6 ms·

“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 t

“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]
- fshbbdssbbgdd 4y ago
  Anecdotal reports from recreational use (higher doses than medical) are that the dissociation, vertigo, and double vision only happen while you’re high, not after it wears off.
  - augustuspolius 4y ago
    I am also confused by this comparison. Yes, Ketamine might cause dissociation… but that’s not a side effect, that’s a catalyst for the actual expected psychological effect. It’s like saying that a side effect of drinking alcohol is feeling drunk.
    - operator-name 4y ago
      > a catalyst For better or for worse.
  - nibbleshifter 4y ago
    I've taken some really, really high doses of ketamine recreationally, it all wears off after a few hours at worst. The disassociation is often a desired effect, it can be incredibly enjoyable.
- deleted 4y ago
  [deleted]
- JamesBarney 4y ago
  By the time you get to ECT for depression you've tried else for your more intolerable depression.
  - augustuspolius 4y ago
    The way this is presented in the article could be dangerous. ECT with its potentially life-altering horrendous side effects is not an alternative to Ketamine with almost non existent negative long term side effects. Both treatments are recommended as the last resort (at least on paper Ketamine is recommended if anti-depressants do not work), with ECT being far more dangerous.
    - operator-name 4y ago
      The cited paper does a much clearer job, but the article does make an attempt: > 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. > “ECT is consistently more successful than ketamine” at helping _patients with serious depression_ > “We need to improve public awareness of ECT for _treatment-resistant depression_.” (emphasis mine)
toss1 4y ago
Yes, an acquaintance from college went through ECT. The guy was previously brilliant. Yes, his illness was part of his later problems, but he was wholly convinced that the ECT was a much larger problem. So much so that as soon as he got out of the institution, he commenced lawsuits against his parents who had set up his treatment (as far as I could tell for legit reasons; it wasn't one of those horror stories of abusing treatment to 'get' someone, just that it went so wrong). I hadn't thought about that in years, but it was my first thought when I saw the headline, I was thinking that was just so obsolete. Indeed, longevity of effect, or specific studies and who paid for them. Yikes.
- Technetium 4y ago
  I just left a comment about a deathly similar situation 2 of my Swedish friends have been in. It hurts my soul knowing they will never have the mental capacities to get justice.
- olliej 4y ago
  The rules for use of ECT are much more strict than they were in the past, so when this happened would be extremely important. ECT as used well into the 80s, possibly even the 90s, was pretty much aversion therapy - essentially just: "you'll behave properly or we'll torture you". In CA at least the rules for use of ECT nowadays are extremely strict, and required frequent confirmation of understanding of what you think you are doing, what is involved, why you are doing it, etc administered by a party not involved in the treatment. > I was thinking that was just so obsolete. Why? The studies for ECT for treatment resistant depression show that it _is_ effective for more than 50% of candidates who undergo it. Note that these are treatment resistant cases, e.g. people for which there is by definition a 100% failure rate for every other option. > Indeed, longevity of effect, or specific studies For some people ECT appears to provide a permanent relief. Some it provides significant improvement for extended (e.g. years) periods, and for some it does not do anything. I can't point to specific studies because at this point there are so many, and that they all have very similar outcomes of more than 50% of recipients having extended or permanent (presumably within bounds of time) improvement in symptoms. > and who paid for them. Generally it's government funded institutions, but I get the general "evil business" conspiracy vibe from this comment. It's important to realize that ketamine and ECT aren't things that you can make profitable. If they work for a given patient they both have extended periods where the patient is not likely to need any treatment, if ever again - the general worst case for a profit driven treatment. Your ability to have a high profit margin is limited by ketamine being a generic drug in the US, and being cheap and easy (in terms of drugs) to manufacture. ECT on the other hand has a large array of costs that can't be avoided, but that also aren't profit centers: you need hospital facilities due to the general anesthesia, an anesthesiologist, the actual doctor, nurses, and a third party to audit and interview patients.
denzilla8080 4y ago
The headaches and muscle pain are temporary. But the memory loss is severe and while not truly hindering, definitely life altering. Years are just blurred together. Some things and people just aren’t there and it’s really hard for me to remember on my own. It more changes the relationship you have with your memory.
- deleted 4y ago
  [deleted]
- MonkeyMalarky 4y ago
  Memories disappear in depression on their own already. Whole spans of my 20s are just gone.
  - jamincan 4y ago
    That's my experience as well. That entire part of my life is just blurred together.
- joe_the_user 4y ago
  While I think memory loss can vary from person to person, I know that the effective of ECT can be temporary for some people and moreover, sometimes the second just doesn't work (as happened with a friend of mine).
- deleted 4y ago
  [deleted]
- operator-name 4y ago
  If you wouldn't mind me asking, when and what specific type of ECT did you undertake?
  - denzilla8080 4y ago
    2012. I had two probes. I was about 20.
- 4y ago
leetrout 4y ago
In my experience ketamine makes early memories very vivid and makes things easier to recall. I definitely prefer that over losing memories but I have not tried ECT.
sibeliuss 4y ago
The musician Townes Van Zandt underwent ECT and the loss of his memory haunted him his whole (very tragic) life. It's well-known how deep of an impact that had on him, and not for the better. As if the often pleasant, often interesting, often terrifying yet short term and proven harmless side-effects of Ketamine can even compare to the ECT! I would like to see how _much_ better ECT is, given all the factors. Additionally, one can do quick, repeat treatments with ketamine. I'm sure doctors would caution repeatedly getting hooked up to an ECT machine.
- operator-name 4y ago
  A single data point may be a interesting, but strong evidence it does not make. Nor does speculating about a doctors caution without citations. Ketamine in recreational use has equally documented side effects, some quite severe. Extreme circumstances that have caused irreparable damage are rare, but not unheard of. There are also numerous other anecdotes from people that have undergone numerous session of ECT with minor side effects. I'm not for or against ECT or ketamine, I just find the language used and conclusions reached from so little evidence extremely dangerous.
  - DontchaKnowit 4y ago
    What sort of side effects are we talking about? As far as I know, bladder damage is the only actual physical effect of ket
    - olliej 4y ago
      Falling over can do a lot of damage :D
- DFHippie 4y ago
  According to Wikipedia it was insulin shock therapy, not ECT, that cost Townes Van Zandt his memory: https://en.wikipedia.org/wiki/Townes_Van_Zandt#Early_life https://en.wikipedia.org/wiki/Townes_Van_Zandt#Early_life I heard a Radio Lab episode in which a sufferer of chronic depression said that he hyperventilated before ECT to minimize memory effects.
poulpy123 4y ago
I had esketamine treatment, and while not miraculous it was reasonably efficient. After the 2 or 3 first sessions where I found the "psychedelics" weird since I never tried this kind of drugs before, I got used of them and found them actually enjoyable
operator-name 4y ago
I think it's very reasonable to reject one method of treatment just from the side effects alone. I also think it's important to look at the "risk/reward" by looking at how much more effective ECT was against ketamine. > 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). Perhaps you'd reach the same conclusion as you did, and I think the paper puts it best: > 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.

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]
fshbbdssbbgdd 4y ago
Anecdotal reports from recreational use (higher doses than medical) are that the dissociation, vertigo, and double vision only happen while you’re high, not after it wears off.
- augustuspolius 4y ago
  I am also confused by this comparison. Yes, Ketamine might cause dissociation… but that’s not a side effect, that’s a catalyst for the actual expected psychological effect. It’s like saying that a side effect of drinking alcohol is feeling drunk.
  - operator-name 4y ago
    > a catalyst For better or for worse.
- nibbleshifter 4y ago
  I've taken some really, really high doses of ketamine recreationally, it all wears off after a few hours at worst. The disassociation is often a desired effect, it can be incredibly enjoyable.
deleted 4y ago
[deleted]
JamesBarney 4y ago
By the time you get to ECT for depression you've tried else for your more intolerable depression.
- augustuspolius 4y ago
  The way this is presented in the article could be dangerous. ECT with its potentially life-altering horrendous side effects is not an alternative to Ketamine with almost non existent negative long term side effects. Both treatments are recommended as the last resort (at least on paper Ketamine is recommended if anti-depressants do not work), with ECT being far more dangerous.
  - operator-name 4y ago
    The cited paper does a much clearer job, but the article does make an attempt: > 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. > “ECT is consistently more successful than ketamine” at helping _patients with serious depression_ > “We need to improve public awareness of ECT for _treatment-resistant depression_.” (emphasis mine)

toss1 4y ago

Yes, an acquaintance from college went through ECT. The guy was previously brilliant. Yes, his illness was part of his later problems, but he was wholly convinced that the ECT was a much larger problem. So much so that as soon as he got out of the institution, he commenced lawsuits against his parents who had set up his treatment (as far as I could tell for legit reasons; it wasn't one of those horror stories of abusing treatment to 'get' someone, just that it went so wrong). I hadn't thought about that in years, but it was my first thought when I saw the headline, I was thinking that was just so obsolete. Indeed, longevity of effect, or specific studies and who paid for them. Yikes.

Technetium 4y ago
I just left a comment about a deathly similar situation 2 of my Swedish friends have been in. It hurts my soul knowing they will never have the mental capacities to get justice.
olliej 4y ago
The rules for use of ECT are much more strict than they were in the past, so when this happened would be extremely important. ECT as used well into the 80s, possibly even the 90s, was pretty much aversion therapy - essentially just: "you'll behave properly or we'll torture you". In CA at least the rules for use of ECT nowadays are extremely strict, and required frequent confirmation of understanding of what you think you are doing, what is involved, why you are doing it, etc administered by a party not involved in the treatment. > I was thinking that was just so obsolete. Why? The studies for ECT for treatment resistant depression show that it _is_ effective for more than 50% of candidates who undergo it. Note that these are treatment resistant cases, e.g. people for which there is by definition a 100% failure rate for every other option. > Indeed, longevity of effect, or specific studies For some people ECT appears to provide a permanent relief. Some it provides significant improvement for extended (e.g. years) periods, and for some it does not do anything. I can't point to specific studies because at this point there are so many, and that they all have very similar outcomes of more than 50% of recipients having extended or permanent (presumably within bounds of time) improvement in symptoms. > and who paid for them. Generally it's government funded institutions, but I get the general "evil business" conspiracy vibe from this comment. It's important to realize that ketamine and ECT aren't things that you can make profitable. If they work for a given patient they both have extended periods where the patient is not likely to need any treatment, if ever again - the general worst case for a profit driven treatment. Your ability to have a high profit margin is limited by ketamine being a generic drug in the US, and being cheap and easy (in terms of drugs) to manufacture. ECT on the other hand has a large array of costs that can't be avoided, but that also aren't profit centers: you need hospital facilities due to the general anesthesia, an anesthesiologist, the actual doctor, nurses, and a third party to audit and interview patients.

denzilla8080 4y ago

The headaches and muscle pain are temporary. But the memory loss is severe and while not truly hindering, definitely life altering. Years are just blurred together. Some things and people just aren’t there and it’s really hard for me to remember on my own. It more changes the relationship you have with your memory.

deleted 4y ago
[deleted]
MonkeyMalarky 4y ago
Memories disappear in depression on their own already. Whole spans of my 20s are just gone.
- jamincan 4y ago
  That's my experience as well. That entire part of my life is just blurred together.
joe_the_user 4y ago
While I think memory loss can vary from person to person, I know that the effective of ECT can be temporary for some people and moreover, sometimes the second just doesn't work (as happened with a friend of mine).
deleted 4y ago
[deleted]
operator-name 4y ago
If you wouldn't mind me asking, when and what specific type of ECT did you undertake?
- denzilla8080 4y ago
  2012. I had two probes. I was about 20.
4y ago

leetrout 4y ago

In my experience ketamine makes early memories very vivid and makes things easier to recall. I definitely prefer that over losing memories but I have not tried ECT.

sibeliuss 4y ago

The musician Townes Van Zandt underwent ECT and the loss of his memory haunted him his whole (very tragic) life. It's well-known how deep of an impact that had on him, and not for the better. As if the often pleasant, often interesting, often terrifying yet short term and proven harmless side-effects of Ketamine can even compare to the ECT! I would like to see how _much_ better ECT is, given all the factors. Additionally, one can do quick, repeat treatments with ketamine. I'm sure doctors would caution repeatedly getting hooked up to an ECT machine.

operator-name 4y ago
A single data point may be a interesting, but strong evidence it does not make. Nor does speculating about a doctors caution without citations. Ketamine in recreational use has equally documented side effects, some quite severe. Extreme circumstances that have caused irreparable damage are rare, but not unheard of. There are also numerous other anecdotes from people that have undergone numerous session of ECT with minor side effects. I'm not for or against ECT or ketamine, I just find the language used and conclusions reached from so little evidence extremely dangerous.
- DontchaKnowit 4y ago
  What sort of side effects are we talking about? As far as I know, bladder damage is the only actual physical effect of ket
  - olliej 4y ago
    Falling over can do a lot of damage :D
DFHippie 4y ago
According to Wikipedia it was insulin shock therapy, not ECT, that cost Townes Van Zandt his memory: https://en.wikipedia.org/wiki/Townes_Van_Zandt#Early_life https://en.wikipedia.org/wiki/Townes_Van_Zandt#Early_life I heard a Radio Lab episode in which a sufferer of chronic depression said that he hyperventilated before ECT to minimize memory effects.

poulpy123 4y ago

I had esketamine treatment, and while not miraculous it was reasonably efficient. After the 2 or 3 first sessions where I found the "psychedelics" weird since I never tried this kind of drugs before, I got used of them and found them actually enjoyable

operator-name 4y ago

I think it's very reasonable to reject one method of treatment just from the side effects alone. I also think it's important to look at the "risk/reward" by looking at how much more effective ECT was against ketamine. > 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). Perhaps you'd reach the same conclusion as you did, and I think the paper puts it best: > 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.