Eljay said: "(Thanks for the support Stickman!) (I'm a "she" BTW!)"

Oops! Sorry...think I asumed that because I have a male friend called LJ...

arcticdog said: "I realise this is not a representative number in scientific terms but 6 people telling me the same, with no person ever telling me anything positive about the benefits of ECT, leaves me with an impression that after 60-70 years of use, and with still little understanding of it, perhaps it is not as good as doctors tell us it is."

No it isn't a representative sample, nor would it be representative if it was 60 of your friends and relatives. It's called anecdotal evidence and it is not exactly "quality" research, is it? Have you thought about looking up some studies? Your experience is yours and I am not trying to discredit it, but it isn't research. I have looked up some papers, no point posting links here as you need to have login access, but suffice it to say, evidence in strongly in favour of the use of ECT:

"The primary indication for ECT is major unipolar or bipolar depression. Its efficacy is directly proportional to the severity of illness, especially as indicated by changes in psychomotor rate, sleep, appetite, weight, libido and the capacity to experience pleasure. ECT is considered the treatment of choice for depression in the context of many neurologic and medical conditions, including Parkinson's disease, stroke and pregnancy. ECT is also efficacious in the treatment of acute mania and, in some cases, schizophrenia; it is relatively inefficacious, however, in the treatment of depressive episodes in patients with primary personality disorders. It should be the first choice for patients who cannot tolerate pharmacotherapy and for those, such as actively suicidal patients, in whom a rapid response is needed."

(SOURCE: Kraus, R P. Chandarana, P. "Say, are you psychiatrists still using ECT?". CMAJ Canadian Medical Association Journal. 157(10):1375-7, 1997 Nov 15.)

(cont.)

The review article goes on to discuss bi-temporal vs unilateral (non-dominant) therapy, which the author brought up. He (incorrectly) stated that it is do with left or right handedness. About 95% of right handers are left hemisphere dominant vs 50% of left handers. Cerebral dominance is to do with language and mathematical function, not handedness, which is only a guide.

Anyway, it states that unilateral ECT is less effective but also leads to less short term memory loss. So why is this contemptible?

Also - just because the mechanism of action of a therapy is not known, this does not mean it should not be used. There are plenty of therapies where the mechanism is unknown and hypothesised about. If the evidence is that it is safe and effective, then it should be (and is) used.

arcticdog said: "...but had he mentioned ECT as a potential treatment, I would not have continued seeing him."

Huh? Isn't that throwing the baby out with the bathwater? Presumably there was something positive about the therapeutic relationship in the first place? Besides, as your psychiatrist, he MUST present you with all the suitable treatment options.. to do otherwise is poor professional practice

>ECT is considered the treatment of choice for depression in the context of many neurologic and medical conditions, including Parkinson's disease, stroke and pregnancy.< Pregnancy?
Surely you jest! I would have thought time was the correct treatment for pregnancy rather than ECT. Just as time seemed to have been the correct treatment for my depression that was treated by drugs. Fifteen months after seeing the psychiatrist I moved to a country town for work and could no longer access the prescribed drugs from a psychiatrist. However the depression did not come back. Presenting to a psychiatrist for the first time I would have considered it irresponsible had ECT been indicated as a form of treatment. I thought so then and nothing has changed my mind on this. Perhaps if it had been long term and I was desperate, perhaps my view would be different. But little that Stickman says would cause me to change my opinion on this. The research presented is too narrow. I would like to see more, much more. I believe most of this can be countered factually.

Stickman

"Besides, as your psychiatrist, he MUST present you with all the suitable treatment options.. to do otherwise is poor professional practice."

Very few psychiatrists present patients with the full range of treatment options.

Many psychiatric patients could achieve considerable improvement, if not complete control of their symptoms, through adopting specific dietary measures designed to keep their blood sugar levels on an even keel and thus ensure consistent glucose availability to the brain.

All parts of the brain need a constant supply of glucose to ensure proper mental and emotional functioning. The brain uses close to 50% of all available glucose and unlike the heart cannot use other fuel sources such as triglycerides, cholesterol and free fatty acids. The brains of people with a disordered pancreatic and insulin response are regularly starved of glucose and this results in an array of symptoms associated with mental and emotional dysfunction.

In the words of a specialist doctor in this field, “In psychotic depression as well as in schizophrenia there has been found to be 50 – 60% incidence of concurrent Hypoglycaemic Disease. If the Hypoglycaemic Disease is treated, symptoms of schizophrenia and of psychotic depression tend to be far better controlled and in some cases disappear completely.”

I doubt if many patients presenting to a psychiatrist would come away with this sort of advice. The majority would I'm sure come out with a prescription for anti-depressants or some other pharmaceutical, the vast majority of which will only ever mask the symptoms and even then usually only for a certain amount of time before their efficacy is diminished. They will never correct the underlying metabolic disorder, which is what, in not all but in a considerable percentage of cases, is responsible for the symptoms in the first place.

http://www.hypoglycemia.asn.au/articles/hypo_cure-all.html

would appear to support your case Bronwyn. Not to be dismissed lightly

Also
http://qjmed.oxfordjournals.org/cgi/reprint/91/7/505.pdf

David

Bronwyn

I think you have made very valid points.

I gave up on seeing psychiatrists, after you have analysed yourself, what is left?

For me there is cognitive behaviour modification, which is learning new ways to deal with recurring situations - of course this type of treatment doesn't receive the same level of subsidy as does psychiatry, so it has been an intermittent treatment. I am also careful with my diet - natural, organic unprocessed food as often as I can afford. I never eat fast food now. I also have Myalgic Encephalomyelitis - developed as a result of illness and just trying to keep going. So I am very aware of the importance of diet - however, at no stage in my years of treatment did a psych discuss diet.

As for ECT - it was presented to me more as a threat than a treatment, many years ago when I was complaining that my medication left me feeling like a zombie and I was unable to complete my projects at Uni. Maybe it does work for extreme cases - I don't know but it should be considered a last resort.

With proper support, diet and if necessary medication (I am still on meds) mental illness can be managed. I manage much better now, but it is something I live with all the time, just as people with diabetes live with their condition all their lives.

Despite the publicity there is still a stigma attached to mental illness. People who have never experienced it often feel somehow superior. To them I say, "it can happen to you - all it takes is the 'right' set of circumstances to bring you down."