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Electroconvulsive Therapy and it's requirements (self.Psychiatry)

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[–]NootropicJoe -10ポイント-9ポイント  (5子コメント)

Basically, you get ECT if you think 600 watts across the temples for a few seconds is going to change your brain enough so you're not depressed any more. Surprisingly, it works a lot of the time. Most of the time, actually.

If you do get ECT, never, ever let them talk you into getting more then one treatment per month. They treat everyone like they have severe paranoid schizophrenia and recommend(almost force, they'll keep you inpatient for some time if you don't consent to their treatment course) multiple courses in a short time period.

While you will eventually recover and there is statistical evidence it works, it's more invasive then you probably want. Try and get one zap and then refuse treatment until you're out the door(might be over a month), you can always come back for another course but you can't un-zap your brain, you know?

Don't let them spook you, they're scary but it's only if you let them spook you do they have control.

[–]shick 5ポイント6ポイント  (2子コメント)

You don't generally see a clinical effect until after 4-6 ECT treatments so I'd have to strongly disagree with your advice to run after the initial treatment.

This just highlights how reddit is not the place for psychiatric care. Go see your family Dr for a referral to a psych, or go to your nearest hospital if you can't wait that long.

[–]NootropicJoe -2ポイント-1ポイント  (1子コメント)

You ignored what I said.

getting more then one treatment per month

Zapping the fuck out of your brain is traumatic. Let it heal. Don't let them put you through it like a factory where they're just trying to optimize turnover. If you want to be sure you retain maximum cognitive function after ECT, never more then once a month. Once a week probably is fine(a month is just a sure upper bound), and that's about the rate they put you through an entire course here in America; but that has potential for personality loss which you should probably find unethical.

If you think that's ethical, why not give them a partial leuceotomy and obliterate the anterior cingulate while we're at it, if we want to talk about "clinical effect"?

[–]therivernilePsychiatrist/Neurologist (Verified) 1ポイント2ポイント  (0子コメント)

ECT services are run like most OR's, they are very mechanical so that the most patient's can be seen in as safe a manner as possible.

Where are you getting this data about retaining cognitive function and limiting ECT to once per month?

"Personality loss" will have to be more closely defined. Are we talking retrograde amnesia?

Seeing a patient that is pervasively depressed and suicidal get better from ECT is as close to a miracle as can be expected in psychiatry. Ask those patient's what they would sacrifice to not feel that way anymore, then we can talk about the ethics of memory loss as a possible side effect.

In your discussion about the ethics of memory loss/personality loss you brought up stereotactic neurosurgical techniques. Most modern anterior cingulotomies (unilateral and bilateral) have modern data supporting their efficacy in extreme refractory cases of OCD or depression.

In medicine you consider interventions with escalating invasiveness as the severity of the illness escalates. You don't put someone on a ventilator for a runny nose, and you don't perform a cingulotomy for a patient waking up the wrong side of the bed.

I'm interested to know where this poorly veiled vitriol is coming from...you have personal experiences with these processes so it would seem...

[–]therivernilePsychiatrist/Neurologist (Verified) 2ポイント3ポイント  (1子コメント)

I gotta say Joe, there is a bunch of bad shit in this post.

Boiling ECT down to the direct current applied to the brain is an oversimplification of the multiple neurotrophic, neuroendocrine, and neurometabolic processes that are changed by ECT. MST produces seizures without applying direct current to the brain and it still produces remission of symptoms.

There is no "surprise" that ECT works for the majority of patient's that undergo treatment.

An acute treatment course of ECT is prescribed for debilitating psychiatric illnesses. Some patient definately need 3 treatments a week. You also talk about the patient being coerced by the treatment team to be inpatient for treatments...where are you hearing this? Where is this coming from?

How do you know what level of invasiveness the patient does or doesn't want? You keep saying "zap." Are you talking about delivering direct current to the brain? Why would you recommend getting one treatment then refuse other treatments? ECT does not work like that; you need multiple treatments weekly in an acute course of ECT.

Who is the "them" that is spooking the patient? "They're scary but it's only if you let them spook you do they have control." WTF are you talking about?

[–]NootropicJoe -1ポイント0ポイント  (0子コメント)

Oh, I don't know. Just don't get spooked in general, you need to OODA not fight or flight. If you're inside any one of these cognitive reconditioning centers, either of those is a bad idea. Fight, haldol. Flight, haldol. Freeze; high fat and sugar meal, maybe haldol.

I'm pretty sure that it actually makes a "zzzzzzzzzzt" sound when you zap someone, at least with most amps; 600w is a lot of power, but because I've never felt the need to zap someone across the temples to fix their brain with brain damage perhaps I'll never know. I try not to associate with frank psychotics because they are liable to give me their neuroherpes and cause frank psychosis in me.

Don't get me wrong I'm not bashing the concept of therapeutic brain damage, it's better then bashing therapeutic brain damage or ablative therapeutic brain damage, but it's still therapeutic brain damage.

I mean, when you can't measure deficits afterwards, was there ever even a potential for deficits in the first place?