk factor. Risks tend to be those associated with general anesthesia and mild memory loss around the treatment. I had over 2 rounds of 15 treatments over a 6 month period. I haven't had a serious relapse in the 5 years since. I had tried every SSRI and SNRI my insurance would cover. I had been in therapy for over a decade. I was suicidal. ECT saved my life.
  - heavyset_go 4y ago
    Thanks for the clarification. How does the memory loss manifest? Are you aware that you lost time, like can you feel that you did experience time pass for X amount of days, but you just don't remember what took place? Or is the feeling that the time never passed at all, like it was Monday and you woke up on Friday, but it felt like it was actually Tuesday morning, and you have no intuitive feeling that a week passed at all?
hexo 4y ago
Whoa, I firmly believe the electroshock "therapy" was debunked a few times already, wasn't it?
- operator-name 4y ago
  Do you recall where you saw this? As for some counter evidence to your memories, I would suggest you check out the studies cited by the linked paper. ECT is not for everyone, but a last option when all else fails.
- pyuser583 4y ago
  No, quite the opposite. The general consensus is that it’s underutilized.
  - xkbarkar 4y ago
    No, not even close
    - pyuser583 4y ago
      APA position ECT: Electroconvulsive Therapy (ECT) is a safe and effective evidence-based medical treatment. ECT is endorsed by the APA when administered by properly qualified psychiatrists for appropriately selected patients. https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2015-Electroconvulsive-Therapy.pdf https://www.psychiatry.org/File%20Library/About-APA/Organiza... You’re welcome to disagree with the APA, or point out that the APA only represents a small fraction of psychologists, or question whether this is really a consensus opinion. The APA isn’t god. But I don’t think you can say things like “No, not even close” and expect to be taken seriously.
- howinteresting 4y ago
  ECT is a really mild form of what used to be electroshock therapy, and you have full agency over if and when to stop. It works for a lot of people. The problem is the side effects. The memory loss is really rough. Based on my background as a software programmer, my psychiatrist (who has recommended and done ECT for other people) recommended very strongly against ECT for me and said I should try ketamine instead.
knaik94 4y ago
"Relapse rates after ECT are similar to those in resistant depression treated with antidepressants (37% after six months) and are a function of the illness, reinforcing need to continue with antidepressants, ECT, or both after a successful acute course of ECT.37 Emerging evidence suggests maintenance ECT to prevent relapse.38" https://www.bmj.com/content/364/bmj.k5233 https://www.bmj.com/content/364/bmj.k5233 This article is arguing ECT as acute treatment for resistant depression. In most, if not all, cases a patient would become eligible for ketamine treatment at the same time if not sooner than ECT. Memory loss directly due to ECT is the reason most people are strongly against using it. Treatment options are based on minimizing risks, not guaranteeing success. Unless ketamine is contraindicated, it will always be a safer treatment than ECT.
engined 4y ago
After dealing with depression myself, I dove deeply into this world, and actually ended up founding a ketamine and esketamine treatment startup in the Boston area (lumin.health). We've seen pretty amazing results with patients who have otherwise failed antidepressants and/or ECT and TMS (Transcranial Magnetic Stimulation). The reality is that ketamine/esketamine are much more accessible from a patient perspective, and while considered "new" by many in the medical community, offer faster results and carry less stigma for patients than ECT in particular. If ketamine/esketamine don't work, patients typically know within 2-3 sessions, and can walk away with no long term side effects. With ECT, patients generally have to complete a whole course before they see effect, and then are stuck with some of the potential mid/long-term side effects. The space is also at the precipice of a whole new class of psychedelics coming online - MDMA, psilocybin, and more are all 1-5 years out (working through FDA drug trials), and hold promise of both faster results (versus 6-8 months of trialing traditional antidepressants) and fewer downside risks (versus weight gain, sex drive, etc. issues with antidepressants and memory loss, headaches, etc. with ECT and TMS). Bottom line, if you're suffering and considering those treatments, I highly recommend finding a local center and at least learning more about options available to you. Edit: If anyone wants to talk, advice, etc., email is in my profile.
- boredtofears 4y ago
  One rumination I have had about the medical application of psychedelics is to wonder how lasting the effects of all these initial studies will be over the long term. The effects of psychedelics are profound to a person who hasn't experienced them, which is the vast majority of people today. I think, when a person goes through a powerful experience they've never had, it makes them a lot more suggestive, which in turn makes therapies more effective. Will this still be the case if psychedelics usage is normalized? When a person knows what to expect out of the drug will they still remain as suggestible to therapy? My own experience with psychedelics tells me no: once you become familiar with the effects the "high" loses some of it's properties that make it a useful tool for introspection. I haven't done psychedelics in a purely therapeutic setting so there may be something to my observation that I'm missing completely.
  - 4y ago
whatwhatwhat_ 4y ago
I’m in a deep depression, I’d try it. Wiping my memory would be the best gift I could get.
- cryptoanon 4y ago
  Go to a psychiatrist and try ask for ketamine. It has the same effect of detaching you from trauma. It’s like putting your brain through a car wash.
zoklet-enjoyer 4y ago
I enjoy ketamine recreationally. No thank you to electrocution.
warbler73 4y ago
How does it compare to peyote?
LatteLazy 4y ago
A much more interesting comparison is to the current standard treatment methods (SSRI/SNRIs and Therapy). These are both very ineffective.
club_tropical 4y ago
In 200 years, people will study this as a crazy tale from the dark ages. The worst thing for depressed people has been the idea that it's a random/genetic phenomenon as opposed to ecological misalignment with their biospirit.
- sirsinsalot 4y ago
  Tell that to people born with genetic issues leading to increased serotonin transporter density which creates chronic depression in many. Learn some neuroscience.
  - Sapere_Aude 4y ago
    There isn't even evidence that depression is caused by serotonin levels. They never even checked that out in the first place. https://www.ucl.ac.uk/news/2022/jul/no-evidence-depression-caused-low-serotonin-levels-finds-comprehensive-review https://www.ucl.ac.uk/news/2022/jul/no-evidence-depression-c... https://www.ucl.ac.uk/news/2022/jul/analysis-depression-probably-not-caused-chemical-imbalance-brain-new-study https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...
  - club_tropical 4y ago
    Notwithstanding the particulars about serotonin, I'm not disputing that brain chemistry balances might be heritable to some extent, like height. But "depression" is a downstream phenomenon of one's brain chemistry interacting with their ecology. Here's an analogy: If I took Nordic people and gradually shrank the architecture, chairs, and desks around them across a few generations, such that most would have to unnatural bowing of the head and curvature of the spine, they would experience enormous agony - back pains, neck pains, etc (like "depression"). They would even correctly identify that they are suffering due to a genetically inherited length of their skeleton. Now imagine that in such a world, the "medical solution" is to remove a couple of vertebrae to make them shorter or take some pills that anesthetize the neck muscles. Let's even say all that happens without side effects. Many a patient would be happy for the agony to go away. And yet, I still think this is completely the wrong approach. I have deep compassion for depressed people. I believe they should be very careful trusting a system that "shrunk the architecture" so to speak and offers a form of brain chemistry interference as a "solution". In my opinion, depressed people should attempt to remember that it is almost mathematically impossible that they are the descendants of dozens of generations of depressed adults. They would be far better served, in my opinion, to try to recall and recreate the ancestral adaptive environment (the bigger chairs and taller ceilings).
eric4smith 4y ago
tinus_hn 4y ago
Unfortunately the mental health care industry cannot be trusted with weapons like electroshock therapy.
unixhero 4y ago
Electroshock treatment scares me more than almost anything in this world.
lifeplusplus 4y ago
Death also cures depression
Jerrrry 4y ago
These two treatments being anywhere comparable is a massive disservice and borderline negligent. Feeling a little loopy from a hefty Ket dose and having permanent brain damage from being shocked are so far removed from each other that it is an actual failing in different regards. Drugs may figuratively fry your brain, but it is certainly better than literally frying your fuckin brain.
Maursault 4y ago
ECT is electrical lobotomy. It obliterates all the myelin in the body, and the result in all cases is brain damage and pain disorder. It cures depression by eliminating higher cognition. ECT should be banned and illegal. Ketamine, otoh, should be unscheduled.

152 points by voisin 4y ago

Wow, this is genuinely one of the most horrific studies I've seen on HN. I wish from the bottom of my soul that ECT would be banned worldwide for everything except extreme seizure treatment with patient consent. I know 2 people that have been irreparably damaged from it. I want my friends back, and I'll NEVER EVER get them back because Swedish 'doctors' forcefully administered treatment. There will there NEVER be justice because they were essentially lobotomized, and as such no longer have the mental capacities to sue the facility. ECT has an EXTREMELY high incidence of brain damage, and you only have to do one Google Scholar search to find out. Of course this 'study' doesn't track anything other than memory loss and headaches.

downrightmike 4y ago

Yeah, but the history of the two are wildly divergent.

operator-name 4y ago
What are you trying to say here?
- downrightmike 4y ago
  People will have a hard time accepting electric shock as a treatment.

stevenalowe 4y ago

“The side effect profiles of the two treatments differed, with ECT more likely to cause headaches, muscle pain and memory loss, while ketamine was more likely to cause dissociative symptoms, vertigo and double vision.” I’ll take milder effects over pain and memory loss, thanks. No mention of longevity of effect, or specific studies and who paid for them.

Waterluvian 4y ago
Without more information on likeliness, permanence, and magnitude, both sets of symptoms sound potentially intolerable.
- arcticbull 4y ago
  People do ketamine recreationally; the symptoms really aren't intolerably bad, I'm led to believe.
  - saxonww 4y ago
    And the therapeutic dose in this case seems to be roughly 1/2-1/3 of what people do recreationally.
  - nibbleshifter 4y ago
    The worst side effect recreationally is usually mild nausea. The other "side effects" are generally part of its desirable properties ;)
  - elevaet 4y ago
    ECT on the other hand has very few recreational users. I imagine the physical effects of ECT must be very harsh and difficult for the body.
    - pyuser583 4y ago
      Are there any recreational users?
      - elevaet 4y ago
        I was being a bit facetious, but surely in this world of ~8billion people there are some freaky recreational users out there.
- deleted 4y ago
  [deleted]

warrenmiller 4y ago

aren't the side effects of ECT quite severe though? "loss of creativity, drive and energy. difficulty concentrating. loss of emotional responses. difficulty learning new information."

pyuser583 4y ago
Those are also the symptoms of depression.
thrown_22 4y ago
Those are also the side effects of severe depression so you're not missing out on much.
andrewflnr 4y ago
If you take away my creativity and ability to learn, you may as well just kill me. That sounds like a recipe for depression in itself.
- operator-name 4y ago
  You're depressed, which has already destroyed your creativity and ability to learn. Nothing has worked. Your option is to ECT, which may help, or have adverse side effects. Would you try it? If you've not got much to lose, why not? It's not as if suicide is suddenly no longer an option afterwards.
  - generalizations 4y ago
    > which has already destroyed your creativity and ability to learn Don't think that's necessarily the case.
    - operator-name 4y ago
      Loss of focus and difficulty retaining new information are common symptoms for major depressive episodes.

chiefalchemist 4y ago

> All five of the studies independently found that ECT was more effective than ketamine at relieving *severe* depression symptoms. A keyword was left from the title / headline.

rubatuga 4y ago
Definitely a key factor since most psychiatrists reserve ECT for severe depression.
- chiefalchemist 4y ago
  I think the article mentions that. That said, I would presume the Schedule 1 drugs are being approached with a conservative mindset. But they still mind have wider application once the med profession gets past the stigma. The point being, abandoning these new options should be given a fair chance even if there are intials findings like this one.
  - wnoise 4y ago
    Ketamine has been schedule III since 1999. https://www.dea.gov/sites/default/files/2020-06/Ketamine-2020_1.pdf https://www.dea.gov/sites/default/files/2020-06/Ketamine-202...

kingkawn 4y ago

This article completely neglects discussion of side effects. Ketamine has almost none, whereas ECT can cause horrible degradations to quality of life. Any discussion of efficacy that doesn’t include side effects is quackery.

operator-name 4y ago
I'll give you that it's a short article, but: > The side effect profiles of the two treatments differed, with ECT more likely to cause headaches, muscle pain and memory loss, while ketamine was more likely to cause dissociative symptoms, vertigo and double vision.
- howinteresting 4y ago
  I mean the point of ketamine is dissociation. That's where a lot of healing happens. The vertigo and double vision last a little while, possibly the rest of the day. They're not long term or serious. The memory loss from ECT can be long-term for some people. I've personally found ketamine to help a lot with my mental health issues. It's great and I'd highly recommend at least giving it a shot in a therapeutic setting. I'm sure it's interesting recreationally as well, though I've never tried it that way.
- irq 4y ago
  The way the article omits mentioning the ECT memory loss side effect is often permanent, and the way it omits that ketamine’s dissociative effects are always temporary, screams of quackery.

andy_ppp 4y ago

I absolutely love this talk by Sherwin Nuland, it’s beautifully told and always worth remembering that someone who seems so put together on stage can have had quite extreme troubles… electroshock therapy is surprisingly very effective in extreme cases. https://www.ted.com/talks/sherwin_nuland_how_electroshock_therapy_changed_me https://www.ted.com/talks/sherwin_nuland_how_electroshock_th...

lotophage 4y ago
Came to mention this! That is one of my all-time favourite TED talks. If nothing else, it's a fascinating story told well.

nvr219 4y ago

Yeah but ketamine is a lot more fun so I'm gonna stick with that.

operator-name 4y ago
This is a really strange mindset to me - if Ketamine is working why bother even considering switching?
- fragmede 4y ago
  Tolerance. It's possible to build up a tolerance to ketamine, such that it stops working. For those for whom ketamine once every while is sufficient (eg once a month), there's little danger of that, but for those that need to take it every day (under doctor supervision), it's not sustainable.

larryliu 4y ago

Ketamine is a prescription medicine that can be taken oral, intranasal or IV drip. ECT is an inpatient procedure that need one anesthesiologist and one psychiatrist plus nurses to administer, two to three times weekly for three to four weeks. Who pays for the healthcare, definitely want to try the former and use the latter only if the former works poorly.

RichardCNormos 4y ago
operator-name 4y ago
ECT, due to the potential side effects and Ketamine due to how recent it is are both near the "last lines of defence". IRRC both of them cannot compare to psychotherapy, which has far higher effectiveness at the cost of far more resources.
- theGnuMe 4y ago
  In the beginning we only had psychotherapy and it was like 15-30% successful IIRC.. so no, not necessarily.
  - petesergeant 4y ago
    I think it's a reasonable assumption that psychotherapy has improved since the 1940s/1950s when alternative medicines came out.
- richardjam73 4y ago
  ECT has the highest cost of resources.
  - olliej 4y ago
    I'm guessing this was a typo, but if you look at how unbounded the time for psychotherapy to work, I would not be surprised if it did actually end up being the most expensive.

operator-name 4y ago

It's really dissapointingly seeing the comments section do exactly what the article tries to avoid. There seems to be so much lack of understanding for the process of prescribing treatment for depression, and overreliance on endless anecdotes or other singular data points, directly at the antithesis of the study: > “Every single study directly reports ECT works better than ketamine. But _people are still skeptical of ECT, perhaps because of stigma_,” Rhee says, or negative depictions in films such as “One Flew Over the Cuckoo’s Nest” and shows such as “Stranger Things.” “_We need to improve public awareness of ECT for treatment-resistant depression_.” If we read the article carefully, we can see that the headline (as all headlines are) is lacking in nuance: > Most people diagnosed with depression are offered an _oral antidepressant (in combination with psychotherapy) as a first-line treatment option_. But _if oral antidepressants don’t help, or if the person is at imminent risk of hurting themselves_, there are other, more rapid treatment options: ECT, and more recently ketamine or esketamine. Firstly, oral antidepressants and psychotherapy are still the firstly line of defence, and for the majority of people enough. As it is, ketamine or esketamine is nowhere near close - has nowhere near enough evidence and longitudinal studies - to replace SSRIs and psychotherapy as the first line. Unfortunately modern medicine isn't advanced enough to fully understand what's going on with oral antidepressants (we have theories, but the majority evidence is simply statistics), let alone (es) ketamine and ECT. As a result, if oral antidepressants are not effective it can often be difficult to effectively prescribe treatment. Naturally a consequence of this is increased risk, from procedures that may not have much if any benifits, not even including the very real chances of a misdiagnosis! If we look at the cited paper's abstract, the message is even more clear > Question: Is ketamine as effective as electroconvulsive therapy (ECT) in patients with _major depressive episode_? > Findings: This systematic review and meta-analysis of 6 trials with 340 patients suggests that ECT may be superior to ketamine in improving depression severity. Findings also suggest that ketamine and ECT each have unique adverse effect profiles. > The overall pooled SMD for depression symptoms for ECT when compared with ketamine was −0.69 (95% CI, −0.89 to −0.48; Cochran Q, P = .15; I2 = 39%), suggesting an efficacy advantage for ECT compared with ketamine for depression severity. > Both ketamine and ECT had unique adverse effect profiles (ie, ketamine: lower risks for headache and muscle pain; ECT: lower risks for blurred vision, vertigo, diplopia/nystagmus, and transient dissociative/depersonalization symptoms). > Meaning: Although ECT may be more efficacious than ketamine in the acute phase, _treatment options should be individualized and patient-centered, considering different adverse effect profiles and patient preferences._ Both (Es)Ketamine and ECT are useful and sometimes literally life saving therapies for those with treatment resistant depression. Like any treatment some respond effectively and may never have to undergo future treatment whilst others may require constant support. The stigma around ECT and the uninformed experience and use of anecdotes is dangerous, and ignores the reality that there are no good answers, at least with our current medical knowledge. I would advise not drawing any conclusions from limited evidence, and if they want to see more personal anecdotes explore both the positive and negative comments at /r/ECT and /r/TherapeuticKetamine

tcj_phx 4y ago

My friend figured out for herself, when she was in her 30's, that she's a poor methylator who can't turn the food fortification folic acid into a usable form of Vitamin B-9. She once told me that adding L-Methylfolate to her routine was like flipping a switch from "depressed" to "not-depressed". But the doctors had already decided she was being "stabilized" by the anti-psychotic prescriptions they forced on her, so they just added this vitamin to their cocktail of prescriptions. Vitamin B-9 has to do with DNA synthesis... My source for physiology told me that even the mutants get enough Vitamin B-9 from an adequate diet, it's just poor methylators who rely on fortified food who are screwed. Deplin is the prescription form of Vitamin B-9. It's approved as an add-on therapy, for when patients don't respond well to the prescriptions that never work. Usually 'mental health' diagnoses are manifestations of stress: emotional stress is the big one, but malnourishment is often a factor too. Stressed brains use more energy thinking about the stress all the time. ECT should be retired from use. I heard once that brain damage causes the brain to increase production of the steroid allopregnanolone. The beneficial effect of the SSRI's seem to also be related to increased allopregnanolone, NOT to boosting serotonin levels. I wonder if my friend's guardian [0] could consent to her getting electrocuted. [0] https://news.ycombinator.com/item?id=33307982 https://news.ycombinator.com/item?id=33307982 Edit: She remembers being depressed for as far back as her memories go. Someone on twitter says food fortification didn't really take off until the 1980's. Before then you had to explicitly buy "wonder bread" to get fortified flour, now you can basically assume white flour is fortified white flour.

chrsig 4y ago
> But the doctors had already decided she was being "stabilized" by the anti-psychotic prescriptions they forced on her, so they just added this vitamin to their cocktail of prescriptions. Outside of very specific circumstances during hospitalization, doctors can't actually force you to take any medication.
- kortex 4y ago
  Ehhhhhh depends a lot on the circumstances and the hospital/center. In theory, yeah, in practice, it's a lot harder for patients to refuse treatment, for one reason or another.

thornjm 4y ago

I found the origin of ECT quite interesting: depressed people with epilepsy had dramatic improvement in their symptoms following a seizure. They also discovered that the type and location of the seizures had varying levels of effect.

MangezBien 4y ago

I had ECT and it was absolutely life changing. Only thing that ever worked for me. Mild headaches with each treatment and my memories of the time of my treatment is fuzzy. But I think we probably should be investigating why it works so well.

MangezBien 4y ago
After reading the comments in this thread it is clear that people are not current with how ECT is administered in the modern era. 1. You are under general anesthesia 2. The dosage of electricity is very low when compared to how it was done before. 3. The electrical currents are far more focused Stuff like personality changes or loss of creativity is no longer a risk factor. Risks tend to be those associated with general anesthesia and mild memory loss around the treatment. I had over 2 rounds of 15 treatments over a 6 month period. I haven't had a serious relapse in the 5 years since. I had tried every SSRI and SNRI my insurance would cover. I had been in therapy for over a decade. I was suicidal. ECT saved my life.
- heavyset_go 4y ago
  Thanks for the clarification. How does the memory loss manifest? Are you aware that you lost time, like can you feel that you did experience time pass for X amount of days, but you just don't remember what took place? Or is the feeling that the time never passed at all, like it was Monday and you woke up on Friday, but it felt like it was actually Tuesday morning, and you have no intuitive feeling that a week passed at all?

hexo 4y ago

Whoa, I firmly believe the electroshock "therapy" was debunked a few times already, wasn't it?

operator-name 4y ago
Do you recall where you saw this? As for some counter evidence to your memories, I would suggest you check out the studies cited by the linked paper. ECT is not for everyone, but a last option when all else fails.
pyuser583 4y ago
No, quite the opposite. The general consensus is that it’s underutilized.
- xkbarkar 4y ago
  No, not even close
  - pyuser583 4y ago
    APA position ECT: Electroconvulsive Therapy (ECT) is a safe and effective evidence-based medical treatment. ECT is endorsed by the APA when administered by properly qualified psychiatrists for appropriately selected patients. https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2015-Electroconvulsive-Therapy.pdf https://www.psychiatry.org/File%20Library/About-APA/Organiza... You’re welcome to disagree with the APA, or point out that the APA only represents a small fraction of psychologists, or question whether this is really a consensus opinion. The APA isn’t god. But I don’t think you can say things like “No, not even close” and expect to be taken seriously.
howinteresting 4y ago
ECT is a really mild form of what used to be electroshock therapy, and you have full agency over if and when to stop. It works for a lot of people. The problem is the side effects. The memory loss is really rough. Based on my background as a software programmer, my psychiatrist (who has recommended and done ECT for other people) recommended very strongly against ECT for me and said I should try ketamine instead.

knaik94 4y ago

"Relapse rates after ECT are similar to those in resistant depression treated with antidepressants (37% after six months) and are a function of the illness, reinforcing need to continue with antidepressants, ECT, or both after a successful acute course of ECT.37 Emerging evidence suggests maintenance ECT to prevent relapse.38" https://www.bmj.com/content/364/bmj.k5233 https://www.bmj.com/content/364/bmj.k5233 This article is arguing ECT as acute treatment for resistant depression. In most, if not all, cases a patient would become eligible for ketamine treatment at the same time if not sooner than ECT. Memory loss directly due to ECT is the reason most people are strongly against using it. Treatment options are based on minimizing risks, not guaranteeing success. Unless ketamine is contraindicated, it will always be a safer treatment than ECT.

engined 4y ago

After dealing with depression myself, I dove deeply into this world, and actually ended up founding a ketamine and esketamine treatment startup in the Boston area (lumin.health). We've seen pretty amazing results with patients who have otherwise failed antidepressants and/or ECT and TMS (Transcranial Magnetic Stimulation). The reality is that ketamine/esketamine are much more accessible from a patient perspective, and while considered "new" by many in the medical community, offer faster results and carry less stigma for patients than ECT in particular. If ketamine/esketamine don't work, patients typically know within 2-3 sessions, and can walk away with no long term side effects. With ECT, patients generally have to complete a whole course before they see effect, and then are stuck with some of the potential mid/long-term side effects. The space is also at the precipice of a whole new class of psychedelics coming online - MDMA, psilocybin, and more are all 1-5 years out (working through FDA drug trials), and hold promise of both faster results (versus 6-8 months of trialing traditional antidepressants) and fewer downside risks (versus weight gain, sex drive, etc. issues with antidepressants and memory loss, headaches, etc. with ECT and TMS). Bottom line, if you're suffering and considering those treatments, I highly recommend finding a local center and at least learning more about options available to you. Edit: If anyone wants to talk, advice, etc., email is in my profile.

boredtofears 4y ago
One rumination I have had about the medical application of psychedelics is to wonder how lasting the effects of all these initial studies will be over the long term. The effects of psychedelics are profound to a person who hasn't experienced them, which is the vast majority of people today. I think, when a person goes through a powerful experience they've never had, it makes them a lot more suggestive, which in turn makes therapies more effective. Will this still be the case if psychedelics usage is normalized? When a person knows what to expect out of the drug will they still remain as suggestible to therapy? My own experience with psychedelics tells me no: once you become familiar with the effects the "high" loses some of it's properties that make it a useful tool for introspection. I haven't done psychedelics in a purely therapeutic setting so there may be something to my observation that I'm missing completely.
- 4y ago

whatwhatwhat_ 4y ago

I’m in a deep depression, I’d try it. Wiping my memory would be the best gift I could get.

cryptoanon 4y ago
Go to a psychiatrist and try ask for ketamine. It has the same effect of detaching you from trauma. It’s like putting your brain through a car wash.

zoklet-enjoyer 4y ago

I enjoy ketamine recreationally. No thank you to electrocution.

warbler73 4y ago

How does it compare to peyote?

LatteLazy 4y ago

A much more interesting comparison is to the current standard treatment methods (SSRI/SNRIs and Therapy). These are both very ineffective.

club_tropical 4y ago

In 200 years, people will study this as a crazy tale from the dark ages. The worst thing for depressed people has been the idea that it's a random/genetic phenomenon as opposed to ecological misalignment with their biospirit.

sirsinsalot 4y ago
Tell that to people born with genetic issues leading to increased serotonin transporter density which creates chronic depression in many. Learn some neuroscience.
- Sapere_Aude 4y ago
  There isn't even evidence that depression is caused by serotonin levels. They never even checked that out in the first place. https://www.ucl.ac.uk/news/2022/jul/no-evidence-depression-caused-low-serotonin-levels-finds-comprehensive-review https://www.ucl.ac.uk/news/2022/jul/no-evidence-depression-c... https://www.ucl.ac.uk/news/2022/jul/analysis-depression-probably-not-caused-chemical-imbalance-brain-new-study https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...
- club_tropical 4y ago
  Notwithstanding the particulars about serotonin, I'm not disputing that brain chemistry balances might be heritable to some extent, like height. But "depression" is a downstream phenomenon of one's brain chemistry interacting with their ecology. Here's an analogy: If I took Nordic people and gradually shrank the architecture, chairs, and desks around them across a few generations, such that most would have to unnatural bowing of the head and curvature of the spine, they would experience enormous agony - back pains, neck pains, etc (like "depression"). They would even correctly identify that they are suffering due to a genetically inherited length of their skeleton. Now imagine that in such a world, the "medical solution" is to remove a couple of vertebrae to make them shorter or take some pills that anesthetize the neck muscles. Let's even say all that happens without side effects. Many a patient would be happy for the agony to go away. And yet, I still think this is completely the wrong approach. I have deep compassion for depressed people. I believe they should be very careful trusting a system that "shrunk the architecture" so to speak and offers a form of brain chemistry interference as a "solution". In my opinion, depressed people should attempt to remember that it is almost mathematically impossible that they are the descendants of dozens of generations of depressed adults. They would be far better served, in my opinion, to try to recall and recreate the ancestral adaptive environment (the bigger chairs and taller ceilings).

eric4smith 4y ago

tinus_hn 4y ago

Unfortunately the mental health care industry cannot be trusted with weapons like electroshock therapy.

unixhero 4y ago

Electroshock treatment scares me more than almost anything in this world.

lifeplusplus 4y ago

Death also cures depression

Jerrrry 4y ago

These two treatments being anywhere comparable is a massive disservice and borderline negligent. Feeling a little loopy from a hefty Ket dose and having permanent brain damage from being shocked are so far removed from each other that it is an actual failing in different regards. Drugs may figuratively fry your brain, but it is certainly better than literally frying your fuckin brain.

Maursault 4y ago

ECT is electrical lobotomy. It obliterates all the myelin in the body, and the result in all cases is brain damage and pain disorder. It cures depression by eliminating higher cognition. ECT should be banned and illegal. Ketamine, otoh, should be unscheduled.