4 ms·

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, po

by 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.

toss1 4y ago
Well, it was in the late 1980s, and it certainly created an aversion response! (although perhaps not the intended reaction) >> was pretty much aversion therapy - essentially just: "you'll behave properly or we'll torture you". If it has changed sufficiently to be essentially unrecognizable vs prior practice, that is probably a good thing... Still, knowing what I do about neuroscience from a minor in college, it still seems like heavy artillery barrages to deal with an insect infestation, or burn the village to save it. The real work of the brain & nervous system happens in hundreds of subtle interactions within cells and in the synapses, the patterns of the synapses, etc, and this is just a global sledgehammer. It'll likely have measurable effects, although 50% seems pretty much like toss-a-coin Russian Roulette with your brain. Perhaps an OK bet in true desperation, but...
- olliej 4y ago
  > If it has changed sufficiently to be essentially unrecognizable vs prior practice, that is probably a good thing... The aversion therapy element is gone entirely - it is always performed under general anesthesia, the patient must consent explicitly, and the patient consent and understanding must be checked regularly by a third party. > The real work of the brain & nervous system happens in hundreds of subtle interactions within cells and in the synapses, the patterns of the synapses, etc, and this is just a global sledgehammer. Modern ECT is performed with low voltages applied to specific regions, as this and every other paper involves goes into the details of. > It'll likely have measurable effects, although 50% seems pretty much like toss-a-coin Russian Roulette with your brain. The success rate is greater than 50%, but it's also fairly dismissive to act like there's no cost involved in the alternative. For example, would you be saying "sure there's a 50% chance this cancer cure will save your life, but it has a bunch of terrible side effects, so it's basically Russian roulette" > Perhaps an OK bet in true desperation, but... Again with the dismissiveness. Neither ECT nor ketamine are considered for anything other than extreme cases for which all alternatives have failed, so weighing the side effects of these treatments against the symptoms of mild and/or treatable conditions is kind of shitty? I get it, due to personal experience you are biased against ECT, and so whether a bunch of research demonstrates that it can be beneficial is not relevant to you. But you don't get to then act like the alternative is some kind of panacea free from these side effects that are apparently so bad.
  - toss1 4y ago
    Yes, I get it, modern ECT is very much improved. However, I don't recall even implying or "act[ing] like the alternative is some kind of panacea", and I don't hold such a position, and I don't say there is no cost in the alternative. In fact, it is likely that both are major problems, and will at some point be considered barbaric (as will the cancer chemotherapy you mentioned). All three are deliberate massive disruptions to the entire system, not at all targeting the actual problem, and in fact any benefit is simply a welcome side-effect. An analogy would be a problem in some towns in the midwest US, and ECT is like hitting the zone with a Magnitude 9.3 earthquake and Ketamine/Chemo is like hitting the zone with a massive flood. Sure, the problem may go away, but... The best advances are being made in immunological cancer treatments, which are far more targeted, and looking far more effective. Eventually, we'll be able to know more to know which small subset among the 100 billion neurons and ~quadrillions of synapses to target. Meanwhile, considering either ECT or systemic drugs as much more than a few steps up vs applying leeches is just wrong. I haven't seen a shred of research that indicates understanding of exactly what brain structures are being targeted, and why nevermind what neurons, for ECT or the systemic drugs, and quite a bit on basically empirical, 'well we do this and it gets a desired effect X% of the time'. Sure, that is way better than nothing, and it is all we have, but it is NOT anything like the desired end state of diagnosing IN DETAIL and EXACT problem and it's detailed mechanism, and then repairing it.

by olliej 4y ago

toss1 4y ago

Well, it was in the late 1980s, and it certainly created an aversion response! (although perhaps not the intended reaction) >> was pretty much aversion therapy - essentially just: "you'll behave properly or we'll torture you". If it has changed sufficiently to be essentially unrecognizable vs prior practice, that is probably a good thing... Still, knowing what I do about neuroscience from a minor in college, it still seems like heavy artillery barrages to deal with an insect infestation, or burn the village to save it. The real work of the brain & nervous system happens in hundreds of subtle interactions within cells and in the synapses, the patterns of the synapses, etc, and this is just a global sledgehammer. It'll likely have measurable effects, although 50% seems pretty much like toss-a-coin Russian Roulette with your brain. Perhaps an OK bet in true desperation, but...

olliej 4y ago
> If it has changed sufficiently to be essentially unrecognizable vs prior practice, that is probably a good thing... The aversion therapy element is gone entirely - it is always performed under general anesthesia, the patient must consent explicitly, and the patient consent and understanding must be checked regularly by a third party. > The real work of the brain & nervous system happens in hundreds of subtle interactions within cells and in the synapses, the patterns of the synapses, etc, and this is just a global sledgehammer. Modern ECT is performed with low voltages applied to specific regions, as this and every other paper involves goes into the details of. > It'll likely have measurable effects, although 50% seems pretty much like toss-a-coin Russian Roulette with your brain. The success rate is greater than 50%, but it's also fairly dismissive to act like there's no cost involved in the alternative. For example, would you be saying "sure there's a 50% chance this cancer cure will save your life, but it has a bunch of terrible side effects, so it's basically Russian roulette" > Perhaps an OK bet in true desperation, but... Again with the dismissiveness. Neither ECT nor ketamine are considered for anything other than extreme cases for which all alternatives have failed, so weighing the side effects of these treatments against the symptoms of mild and/or treatable conditions is kind of shitty? I get it, due to personal experience you are biased against ECT, and so whether a bunch of research demonstrates that it can be beneficial is not relevant to you. But you don't get to then act like the alternative is some kind of panacea free from these side effects that are apparently so bad.
- toss1 4y ago
  Yes, I get it, modern ECT is very much improved. However, I don't recall even implying or "act[ing] like the alternative is some kind of panacea", and I don't hold such a position, and I don't say there is no cost in the alternative. In fact, it is likely that both are major problems, and will at some point be considered barbaric (as will the cancer chemotherapy you mentioned). All three are deliberate massive disruptions to the entire system, not at all targeting the actual problem, and in fact any benefit is simply a welcome side-effect. An analogy would be a problem in some towns in the midwest US, and ECT is like hitting the zone with a Magnitude 9.3 earthquake and Ketamine/Chemo is like hitting the zone with a massive flood. Sure, the problem may go away, but... The best advances are being made in immunological cancer treatments, which are far more targeted, and looking far more effective. Eventually, we'll be able to know more to know which small subset among the 100 billion neurons and ~quadrillions of synapses to target. Meanwhile, considering either ECT or systemic drugs as much more than a few steps up vs applying leeches is just wrong. I haven't seen a shred of research that indicates understanding of exactly what brain structures are being targeted, and why nevermind what neurons, for ECT or the systemic drugs, and quite a bit on basically empirical, 'well we do this and it gets a desired effect X% of the time'. Sure, that is way better than nothing, and it is all we have, but it is NOT anything like the desired end state of diagnosing IN DETAIL and EXACT problem and it's detailed mechanism, and then repairing it.