Talk:Electroconvulsive therapy/Archive 5

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Bit of a miserable article

Sorry, but just driving by, this article isn't all that flash. I'm afraid I don't have the time to fix it myself, but i thought I'd point out a few things.

Firstly, the article is very inconsistent and poorly cited. For example, take the section on brain structure and ECT. It spends the first paragraph mentioning how all these large international organisations have definitively found that there is no effect, which appears well cited. Then, it jumps to mentioning how 1 organisation delibrately left out facts, and goes into great detail into 2 articles on animal autopsies, from 50 odd years ago. This really seems like minority viewpoint, and stinks of somebody just adding their 2 cents onto the end of a better done and more comprehensive paragraph. Furthermore, it then mentions that "Numerous other studies between 1942 and 1949 on both humans and animals have found similar findings but were all left out of the 1990 APA report", the presence of human studies would be much more relevant to the topic and should be discussed instead. But more to the point, why haven't these two articles been identified by any of the organisations mentioned in the first paragraph; it seems like somebody's just gone and randomly found 2 anti-ECT articles and plonked them in and then declared a coverup. Also, why are we referencing a book for two articles, surely we can find the proper reference for the articles themselves? If they're not indexed, because they're too old for example, why can't we use any of the other many studies that apparently exist, I'm sure one of those would be more appropriate. Without knowing where they were published, how can we be certain they're legit, or even peer reviewed?

Secondly, under the history section, it's mentioned that "Unilateral ECT has never been popular with psychiatrists and is still only given to a minority of ECT patients". Aside from the fact that I'm pretty sure that's wrong, the reference does not seem to mention the lack of unilateral ECT popularity.

Thirdly, the section on patient experience is largely too long and anaecdotal. It's fair enough having a few of each, but half a dozen of each is too much. Furthermore, the majourity of patients undergoing ECT don't have a particularly negative experience, and most of them find it positive. But having such a large number of severely negative experiences gives undue weight to an extreme minority reaction. Especially since they're all regarding what appears to be severe memory loss (even the positive ones) and long term memory loss is rare if it happens at all. It's like if I found the article on a certain type of car, and put under "driving experience" 12 examples all of which involved the driver crashing their car, sure, it happens and is interesting, but it's misrepresenting something as common which is normally quite rare.

I'm sure there are other things, but they're the things that bug me most. It seems this page has been hijacked by PoV warriors. 203.5.70.1 (talk) 16:08, 10 September 2009 (UTC)

++++++++++++

• Despite the messy state of the current article, imho, it is currently much less biased than it was a couple years ago when the article read like a pro-ECT brochure. As stated in the first sentence of the article, ECT is highly controversial. And when you have a topic so controversial, what's appropriate is to remain objective and present the main opposing viewpoints and references to corresponding evidence for each side. I can tell you that a couple years ago this article read like a pro-ECT brochure because of biased editing. The problem with only incorporating the APA position is that there is a severe conflict of interest. You have to realize that psychiatrists conducting ECT on a regular basis make yearly salaries that can be two to three times as high as psychiatrists who do not. There is a vested financial interest. It is a money-making industry, not some humanitarian non-profit industry. If ECT were banned, the salaries for thousands of psychiatrists would be slashed in half or more, and others would also be losing money like hospitals, anaesthesiologists and psychiatric nurses. Yes, the APA position needs to be prominently stated with references to published papers, but it would not be fair and objective to post only the APA position.

• With regard to the old animal studies, we don't really need to reference studies from the 1940's because there is new evidence showing that electroshock produces substantial brain damage in animal models. For example, a recent Russian rodent study utilizing sophisticated technology documented up 10% loss of neurons in parts of the brain after electroshock, and a new Brazilian study found that electroshock produces numerous tiny lesions in the brains of animals. It simply isn't possible to rely solely on human studies, because, quite frankly, there aren't any relevant modern human studies checking for the type of diffuse, substantial damage found in the animal studies. It's not the type of damage that shows up on MRI's and CT scans. It's the type of damage that only shows up under a microscope on autopsy when comparing a large number of electroshocked brains to control brains. And these studies simply aren't being done in humans at the present time.

• Despite over fifty years of ECT use, it wasn't until a few years ago that Sackeim pubished the first-ever, large-scale prospective study evaluating cognitive function in post-ECT patients! And mind you, this study documented routine, persistent, global cognitive deficits in post-ECT patients. It did not find this in the unilateral patients, but Sackeim pointed out in his paper that this does not suggest that unilateral patients don't also have long term cognitive damage, because another study would be necessary that utilizes a neuropsychogical testing battery specifically targeted to right-brain function. But that's not all. Soon after Sackeim published his study, a Canadian study led by Glenda Macqueen was published assessing cognitive function in bipolar patients compared to controls before and six months or more after ECT. This study ALSO documented substantial, routine, global cognitive deficits. In other words, both the Sackeim and Canadian studies concluded that ECT can lead to permanent mental retardation compared to patients not undergoing the procedure. The APA does not tell people this. Instead, informational materials from places like Mayo Hospital and the APA downplay any potential negative effects of ECT, and more or less limit the risk to short-term memory loss with some slight suggestion of rare problems with long-term memory problems. Harold Sackeim himself can be seen on YouTube discussing this very problem, his position being that agencies stressing the stigmatization and safety of ECT are exaggerating, and that some of the people on the other side are also exaggerating. His comments infuriarated a lot of people, because given his own controversial ties to the industry and previous claims as to the safety of ECT, many saw this as an attempt to get himself out of hot water.

• The Mayo website does not tell people about these studies. And a third recent study found that post-ECT patients often have substantial cognitive deficits that they are not even aware of, and that a large percentage of these people even erroneously believed their cognition was better after ECT, even though careful before and after testing clearly showed the opposite. Based on the findings of the study, the researchers concluded that people with cognitively demanding careers should think twice before having ECT. Then there are sham-ECT studies showing that sham-ECT (where persons are anaesthetized but not shocked) can produce an antidepressant effect nearly as robust as real ECT! And no, the APA and leading researchers who make money from ECT do not reference these studies. They are left out. I could go on typing for a couple more pages talking about functional brain imaging studies, animal studies, etc, but I only wanted to help explain to you why it is not as simple as it looks. I agree with you that this article needs to be cleaned up and better sources should be used in some areas, but to make the content of this article simply mirror the position on the Mayo or APA website, or some paper by Charles Kellner would be a huge mistake. Danrz (talk) 04:35, 13 September 2009 (UTC)

++++++++

• Ahh!, wall of text attack. Anyway, let me go through your points slowly so my brain doesn’t explode. With regards to being a money making industry, I think you’ll find that most psychiatrists wouldn’t be psychiatrists if they were actually interested in making money, and would do something predominantly procedural. If ECT truely was all about the money, and thus gave no job satisfaction, I’m sure people would instead do specialties that actually give them more money, as well as job satisfaction. Also, it’s a bit like saying that surgery organisations can’t be trusted and have a severe conflict of interest and are thus not the people to ask about surgery questions as they have a vested interest in performing surgery. I guess you could say the same thing about any professional body on second thoughts. In fact, you could say that a research has a vested interest in publishing studies that are critical of ECT, because they “rock the boat” and bring him fame. But I digress.

• With regards to old animal studies, according to Wikipedia policy, and as a courtesy to anyone actually interested in looking the evidence for themselves, we really need to try to find the correct reference link, as opposed to having somebody try to scrounge up a book that may be hard to find. The Sackeim stuff is good, although I’m quite sceptical as to the relevance of animal studies from a long time ago that aren’t referenced properly. Quite a bit of the stuff mentioned in detail is of quite uncertain relevance. Sure, you get brain changes in rats, but what happens in animals doesn’t necessarily happen in humans (hey, even intraspecies things don’t necessarily follow - what happens in elderly may not happen in young adults), and random brain changes are of uncertain relevance. The Sackeim stuff is much better and more interesting, and needs to be brought to higher prominence, and especially referenced properly. I’m sure a proper reference can be found easily.

• I found the Glenda MacQueen article previously mentioned at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1911194, full text so very handily available. It’s an interesting read, and thank you for drawing it to my attention, but I should like to add that it specifies that the changes are unlikely to change the risk:benefit ratio much. I don’t think you can say that the cognitive deficits were global however, nor do I think you can claim that these patients routinely had deficits from this style of study. It’s also little inappropriate to say that these deficits that occur lead to “mental retardation” however.

• With regards to the APA and NICE guidelines, I was unable to access the APA so only delt with the NICE. It does in fact mention cognitive problems that are long term. In addition, it calls for additional data on long term safety. Most medical organisations do not deny that there are adverse events with ECT, but instead it’s all about risk:benefit (just like everything else in life).

• More importantly, I would also like to point out that the adverse events section really needs to be summed up, and it’s unduely long and reads like a literature review as opposed to anything synergistic. I’d think it would be better served in the form of “these studies say cognitive impairment happens, 1,2, structural damage, 3,4, these studies say there aren’t any cognitive impairments, 2,3,4,5”, etc, here’s a big one from each that we want to describe in detail”.

• With regards to infuriating people by saying they’re exaggerating, the nature of anecdotal evidence though is that it’s unreliable and yet people are convinced about it. It’s like if I made an announcement that a common cold isn’t caused by cold weather, I’m sure there would be some people who would be convinced even in the face of a lack of evidence and get quite angry with me. That doesn’t mean that what I say isn’t true. Alternatively, it's possible that these subjective things just are just difficult to measure (point brought up by the NICE article). By the way, since when has being a psychiatrist who’s a specialist in something and talking about it a lot been controversial?

• With regards to the third study you mentioned, I really need a link to comment, as well as a link for sham-ECT vs ECT efficacy.

• With regards to the APA and leading researchers leaving out studies, most likely it's because it's just not relevant for their publication in general (eg, a patient information article that tries to stay under a page doesn’t particularly need to feature that something is causes brain changes in rats but this hasn’t been shown in humans, afterall panadol is lethal in cats, nor does a suggested protocol need to mention the probability of long term side effects unless it alters their practice), or more uncommonly, it’s a poorly designed study, or it's outweighed by other evidence and the study was small. Patient information articles are often simplified, and more detailed discussion about adverse events is left between the physician and the patient.

• Just lastly 1. Just because somebody makes money from something doesn’t mean they can’t be trusted. An expert at something is likely to be somebody who makes a living out of their knowledge. Somebody who makes a living out of something is most likely to be the most knowledgable with it. 2. The Wikipedia article doesn’t need to mirror the position of the Mayo or APA website, but right now it’s messy, unreferenced properly, misleading (hey, there’s no section on... you know, actual benefits!), etc. While ECT does have some side effects, quite a few of which may have a significant impact on a patient’s life, it’s really no different from the majority of treatments out there, and it definitely beats an untreatable severe mental disorder. 203.5.70.1 (talk) 16:08, 15 September 2009 (UTC)

For what's it's worth, I've watched this page for a long time and I'm the one that found the MacQueen article referenced above and brought it into consideration in the first place. I discuss this article below in the "cognitive effects" discussion section. The deficits documented were global in nature. That's the proper and common descriptive term used where cognitive deficits manifest across multiple domains, and that term has been used by other researchers referencing this study, including Dr. Breggin. As I note below, the comment in the abstract about the findings not changing the risk/benefit ratio are not a scientific observation or conclusion. It is a subjective interjection. And for comparison purposes, I reference another study finding cognitive dysfunction across multiple domains where the researchers state the implications as to the risk/benefit ratio quite differently. The deficits found in the MacQueen study were substantial, and it was not a minority finding. Same way with the Sackeim study which was large scale. P was <0.001, suggesting that pretty much everyone having bilateral ECT had problems, and there's no reason to think unilateral doesn't also cause permanent cognitive global cognitive damage just for common sense reasons, and Sackeim pointed this out in his paper.

With regard to animal studies, I'm not really impressed with your comment that just because something happens in animals doesn't mean it will happen in humans. We're talking about crude energy passing through organic tissue, and damage has been documented in multiple animal species. I don't even see the most well-known pro-ECT researchers suggesting this. If you wanted to include some little footnote to the reader, feel free. But don't suggest that this information isn't relevant, because the only way this type of damage can be found to begin with is with these animal studies with very particular procedures, and they can't be duplicated in humans realistically. Because of this, the studies are vitally important. And it's not just older studies. There are new ones coming out saying the same thing. The Brazilian government has financed research trying to get an answer as to whether ECT is really safe and effective or not with the aim of being neutral and objective, and the research teams have published animal studies showing that ECT leads to a hard to detect form of significant brain damage and offered their opinion in one of their papers that it's reasonable to conclude that the findings apply to humans and explain the memory loss and other problems. And to date, leading pro-ECT advocates like Kellner, Abrams and Fink, for example, won't even acknowledge any of these studies, and it's not because the studies are debunked, antiquated, or poorly designed. They're just being ignored. Fink again just published a new book supposedly reviewing the literature, and conveniently ignores any study that he can't explain away. WanderingStranger (talk) 04:38, 16 September 2009 (UTC)

You may want to refresh your stats knowledge. A low P value does not imply in any way that everyone had problems, rather that they were unlikely to be due to simply chance. Conclusions that everyone had problems cannot be drawn from a comparative study of this nature. In this case, you are merely measuring averages, not change after ECT. If you wanted to see what proportion of people had these changes, you would need to do a RCT. Also, please provide references for your statements here, I’m too lazy to find which of the many Sakeim papers on ECT (hasn’t he had a couple hundred or something ridiculous like that?) he mentions that unilateral causes permanent cognitive damage as well. It’s entirely possible that unilateral ECT does not cause cognitive changes, or the cognitive changes are of a greatly reduced magnitude such does it not matter, and a study into this area really needs to be found. Especially since unilateral ECT is by far the first line.

With regards to animal studies, what happens with one species doesn’t necessarily follow, even if common sense dictates it will, and I can think of many examples of this. Also, studies from long ago are likely to not be following modern protocols, which are much safer than what happened in the 50s and 60s. Without looking at the papers themselves, I can’t even comment on the use of controls, what protocols, etc, etc.

For a literature review from 94, have a look at this http://ajp.psychiatryonline.org/cgi/content/abstract/151/7/957. It’s only the abstract, which is a shame because only reading abstracts can be quite misleading. And true, it’s hard to duplicate said studies in humans anyway, but that doesn’t change the fact that there are still limitations of animal studies. You could also check autopsies. I can’t comment on any of the things you’ve mentioned because you haven’t provided a proper reference to any of them.

I don’t really have enough time to fix things up here in this page, so I thought I’d summarise. The page is very poorly referenced. The adverse events page needs to be chopped down and synergised, rather than reading like a literature review of negative ECT studies, the effectiveness section is a good model of this. Two studies on animals in the 40s and 50s, both poorly referenced, are given as much pagespace as the APA and NICE position on structural brain damage. Without a proper reference, we’re taking an editor’s word that the book he read has an author who read the article and drew the correct conclusions. History is listed under legal status (???). Involuntary ECT section is unduely US focused and needs anecdotes chopped out of it (choose 1 or 2 and mention details). Patient experience section is very silly (anecdotal, and every person mentioned there has very severe memory deficits, which certainly aren’t all that common, and besides the ECT patient experience section if it continues to exist, should be about experiences of the ECT process itself). That’s all I can think of for now. As it is, this article feels like a good article which has been derailed by everyone adding overly detailed accounts of their favourite PoV.203.5.70.1 (talk) 05:54, 16 September 2009 (UTC)

I don't need to refresh my stats knowledge. Dr. Peter Breggin wrote the following in a published, peer-reviewed article: "Probably to disguise the wide swath of devastation, the Sackeim study did not provide the percentage of patients afflicted with persistent cognitive deficits; but all of the multiple tests were highly significant (p < .0001 on 10 of 11 tests, and p < .003 on the 11th). Also, the individual measures correlated with each other. The statistical data indicates that a large percentage of patients were significantly impaired."

http://breggin.com/index2.php?option=com_docman&task=doc_view&gid=203&Itemid=3

The rest of what you write isn't any better. I'm not going to bother with it. WanderingStranger (talk) 17:15, 16 September 2009 (UTC)

Question from wikipedia user

Sorry, but I don't understand hitting somebody with lightning or an electric-chair can cure them. This made me also think of Frankenstein, perhaps we could even make zombies by using electricity. It seems that in the article it states that this type of 'treatment' is rather old. Why is it used at all these days?

Did you even read the fuckin' article? [[User:SonicNiGHT|SonicNiGHT]] (talk) 09:37, 25 July 2009 (UTC)

Lutchman citation

I'm trying to see if the Lutchman reference supports the sentence it is attached to. I'm looking at the abstract for the Lutchman article, but I can't interpret it. In particular, I want to know what "split-half reliability" means.--Mumia-w-18 (talk) 15:00, 1 January 2008 (UTC)

Both that and internal reliability are measures of how good the questionnaire is - not sure on specifics, although this article may help. I would guess it fits in under the whole is a questionnaire consistent, reliable, does it have inter- and intra-operator validity, all that sort of thing. Nmg20 (talk) 16:57, 1 January 2008 (UTC)

Thank you.--Mumia-w-18 (talk) 18:30, 1 January 2008 (UTC)

Cognitive effects

Hi, I took a look on scholar.google.com and it is pretty easy to find that patient outcomes are a lot worse than depicted in the article. One noteworthy study is this one which reports long term cognitive deficits and long term memory losses in patients receiving ECT.

The article also totally overlooks the subjective experience from the patient, an oft overlooked aspect in psychiatry, but all the research I find, such as this reports a not too positive experience. --Benjaminbruheim (talk) 20:01, 7 January 2008 (UTC)

Hi - that study's worth including, although there's a lot of Sackeim in there already. In terms of the patient experience stuff, I'm sure we've discussed that study before, and in any event their conclusion is something like "it's complex and multi-faceted" - which is a heck of a long way from your gloss of "not too positive". The range of offerings in the literature section reveal that some people think it was the worst thing that ever happened to them and others think it's the best: I don't see any convincing evidence for overwriting either of those viewpoints. Nmg20 (talk) 00:13, 8 January 2008 (UTC)

==

Neuropsychiatr Dis Treat. 2008 Jun;4(3):613-7.

Neuropsychological effects and attitudes in patients following electroconvulsive therapy.

Feliu M, Edwards CL, Sudhakar S, McDougald C, Raynor R, Johnson S, Byrd G, Whitfield K, Jonassaint C, Romero H, Edwards L, Wellington C, Hill LK, Sollers J, Logue PE.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center Durham, NC, USA.

The current study examined the effects of electroconvulsive therapy (ECT) on neuropsychological test performance. Forty-six patients completed brief neuropsychological and psychological testing before and after receiving ECT for the treatment of recalcitrant and severe depression. Neuropsychological testing consisted of the Levin Selective Reminding Test (Levin) and Wechsler Memory Scale-Revised Edition (WMS-R). Self-report measures included the Beck Depression Inventory (BDI), the Short-Term Memory Questionnaire (STMQ), and several other measures of emotional functioning and patient attitudes toward ECT. The mean number of days between pre-ECT and post-ECT testing was 24. T-test revealed a significant decrease in subjective ratings of depression as rated by the BDI, t(45) = 9.82, P < 0.0001 (Pre-BDI = 27.9 +/- 20.2; post-BDI = 13.5 +/- 9.7). Objective ratings of memory appeared impaired following treatment, and patients' self-report measures of memory confirmed this decline. More specifically, repeated measures MANOVA [Wilks Lambda F(11,30) = 4.3, p < 0.001] indicated significant decreases for measures of immediate recognition memory (p < 0.005), long-term storage (p < 0.05), delayed prose passage recall (p < 0.0001), percent retained of prose passages (p < 0.0001), and percent retained of visual designs (p < 0.0001). In addition, the number of double mentions on the Levin increased (p < 0.02). This study suggests that there may be a greater need to discuss the intermittent cognitive risks associated with ECT when obtaining informed consent prior to treatment. Further that self-reports of cognitive difficulties may persist even when depression has remitted. However, patients may not acknowledge or be aware of changes in their memory functioning, and post-ECT self-reports may not be reliable.

PMID: 18830401 [PubMed - in process]

Excerpt from concluding discussion in study:

"Contrary to the established literature, patients indicated memory deficits both before and after receiving ECT, but did not report a significant change in their subjective ratings of memory functioning. Indeed, there was a slight trend towards [patients reporting] improved memory functioning, despite the objective neuropsychological data indicating significantly lower recognition and delayed recall. Thus, self-appraisal of memory functioning seems to be impacted and should be further explored to better understand these findings. As expected, patients self-reported levels of depression were significantly lower following ECT. Thus, the results indicate that ECT was successful in alleviating depressive symptomatology while cognitive deficits persisted with poor insight of cognitive decline post ECT."

(An important novel finding of this newly published study is that patients who subjectively believe that they are not cognitively impaired by the procedure -- or even that their thinking has improved from ECT -- may in truth suffer from significant cognitive deficits from ECT as proven by neuropsychological testing.) —Preceding unsigned comment added by WanderingStranger (talk • contribs) 03:31, 5 October 2008 (UTC)

"When ECT is provided to adolescents, the potential impact of such cognitive changes should be discussed with the patients and their parents or guardians in terms of implications for not only the patient’s emotional functioning but cognitive functioning as well, particularly upon his or her academic performance. In summary, we argue that an individual cost-benefit analysis should be made in light of the implications of the potential benefits versus costs of ECT upon improving emotional functioning and the impact that potential memory changes may have on real-world functioning and quality of life."

=====

J Psychiatry Neurosci. 2007 Jul;32(4):241-9.

The long-term impact of treatment with electroconvulsive therapy on discrete memory systems in patients with bipolar disorder.

MacQueen G, Parkin C, Marriott M, Bégin H, Hasey G.

Mood Disorder Program, St. Joseph's Healthcare, McMaster University, Hamilton, Ont. macqueng@@@mcmaster.ca

OBJECTIVE: Electroconvulsive therapy (ECT) has been controversially associated with long-lasting memory problems. Verbal learning and memory deficits are commonly reported in studies of people with bipolar disorder (BD). Whether memory deficits can be exacerbated in patients with BD who receive ECT has, to our knowledge, not been systematically examined. We aimed to examine whether long-term effects of ECT on discrete memory systems could be detected in patients with BD. METHODS: We studied several domains of memory in 3 groups of subjects who were matched for age and sex: a group of healthy comparison subjects, a group of people with BD who had received ECT at least 6 months before memory assessment and another group with BD that had an equal past illness burden but had never received ECT. Memory was assessed with the California Verbal Learning Test, the Continuous Visual Memory Test and a computerized process dissociation task that examines recollection and habit memory in a single paradigm. RESULTS: Compared with healthy subjects, patients had verbal learning and memory deficits. Subjects who had received remote ECT had further impairment on a variety of learning and memory tests when compared with patients with no past ECT. This degree of impairment could not be accounted for by illness state at the time of assessment or by differential past illness burden between patient groups. CONCLUSIONS: From a clinical perspective, it is unlikely that such findings, even if confirmed, would significantly change the risk-benefit ratio of this notably effective treatment. Nonetheless, they may highlight the importance of attending to cognitive factors in patients with BD who are about to receive ECT; further, they raise the question of whether certain strategies that minimize cognitive dysfunction with ECT should be routinely employed in this patient group.

PMID: 17653292 [PubMed - indexed for MEDLINE]

This last study I find disturbing because it reveals significant global deficits in cognitive function six months and beyond in bipolar patients after ECT, suggesting permanent adverse consequences to cognition. Yet despite this, the authors feel the need to interject a subjective opinion amidst the science to say that such findings shouldn't limit the administration of ECT to bipolar patients given its purported efficacy for controlling the bipolar disorder, or in their words, that it shouldn't change the "risk/benefit" ratio. This is in stark contrast to the opinion rendered in the first study, where the authors stress that "cost-benefit analysis should be made in light of the implications of the potential benefits versus costs of ECT upon improving emotional functioning and the impact that potential memory changes may have on real-world functioning and quality of life."

WanderingStranger (talk) 03:15, 5 October 2008 (UTC)

Electroconvulsive Therapy in Pregnancy

I just added a citation of this source.

Author: Jacquelyn Blackstone, Michael G. Pinette, Camille Santarpio, Joseph R. Wax. Web page: “Electroconvulsive Therapy in Pregnancy.” Web site: “Obstetrics & Gynecology.” Date: 2007. Institution: American College of Obstetricians and Gynecologists. Date of access: February 9, 2008. Web address: http://greenjournal.org/cgi/content/short/110/2/465.

Chris Dubey (talk) 04:59, 10 February 2008 (UTC).

Good source but I'm wondering if it is not bit too long creating undue weight. I have no facts or figures here but I would think that the procedure is not performed often on pregnant women. Could we not exclude the authors and tighten it up a bit? --scuro (talk) 05:46, 10 February 2008 (UTC)

I will remove the author's name from the in-text citation and see what other summarization would be good. Chris Dubey (talk) 16:18, 10 February 2008 (UTC).

Scuro, I used Google to briefly search for ECT and pregnancy. Although I did not find reliable sources, the sources do report that: "During pregnancy. ECT has been found safe during all trimesters of pregnancy by the American Psychiatric Association" (Brattleboro Retreat Psychiatric Review, 1996, quoted by About.com); "SALT LAKE CITY (AP) - A bill that would have banned those under the age of 18 and pregnant women from electroshock therapy was heard by a House committee Thursday night, which decided not to vote on the legislation" (Casper Star Tribune, 2003, quoted by HealthyPlace.com); "ECT is safe in all trimesters of pregnancy, and may pose less risk to the fetus than treatment with many psychotropic medications" (New York State Psychiatric Institute, 2001, quoted by survivorlink.org).

Sources.

<http://bipolar.about.com/gi/dynamic/offsite.htm?zi=1/XJ/Ya&sdn=bipolar&cdn=health&tm=45&gps=549_505_1020_563&f=10&su=p284.8.150.ip_&tt=14&bt=0&bts=0&zu=http%3A//www.ect.org/resources/pregnancy.html>.

<http://www.healthyplace.com/Communities/Depression/ect/news/2-14-2003_utah.asp>.

<http://www.survivorlink.org/electroshock/Electroshock%20Policies/NYPI1.html>.

Chris Dubey (talk) 16:48, 10 February 2008 (UTC).

I have a request for any user who edits this article. Would you please try to find more proper sources about electroshock and pregnancy? I would like to have good, secondary sources about the statements about electroshock and pregnancy by the American Psychiatric Association, New York State Psychiatric Institute, the Surgeon General of the U.S. Public Health Service, or any other authorities on this topic. I would also like more sources that cite scientific studies about this, especially about the objective effects, by which I mean the effects outside the mind. I do not know if the Web page on About.com that I mentioned above is proper or not, by Wikipedian standards. Nmg20, since you seem to be someone with a high amount of knowledge on ECT, would you please try to do this? If you want to discuss this with me more, email me with the link on the left of my user page, because I rarely check my talk page. Thank you in advance. Chris Dubey (talk) 01:04, 16 February 2008 (UTC).

Hi, Chris - not long on time at the moment, but a pubmed search turned up (I only went back to 1990):

Case studies (safe) - PMID 14560648, PMID 17804997, PMID 11593722 (Japanese), PMID 10614034 (two patients), PMID 8198651 (twins), PMID 11941159 (twins), PMID 2246991

Case studies (harmful) - PMID 10668602 (death) (French), PMID 10074880 (premature labour), PMID 9871846 (spontaneous abortion)

Interesting article on the physiological impact of ECT on the foetus - PMID 12492807

Review articles primarily on ECT in pregnancy: PMID 7995506, PMID 8045538, PMID 11941169

Review articles mentioning it - PMID 11692973, PMID 10730103 (German)

The most convincing article is PMID 8045538, which reviews 300 case reports and reports complication rates. In and of itself, the fact that many of the case studies focus on high-risk patients suggests ECT is safe, and review articles support this - but there are horror stories out there. I can try to get hold of specific papers if there are any that interest you, Chris - let me know. Nmg20 (talk) 23:10, 18 February 2008 (UTC)

Nmg20, thank you. I do not have a request for a specific paper now, but I will keep your offer in mind. When you continue work on the article, would you help cite some of the material you just provided? I think it is important, because the articled previously lacked any reference to ECT's effects on pregnancy and childbirth. Chris Dubey (talk) 02:00, 19 February 2008 (UTC).

Latest set of edits

I've reverted a succession of recent edits, I'm afraid, for the reasons which follow.

• Changing "It is widely accepted" to "some people believe" is against consensus per the previous discussions here. It is also weasel words - the scientific position is overwhelmingly against ECT causing brain damage.
• Removing the sentence about duress in involuntary ECT is unwarranted.
• Insulin shock therapy is not relevant to this article - it has nothing to do with ECT.
• Changing "modern medicine" to "psychiatry" is unwarranted and removes the point - that ECT is the only form still practiced by modern medicine.
• Breggin is already mentioned, and as he's still alive - as is the frequently ludicrous anti-psychiatry movement - he doesn't belong in the history section, and doesn't warrant a second mention per WP:Weight and (again) previous discussions here.

Nmg20 (talk) 12:00, 20 March 2008 (UTC)

Hi, Nmg20. Thanks for disallowing the removal of my sentence about duress in involuntary ECT. I know there's no citation of a source for that claim, but it's common knowledge that people will at least sometimes be dishonest when under duress. I imagine there are sources to prove that point at least.

I also just added some references to a recent case discussed in "The New York Sun." I did the footnotes and sources. Chris Dubey (talk) 16:46, 13 April 2008 (UTC).

David Tarloff

I normally don't involve myself in edit wars. However, I recently added important information about the real, recent case of electroshock patient David Tarloff. User Keyblade5 undid my edit. That was unwarranted. The citations had footnotes and sources and the source was appropriate, newspaper "The New York Sun." If I need to, I will continue to contest this with higher authorities in Wikipedia. Chris Dubey (talk) 01:52, 15 April 2008 (UTC).

It seems that I mistakenly believed the revert had removed my addition. All right. I'll carry on. Chris Dubey (talk) 18:33, 15 April 2008 (UTC).

This is an interesting case, but it seems a little inconclusive at the moment. Given that the sources and their inclusion in the article don't try to claim any cast-iron connection between the two events, however, it's probably worth a mention. Would it be better in a different section? It isn't ultimately a "nonfictional depiction"... Nmg20 (talk) 10:56, 16 April 2008 (UTC)

Hi, Nmg20. Well, you know my basic beliefs about electroshock. I believe it should generally be voluntary only, but I also believe it is unsafe. I know my bias about it and I have an idea of yours. I understand that we disagree, but I strongly approve of this reference. So, if my words are strong, you should know why.

I do not know of a better section for that reference. You stated, "It isn't ultimately a "nonfictional depiction"..." I want to know what reasoning you are using to reach that conclusion. Nonfiction means a description of reality. Fiction means a description of unreality. Are you saying that this case is fiction? Just because the details are uncertain doesn't make it fiction. The effects of ECT on the general population are uncertain. Yet the indefiniteness does not make claims, in scientific reports, about electroshock fictional. Whether those claims are true or false, they are still in the category of nonfiction. What reasoning are you using in your claim that the reference is not a nonfictional depiction? Chris Dubey (talk) 00:27, 17 April 2008 (UTC).

Hi Chris. Like you, I understand that we disagree, and because your addition was well-sourced - as I said above - I think it's worth a mention. My issue over "nonfictional depiction" was more that it isn't a depiction - but that applies to a few of the items in this section now. My concern is that there is to my mind a difference between newspaper reports and (auto)biographical sources - but I haven't a clear idea how to address this, so was just flagging it up. Nmg20 (talk) 10:16, 24 April 2008 (UTC)

I agree that there is a difference between newspaper reports and autobiographical sources. Obviously, the newspaper reports are more verifiable and should be considered more credible. However, there are autobiographical sources in both the negative and positive depictions. If you want, we could separate the news articles from the autobiographical sources. I approve of you doing that, as long as you do not delete any citations without first consulting everyone on the talk page. Chris Dubey (talk) 16:12, 24 April 2008 (UTC).

Chris has taken some time finding this info and the info would be of interest to some readers. To me the issue is of undue weight, due to it's expanding nature it is starting to dominate the article visually. The solution is to expand the fictional depictions article to include all forms of depiction, and title it something like, "Depictions of ECT".--scuro (talk) 16:32, 24 April 2008 (UTC)

Scuro, if you mean putting both the fictional and nonfictional and positive and negative depictions in a different article linked from the main article on ECT, then that is okay with me. Chris Dubey (talk) 18:55, 27 April 2008 (UTC).

Simone D.

I just added a reference to the case of Simone D. The source is MindFreedom. I expect this reference, like the previous one, will be contested. If anyone has a comment, go ahead here. Chris Dubey (talk) 02:47, 19 April 2008 (UTC).

I added another source for this reference. The other source is Lauren Tenney, published on the Web site of the New York State Office of Mental Health. Chris Dubey (talk) 03:07, 19 April 2008 (UTC).

New Edit and Technical Error

I added more references and bifurcated the nonfictional depictions into a section for positive depictions and a section for negative depictions. Wikipedia had some technical errors and was doing things I didn't tell it to do. The list of famous people who underwent ECT kept moving and I put it back in the article, but I couldn't put it back in its own section. Chris Dubey (talk) 15:35, 20 April 2008 (UTC).

This section got deleted and Wikipedia is in read-only mode right now.

In his Zen and the Art of Motorcycle Maintenance, Robert Pirsig gives several references to psychiatric treatments he received. In particular, he describes how Phaedrus (Pirsig's alter-ego) underwent destruction ECT to erase any personality whatsoever. Despite this treatment Pirsig describes how he retains some of Phaedrus' memory.

Chris Dubey (talk) 15:39, 20 April 2008 (UTC).

Chris Dubey (talk) 19:03, 20 April 2008 (UTC). Something is still wrong. I tried to added another reference and Wikipedia deleted part of the existent information in the preview.

This is the new reference.

In about 1973, Canadian Sue Clark was about 17 when she ran away from her abusive family, was briefly homeless, was taken in to Brockville Psychiatric Hospital in Ontario, and received involuntary electroshock . Her father gave the staff permission to perform the procedure. After the fifth elecroshock, Clark went into cardiac arrest. The staff revived her. "Now 52, she still misses trains and doctor’s appointments, and had to drop out of Carleton University after being unable to retain new information".

Source. Author: Jay Heisler. Article: "Shining new light on an old procedure: Doctors, patients weigh pros and cons of electroconvulsive therapy." Web page: “Halifax Commoner.” Web site: “the commoner.” Date: February 22, 2008. Institution: School of Journalism, University of King’s College. Date of access: February 24, 2008. Web address: http://blogs.ukings.ca/thecommoner/wp-content/uploads/2008/02/issue98.pdf.

Scuro's Deletion of References without Prior Discussion

Scuro, you need to clearly present your evidence, arguments, and/or links to the Wikipedian rules before I will allow you to delete the important reference in the introduction and to reinstate the overgeneralization that ECT is "widely accepted" to not cause brain damage. By the way, I actually saw the full report by Sackeim that concluded brain damage. I can find it again. I figured that it didn't matter that Breggin was the reporter, because he wasn't an author of the study. I want you to explain your next proposed edit that undoes my important contributions and consult with me before you perform such an edit.

I've deleted it again because you, or Breggin? have read far too much into that single report. The change was yours, you were notified that the issue was discussed in talk extensively, the ball was and still is in your court...go back and read those sections and see the evidence that was presented at that time. Then lets discuss whatever else you can add to this subject. Sound like a plan?--

Okay, I agree about "reading too much into the report." Breggin's report about the study was biased and Sackeim did not mention the term "brain damage" in the study. But if anyone deletes my contributions again without first consulting me, I am going to take action. I disagree with some claims in the introduction, but, instead of immediately deleting them, I added "citation needed." I think adding "citation needed" or noting the problem on the talk page first is better than deleting without consulting with the editor who authored the disputed edit.

Megara Sanderson

I am writing this here because I could not add it to the bottom. Nmg20, I am letting you know that I will revert your edit that deleted the source Megara Sanderson. The source is a blog, but it is also a copy of the latest issue of the student newspaper of Middlesex Community College. So, the source is actually a news organization and the article was supervised by the Journalism Club of the college. The author is the President of the Journalism Club and Events & Culture Editor of the newspaper. This is the home page of the newspaper: http://theflyinghorse.net/

Here is information about Megara Sanderson as a staffperson: http://theflyinghorse.net/contact_info.html

Let me know your thoughts. Chris Dubey (talk) 15:27, 3 May 2008 (UTC).

(moved to the bottom of the page)

Ok - I'm still not sure that would qualify as a source worth including here. Student newspapers are a pretty uneven group at the best of times (or at least, the one I used to edit certainly was!), and I'm not sure they'd pass as decent published sources. Any thoughts from Scuro or other editors? Nmg20 (talk) 10:36, 7 June 2008 (UTC)

Nmg20, I left a note on your talk page. —Preceding unsigned comment added by Chris Dubey (talk • contribs) 21:19, 3 May 2008 (UTC)

Latest edits - June 2008

Chris,

Looking through your latest set of edits, I've found myself adding a lot of requests for citations, and I've removed a couple you have included which are not really suitable for inclusion - the [Psychiatric Abuse] website is just not a reliable source. I also have my doubts about the AHRP both because they're quoting something called "The Committee for Truth in Psychiatry", which smacks of POV, and because the article features a couple of misspellings suggesting it was not taken from a legitimate news source where it would have been subbed. Similarly, although I've left in the Norwich Evening News one, I do have my doubts given that the second story on the front page is currently "Family devastated as puppy stolen"! As ever, if we can get better, more neutral sources for these, I'm very happy that they remain in the article, and I've left them in for now. Nmg20 (talk) 10:36, 7 June 2008 (UTC)

I agree that those sources you deleted were noticeably biased. I will search for better sources to support those claims. As for the Norwich Evening News, I think you are being too critical. The entry "Wikipedia:Reliable sources" states, "Material from mainstream news organizations is welcomed, particularly the high-quality end of the market, such as the The Washington Post, The Times of London, and The Associated Press. However, great care must be taken to distinguish news reporting from opinion pieces." That source is a news article, not an opinion piece. Although the news organization also did a story entitled "Family devastated as puppy stolen", many news organizations do quasi-entertainment/human interest stories like that, while still doing more important pieces. I know a scholarly report would be better, but I still think it is an appropriate source for this article. Like I said, I will search for better sources for the other claims. —Preceding unsigned comment added by Chris Dubey (talk • contribs) 19:53, 6 June 2008 (UTC)

I added a new source, a YouTube video of legal proceedings with Harold Sackeim. It shows Sackeim saying he received money from Somatics for consulting and he disagrees with Richard Abrams's dismissal of side effects. Unfortunately, the new source somehow cut off the section beneath the ECT Machines section. I do not know how to fix that. Someone please help without deleting my addition. —Preceding unsigned comment added by Chris Dubey (talk • contribs) 20:49, 6 June 2008 (UTC)

I fixed the error. —Preceding unsigned comment added by Chris Dubey (talk • contribs) 22:11, 6 June 2008 (UTC)

On the subject of that news article, I don't think the Norwich Evening News is anywhere near the Washington Post, the Times, or the other publications you mention, and I suspect the author of that article knows next to nothing about ECT - so I'm not at all convinced it passed WP:Weight - but I'll leave it in for now.

On an unrelated note, the problems on the talk page which I didn't understand when you mentioned them were caused by missing a backslash out of a reference. To use a repeated reference, you need to type<ref>ref name="xxxxxx"/</ref> - if you miss it off, it won't work!Nmg20 (talk) 10:41, 7 June 2008 (UTC)

Effects on brain structure

This section now has a multitude of hardcopy, scholarly sources showing electroshock has caused physical brain damage and abnormalities. —Preceding unsigned comment added by Chris Dubey (talk • contribs) 23:12, 6 June 2008 (UTC)

No, it doesn't, Chris, and we have been over all of these before. To deal with them in turn:

• Templer DI, Veleber DM. Can ECT permanently harm the brain? - per Talk:Electroconvulsive_therapy/Archive_1 in the citations section, this article only exists on anti-ECT websites, not on pubmed - it is a fiction.

• Not all journals are indexed on PubMed, and some are only indexed after a certain date.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=journals&Cmd=ShowDetailView&TermToSearch=4658 This seems to be an actual photocopy of the article from this journal that I just found on Google. http://psychrights.org/Research/Digest/Electroshock/PBregginCites/CanECT%20Pemntlybeharmful.pdf WanderingStranger (talk) 05:31, 5 October 2008 (UTC)

• Calloway SP, Dolan RJ, Jacoby RJ, Levy R. ECT and cerebral atrophy. Acta Psychiatrica Scandinavica 1981; 64: 442-445. As I wrote in archive 1: "This paper does find an association with frontal lobe atrophy and ECT. Criticisms would be that (1) it's 25 years old and (2) it's a retrospective review of scans, and so can't prove causation - the frontal lobe changes could be a symptom of severe depression or other mental illness rather than caused by the ECT. So it would not be true to say this paper shows ECT causes these changes - but the side effects section of the article doesn't say that, so it's fine." In short, it does not say ECT causes brain changes.
• Diehl DJ, Keshavan MS, Kanal E, et al Post-ECT increases in T2 relaxation times and their relationship to cognitive side effects: a pilot study. Psychiatry Res 1994 (November); 54(2): 177-184. Again from my notes in archive 1: "It doesn't find any evidence of brain damage - just "significant post-ECT T2 increases in the right and left thalamus" which may be responsible for memory impairment. The mechanism? "These findings are consistent with a post-ECT increase in brain water content (perhaps secondary to a breakdown of the blood-brain barrier)"." This was a pilot of six patients, and found what is at best an abnormality, not damage.
• Dolan et al. The cerebral appearance in depressed patients. Psychological Medicine 1986; 16: 775-779. This is the only one which is just about valid, finding "sulcal widening". It's also 22 years old and has never been successfully repeated to my knowledge.

Accordingly, I'm removing all those references from the article. We have been over them before, and I'm disappointed to see them reproduced here yet again - I suspect the source was this laughable bibliography which was highlighted in Talk:Electroconvulsive_therapy/Archive_3 in the "research into structural brain damage" section. Nmg20 (talk) 10:50, 7 June 2008 (UTC)

I am upset. Nmg20 and Scuro, you seem to be following the rules, but I feel upset. I will go into a soliloquy now.

It seems that I am again witnessing the cold, "I know what's best for you / I am an expert" style in which the doctors involuntarily electroshocked me. That's right. In case you haven't figured it out yet, I had electroshock against my will, 16 times exactly, in 2006, at about 22 years of age. I am only 24 now. I said what I needed to say to escape that assault and torture. I am so tired of doctors listening more to statistics and scientific experts than the patients who had electroshock. I guess I should be glad that you didn't delete the citations of the YouTube videos of Harold Sackeim. I cringe to think of what rule you would use to delete those. I hope that in the future patients press charges and make lawsuits against people who involuntarily electroshock them and their accomplices and prosecute them to the full extent of the law. I have been encouraging the people in my networks to do so, after getting an advance directive for healthcare to make sure they never get electroshocked again. Now, after many months, I have watched pro-electroshock editors team up to dominate this article and quash opposition. I wonder if they even had electroshock or if they are relying only on what they read and hear about it. At least if they had it and liked it, they would have that experience to better understand it, though I imagine they would also have the cognitive impairments that usually accompany it. I know what it's like to have some of those. Knowing I was given cognitive impairments without my consent makes it even more distressful. Just the fact that my body was used at all against my will is a horror. It is equal to sexual assault. My brain should be as private a part of my body as my reproductive organs. But the psychiatrists didn't care or didn't want to listen. Well, I will see their names in the news after I make my story public, with the help of local psychiatric watchdogs and maybe even some politicians whom I have spoken to. I will do whatever I reasonably can to end involuntary electroshock in my region.

I am resigning from being an editor on this article. I'm going to try to keep myself from watching it in the future. I don't want anyone to respond. I am done. Chris Dubey (talk) 14:35, 7 June 2008 (UTC).

The multiple edits on this article caught my eye. Once here I saw pretty obvious and recent POV pushing edits. Some see the procedure as life saving, others as life destroying. Both viewpoints can live on the page and in fact are represented on the page. If some want only one viewpoint to exist that is bias.

Beyond first hand accounts, recent edits use synthesis WP:SYN to put across obvious POV pushing, this shouldn't be tolerated no matter what the justification. If one really wants to show the procedure in a negative light, one should take the time document the evolution of the procedure and the outcomes associated with earlier versions of treatment. It would be a lot of work to do it properly. That would actually provide a public service to all in that some older techniques are still being used in some parts of the world and criticism in this instance is justified. When this is done in a neutral way, you will find other editors may assist, especially if help is requested.--scuro (talk) 00:09, 8 June 2008 (UTC)

I had three courses of ECT in my late teens/early twenties and seem to have avoided these "cognitive imapairments"; I am now stuying at a postgraduate level with no problems at all. I honestly believe that, without ECT, I would not be alive today. Surely a doctor must attempt to protect the mentally ill patient from their illness. —Preceding unsigned comment added by Katyesa (talk • contribs) 01:15, 10 June 2008 (UTC)

Usage in routine practice

There is a sentence in the lead that says ECT for major depression is most often used as a last resort when other treatments have failed, and is also used in other conditions. Can I clarify whether this sentence is intending to apply the "use as last resort" to all the conditions, or only major depression?

In the Indications section, it says that for "severe depression" it is "generally reserved for use as a second-line treatment for patients who have not responded to drugs". Clearly this is a different statement both in referring to the informal category of "severe depression" (unless it's talking about ICD severe depressive episode) rather than the DSM diagnosis of major depression, and last resort is now second-line, and treatment is now just drugs.

Is there a source already in the article for these statements? They aren't themselves sourced. I mean not just on what guidelines are recommending or stipulating, but statistics or case studies of the actual usage in routine practice - in what sense is it used as a "last resort" or "second-line treatment" - after how many drug trials and for how long on average? In what proportion of cases are what forms of psychotherapy tried before ECT is applied? How much social intervention is tried first? How is "severe" assessed? How often does immediate danger to self over-ride attempts to try other interventions? EverSince (talk) 21:55, 26 July 2008 (UTC)

Excellent points. The National Institute for Clinical Excellence guidelines open (section 1.1) by saying:

It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition isconsidered to be potentially life-threatening, in individuals with:

• severe depressive illness
• catatonia
• a prolonged or severe manic episode

The Royal College of Psychiatrists guidance goes into more detail as to what "an adequate trial" might mean, and also allows a first-line use as follows:

Electroconvulsive therapy may be the treatment of choice for severe depressive illness when there is an urgent need for treatment, for example when the depressive illness is associated with:

• attempted suicide
• strong suicidal ideas or plans
• life-threatening illness because of the patient’s refusal of food or fluids.

Electroconvulsive therapy may be considered for the treatment of severe depressive illness associated with:

• stupor
• marked psychomotor retardation
• depressive delusions or hallucinations.

In the absence of the above, ECT may be considered as a second- or third-line treatment of a depressive illness that has not adequately responded to antidepressant drug treatment and where social recovery has not been achieved (e.g. an inability to return to work). Initial treatment failure may be defined as a lack of recovery after a course of an antidepressant drug given at a proven effective dose for at least 6 weeks (with the exception of elderly sufferers, who may take longer to respond to antidepressant drug treatment). A switch to an antidepressant drug with a different mode of action is the preferred second-line treatment.

I appreciate this is only the UK line, but it does seem to explain some of the discrepancies you rightly highlighted - there are situations in which ECT can be first, second, and third-line (although I don't think it's ever "routine", even in someone who has had several treatments). I'll add the Royal College as a ref. Nmg20 (talk) 06:35, 27 July 2008 (UTC)

Yes that does shed some light on it; I'll look to add some of those indication details to the article sometime also. They do seem to leave quite a lot of elbow room. It seems that the RCP are not including psychotherapy as a treatment option to try first. Whereas NICE just say "treatment" - and as I recall, the NICE depression guidelines recommended psychotherapy/CBT even for severe clinical depression, so presumably they are including it. I have a vague recollection that the APA depression guidelines (a few years older if i recall?) seemed more in readily in favor of using ECT, and for a lower severity of depression, than the NICE depression guidelines. Will have to check out again.

Still, while guidelines like that can source what is recommended, the article is stating what "is" in reality happening, "most often" or "predominantly" or "generally" for major depression or for severe depression. The guidelines themselves, and other sources in this article, point out that services don't necessarily follow recommendations and that there is a lot of variation between services and clinicians. I'll look for an empirical source. EverSince (talk) 08:53, 27 July 2008 (UTC)

Sticking to guidelines for now, and quoting at length because it seems such a complicated picture across the various docs and there seem to be some serious differences between UK & US:

Just to complete the UK line as per the above:

The RCP guidelines above also add: "A switch to an antidepressant drug with a different mode of action is the preferred second-line treatment. If the depressive illness persists, several options are available, namely, adding an augmenting agent, such as lithium carbonate or triiodothyronine, switching to a monoamine oxidase inhibitor for patients with atypical major depression, adding either cognitive therapy or another form of psychotherapy, or switching to ECT. Patient choice is important."

The NICE ECT guidelines above also say:

"ECT is used in current UK clinical practice as a treatment option for individuals with depressive illness, catatonia and mania. It is also occasionally used to treat schizophrenia." "As the longer-term benefits and risks of ECT have not been clearly established, it is not recommended as a maintenance therapy in depressive illness." "The evidence for the effectiveness of ECT in schizophrenia in general was not conclusive and therefore ECT is not recommended in this population." "Doctors should be particularly cautious when considering ECT treatment for women who are pregnant and for older or younger people, because they may be at higher risk of complications with ECT." "While some individuals considered ECT to be a beneficial and lifesaving treatment, others reported feelings of terror, shame and distress, and found it positively harmful and an abusive invasion of personal autonomy, especially when it was administered without their consent."

The NICE depression guidelines[1] put this into context of overall depression treatment:

Moderate or severe depression:- Medication, psychological interventions, social support

Treatment-resistant, recurrent, atypical and psychotic depression, and those at significant risk:- Medication, complex psychological interventions, combined treatments

Risk to life, severe self-neglect:- Medication, combined treatments, ECT

Now the US guidelines. The 1999 US Surgeon General report[2] said:

"first-line treatment for most people with depression today consists of antidepressant medication, psychotherapy, or the combination...In situations where these options are not effective or too slow (for example, in a person with delusional depression and intense, unremitting suicidality) electroconvulsive therapy (ECT) may be considered."

"Examples of specific indications include depression unresponsive to multiple medication trials, or accompanied by a physical illness or pregnancy, which renders the use of a usually preferred antidepressant dangerous to the patient or to a developing fetus. Under such circumstances, carefully weighing risks and benefits, ECT may be the safest treatment option for severe depression."

The APA 2001 The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging Second Edition (the link in the article is broken but this seems to be it says:

"There is considerable variability among practitioners in the frequency with which ECT is used a first-line or primary treatment or is only considered for secondary use after patients have not responded to other interventions. ECT is a major treatment in psychiatry, with well defined indications. It should not be reserved for use only as a “last resort.”"

Primary use: "Therefore, when a rapid or a higher probability of response is needed, as when patients are severely medically ill, or at risk to harm themselves or others, primary use of ECT should be considered." "Other considerations for the first-line use of ECT involve the patient’s medical status, treatment history, and treatment preference. Due to the patient’s medical status, in some situations, ECT may be safer than alternative treatments...this circumstance most commonly arises among the infirm elderly and during pregnancy. Positive response to ECT in the past, particularly in the context medication resistance or intolerance, leads to early consideration of ECT. At times, patients will prefer to receive ECT over alternative treatments, but commonly the opposite will be the case." "Some practitioners also base a decision for primary use of ECT upon other factors, including the nature and severity of symptomatology. Severe major depression with psychotic features, manic delirium, or catatonia are conditions for which there is a clear consensus favoring early reliance on ECT"

Secondary use: "The most common use of ECT is in patients who have not responded to other treatments. During the course of pharmacotherapy, lack of clinical response, intolerance of side effects, deterioration in the psychiatric condition, the appearance of suicidality or inanition are reasons to consider the use of ECT."

Defining prior treatment failure: "The definition of medication resistance and its implications with respect to a referral for ECT have been the subject of considerable discussion... At present there are no accepted standards by which to define medication resistance. In practice, when assessing the adequacy of pharmacological treatment, psychiatrists rely upon factors such as the type of medication used, dosage, blood levels, duration of treatment, compliance with the medication regimen, adverse effects, nature and degree of therapeutic response, and type and severity of clinical symptomatology (Prudic et al. 1996). For example, patients with psychotic depression should not be viewed as pharmacological nonresponders unless a trial of an antipsychotic medication has been attempted in combination with an antidepressant medication (Spiker et al. 1985; Nelson et al. 1986; Chan et al. 1987). Regardless of diagnosis, patients who have not responded to psychotherapy alone should not be considered treatment resistant in the context of referral for ECT." ..."medication-resistant patients may require particularly intensive ECT treatment to achieve symptomatic improvement." "...a patient with a nonpsychotic, chronic major depression, who has failed to respond to multiple robust medication trials may be less likely to respond to ECT than other patients. Nonetheless, the probability of response with alternative treatments may be still lower, and the use of ECT justified."

Plus: "In current practice ECT is rarely used as a first-line treatment for patients with schizophrenia. Most commonly, ECT is considered in patients with schizophrenia only after unsuccessful treatment with antipsychotic medication." "ECT may also be considered in the treatment of patients with schizoaffective or schizophreniform disorder "

In sample consent doc: "Whether ECT or an alternative treatment, like medication or psychotherapy, is most appropriate for me depends on my prior experience with these treatments, the features of my illness, and other considerations. Why ECT has been recommended for me has been explained."

Sample consent for maintenance: "I will receive ECT to prevent relapse of my illness. Whether ECT or an alternative treatment, like medication or psychotherapy, is most appropriate for me at this time depends on my prior experience with these treatments in preventing, the return of symptoms, the features of my illness, and other considerations. Why continuation/maintenance ECT has been recommended for me has been explained."

And ending: "One survey found that following ECT most patients reported that it was no worse than going to the dentist, and many found ECT less stressful. Other research has shown that that the vast majority of patients report that their memory is improved following ECT and that if needed, they would receive ECT again."

The 2000 APA depression guidlines[3][4] say:

Choice of an initial (primary?) treatment modality: "In the acute phase...the psychiatrist may choose between several initial treatment modalities, including pharmacotherapy, psychotherapy, the combination of medications plus psychotherapy, or electroconvulsive therapy [I]. Selection of an initial treatment modality should be influenced by both clinical (e.g., severity of symptoms) and other factors (e.g., patient preference) .... Electroconvulsive therapy should be considered for patients with major depressive disorder with a high degree of symptom severity and functional impairment or for cases in which psychotic symptoms or catatonia are present [I]. Electroconvulsive therapy may also be the treatment modality of choice for patients in whom there is an urgent need for response, such as patients who are suicidal or refusing food and nutritionally compromised"

Maintenance: "Patients who exhibit repeated episodes of moderate or severe major depressive disorder despite optimal pharmacologic treatment or patients who are medically ineligible for such treatment may be maintained with periodic ECT"..."Maintenance ECT is usually administered monthly; individuals for whom this is insufficient may find treatment at more frequent intervals to be beneficial. The optimal length of maintenance treatment is not known and may also vary depending on the frequency and severity of recurrences, tolerability of treatments, and patient preferences. For some patients, maintenance treatment may be required indefinitely."

Plus:

"ECT is highly effective in major depressive disorder with psychotic features and may be considered a first-line treatment for this disorder"

"Catatonic depression: When relief is not immediately obtained by administering barbiturates or benzodiazepines, the urgent provision of ECT should be considered. The efficacy of ECT, usually apparent after a few treatments, is well documented; ECT may initially be administered daily."

"...apathetic major depressive disorder in elderly patients with complicating general medical conditions. ECT should be considered for many of these patients"

"In selected cases not responding to or unsuitable for medication, for patients with major depressive disorder with psychotic features, or for individuals electing to use this modality as a matter of preference after having weighed the relative risks and benefits, ECT may be used as an alternative treatment; the current literature supports the safety for mother and fetus, as well as the efficacy of ECT during pregnancy"

"ECT...should be considered in virtually all cases of moderate or severe major depressive disorder not responsive to pharmacologic intervention. Even medication-resistant patients may show at least a 50% likelihood of a satisfactory response to ECT"

And finally, Practice parameter for use of electroconvulsive therapy with adolescents.[5]

Indications: Before an adolescent is considered for electroconvulsive therapy (ECT), he/she must meet three criteria:

Diagnosis: Severe, persistent major depression or mania with or without psychotic features; schizoaffective disorder; or, less often, disorder; or, less often, schizophrenia. ECT may also be used to treat catatonia and neuroleptic malignant syndrome [MS].

Severity of Symptoms: The patient's symptoms must be severe, persistent, and significantly disabling. They may include life-threatening symptoms such as the refusal to eat or drink, severe suicidality, uncontrollable mania, or florid psychosis [MS].

Lack of Treatment Response: Failure to respond to at least two adequate trials of appropriate psychopharmacological agents accompanied by other appropriate treatment modalities. Both duration and dosage determine the adequacy of medication trials. It may be necessary to conduct these trials in a hospital setting. ECT may be considered earlier in cases in which (1) adequate medication trials are not possible because of the patient's inability to tolerate psychopharmacological treatment; (2) the adolescent is grossly incapacitated and thus cannot take medication; or (3) waiting for a response to a psychopharmacological treatment may endanger the life of the adolescent

So basically....not really a "last resort" in the general sense. It's a first resort in some types of depression; in many cases it seems like only medication trials need be tried; with psychotherapy interventions getting some mention but not quite the same sense that they have to be tried first (and if they are, meds must still also be tried); only a bare mention of trying social intervention/support first. And there seems to be "considerable variation among practitioners", and major differences in which groups ECT is recommended for or whether it's recommended at all as a maintenance treatment. EverSince (talk) 14:22, 1 August 2008 (UTC)

Excellent work, EverSince - you've very much left my paltry two references in the shade!

I think I'm going to end up quibbling over what counts as a "last resort", though. Yes, there are circumstances in which it is a first-line treatment, but those circumstances are at one extreme of the clinical spectrum (delusional depression, intense unremitting suicidality, unresponsive to or unsuitable for medication, unrelieved catatonic depression). I'd be wary of a change which lost the rarity of it being recommended as a first- or even second-line treatment.

I'm also pleasantly surprised that so many of the caveats mentioned are formally acknowledged in the guidelines. Is it worth mentioning this in the article?

On the talking-therapy front, the NICE guidelines state that, in the UK at least, psychotherapy is first-line for mild depression (chapter 4, "Summary of Recommendations": "Antidepressants are not recommended for the initial treatment of mild depression, because the risk–benefit ratio is poor" and "In both mild and moderate depression, psychological treatment specifically focused on depression (such as problem-solving therapy, brief CBT and counselling) of 6 to 8 sessions over 10 to 12 weeks should be considered"), and CBT is part of the recommended treatment programme for both those who don't respond to antidepressants and those with recurrent depression. The issue with including detail in this article would be that it's not primarily about depression and the NICE guidelines discuss eight different types of depression; however, I think it would be fair to say that ECT would not be tried in the UK, at least, until antidepressants and at least one course of CBT had failed.

The other problem we have in all this is how to synthesise the US and UK guidances, an issue which is as you say tricky. Nmg20 (talk) 06:47, 3 August 2008 (UTC)

Firstly sorry for the further avalanche of extracts below, i believe it's relevant and can help when actually editing the article, and with the articles below many might not have full text access.

Just to add another guideline on ECT (translated by Google as EKT...). It seems to only only focus on medication beforehand:

German Medical Association guidelines

"Unlike many other countries (eg Britain, Scandinavian countries, USA), this therapeutic procedure in Germany comparatively rarely used (about 1,000 patients per year)...the most common is the EKT after Psychotropics treatments with no success.

The following psychiatric disorders EKT is the first therapy Choice:

- wahnhafte [psychotic?] depression, depressive stupor, schizoaffektive with psychosis, severe depressive resentment, - Major depression with high suicidality or food denial, - acute, life (pernicious) catatonia.

As the second choice therapy is indicated for the EKT: - (pharmakoresistenter) Major depression, according to Applikation of at least two different antidepressants possible different drug classes in sufficient strength and to sätzlichem therapeutic sleep deprivation, 2nd drug, not life-Katatonien and other acute exazerbierten schizophrenic psychosis after unsuccessful neuroleptics-Behand, 3rd drug crazes after unsuccessful treatment with neuroleptics, Lithium or carbamazepine.

Less indications can therapieresistente schizophreniforme disorders, therapieresistente schizoaffektive disorders, Parkinson's therapieresistente Syndromes and the neuroleptische malignant syndrome."

But anyway, I agree entirely with making sure the article reflects the frequency of what line of treatment. And this varies to some extent depending on applicable guideline, clinical features, service/clinician, and apparently on sociodemographic factors like age. And bearing in mind that things like sutained suicidal ideation are hardly uncommon in hospitalizable depression. And these points really do need to be based on service statistics rather than just guideline statements - but they seem frustratingly hard to find?? It is not the case that ECT is not used in routine practice in the UK unless CBT had been tried. In terms of guidelines alone, the RCP and some psychiatrists actively disagree with/ignore NICE, for example promoting ECT for less severe depression and as a continuation treatment.[6] Obviously the American guidelines and practices affect many more people, and they're more in favor of ECT for more cases and long-term, and clearly only medication need be tried in many cases. This Pakistani article says "A popular misconception is that ECT is used only as a last resort. This probably arises from the earlier false presumption, even in the developed countries, that ECT should only be used in medication-resistant patients." On the other hand, several countries have banned or severely restricted ECT, including the nation of its inventors Italy.

I think a very important distinction needs to be made between "last resort" from the point of view of the remit of a hospital psychiatrist, and from the point of view of other professionals, consumers or the public. I'm quoting at length again because overall statistics seem hard to find, and 'cos may might not have access to the full texts of these:

A Western Australian Survey On Public Attitudes, about 2/3 of whom had "reasonable knowledge of ECT", were given this vignette:

Bill is 35 years old. He has lost his job and has had difficulty getting another one. He worries about the finances of his family of 6. He has become very depressed, and has not been eating or sleeping well. He does not enjoy activities he usually enjoys and finds no pleasure in life. He has suffered like this for more than 2 years. His Psychiatrist diagnosed him with Depression but anti-depressants failed to make him better. How would you feel about Bill being treated with ECT?

74 strongly opposed and 109 opposed ECT (183 total), while 134 agreed and 40 strongly supported (174 total).

The authors conclude:

This vignette was more complex than the others with its combination of depression and adverse social factors. About 18% of respondents recognised that Bill’s depression likely stemmed from his impoverished situation, and preferred other alternative treatments, such as counselling, and/or practical assistance, like getting him a job. These respondents did not think that ECT was useful since his financial problems would remain after the treatment. Other participants reported that Bill could not afford the treatment since he was already having financial difficulty. His depression could worsen in the face of secondary problems, such as additional financial burden from the costs associated with the treatment. It is of some concern that efficacy studies on ECT, such as Black et al.’s study (1989), often stated the clinical diagnoses of the patients without any reference to the psychosocial triggers of their psychiatric conditions. Psychosocial factors were apparently not taken into account when assessing the recovery of the patient. For instance, evaluations were rarely conducted after ECT to ascertain the patients’ ability to cope socially and/or emotionally within their communities. It seemed that respondents in the current study were realistic about the problems associated with recommending ECT to someone in Bill’s position

.

Electroconvulsive Therapy for Depression by Sarah Lisanby MD in the New England Journal of Medicine says:

"Briefly, the primary indications for ECT among patients with depression are lack of a response to or intolerance of antidepressant medications, a good response to previous ECT, and the need for a rapid and definitive response (e.g., because of psychosis or a risk of suicide). ECT can be used in both unipolar and bipolar disorders."

"Although ECT is more effective than antidepressant medications, it is typically reserved for use after several medication trials because of its relatively higher risk of side effects."

And gives this vignette:

An 82-year-old widowed woman with a history of recurrent unipolar major depression is referred to the electroconvulsive therapy (ECT) service of an academic medical center. During her illness, she has had four episodes of major depression consisting of periods of depressed mood, crying spells, loss of interest in usual activities, insomnia, loss of appetite and weight, difficulty with concentration, feelings of helplessness and hopelessness, and thoughts of suicide. During the current episode, which has lasted for 6 months, she has had typical symptoms of melancholic depression, as well as psychotic symptoms (e.g., a somatic delusion that she has terminal cancer), with suicidal ideation and a plan for taking a drug overdose. Previous treatment during this episode has included citalopram (Celexa), duloxetine (Cymbalta), and the combination of olanzepine (Zyprexa) and duloxetine, but the patient did not have a response to any of these agents. She could not tolerate the anticholinergic side effects of tricyclic antidepressants. Her psychiatrist seeks specialty consultation regarding the appropriateness and safety of ECT for this patient.

And concludes:

I would recommend ECT for the patient described in the vignette for several reasons. ECT would be appropriate given her lack of a response to or intolerance of adequate trials of antidepressant medications and neuroleptic agents. In addition, the presence of suicidal ideation with a plan for suicide underscores the need for a rapidly acting and definitive treatment. The presence of the psychotic subtype in this patient is a good prognostic indicator for a response to ECT, as is her age. It would be appropriate to consider starting with right unilateral ECT at an adequate dosage above the seizure threshold, but if she does not have a response, bilateral ECT could be used. Given the severity of her depression and her history of multiple episodes, I would also recommend combining ECT with an antidepressant medication to prevent a relapse, tapering the ECT rather than abruptly discontinuing it on remission, and adding a mood stabilizer to the antidepressant to prevent a relapse. Maintenance ECT is also a reasonable strategy, and it should be discussed with the patient and her family before the initiation of treatment.

I know it's only a brief vignette but what's not mentioned at all is quite telling. No consideration of what this woman's own views are, on ECT or anything, whereas the guidelines say patient preference is important in the determination of appropriateness. There are recommended evidence-based psychotherapies for severe depression, psychotic beliefs and complicated bereavement, but the possibility is not even on the radar. Although it says this elderly woman is widowed, there's no mention of whether she's living alone or not, how things are with family/friends or not, has had any social support or intervention. It says she's had feelings of helplessness and hopelessness, but apparently it doesn't matter what about or why she feels she can't achieve the things of concern to her. It's just a hospital case, and various drugs haven't worked so...

Electroconvulsive Therapy: Evidence and Challenges (2007) reports:

"ECT is a primary treatment for psychotic depression and is preferred to multiple medication trials." "It is common, however, for patients with psychotic depression to be inadequately treated before referral for ECT. Only 2 of 52 (4%) of patients with psychotic depression in the CUC study and only 5 of 106 patients (5%) in the CORE study had received adequate antidepressant and antipsychotic medication trials. Failure to identify the psychotic form of the depressive illness and inadequate pharmacotherapy are possible explanations."

"Depressed patients are characterized as "treatment resistant" when they do not respond to 2 antidepressant treatment trials [bold mine] estimated as adequate for dosing and duration. Sufficiency of prior medication trials can be estimated using an Antidepressant Treatment History Form (ATHF)." [so "treatment-resistant" is being defined as "drug-treatment-resistant...right? This, I believe, is a very widespread practice that this article needs to reflect]

Regarding clinical variation in the US it says:

"Electroconvulsive therapy practice is unregulated, and the education of physicians in its prescription and administration is poor. Electroconvulsive therapy is not a required subject in US medical schools and, surprisingly, is not a required skill in psychiatric residency training. The lack of experience with ECT during residency training and the failure to require such experience for specialty certification limits the ability of clinical psychiatrists to recognize patients for whom ECT may offer effective relief." ...

"Privileging for ECT practice at institutions is a local option, no national certification standards are established, and no ECT-specific continuing training experiences are required of ECT practitioners. As a consequence, unsettling observations of variable clinical practices have surfaced. These include lower remission rates in community hospital services (30%-47%) and higher 6-month relapse rates (77%) than in the academic CUC and CORE studies."

"Despite its well-documented efficacy and safety, ECT is widely stigmatized as a last-resort treatment. This image is largely the result of professional and public preoccupation with the effects of ECT on memory and the failure to fairly consider the treatment's benefits compared with alternative treatments"

EverSince (talk) 17:47, 3 August 2008 (UTC)

links

Nmg20, the link you changed to does not seem to be a restoration to the same document (the 2001 APA ECT guidelines), so the indications section is now mis-citing. Can I check whether you are objecting to the convenience link to the guideline on the third-party site (given that the APA link appears broken), to be used in addition to the new one you put in (which appears to be newer but what year? says copyright 08 on every webpage).

Regarding the Cardoso et al. article, can I clarify that although I included their caveat that the relevance is unclear (which actually was based on the timing schedule being different, not because it was on rats as your edit comment suggested), it is the article that is making links to human ECT effects, not me. EverSince (talk) 23:48, 14 August 2008 (UTC)

Yes, my objection is to the third-party site. Particularly in a controversial article such as this, any third-party site is going to be more open to question than if we can cite the source on the website of the body who published it. That said, I apologise for including the wrong link, and quite understand that, as the old one wasn't working, it was necessary to change it! I'll see if I can find the right one over the weekend.

Regarding the Cardoso study, I have a fundamental objection to the inclusion of isolated primary sources to suggest something (in this case brain damage) which has been found repeatedly in reviews of the topic not to be an issue. That's per WP:MEDRS section 1.1 and WP:MEDMOS "citing medical sources". My specific objection to the source is that I actually didn't agree that the article was making links to human ECT effects. I assume you're referring to the discussion, where the authors state: "An important caveat of our results is that it is unclear to what extent they are relevant to the use of electroconvulsive therapy in psychiatry, because the protocol employed in this study is different from that used clinically. Evidence from previous studies (Gombos et al., [1999]; Vaidya et al., [1999]) and from our pilot experiments indicates that treating rats either with five to ten widely spaced ECS (at 24- or 48-hr schedules) or with two stimulations only 2 hr apart does not lead to loss of hippocampal neurons." Having included that caveat, they do go on to say that maybe their results indicate that repeated ECS in rats can sensitise particular neurons to damage, but they make clear that their work is on rats not humans and uses a different protocol to that used in humans. That means it really has no place here. Nmg20 (talk) 11:15, 15 August 2008 (UTC)

What form of rat ECT is the equivalent of human ECT? Remember that ECT has many properties to it such length of duration, pulse type etc. How do you determine the equivalent dosage in rats? Are the two brain types similar enough to make this comparison? You are comparing apples and oranges here to what end? It smacks of OR. So yes, I agree fully with Nmg.--scuro (talk) 13:00, 15 August 2008 (UTC)

The APA site would be preferable and I tried searches for it there, but perhaps it'll turn it up. In the meantime I'll fix the 2nd cite.

There are due weight and balance issues with the primary study regardless of medmos. But the study does make links to human ECT, they frame the article in it via the second and the last sentences. And the quote above, talking about the question of relevance to human ECT, continues: "However, we show here that, when the two stimulations spaced by 2-hr interval are preceded by a course of seizures administered on a 24-hr schedule, they produce significant neuronal damage." and then "In conclusion, this study answers positively the question of whether repeated administration of ECS seizures can cause brain lesions. Our data are consistent with findings from other animal models and from human studies in showing that neurons located in the entorhinal cortex and in the hilus of the dentate gyrus are particularly vulnerable to repeated seizures" ... "Therefore, the finding that ECS seizures caused loss of synapses in the entorhinal-dentate pathway sheds new light on cellular processes that may underlie its amnestic effects..." and that it's plausible that if similar neural damage is found in other brain areas, this might underlie other effects of human ECT including antidepressant effects.

And I would note that the brain structure subsection here says that current research is examining the possibility that ECT causes neural repair, the source being a 2006 interview with a psychiatrist who is citing a primary study on cell cultures and mice that appears no different in status - and several years older - than the one above. It could be balanced in a short paragraph on nonhuman animal studies.

Btw, although the APA & NICE guidlines have been cited in the lead as concluding that ECT doesn't cause brain damage, the APA guidelines as I recall actually only said the evidence "speaks strongly against" it, and NICE only that the six scan studies reviewed didn't provide any evidence of it, but no studies on the developing brain (I've since added that caveat), and strangely enough, a table in their independent final assessment report suggests some evidence was found (which the UK ECT Group did report).[7] EverSince (talk) 13:29, 15 August 2008 (UTC)

Scuro, please, I already noted before your comment that it is the scientific article making the comparisons not me, it is you speculating and misdirecting questions to me for some reason. EverSince (talk) 13:29, 15 August 2008 (UTC)

For the sake of completeness since I mentioned it, 2003 UK ECT review group PMID 12642045 "Observational studies of structural brain changes after ECT. Three studies compared ventricular/brain ratios (VBR) on CT scans of patients treated with ECT with those who had not received ECT. There was some evidence that ECT-treated patients had increased VBR and cortical atrophy compared with controls, but no association with lifetime ECT exposure was seen. VBR and the other measures were strongly associated with age within all groups, which could have confounded the results."

You have interpreted my objection incorrectly. I have little time right now and will be busy for a week so this is my last chance to explain for a while. I get it that it is the scientific article making the comparisons and not you...but is this speculation noteworthy enough to make it to the article? Anyways,...although I have not read the research paper to date ( I will if this is still an issue in a weeks time ) the question is, does the research paper describe the exact form of ECT used. Specifically did the article mention electrode placement, length of time that the stimulus was given, and the property of the stimulus? I have seen far too many research papers touted as being noteworthy in Wikipedia articles that have no bearing on the article. For example in the ADHD article contributors have cited addiction studies that proves that stimulants cause all sorts of problems. When one gets down to it one finds that the studies were addiction studies so doses were extremely high or the mice were injected with a stimulant. None of that happens with therapeutic levels of medication and the response is naturally different. They have done an apple and oranges comparison. I have no doubt that one can induce brain damage in mice with enough electricity. Better yet you can kill the whole brain. The question I have is the purpose of this study to look at therapeutic forms of ECT and if not, what relevance does it have to article?...and if so, how did they determine what the equivalent therapeutic level is in a mouse? This is why I stated that posting such a study could smack of OR.--scuro (talk) 16:55, 15 August 2008 (UTC)

You stated that I was comparing apples and oranges here, but I understand from what you say that you meant the authors in the article (PMID 17705293) although you hadn't read it. I've already outlined the links the article makes to human ECT; they also cite Sterling 2000 in doing so. If you've read it now you'll have seen that they of course provide the procedural details you mention, sufficient to produce a brief seizure in rats as per standard animal model research, and replicating similar prior findings (2005 PMID 14557909 in which the authors do not mention human ECT). Anyway I don't have any intention of being an advocate for it, i just took it for what it seemed to be saying. For the record 1998 PMID 9773357 is the mouse study which is currently supporting (via the cited interview with a psychiatrist) the statement here that Current research is examining the possibility that "...rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness". It seems that, at the very least, this needs to specify that the citation was to non-human research, and that similar animal research is also examining the possibility that it damages neurons (note that both refer to it as "ECS"). EverSince (talk) 00:19, 27 August 2008 (UTC)

Unfortunately I am now a little under the weather. I have no objection to the + ect passage specifying that it is non-human research. If you could kindly give me a little more time I examine what you have cited and should get back to you this weekend.--scuro (talk) 02:14, 29 August 2008 (UTC)

I do not have full access to any of the articles. Basically, you can only make reference to what other authors can fact check. No study speaks of structural brain damage. Loss of brain cells does not equal brain damage. A few drinks cause loss of brain cells. Even so, we do not know if the rats were administered a "therapeutic" type shock following best practices, or if the authors used wider parameters to look for any possible effect. Then there is the question of if you can extrapolate findings on rats to humans. Finally the best sources on topio are secondary sources of which we have many excellent sources that are already cited.--scuro (talk) 12:18, 1 September 2008 (UTC)

You shouldn't tell other editors that they cannot reference peer-reviewed literature because you don't have free online access to it; personally I am sympathetic to the inequality (and recently raised the issue at Village Pump) but that is a major misreading of the Wikipedia policy on verifiability. And please don't imply I said things that I didn't. Only the guidelines, talking about other human studies, described them as assessing brain damage. I never said these animal studies are saying that. They do speak of structural effects and neural damage.

I have already relayed the ways in which the article's authors make links to human ECT, despite their caveat that their schedule differered from the typical human one. Speculations of equivalence to the effects of a few alcoholic drinks are irrelevant, and the issue of extrapolation applies to all animal model research, including that already in the article whose exclusion hasn't been suggested. The issue of primary vs secondary sourcing is a fair point, but as per WP:NOR the former can be used with care. And this Wikipedia article currently includes a speculative interview statement supported by a single decade-old primary mouse study. The above correspondence published by Nature seems to be of at least equal status to that interview.

FWIW, these studies have been published since the guideline reviews, and there is another 2005 Electroconvulsive Shock Induces Neuron Death in the Mouse Hippocampus that states in its general intro review that: "The question of whether cell death occurs in electric shocks remains open." Their own study uses a procedure and schedule of electric shocks that is "an analog of electroconvulsive therapy used in clinical practice" and concludes: "This study reports the first quantitative analysis of cells in the hippocampus after convulsions induced by repeated electric shocks. A small (5–10%) but significant decrease in the number of cells in field CA1 and the dentate fascia was found in experimental animals. Thus, the answer to the first question addressed in this study is positive: neuron death in the hippocampus does occur in electric shocks." They also discuss methodological reasons why some prior animal studies didn't uncover evidence of neural cell death (a possibility those studies raised themselves) and how their findings of fiber sprouting may actually be signs of seizure-induced cell death, and "death may afflict both “old” neurons and neurons appearing in response to convulsive activity-induced neurogenesis but not surviving for various reasons." EverSince (talk) 17:17, 1 September 2008 (UTC)

You seem to attribute personal assumptions into identifying my behaviour. Wiki states that we should focus on the article and not the contributors, following this guideline would be kindly welcomed. Perhaps the best path to take here is for you to suggest an addition in talk. Please keep the following guidelines in mind.

http://en.wikipedia.org/wiki/Wikipedia:WikiProject_Medicine/Reliable_sources#Using_primary_sources_to_.22debunk.22_the_conclusions_of_secondary_sources

http://en.wikipedia.org/wiki/Wikipedia:WikiProject_Medicine/Reliable_sources#Cite_peer-reviewed_scientific_publications_and_check_community_consensus

Although significant-minority views are welcome in Wikipedia, such views must be presented in the context of their acceptance

Looking forward to your response.--scuro (talk) 01:32, 2 September 2008 (UTC)

Nah wasn't doing that at all and have no interest in it, was in line with guidelines in trying to counter apparently misleading statements. Had enough of doing that now so am not going to have anything more to do with this article for now at least. EverSince (talk) 13:39, 2 September 2008 (UTC)

Sorry - been busy. I'm afraid I'm still far from convinced this passes muster in terms of the two guidelines I posted above, and the authors state explicitly in their conclusion that "An important caveat of our results is that it is unclear to what extent they are relevant to the use of electroconvulsive therapy in psychiatry, because the protocol employed in this study is different from that used clinically." That line is a clear deal-breaker in my opinion... Nmg20 (talk) 17:58, 2 September 2008 (UTC)

That is exactly the point I was getting at earlier but I couldn't read the studies to check for it.--scuro (talk) 02:35, 3 September 2008 (UTC)

(post-time-out) For the record, the protocol in the other article above (2005) was actually "as close as possible to the clinical protocol" (I had already noted that they describe it as an analog). And for the record, in direct contradiction to above comment about not being able to check it, the caveat in the other (2008) article was included in the original edit & discussed here. It is unfortunate that links suggested by peer-reviewed researchers in the field are being excluded because they are careful to also include caveats, while a misleading outdated interview comment by a psychiatrist remains (reflects real life though I guess). EverSince (talk) 14:30, 28 October 2008 (UTC)

major edit

I will be performing a fairly major edit of this page in accordance with a more realistic worldview.

shadowcreatorii —Preceding unsigned comment added by ShadowCreatorII (talk • contribs) 22:59, 1 October 2008 (UTC)

I'd be interested in what needs changing. I'd encourage you to discuss before editing.--scuro (talk) 04:18, 14 October 2008 (UTC) Editing note - I've moved a few posts around so that they follow in chronological order. Nothing else was changed.

What does this mean?

You should explain yourself better as to what exactly you refer to as a 'more realistic worldview' before making a mjor edit of this page. Your rather obscure statement doesn't seem to follow the usual Wiki editing expectations. Brattysoul (talk) 03:18, 14 October 2008 (UTC)

-I think it means the plan is to add ideological bias. 24.81.197.216 (talk) 02:53, 1 January 2009 (UTC)

Voltage?

What are the typical voltages used for this? I think that should be added to the article, perhaps under the 'equipment' section (where it does mention the typical current used). —Preceding unsigned comment added by 87.81.240.78 (talk) 21:26, 30 March 2009 (UTC)

Its usually over 9kV. —Preceding unsigned comment added by 202.40.139.164 (talk) 06:55, 7 May 2009 (UTC)

If the regulating factor is flow, and it is balanced somehow, at least mention the potential forces (volts) involved with this. The only way you could control the flow is by adjusting the resistance or force.... Msjayhawk (talk) 03:12, 26 January 2010 (UTC)

A number of parameters should be considered. In the article the Current and Power levels were statated. The Voltage can be determined by dividing the Power level by the Current level. However, just as important are electrical waveforms and frequencies (e.g. sine-wave/pulse), pulse durations, and currents. The currents and their waveforms have the greatest effect. Remember, a common static-shock can be as much as 20,0000 volts and be nothing more than an annoyance. —Preceding unsigned comment added by 63.119.13.37 (talk) 15:57, 21 February 2010 (UTC)

Voltage is related to resistance of the human subject which is guessed at with an ohm meter before the procedure. Also there is the break down threshold in the material, as in once electricity starts to flow through a pathway the previous resistance drops dramatically. Very similar to lightning.--Mark v1.0 (talk) 13:15, 22 September 2013 (UTC)

If you are concerned about the pain/damage that the discharge produces, then you need to look at the current, not the voltage. You can get a 100.000Volt electrostatic discharge and not even notice it. As a matter of fact, when you take off a wool sweater you've been wearing for a while on a dry day, you can hear all the sparks as it rubs against your hair and even see them if you are in a dark room. It's just that it's so small a current that you don't get shocked. — Preceding unsigned comment added by 191.83.162.64 (talk) 22:54, 2 September 2019 (UTC)

bipolar manic depressive disorder cluster personality disorder

would this be help ful in these cases well they are for one person me ive tried many diffirent drugs and have little hope to be what pepole call normal

Wikipedia as a rule doesn't offer medical advice. But in all honesty, would you really want highly specialised medical advice from somebody randomly over the internet, of uncertain qualifications, who's unfamiliar of your complex circumstances and unable to evaluate you properly? I suggest you discuss medical decisions such as these with your psychiatrist for a more personalised, trustworthy, and intelligent answer. 203.5.70.1 (talk) 17:01, 15 October 2009 (UTC)

He never said he was normal, lol SonicNiGHT 09:01, 27 August 2010 (UTC)

Status Epilepticus

I did not see this listed, but ECT is also used to treat status epilepticus. Is there any reason why this is not in the article? —Preceding unsigned comment added by Mkayatta (talk • contribs) 14:51, 22 July 2009 (UTC)

ECT is documented to be a CAUSE of non-convulsive status epilepticus. ECT has been used to treat other mental disorders or neuropsychiatric symtpoms as well, but they aren't all listed in this article. It's main uses are listed in the article. Danrz (talk) 04:43, 13 September 2009 (UTC)

ECT may induce a non-convulsive status and EEG monitoring is in place to catch that. However, status that happened all on it's own CAN be controlled with ECT as ECT itself increases seizure threshold. —Preceding unsigned comment added by 143.104.52.17 (talk) 21:19, 23 October 2010 (UTC)

I removed the movies "A Beautiful Mind " and "Regeneration" from Fictional and semi-fictional depictions Character in A Beautiful Mind receives Insulin Coma Treatment and the treatment in Regeneration is not ECT but an electric current given through the mouth. —Preceding unsigned comment added by S. Belt (talk • contribs) 12:57, 19 November 2009 (UTC)

Mind Control?

Given the amount of controversy it seems placing this article under the category "Mind Control" would be comparable to creating a category titled "Beneficial and Harmless Psychiatric Treatments" and placing it alongside Mind Control and Human Rights Abuses. I can much more clearly see the argument for leaving it in the latter category but the term Mind Control seems strikingly biased to me. I'm going to be bold and remove it but if I am in the wrong I would like very much to hear why that is an appropriate label. 173.2.184.63 (talk) 00:04, 27 November 2009 (UTC)

Only possible justification would be in regard to Ewen Cameron's use of ECT to depattern people in Montreal. For what it's worth, I think you're right to remove the categorisation though. Freekra (talk) 00:49, 27 November 2009 (UTC)

I wasn't aware of the categorization on this page, but there is a history of experimental use for this purpose. For example, the Montreal case mentioned above. Also, highly notable is the use by psychiatrist HC Tien. See here, and also here. And there's more. Read about its history in New Zealand, for example. So, at least from a historical and experimental perspective, yes, it's been used for this purpose. And as to other types of abuse, read about how it was forced on Chinese children recently because they were spending too much time on the internet. Danrz (talk) 02:16, 27 November 2009 (UTC)

Also, as its action remains unknown, it is still essentially an experimental procedure. I've created a category "Human experimentation in psychiatry" to which I've added this page. This category is not meant to equate to a moral judgement or condemnation of any particular practice but to be used when any procedure in psychiatry meets the criteria of being an experimental procedure.FiachraByrne (talk) 09:17, 8 March 2011 (UTC)

Did they use it during the MKULTRA years? I know there have been some people who have testified to some pretty extreme abuses from the program. Given that the CIA destroyed most of the documents of the project to protect themselves from criminal liability, if we can find victim testimony and include it, it would be relevant to the category. I think it would be folly to think that among the hugely illegal and unethical things that CIA did in the years of publicized mind control projects that ECT never crossed their mind. It may have been a conspiracy theorist that put it under this category, but the use of extreme experimental procedures in the pursuit of psychological control is well documented.Bloomingdedalus (talk) 19:58, 18 June 2011 (UTC)

Update -- I have found a source from the Indiana School of Medicine, Center for Bioethics which confirms that ECT was employed during MKULTRA, I have not thoroughly examined the main page to see if there is a reference to it's use in regards to this program or others is cited or mentioned, but it does justify the category of "mind-control" which makes no judgments as to the efficacy of ECT in achieving "mind-control" (whatever that constitutes): http://bioethics.iu.edu/reference-center/ect-mkultra/ Bloomingdedalus (talk) 22:17, 19 June 2011 (UTC)

Is Yang's usage belonging to Mind Control? Please see Yang Yongxin, the man who uses ECT as a punishment for "Behavior Correction"? — Preceding unsigned comment added by Mariogoods (talk • contribs) 02:48, 24 July 2018 (UTC)

Electroconvulsive therapy (ECT) and Deep brain stimulation (DBS)

I wonder if Electroconvulsive therapy (ECT) should be linked to Deep brain stimulation (DBS) as both are used for the similar reasons (mental health) and involve the use of electricity. --Antidote 13:43, 9 April 2010 (UTC)

List of people who have undergone ECT

The inclusion of Dave Mustaine on the list appears to be in error. The interview used as a source has Dave Mustaine describing how he received "electric shock" therapy to increase the mobility of his arm after an injury, to make him capable of playing guitar again. This sounds like it was not ECT some sort of electrical stimulation procedure that would be performed on the nerves and/or muscles of the arm since it has nothing to do with the central nervous system and was not a psychiatric procedure.75.66.80.108 (talk) 00:51, 9 May 2010 (UTC)

I've removed him from the list. Per the citation, it sounds like he simply had TENS therapy to his arm, not ECT. --CliffC (talk) 21:35, 17 October 2010 (UTC)

I think it might be best to create a separate page listing people who have undergone ECT and link to it in the article.FiachraByrne (talk) 09:23, 8 March 2011 (UTC)

Too Long Label

I totally agree with this. I also get feeling that the article is so long in order to placate the anti-ECT agitators who would rather this article be their own soap box, no?76.120.66.57 (talk) 20:52, 17 October 2010 (UTC)

NEW ARTICLE FOR ECT CONTRAVERSY

I think the ECT controversy is so important and so complex since there are multiple mechanisms of controversy that this should be its own web page or an extended one. —Preceding unsigned comment added by 173.162.221.82 (talk) 20:45, 28 November 2010 (UTC)

Wikipedia doesn't generally encourage content forks until an article grows quite large, so as to keep all related material together. Right now the article doesn't seem that large. --CliffC (talk) 22:45, 28 November 2010 (UTC)

I actually think that this is a good idea given the article length and problems with its current structure. However, this should not be used as an opportunity to elide any controversial aspects of the treatment in the main article. These should be treated, but succinctly.FiachraByrne (talk) 09:20, 8 March 2011 (UTC)

Psychoanalysis

I have an ancient dog-eared book written by psychoanalyst A.A. Brill in 1938. Here's what he had to say about this subject:

"A chronic schizophrenic may remain in a hospital for years in a state of indifference, but now and then he may suddenly act like a rational being. Sometimes a severe shock, such as an accident or illness which threatens his self-preservative instinct, brings the schizophrenic back to reality for a time. The latest form of therapy for schizophrenics is based on this very idea. I am referring to the insulin or, as it is called, the shock therapy, because the patient receives such a shock through the hypogycemia that for a time at least he gives up his phantasy world. But it matters little whether hypoglycemia cures or only produces a transient change; the fact that schizophrenics occassionally return to normality spontaneously and then relapse, and the fact that an accidental or experimental shock can drive them back to reality at least for a time, clearly shows that the psychotic, too, is not altogether detached from reality."

(*The Basic Writings of Sigmund Freud* [introduction] A. A. Brill, The Modern Library, 1938. pg.23-24.)

I have to wonder if modern medicine is beating its head against a wall in futile reductionist attempts to find physical explanations for a purely psychological phenomenon, even to the point where common sense is abandoned. Snud (talk) 23:13, 28 November 2010 (UTC)

Well, this isn't place to do that. Also, the quote you cite betrays your notion anyway. That's like a murderer showing a photo of him murdering while saying "You have to wonder why people murder, I don't get it." Why are you wasting space here?76.120.66.57 (talk) 06:20, 5 December 2010 (UTC)

I thought it was interesting. It made me think about something I never thought of before. Are you not interested in thinking about it? Isn't this a discussion page? Haven't I provided documented facts you didn't know before? I do realize that my information might be disturbing to the lambs, but I know you aren't one of those.Snud (talk) 05:56, 6 December 2010 (UTC)

Come to think of it, I'm getting tired of people preferring incomprehensible gobbledy gook reductionistic explanations for mental illness rather than emotions and drives. What's wrong with common sense, huh? Nowadays it seems that mental illness no longer exists; just nerve damage. It's so naive and simple minded I'm getting sick of it. You know, there are still no neurological, lab or genetic tests for any mental illness, and therefore no mechanical explanations for the efficacy of ECT, so please take YOUR foolish, la de dah objections elswhere!— Preceding unsigned comment added by 71.107.88.57 (talk • contribs)

The quote you used was talking about insulin shock therapy, not Electroconvulsive therapy. If you don't know what hypoglycemia means, perhaps you should use a dictionary before including quotes irrelevant to topics. The physical underlies everything, which is why legitimate scientists look to the physical for a set of symptoms. The point of this quote is that the psychiatrist was intentionally putting someone in mortal danger to see if it would draw someone back to a "realistic" view of the world. That being said, 1938 is hardly "modern" medical practice, it's a rapidly changing field which has exploded in complexity and knowledge in the past 80 years. I do share your skepticism toward some psychological diagnosis, but there are also people who are very clearly and realistically affected by mental illness, if a man says he sees 10 foot tall snails following him, he's probably hallucinating. If you want to understand the truth and limitations of neurology vs. psychiatry, I suggest you start by learning the word "hypoglycemia" and continue studying from there. I have that exact edition of Freud, by the way, on my shelf: 1938, Modern Library, Basic Writings, introduction by Brill. The next place you should start is Martha Mitchell then get a solid neuroanatomy book and put down Freud for a while. Bloomingdedalus (talk) 20:13, 18 June 2011 (UTC)

As you say 1938 is hardly modern medical science, yet today we still use the terms and definitions they invented at that time like (psychotic). Penicillin had not even been used to treat syphilis a physical illness believed to be a mental illness. Today science can see the smallest thing and can not find a physical cause to mental illness. If science did find a physical cause, the illness would then be a Neurological disorder not mental illness. --Mark v1.0 (talk) 13:51, 22 September 2013 (UTC)

Stats for rates of administration of voluntary and involuntary ECT in the USA

There does not appear to be any recent stats (i.e. within the past 20 years) for the use of ECT on either a voluntary or involuntary basis for the US. Therefore, the surgeon general's statement on the rate of involuntary ECT use as "uncommon" is not simply ambiguous, but, I think, currently unsupported. I've changed the lead, citing what data I could find, to reflect this. Does anyone have any national data for the use of vol and invol ECT that could be added to the article?FiachraByrne (talk) 11:38, 24 February 2011 (UTC)

Any stats again on ECT usage worldwide or elsewhere would be appreciated. I know there are statistics for the England, Wales, Scotland and Ireland (republic of) and also Australia. Italy we know hardly has any ECT. Are there stats for any other jurisdictions? Could people post any sources on stats here. The US stats, which are a bit questionable anyway (based on clinicians recollection of how often they've used ECT) date from about 1988-89 I think. Other than Texas there are no current stats for the US. FiachraByrne (talk) 09:26, 8 March 2011 (UTC)

Roughly 6% of people (600 of every 10,000) suffer from major depressive disorder (ref 1, 2. In the United States, nationwide 5 in 10,000 people were treated with ECT, as of in 1995" (ref 3). This suggests that 5 of every 600 people with major depressive disorder undergo ECT; that's less than 1%. -- Niubrad (talk) 08:22, 31 August 2015 (UTC)

Article Lead Might Need a Rewrite

I think the lead for this article is impressionistic, defensive, and somewhat ideological. I think it could do with a rewrite including only material that has a solid empirical base. I don't think it should seek to champion or denigrate the procedure but simply to reflect what information there is out there on it, good and bad.FiachraByrne (talk) 13:28, 24 February 2011 (UTC)

I agree. I tried to clean up some of the more egregious problems. But the task of streamlining this is a bit daunting, especially considering the expected resistance.John^DO|^{Speak your mind} 05:00, 6 March 2011 (UTC)

Well, I suggest we just look at each statement in the article and see is it justified. For instance the statement that 1 million people receive ECT worldwide relies on a pretty weak source. I don't think that a simple statement by Larry Tye, a medical reporter, is sufficient to support this claim. Are there any real figures for ECT usage. 20:03, 6 March 2011 (UTC)

OK - I've removed unsubstantiated statements from the lead (e.g. numbers worldwide receiving ETC, etc). I've also reformulated statement that ECT is regarded as safe and effective stating that this is the view held by the majority of psychiatrists (which is supported) but that it remains a controversial procedure as reflected in popular opinion, legal restrictions on its usage, disputes within psychiatry and medical profession (and indeed other mental health professions) as to its efficacy and safety. Also that it has been recently decided by FDA to maintain it in Class III devices (highest risk). I think these additions are factual and balanced. There are other items I'd like to tackle in the lead - not least the general bias, also quite evident in the article, to treat ECT as if it were solely or predominantly an American phenomenon with passing references to the UK. But I think for now it is best to move on to the main body of the article. We need to think about which sections would make good sub articles. FiachraByrne (talk) 04:37, 8 March 2011 (UTC)

I think an obvious choice would be to create a new page entitled the History of electroconvulsive therapy and retain at most a paragraph or two -very tightly written and hitting on all the points pertinent to its present use and image - of the history of ECT. However, this will require the preparation of a decent article, incorporating the info here, on the history.FiachraByrne (talk) 09:14, 8 March 2011 (UTC)

Effects related to endorphine / mu-receptor stimulation?

Release of endogenous opioids following transcutaneous electric nerve stimulation in an experimental model of acute inflammatory pain., has it ever been considered that the affects of ECT may be mediated via the opioid system? 74.209.54.156 (talk) 23:03, 18 July 2011 (UTC)

Unsupported assertion

This is an excellent presentation because it includes the failure of evidence.

Unfortunately, the opening description plainly violates the rules of science by asserting that electrovonvulsive therapy is "effective"

As the discussion, and literature, point out this assertion is plainly unsupportable. Rulesofscience (talk) 18:45, 13 August 2011 Rulesofscience (talk) 18:48, 13 August 2011 (UTC)

I don't see what you are complaining about. The article does not assert the ECT is effective, it only says that the majority of workers regard it as effective, and it gives a number of references to back up that assertion. Looie496 (talk) 17:42, 14 August 2011 (UTC)

ECT&DST as possible cause of brain damage

I am not normally a wikipedia editor so I don't know how to incorporate this information. Injuries have occurred because of use of ECT with DST (Deep Sleep Therapy) in Australia at Chelmsford Private Hospital that lead to hypoxia or anoxia in the patient. A judgment from the Australian NSW Supreme Court in which medical experts outline how in this case brain damage occurred. [ http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/nsw/NSWSC/1997/168.html ] The relevant subheading is ECT as possible cause of brain damage in the judgment.

ECT has long been regarded as an appropriate physical treatment for some types of psychiatric illness, especially depression (cf. Bolam v. Friern Hospital Management Committee (1957) 1 WLR 582) although the situations accepted by the bulk of medical practitioners as appropriate for its use have been progressively circumscribed as various forms of psychiatric illness have become better understood, and as other, less traumatic, forms of therapy have been developed. It is a treatment which involves some well recognised risks. (Again I interpose to say that nothing I now say about ECT or the circumstances in which it was used in respect of the plaintiff is intended as in any way bearing on any question of liability which may ultimately need to be resolved; I expressly refrain from any comment on the question whether in the circumstances of this case, the administration of ECT and the manner of its administration were appropriate). ECT involves the sending of an electric charge through the brain and that has an effect on the oxygenation process to the brain. Dr. Phillips explained it, saying:-

"... it is certainly more than an instant. There are two parts to this. There is the actual moment of the electrical impulse, which will vary, depending on the machinery used and a variety of other factors, and respiration will be stopped momentarily then. That does not matter particularly. The patient then, and this is why ECT is used, the patient will then have an epileptic seizure. The first phase of an epileptic seizure is a phase whereby the patient goes into muscle spasm and during that phase, which can last from seconds to over a minute, respiration will cease. The patient then goes into the second phase of the epileptic seizure, which is a phase of contraction and relaxation of muscles, the characteristic, the lay idea of the seizure, and respiration will be disordered but will continue during that period. So it is the phase, the tonic phase, the tonic phase of contraction of muscles during which respiration ceases that is my concern in relation to anoxia."

The risk of anoxia during ECT being well recognised, usual practice according to Dr. Phillips (again without challenge or contradiction) is for the patient to be oxygenated prior to the actual electro-convulsion and as quickly as possible following the tonic phase of the epileptic seizure. There is no evidence that oxygen was given on occasions when ECT was administered to the plaintiff. — Preceding unsigned comment added by 124.168.188.47 (talk) 14:02, 9 December 2011 (UTC)

Thanks, but testimony in a court case involving an unusual way of using ECT would not constitute an appropriate source for this article. The minimum we would need would be newspaper coverage, and discussion in an academic review paper would be much better. There is a large literature on the potential of ECT to cause brain damage, so we don't really need to be scraping for obscure sources. Regards, Looie496 (talk) 16:51, 9 December 2011 (UTC)

There are many articles that document brain damage, but you have to find them. Why is anesthesia used during ECT? Because some form of damage is going on. Thats why we feel the sensation of pain. http://www.wildestcolts.com/psych_opp/d-electroshock/1-shock.html has some references I hope to add to balance out the "goodness" of ECT.--Mark v1.0 (talk) 22:50, 31 January 2014 (UTC)

Removed badly written and un-sourced content

I removed the following text from the "Administration" section.

Informed consent is sought before treatment. Patients complain usually after the fact, that there was no truthful informed consent given. Databases collected over the years show this, ect.org has one, but there were others collected in previous decades. Perhaps the most troubling claim is that the current is actually higher, so ECT may be far more dangerous on the brain itself, which contradicts the claim that ECT is "highly safe." One can easily conclude that with enough shocks, and given the seizure threshold becomes more difficult to surpass, requiring often, higher doses of current to induce the seizure, ECT's cummulative damage in of itself, warrants it a brain damaging procedure. The ECT of "yesteryear" was routinely thought of as barbaric, brain damaging by top neurologists. So one huge question is if electircity is the same, or higher, how is it possible that ECT is at all safe, given the numerous anecdotal horror stories of memory loss, especially with increased frequency of shock. To further confound the debate, there is no talk of the actual voltage, current, or possible risk of any long term cognitive impairment, when many report permanent memory loss, sometimes up to a decade or more of autobiographical memory loss. There is also the troubling issue of court ordered or "forced ECT," survivors like Leonard Roy Frank have spent his life advocating against his forced 40 shock treatments that he believes destroyed his memory, personality, and caused life long trauma, and cogntiive diability, despite fighting to expose the utter misinformation, and coercion of this industry.

Patients are also made aware of risks and benefits of other treatments and of not having the procedure done at all. Depending on the jurisdiction, the need for further inputs from other medical professionals or legal professionals may be required. ECT is usually given on an in-patient basis.

It's very badly written with grammatical errors, spelling errors, un-encyclopedic language, "scare quotes", and is un-sourced. Onlynone (talk) 19:31, 1 January 2012 (UTC)

The article would be improved with a section discussing the possible placebo effect of its use and comparison with other ghastly medical procedures such as bloodletting. Without knowledge of its mechanism, ECT efficacy is dubious at best. Galfromohio (talk) 18:51, 30 June 2012 (UTC)

Unreferenced paragraph removed

I've removed the following unreferenced paragraph. It seems to be pushing a particular point of view and the claim that "ECT has also been lumped in the same categories as lobotomy and insulin comas, which are now universally regarded as dangerous and a form of torture" is particularly problematic and runs contrary to the rest of the article. Note also that I've removed the link to the ECT stories - the link was broken when I tried to access it.

Recent studies question if the risks of ECT outweigh any benefits mostly due to accounts of persisting memory deficits in former patients. There is also great concern over claims that the voltage and current is actually higher than in the days when ECT was considered a very dangerous treatment by most mainstream psychiatrists. ECT has also been lumped in the same categories as lobotomy and insulin comas, which are now universally regarded as dangerous and a form of torture. However, many survivors have reported severe cognitive problems including unexpected memory loss, numerous reports of years of life memories "washed away." Some reports and studies show patients losing a decade or more of memory (retrograde amnesia), and inabilities to retain new information, including loss of simple cognitive skills. There may be a huge disconnect over what the ECT industry calls a "highly safe and effective procedure" (claiming memory loss occurs only around the time course of treatments), and what many former patients report as a "memory eraser," a term frequently used by "bad outcome" ECT stories. Lack of truthful informed consent has also been a key issue troubling those patients, as well as doctors, who question the basic ethics behind ECT. Some personal accounts tell of devastation due to cognitive loss of former ECT patients. Julie Lawrence 2007 Personal ECT Stories HealthyPlace

Watermelon mang (talk) 21:18, 31 January 2012 (UTC)

POV and weasel words

i dont know how to make the cool markings that indicate a wiki principle needs attention. i added a wiki pov note to the sarcastic bit about the surgeon general and 'gross' damage. it's a medical term and explanation is warranted (thus i did not remove the sarcasm.)

the weasel words "small minority" are used in the first paragraphs about ect in other countries. if there isnt a citation i'm not sure where this comes from, though i am entirely willing to believe it.  :-) Tkech (talk) 23:25, 6 March 2012 (UTC)

Carol Kivler testimonial and mechanism of action

I have removed new content on the mechanism of action and an endorsement from Carol Kivler. Medical content on Wikipedia is strictly governed by guidelines and policies. I'm not sure the Kivler testimonial, or any testimonial, is appropriate for an evidence-based article. A very important guideline is Wikipedia:Identifying reliable sources (medicine). The source (Perrin et al.) for the mechanism of action content does not conform to that guideline.

Perrin et al., an fMRI study of ECT and frontal cortical connectivity in severe depressive disorder, is not appropriate for the claims the new text makes. Per the guideline I linked to above, we rely on expert reviews to put such results into context. This study can be mentioned once a review has done that, if the review gives it sufficient importance to warrant inclusion.

Also, it's important to be very precise in paraphrasing sources. The recent edit said, "The group's findings confirmed the hyperconnectivity hypothesis of ECT" which is stronger than the source's "The findings reported here add weight to the emerging “hyperconnectivity hypothesis” in depression..."

I'm not contesting the veracity of any of the content. But to be included in Wikipedia, the relevance and accuracy of all medical content must be supported by sources that conform to the above guideline - usually systematic reviews, graduate-level textbooks, national or international professional guidelines, or similar, that can be expected to accurately reflect the current scholarly consensus. --Anthonyhcole (talk) 07:41, 7 April 2012 (UTC)

Rollback of edit to "There is a significant risk of memory loss with ECT"

I used the rollback feature to change the last edit which added the word temporary to the following sentence: "There is a significant risk of temporary memory loss with ECT". I wanted to revert because that is not supported by that source - they emphasise, rightly or wrongly, permanent memory loss. I should have reverted the edit rather than use the rollback feature, however. FiachraByrne (talk) 22:04, 1 November 2012 (UTC)

Here's the diff [8] FiachraByrne (talk) 22:06, 1 November 2012 (UTC)

Actual examples should be removed

The topic says that "In 2012, CNN revealed a video of Andre McCollins at the Judge Rotenberg Center Center for behavioral therapy in Canton, Massachusetts being subjected to Electroconvulsive therapy.[145] The 18 year old boy's mother described Andre as being "tortured, terrorized and abused" by this type of treatment.[146]" This topic should be removed since it is not a video with an example of electroconvulsive therapy. If you go to the CNN reference in youtube (reference 145), Anderson Cooper states very clearly that it was a case of "aversive therapy" using SKIN SHOCK. So, again, nothing to do with electroconvulsive therapy, watch it at about two minutes of the video. (Francisco) — Preceding unsigned comment added by Fguarn (talk • contribs) 18:26, 13 November 2012 (UTC)

I've removed it. Thanks for the information. Looie496 (talk) 18:49, 13 November 2012 (UTC)

Citing sources behind paywalls

"A 2011 paper in the Journal of Psychiatric Nurses Association reported that ECT was effective.[27]"

I can't access the article without paying for it, so I can't confirm that the paper actually supports ECT. In light of this problem, should the paper be cited at all?— Preceding unsigned comment added by Sonicsuns (talk • contribs)

Our sourcing policies don't require that free online versions of sources be available -- it's always good if possible, but often would mean that essential and highly reputable sources could not be used. In this case, though, that appears to be a very short opinion piece that doesn't really add anything of substance to our article, so I would be supportive of removing that line if that's what you would like to do. Looie496 (talk) 21:20, 19 March 2013 (UTC)

I think that is a strong and important statement. I don't think it should be removed. And yes, unfortunately this is a problem and WP:PAYWALL says that wikipedia does not guarantee ease in accessing sources. MidnightRequestLine (talk) 01:34, 20 March 2013 (UTC)

I hope an editor will make corrections to the "administration" section.

A few basic points: ECT is a treatment for severe episodes of major depression, mania, and some types of schizophrenia. No changes in medication are made prior to beginning treatment, with the exception of benzodiazapenes. Benzodiazapenes can interfere with the efficacy of ECT, so a patient may be tapered off prior to beginning treatment. However, if this will be counter-therapeutic, a benzodiazapene antagonist can be used at each ECT session. ECT is usually administered three times a week, on alternate days, over a course of two to four weeks. It is administered under general anesthesia, after which a muscle relaxant is given to control the seizure activity (the only seizure activity to the body is a clenching of the jaw, and a twitching of the foot [a tourniquet is placed around one ankle prior to the administration of the muscle relaxant]). The patient's EEG, ECG, and blood oxygen levels are monitored during treatment. The controlled electrical stimulus lasts from a fraction of a second to a maximum of six seconds. Over the past decade, unilateral ECT has overcome bilateral ECT as the treatment of choice, because it is associated with significantly less memory impairment.

Source: Duke University Medical Center, Department of Psychiatry — Preceding unsigned comment added by 174.252.176.216 (talk) 23:10, 24 March 2013 (UTC)

Thanks for pointing out that the article could use more detail in this section. However for information of this nature to be added to the article, it must be supported by a published, reliable medical source, as per the WP:MEDRS guideline. The source provided is not useful in that regard. I will do some digging for sources and see what i can find.Jytdog (talk) 00:01, 25 March 2013 (UTC)

source gathering. First line is handled in "patient selection" section, not in administration section.

Snd line. Apparently there is little consensus on whether meds should be tapered or maintained. As for reducing benzos, that is clinical practice, as is potentially administering a benzo antagonist, as benzos increases the seizure threshold, but apparently the ECT treatment given can also be adjusted to compensate for that. anesthesia and muscle relaxant are already covered in the administration section. duration of a given treatment, their frequency and duration of treatment overall are discussed here as is monitoring. location of electrodes is as you say. OK I will add this content to the article with these sources. Thanks again for the suggestion. — Preceding unsigned comment added by Jytdog (talk • contribs) 00:46, 25 March 2013 (UTC)

Sorry Jytdog - in fixing above comment (so full comment and reference would display) I wiped your original signing of the comment and had to replace it with the above template. FiachraByrne (talk) 02:47, 25 March 2013 (UTC)

Thanks for mixing my mistakes :) Jytdog (talk) 14:02, 25 March 2013 (UTC)

section of text for deletion

I was just reviewing the article for violations of WP:OR and was also fixing some citation needed tags when I came acrss this:

"There are recent animal studies that have documented significant brain damage after an electroshock series. For example, in 2005, Russian researchers published a study entitled, Electroconvulsive Shock Induces Neuron Death in the Mouse Hippocampus: Correlation of Neurodegeneration with Convulsive Activity. In this study, the researchers found that after an electroshock series, there was a significant loss of neurons in parts of the brain and particularly in defined parts of the hippocampus where up to 10% of neurons were killed. The researchers conclude that "the main cause of neuron death is convulsions evoked by electric shocks."[78] In 2008, Portuguese researchers conducted a rat study aimed at answering the question of whether an electroshock series causes structural changes in vulnerable parts of the brain.[79] According to the authors, "This study answers positively the question of whether repeated administration of ECS seizures can cause brain lesions. Our data are consistent with findings from other animal models and from human studies in showing that neurons located in the entorhinal cortex and in the hilus of the dentate gyrus are particularly vulnerable to repeated seizures." However, they question the applicability of their own research with respect to Electroconvulsive therapy in humans: "An important caveat of our results is that it is unclear to what extent they are relevant to the use of electroconvulsive therapy in psychiatry, because the protocol employed in this study is different from that used clinically. Evidence from previous studies (Gombos et al., [1999]; Vaidya et al., [1999]) and from our pilot experiments indicates that treating rats either with five to ten widely spaced ECS (at 24- or 48-hr schedules) or with two stimulations only 2 hr apart does not lead to loss of hippocampal neurons".[79]"

So, this should be deleted under WP:MEDRS. The content immediately above this part, discusses results in HUMANS describing both negative and non-negative effects on brain structure. The sources cited above are reviews. What we have here, are primary studies in animals, that are added together to lend extra WP:WEIGHT to the negatives side. This violates WP:MEDRS and should be deleted. I intend to do so, but because this is a big chunk I wanted to give folks a chance to comment.Jytdog (talk) 00:22, 26 March 2013 (UTC)

Agreed, and after four days without objection, I have removed it. Zad68 14:09, 29 March 2013 (UTC)

Thanks!Jytdog (talk) 14:22, 29 March 2013 (UTC)

Mechanism of Action

The mechanism of action section is terribly written. Whilst it is true that the definitive mechanism isn't known, there are several promising theories, which the section makes no mention of. Changes in serotonergic neurotransmission (e.g. 5-HT1A receptor increases'reductions), dopaminaminergic neuortransmission (Increases in HVA levels in CSF, decreased D2 receptor binding, increased D1 and D3 receptor binding), neurogenesis (BDNF and VEGF, and BrdU studies of neuorgenesis in animals). I don't know how to write stuff on wikipedia, but for someone who does, please look at recent(ish) reviews on the topic: The use of MST and ECT in Treating depression, ebmeier & Allan international review of psychiatry 23(5): 400-412 (2011). Merkl, A. et al. Antidepressant electroconvulsive therapy: mechanism of action, recent advances and limitations. Experimental neuorology 219: 20-26 (2009). Scott, A. Mode of action of electroconvulsive therapy. Advacnes in psychiatric treatment 17: 15-22 (2011).

The section needs to be better than this. Someone please make it so! — Preceding unsigned comment added by 163.1.236.35 (talk) 11:20, 8 April 2013 (UTC)

Our articles on academic topics are in general very underdeveloped, so don't expect anybody to come along and do this. You should feel free to edit the article, or if you would like to suggest specific changes here on this talk page, I would be happy to react to them. Regards, Looie496 (talk) 15:51, 8 April 2013 (UTC)

Needed Citation in Adverse effects: Effects on memory

I suspect that the source for the Sackeim reference that has been marked-up "citation needed" is: Sackeim et al 2007, 'The Cognitive Effects of Electroconvulsive Therapy in Community Settings' Neuropsychopharmacology, vol. 32, pp. 244–254 (The full paper can be found for free here: http://www.nature.com/npp/journal/v32/n1/pdf/1301180a.pdf)

The uncited text in this section is a little vague and unencyclopedic but its substance appears well-sourced. Again, I can only speculate but it looks like the Wikipedia editor was trying to paraphrase the conclusion that appears on page 252 of the paper. Hope this helps. 114.76.75.113 (talk) 07:33, 11 April 2013 (UTC)

Introduction Paragraph

The introduction paragraph has gone throught quite some re-edits. The latest change can be seen here: http://en.wikipedia.org/w/index.php?title=Electroconvulsive_therapy&diff=572065183&oldid=570438334

The following is the disputed insert which is highlighted by bold: Electroconvulsive therapy (ECT), formerly known as electroshock, is a controversial psychiatric treatment in which seizures are electrically induced in anesthetized patients for symptom remission. Its mode of action is unknown.[1] Its efficacy has been questioned, with some meta-analyses illustrating a statistically significant, and positive, effect of the procedure while others suggest the procedure is no more effective than a placebo (see discussion following). The use of electroconvulsive therapy evolved out of convulsive therapy. Long before electric shocks were being administered to induce seizures, doctors were using other drugs and methods to induce seizures as a means of treatment for severe depression and schizophrenia. Today, ECT is used as a treatment for clinical depression that has not responded to other treatment, and sometimes for mania and catatonia.[2] It was first introduced in 1938 Italian neuropsychiatrists Ugo Cerletti and Lucio Bini, and gained widespread popularity as a form of treatment in the 1940s and 1950s.[3][4]

59.93.247.233 (talk) 07:21, 16 September 2013 (UTC)

False gender gap removed

http://www.medscape.com/viewarticle/810193 — Preceding unsigned comment added by Stubborn Myth (talk • contribs) 05:25, 28 October 2013 (UTC)

Early history

The first sentence of History currently reads "As early as the 16th century, agents to induce seizures were used to treat psychiatric conditions". There are much earlier uses: there are well-attested records from the classical era by Pliny and Largus of physicians directing patients suffering from epilepsy or other conditions to touch electric rays in the hope of a cure. —BillC ^talk 10:05, 15 February 2014 (UTC)

Section mentioning Dr. Peter Breggin is biased

The section mentioning Dr. Peter Breggin is extremely biased and misleading. First of all, Dr. Breggin is not a critic of evidence-based psychiatry at all. One of his main points of criticism is that ECT has never had any evidence for its efficacy. There has never been a study comparing ECT with placebo that showed any benefit beyond 4 weeks. Dr. Breggin criticizes the use of ECT because of its lack of evidence. So to say he is a critic of evidence-based medicine is misleading and meant to bias the reader against his views. Finally, the statement that the scientific consensus does not agree is nothing more than an appeal to authority. The citations at the end of that sentence do not support this statement. The most comprehensive review of ECT can be found here: http://www.power2u.org/downloads/1012-ReadBentallECT.pdf.

50.172.42.35 (talk) 19:10, 5 March 2014 (UTC)

Cancer and ECT

The Author wrote: that ECT could be administered; but,"with caution in those whose cancers are in remission or under control". I was curious if the Author could provide a reference for this? A friend took more than 10 ECT treatments and underwent a colonoscopy during her "treatment" only to find out she had a tiny cancer growing in her colon (like 3-5 mm in size). She informed her ECT "doctors" of her condition; they were sorry she had cancer; but, showed little concern for any possible interaction with ECT. She underwent one or two more "treatments" and when they resectioned her colon soon after, her surgeon discovered that her cancer had spread to her lymph nodes afterwhich she had to suffer with chemotherapy. Is this a coincidence or did her tiny cancer just randomly enter her lymphatic system? Even her oncologist characterized her cancer as "strange". 67.1.18.229 (talk) 17:16, 24 March 2014 (UTC)

Sorry about your friend. interesting question about our article. you make a good point that the current text is not supported by any reference. I did some digging and as near as I can tell, the only kind of cancers relevant to ECT are brain cancers - they are a contraindication. I've corrected the text. Jytdog (talk) 17:34, 24 March 2014 (UTC)

10.1 Fictional Examples. A Beautiful Mind inaccurate

Tplew1 (talk) 01:42, 3 April 2014 (UTC) 10.1 Fictional Examples has the movie A Beautiful Mind listed. ect is not shown in this film. insulin shock therapy is shown. Tplew1 (talk) 01:42, 3 April 2014 (UTC)  Done, thanks! Jytdog (talk) 02:03, 3 April 2014 (UTC)

POV takeover of page- needs work being restored to NPOV

Hope people see this, the sections on adverse effects, efficacy, controversy over long term effects are all extremely biased, and deliberately any sources that are not pro ECT like "Journal of ECT". — Preceding unsigned comment added by 42.3.97.91 (talk) 02:13, 13 May 2014 (UTC)

42.3.97.91 you are clearly new to Wikipedia. You need to be more specific, and back up what you say with reliable sources, as we define reliable sources at Wikipedia. Please read WP:VERIFY and WP:MEDRS. This is not a forum to discuss views on ECT - this is a page to discuss improving the article, according to Wikipedia's policies and guidelines. I don't intend to be mean, but there is a rational foundation for what we do here. 02:33, 13 May 2014 (UTC)

OK, why is research like Peter Breggin and Harold Sackheim nowhere to be found in the article? Here's his wikipedia entry. http://en.wikipedia.org/wiki/Harold_A._Sackeim As you can see, he's not some schmuck, and is actually a proponent of ECT. Could we please consider mentioning his 2007 research under the Adverse Effects section? — Preceding unsigned comment added by 42.3.97.91 (talk • contribs) 07:17, 13 May 2014‎ (UTC)

above, i asked you to read WP:MEDRS. What that says, is that we don't use what we call "primary sources" in health related articles; we rely on reviews and statements by major medical and scientific bodies. btw, if you look at the section on adverse effects on memory and the conclusions of the 2007 primary source you cite, you will see that reviews have absorbed Sackheim's findings and that those findings - that sine wave stimulation and bilateral electrode placement were both associated with bigger problems - are in the article.Jytdog (talk) 11:51, 13 May 2014 (UTC)\\

Negative patient reports

Numerous patients have reported that they feel, rightly or wrongly, that they were damaged, sometimes severely, by ECT. There is one book published by Rutgers University Press, and another by Random House, on this topic. They do not purport to be giving medical analysis; they are reporting their own experiences. (The authors themselves received ECT.) Wouldn't it be more honest to mention these books and say what is wrong with them, if in fact they are defective? Why are negative patient reports not allowed? The following were removed after I added them: Prof. Linda Andre, "Doctors of Deception: What They Don't Want You to Know about Shock Treatment," Rutgers University Press, 2009, ISBN: 0813544416 Jonathan Cott, "On the Sea of Memory: A Journey from Forgetting to Remembering," Random House, 2005, ISBN: 1400060583 "The Electroshock Quotationary," ed. Leonard Roy Frank, 2006, http://endofshock.com/102C_ECT.PDF, retrieved 2014-08-17 "ECT = Intentional Brain Damage," The Experience Project, http://www.experienceproject.com/stories/Have-Had-Ect/914469; retrieved 2014-08-17 The last two are from less verifiable sources, but that people are making these comments alarm me. That they cannot be mentioned in the article alarms me more.deisenbe (talk) 02:40, 18 August 2014 (UTC)

If negative patient reactions to the treatment are indeed a significant complication of the treatment, that will be reported in the secondary literature and can be included here. We cannot possibly include mention of every individual who came away with a negative view of the treatment, just like we cannot possibly include mention of every positive story. Blogs and self-published materials like essays are primary sources for the views of the authors and secondary sources would be required to establish that the use of those primary source complies with WP:WEIGHT. The article already has a large section on adverse effects (although the sourcing could be improved) including memory loss and brain structure, please read through that and see if your concerns aren't already covered in the article. Zad68 02:10, 18 August 2014 (UTC)

Deisenbe please assume good faith. We are a community made up of lots of different kinds of people which means there are disagreements. We talk them through. Please change the section header. thanks. Jytdog (talk) 03:14, 18 August 2014 (UTC)

I must admit that there are also on the Internet first-person reports of patients who believe they were much helped by ECT.deisenbe (talk) 03:36, 18 August 2014 (UTC)

:) Thanks for changing that. Yep, people say lots of things and importantly, experience a lot of things. But we want this article to be science-based, not anecdote-based. So we rely as much as we can on statements by major medical and science bodies (Like the NIH in the US or the NHS in the UK) or by good reviews published in the scientific literature. Those kinds of sources help us get as close to "truth" at any given time as we limited humans can... thanks again for talking. Jytdog (talk) 04:21, 18 August 2014 (UTC)

Use of uncommon words

I have changed the word "efficacious" to the word "effective". It is only a minor edit but I think this could be an indication that there may be other issues like this within the article. There was also the word "efficacy" but I left that in.

Wikipedia is supposed to be wide reaching. I am of the school of thought that says that commonly used words should be used where possible in any informational writing.--Hypernator (talk) 19:06, 29 September 2014 (UTC)

I came back to this because I felt that I had used an insufficient word replacement. Instead of replacing the word "efficacious" with the word "effective" I have expanded the sentence. I have now written the whole dictionary definition for the word efficacious into the sentence. It is not too long but, most importantly, it makes it far easier for a layperson to understand what is being said now. The word "efficacious" does not seem to be commonly used.--Hypernator (talk) 15:42, 2 October 2014 (UTC)

Balanced?

I wonder if this article is sufficiently balanced? I'm no Wikipedia expert but it generally reads as very pro-ECT. Any evidence which does not support the use of ECT is buried in the middle of sections. And the 'Controversy over long-term effects on general cognitiion' section has barely a mention of opposition to the view that ECT is safe and effective. I think Read and Bentall's review could be mentioned again here: http://www.ncbi.nlm.nih.gov/pubmed/21322506

I'm not advocating a complete overhaul of the page, I thought it was an interesting read. However, the tone of positive certainty left me feeling uneasy. Psychiatry has a chequered history, having evolved over the years through a lot of trial and error. Although there are a range of useful ideas and treatments it is important not to fall for the lure of simple answers, when the evidence base shows mental health is far from simple.

I wonder if perhaps a Criticism section could be created, separate from adverse effects, for clarity? 193.60.159.61 (talk) 10:36, 4 December 2014 (UTC)

The specific concerns you are bringing up deal with how much WP:WEIGHT or emphasis to give to each viewpoint. In this case, any discussion about "pro" or "anti" anything needs to be sourced to reliable sources, in this case our guideline for medical sources for medical claims. If the majority sources are "pro" ECT, then we are too. We do not give equal validity to all positions. I do not like criticism sections, and prefer that any critiques be incorporated into the article. Yobol (talk) 17:31, 4 December 2014 (UTC)

Alleged copy vio

I put in the following:

In 1785, the therapeutic use of seizure induction was documented in the London Medical Journal. As to its earliest antecedents one doctor claims 1744 as the dawn of electricity's therapeutic use, as documented in the first issue of Electricity and Medicine. Treatment and cure of hysterical blindness was documented eleven years later. Benjamin Franklin wrote an electro static machine cured "a woman of hysterical fits." G.B.C. Duchenne, the mid 19th century "Father of Electrotherapy," said its use was integral to a neurological practice.

In the second half of the nineteenth century, such efforts were frequent enough in British asylums as to make it notable.

This is all paraphrase. If you have an issue, please discuss it here. 7&6=thirteen (☎) 18:31, 28 December 2014 (UTC)

thanks for removing the copyvio from this version of your edit. Jytdog (talk) 19:04, 28 December 2014 (UTC)

I apologize. No copy vio was intended. I am glad we have come to a consensus. Best regards. 7&6=thirteen (☎) 19:06, 28 December 2014 (UTC)

edit warring over content based on outdated review

IP editor 193.60.159.61 added content based on an old review, which I removed on the basis of MEDRS, as our article already cites newer reviews. The IP editor has been re-inserting it, not providing a response to the violation of the guideline, for example here: dif. Per WP:BRD the burden is on the IP address to open a discussion. I have gone ahead and done it. IP, please explain how the content you want to add is OK per WP:MEDRS. Thanks. Jytdog (talk) 17:12, 16 February 2015 (UTC)

ECT mania addition

I think it is critical to indicate that ECT should only be used to treat mania AFTER at least one trial of psychotherapy has been conducted. — Preceding unsigned comment added by Ahuelsman (talk • contribs) 19:46, 29 March 2015 (UTC)

 Done. OK? Jytdog (talk) 20:01, 29 March 2015 (UTC)

Edits under "Usage"

Electroshock therapy has mass versatility and is performed on approximately 100,000 people a year. Although it is more common in older patients and in women, it has the capability to be used across all age spectrums, including in children. In addition, it can also be administered to pregnant women who can't take anti-depressants and to patients who have serious medical problems/illnesses. ECT has the vital function of getting people who are acutely suicidal out of that desperate state [1]

References ^ Fawcett, Kirstin.[1], "Electroconvulsive Therapy: What it is, How it Works and Who it Helps." U.S. News Health, October 29, 2014.

These changes will make the eliminate the original first line under "usage" and make it sound more scholarly and increase clarity. It will also add the broad overview of the usages of ECT in women, wide age spectrums, and patients with medical problems; this is gone into more depth in the sections "United states" etc. but would be useful in the usage section. The addition of the concluding sentence is also new information that is key to include under usage. Lewilson95 (talk) 20:04, 29 March 2015 (UTC)

that source fails WP:MEDRS - we cannot use it for content related to health ( like what ECT can and cannot be used for) Popular media is OK for some things, as described in the section on that in MEDRS. Jytdog (talk) 20:20, 29 March 2015 (UTC)

I don't understand why this information cannot be used. I am an undergraduate student- can you explain how this is not a reliable source? Lewilson95 (talk) 14:04, 31 March 2015 (UTC)

Thanks for writing. Did you read WP:MEDRS? thx Jytdog (talk) 14:07, 31 March 2015 (UTC)

Header Photo?

Can we please add a header photo? One that might show a person enjoying the procedure? All the pictures we have so far are historical, but it would be nice to see this topic further developed with a simple picture at the top of the page. I'd like for somebody looking into this therapy article to see that it is a modern procedure and that it is not as scary as the current historical pictures depict. — Preceding unsigned comment added by Kjk5182 (talk • contribs) 20:48, 5 April 2015 (UTC)

I very much doubt that anyone 'enjoys' ECT. And as for a picture, even if one were available (we rely on volunteers uploading images, and can't simply produce them on request), there are clearly issues of confidentiality involved in showing someone undergoing a psychiatric procedure - per the Wikipedia:Image use policy we would require the consent of the individual before using such an image. AndyTheGrump (talk) 21:07, 5 April 2015 (UTC)

I would consent as the subject, but when I asked for permission to have myself photographed undergoing ECT, my request was denied by the hospital legal department due to "liability issues". Since the procedure would involve at least 5 individuals besides myself (an anesthesiologist, their assistant, a doctor, a nurse, and of course a photographer) whose consent would also be required, I assume that they expect more than a simple verbal request. I have neither the expertise nor motivation required to write a legally binding document protecting the confidentiality and liability of all involved, but if someone were to contact me with a link to an appropriate public domain document that could be filled out by myself and others then presented to hospital legal staff, that might be enough. I agree that a more accurate and contemporary photo would improve the article. In my experience it is not as visually striking of a procedure as one might imagine, most closely resembling the typical use of general anaesthesia with ventilation provided via ambu-bag instead of intubation (or as I personally describe it, "like surgery, but without the surgery"). - Syd (talk) 21:07, 21 April 2015 (UTC)

Additional famous persons

I believe the 'Famous cases' section needs a bit more information in order to provide readers with sufficient information. A very notable person who has undergone ECT is Sherwin B. Nuland, award-winning author and surgeon. Kyliempaul (talk) 01:30, 19 April 2015 (UTC)kyliempaul

Personally, I can see little merit in a 'famous persons' section at all - it can only ever consist of random anecdotes. AndyTheGrump (talk) 01:51, 19 April 2015 (UTC)

I think since ETC is such a misunderstood topic (due to portrayal in film), including famous persons who have undergone ETC would be beneficial. I know when I first read the article, I found the 'Famous cases' section to be very interesting.Kyliempaul (talk) 14:32, 19 April 2015 (UTC)kyliempaul

edits undone - claimed that they were not relevant, amount of electricity ECT

I tried to add a paragraph with a simple calculation to give an overview of the amount of voltage that is usually used with ECT. The edit was rather quickly reversed and it was claimed it was not 'relevant'.

I don't understand how this can NOT be considered relevant. In everyday life typically voltage is what people are familiar with not watts or ampere. Adding the voltage contributes to a better understanding. Generally when talking about electricity we rarely describe it as a relation between watts and ampere. The average reader will be far more familiar with volts. The current form is rather cryptic and I would guess many will not find it too useful or insightful.

Please see below of an overview of the edit:

https://en.wikipedia.org/w/index.php?title=Electroconvulsive_therapy&diff=667337188&oldid=667332599 - old version:

typically, the electrical stimulus used in ECT is about 800 milliamps and has up to several hundred watts, and the current flows for between one and 6 seconds.To put that into perspective, according to Ohm's law a current of 800 milliamps and a power of 100 watts corresponds to a voltage (V) of 125.

new version:

Typically, the electrical stimulus used in ECT is about 800 milliamps and has up to several hundred watts, and the current flows for between one and 6 seconds. -

Any thoughts on how one could give a better overview of the amount of electricity that is used with ECT? On the internet one can read about various unsubstantiated claims ranging from extreme doses to mild electric currents. Personally I doubt that in the current form a reader will be able to get a better understanding regarding this unless they do some conversion of the above numbers or a reliable source mentioning voltage is cited.

The claim that I failed to demonstrate relevancy is a logical fallacy and frankly doesn't make any sense at all.

Let's assume the following:

1. The entire paragraph mentioning watt, and milliamps is irrelevant. Then why is it there in the first place and was not deleted by the people claiming non-relevance?

2. The paragraph is indeed relevant. (I don't think any reasonable person would argue against this) If it is relevant how can converting the numbers to a more understandable form not be relevant? I don't add any new information. I just make the present information more readable and understandable. I don't think anyone would argue that milliamps and watts give the average person more information than volt does.

In the talk section there are at least several people stating the electricity such as volt should be mentioned and the amount of electricity should be in a more understandable form. Not surprising since almost everyone would have to think hard what the current information actually could mean. A simple conversion does solve this problem while leaving the actual information unchanged.

My edit is as relevant as the numbers that I convert.

If they aren't relevant why haven't they been deleted yet?

The answer is of course because they are relevant!

The could be other arguments against my edit. I would welcome any feedback or suggestions how to improve it. Relevancy certainly isn't the problem here.

— Preceding unsigned comment added by 93.34.7.47 (talk) 14:55, 17 June 2015 (UTC) 

You have cited no source demonstrating that your calculation is relevant, and you seem to have a fundamental misunderstanding of electricity - voltage is not a measure of the 'amount of' anything, other than potential difference. A typical static discharge (e.g. caused by earthing oneself after walking over a nylon carpet) may result from a potential difference of 20,000 volts or more. [9] You aren't putting anything 'into perspective', you are merely adding a number that you appear not to understand the meaning of. AndyTheGrump (talk) 18:17, 17 June 2015 (UTC)

Hello thank you for the reply. I understand what i wrote about electricity. I have used informal language here and called it "amount". This has nothing to do with my edit. From what you have written about electricity you don't seem to have an understanding of it. It is very clear from the context that the 20,000 volt discharge that you mentioned is indeed irrelevant here.

Adding voltage IS certainly very helpful and makes the paragraph more understandable for the average reader.

Please see other related medical wikipedia articles and note how they do use voltage. It is what you would expect. Or is this also irrelevant? Please tell me why it is relevant there and not here? As I stated before it doesn't make any sense. Simple calculations are not original research. You have cited no source why it is irrelevant. (The 20,000 volt example has nothing to do with this case) Similiar medical articles are using voltage and you can not cite a source why this one shouldn't.

https://en.wikipedia.org/?title=Defibrillation https://en.wikipedia.org/wiki/Artificial_cardiac_pacemaker — Preceding unsigned comment added by 93.34.7.47 (talk) 18:45, 17 June 2015 (UTC)

Wikipedia articles are based on sourced content. Cite a source. AndyTheGrump (talk) 19:04, 17 June 2015 (UTC)

Wikipedia does allow simple calculations. I don't need a source for that.

quote: ---Any relatively simple and direct mathematical calculation that reasonably educated readers can be expected to quickly and easily reproduce. For example, if given the population and the size of a specific area, then the population density of that area may be included. https://en.wikipedia.org/wiki/Wikipedia:These_are_not_original_research#Simple_calculations---

— Preceding unsigned comment added by 93.34.7.47 (talk) 19:22, 17 June 2015 (UTC) 

Unless you can cite a source demonstrating that voltage is relevant, it doesn't belong in the article, end of story. AndyTheGrump (talk) 19:35, 17 June 2015 (UTC)

So it is wrong just because you say so because it is your personal opinion?

I don't need a source that says voltage is relevant just like no one needs a source to convert celsius to fahrenheit or to use km or miles. These are used in everyday life. I don't need to prove that they are relevant.

Can you cite a source that says voltage should not be used in an electro-stimulation medical context? There isn't any.

Please refer to the link above:

quote-- Any relatively simple and direct mathematical calculation that reasonably educated readers can be expected to quickly and easily reproduce. For example, if given the population and the size of a specific area, then the population density of that area may be included. ---

What I did was perfectly legitimate. Or do I need to prove in the above example that population density is relevant and useful before adding it? — Preceding unsigned comment added by 93.34.7.47 (talk) 20:15, 17 June 2015 (UTC)

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Little mention of few high quality studies of efficacy for depression or suicide - ignores critical review

Electroconvulsive_therapy#Efficacy (for depression) mentions supportive 2003 and 2008 reviews but ignores the 2010 Read & Bentall review which finds the few high quality (randomised/blinded placebo controlled) studies do not support efficacy for depression or reduction in suicide. The Read and Bentall review is already cited twice but could be used much more widely to update this article - or has there been an effective rebuttal of its conclusions ? - Rod57 (talk) 12:53, 20 August 2016 (UTC)

The 2010 Read & Bentall paper has been discredited by at least one source. McCall et al, referring to this paper (reference #9), state:

"...evidenced-based mainstream summaries of [ECT's] mechanism have been lacking, while evidence-poor papers with an anti-ECT agenda have suggested that the mechanism of ECT is through brain damage (9, 10) or via placebo effects (11). These theories are wrong, and join a long list of discredited theories of ECT's mechanism."

Some will find further reading of McCall to be an "effective rebuttal", while others might refer to the lack of sources citing this review article. On the other hand, while somewhat dated, a 2003 Cochrane Review of ECT for depression in elderly does cite insufficient controlled evidence in this population. I do note that Cochrane has a Protocol for a systematic review of ECT for depression, but this has not yet been completed. Drdaviss (talk) 17:51, 20 August 2016 (UTC)

Thanks for responding. It looks like McCall is saying R&B is evidence-poor concerning the mechanisms rather than the efficacy - it doesn't seem to rebut R&B's data selection or conclusions. Can you see anything in R&B that is wrong or unsupported ? I expect that R&B would be ignored (eg not cited) by people who's careers it doesn't support but that doesn't make it a biased or incompetent review. Is there a later review of placebo controlled trials that discusses it ? - Rod57 (talk) 11:11, 25 August 2016 (UTC)

Rod57, Read and Bentall's review is actually cited by several other articles. Including these four:

http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21322506/citedby/?tool=pubmed

And Google Scholar says the review is cited by a whopping 76 articles!

https://scholar.google.com/scholar?um=1&ie=UTF-8&lr&cites=4291584614773394436

Don't listen to Drdaviss. Christopher James Dubey (talk) 06:06, 7 September 2016 (UTC)

One sentence in one paper really doesn't "discredit" an entire other paper, no matter how much the authors think so, especially when it makes such a brief criticism with little reasoning to support that criticism and no citations of the actual words of the article it criticizes. I highly suspect this Wikipedia article on ECT has been monitored by people working in support of the ECT industry, but since I can't pinpoint any specific user conflicts of interest, I'm not going to make any assertions right now. Read and Bentall's review is much longer than the article by McCall et al that criticizes it, plus it cites a much larger number of sources. I used to edit this Wikipedia article about eight years ago and I have seen how much has been removed, including a larger citation of Read and Bentall's review. Many sources have been wiped out. While Read is certainly biased against ECT, it should also be noted that The Journal of ECT is itself very biased in favor of ECT. Even this Wikipedia article currently notes that Dr. Charles Kellner is "a prominent ECT researcher and former chief editor of the Journal of ECT." Kellner has written and spoken many times in favor of ECT, while downplaying any potential risks/harms. Christopher James Dubey (talk) 00:34, 4 September 2016 (UTC)

By the way, I am an ECT survivor. I will openly admit my bias. But I have been following the scientific and ethical debates over ECT since about 2006 when my involuntary ECT ended. I have had limited contact with John Read. I'm in the activist circles that include him. I can answer questions about how things have developed in the controversy in recent years. I can help people look up things about this and find sources. Christopher James Dubey (talk) 00:46, 4 September 2016 (UTC)

Regardless of whether you admit your bias or not, if the pro-ECT sources can't be trusted because they show bias, then you must also be ignored for the same reason. Bias is bias. Having an actual background in psychology, with a degree in same, The majority of the evidence I've seen shows that it can be quite beneficial for a short list of intractable mental disorders. That the fact still is a bit unusual to me thirty plus years after first being exposed to the data (in university) shows that I do not have any sort of bias in favor. I do NOT believe that it should be forced upon anyone absent informed consent. Speaking for myself, having suffered with major or minor depression most of my life, the one period where I actually felt optimistic, useful, valuable, without taking any sort of antidepressants was after an involuntary grand mal seizure brought on by two prescription meds that contraindicated each other, caught by neither the physician nor the pharmacy. The remission started a few days after and lasted for several weeks. And it was not an imaginary phenomenon. I go back and read my Facebook posts from the period and they're almost comically upbeat, a marked contrast to my usual sober self. And a marked contrast to posts made just a few days or a week before the seizure. Honestly, it never occurred to me to wonder why exactly I was feeling that way for at least couple of weeks. I'd forgotten completely about what I'd learned about the history of ECT--it arose out of a simple observation, across a couple of centuries, that people who suffered from severe melancholy or depression, who also suffered from a seizure disorder, often experienced a remission in the depression following a seizure. Until I suddenly remembered one day and had a serious head-spinning WTF? moment wondering if I had actually learned that. I confirmed it with a little research; I had indeed learned it in college and it had an additional thirty years of evidence to back it up. Though I'm now open to the idea, I myself have not undergone ECT. I've been talking to psychiatrists about it for several years following the involuntary seizure I had, and have found them uniformly cautious in the extreme about the idea. Every one I've spoken with, and that's more than ten, accepts it as a completely valid and often successful medical intervention for some patients, but not the first arrow to reach for in the quiver. I'll add this: some really boneheaded drugs or other interventions have been approved for use in medicine, and had to be yanked back out of the field when harm became apparent. And pretty much every single modern one has ambulance-chasing lawyers circling it like hyenas eager to bite off a few million dollars or so. Where are the hyenas circling the manufacturers of the ECT equipment or doctors who use it? The primary difference between ECT and those other interventions is that it's a lot harder to discredit something that's been under close observation for a couple hundred years. You make ECT sound like Egas Moniz riding around in the Leukotomy Wagon doing house calls with an ice pick in his back pocket. (And if you don't know who that is, or the difference between a lobotomy, leukotomy, or lobectomy, you might be out of your depth here). Speaking solely for myself, if my depression ever worsens to a degree I can no longer live with, I will undergo ECT if my shrink prescribes it, with little worry of harm. joeledux@gmail.com

I'm just going to go out on a limb here, and say I'm sorry: but your personal experiences don't make a dime's worth of difference in terms of the article. I personally would be willing to have a frontal lobotomy myself at the moment. But this is not supposed to be a forum, and our feelings and experiences don't matter when it comes to this Wikipedia article. Alt lys er svunnet hen (talk) 09:18, 3 November 2017 (UTC)

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• Corrected formatting/usage for http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/Statisticalhealthcare/DH_4000216
• Corrected formatting/usage for http://www.psychiatrictimes.com/electroconvulsive-therapy/content/article/10168/1897020
• Added archive https://web.archive.org/web/20111226033633/http://www.cqc.org.uk/sites/default/files/media/documents/mental_health_act_1983_201107084458_0.pdf to http://www.cqc.org.uk/sites/default/files/media/documents/mental_health_act_1983_201107084458_0.pdf
• Added {{dead link}} tag to http://www.cqc.org.uk/sites/default/files/media/documents/20120821_mha_ect_booklet_final.pdf

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External links modified

Hello fellow Wikipedians,

I have just modified 2 external links on Electroconvulsive therapy. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:

• Added archive https://web.archive.org/web/20070521100602/http://www.nice.org.uk/page.aspx?o=62452 to http://www.nice.org.uk/page.aspx?o=62452
• Corrected formatting/usage for http://www.cqc.org.uk/content/cqc-says-care-people-treated-under-mental-health-act-still-needs-improve

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This message was posted before February 2018. After February 2018, "External links modified" talk page sections are no longer generated or monitored by InternetArchiveBot. No special action is required regarding these talk page notices, other than regular verification using the archive tool instructions below. Editors have permission to delete these "External links modified" talk page sections if they want to de-clutter talk pages, but see the RfC before doing mass systematic removals. This message is updated dynamically through the template {{source check}} (last update: 5 June 2024).

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Cheers.—InternetArchiveBot (Report bug) 03:16, 19 September 2017 (UTC)

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