I have never had long term memory losses and I didn't observe any modification in eating habits (not induced by depressive or eccitative phases). I am not able to dose those hormons then.

Perhaps you will find some hints and answers here:

1: Elias A, Chathanchirayil SJ, Bhat R, Prudic J. Maintenance electroconvulsive

therapy up to 12 years. J Affect Disord. 2013 Nov 18. pii: S0165-0327(13)00800-8.

doi: 10.1016/j.jad.2013.11.005.

2: Lima NN, Nascimento VB, Peixoto JA, Moreira MM, Neto ML, Almeida JC,

Vasconcelos CA, Teixeira SA, Júnior JG, Junior FT, Guimarães DD, Brasil AQ,

Cartaxo JS, Akerman M, Reis AO. Electroconvulsive therapy use in adolescents: a

systematic review. Ann Gen Psychiatry. 2013 May 30;12(1):17. doi:

10.1186/1744-859X-12-17.

3: Gallegos J, Vaidya P, D'Agati D, Jayaram G, Nguyen T, Tripathi A, Trivedi JK,

Reti IM. Decreasing adverse outcomes of unmodified electroconvulsive therapy:

suggestions and possibilities. J ECT. 2012 Jun;28(2):77-81. doi:

10.1097/YCT.0b013e3182359314. Review.

4: Reti IM, Walker M, Pulia K, Gallegos J, Jayaram G, Vaidya P. Safety

considerations for outpatient electroconvulsive therapy. J Psychiatr Pract. 2012

Mar;18(2):130-6. doi: 10.1097/01.pra.0000413280.95843.d3.

5: Allan CL, Ebmeier KP. The use of ECT and MST in treating depression. Int Rev

Psychiatry. 2011 Oct;23(5):400-12. doi: 10.3109/09540261.2011.614223. Review.

6: van Schaik AM, Comijs HC, Sonnenberg CM, Beekman AT, Sienaert P, Stek ML.

Efficacy and safety of continuation and maintenance electroconvulsive therapy in

depressed elderly patients: a systematic review. Am J Geriatr Psychiatry. 2012

Jan;20(1):5-17. doi: 10.1097/JGP.0b013e31820dcbf9. Review.

7: Dunne RA, McLoughlin DM. Systematic review and meta-analysis of bifrontal

electroconvulsive therapy versus bilateral and unilateral electroconvulsive

therapy in depression. World J Biol Psychiatry. 2012 Apr;13(4):248-58. doi:

10.3109/15622975.2011.615863. Epub 2011 Nov 18. Review.

8: Petrides G, Tobias KG, Kellner CH, Rudorfer MV. Continuation and maintenance

electroconvulsive therapy for mood disorders: review of the literature.

Neuropsychobiology. 2011;64(3):129-40. doi: 10.1159/000328943. Epub 2011 Jul 29. Review.

9: Sienaert P. What we have learned about electroconvulsive therapy and its

relevance for the practising psychiatrist. Can J Psychiatry. 2011 Jan;56(1):5-12.

Review.

10: Read J, Bentall R. The effectiveness of electroconvulsive therapy: a

literature review. Epidemiol Psichiatr Soc. 2010 Oct-Dec;19(4):333-47. Review.

11: Moreines JL, McClintock SM, Holtzheimer PE. Neuropsychologic effects of

neuromodulation techniques for treatment-resistant depression: a review. Brain

Stimul. 2011 Jan;4(1):17-27. doi: 10.1016/j.brs.2010.01.005. Epub 2010 Feb 11.

Review.

12: Watts BV, Groft A, Bagian JP, Mills PD. An examination of mortality and other

adverse events related to electroconvulsive therapy using a national adverse

event report system. J ECT. 2011 Jun;27(2):105-8. doi:

10.1097/YCT.0b013e3181f6d17f. Review.

13: Trevino K, McClintock SM, Husain MM. A review of continuation

electroconvulsive therapy: application, safety, and efficacy. J ECT. 2010

Sep;26(3):186-95. doi: 10.1097/YCT.0b013e3181efa1b2. Review.

14: Semkovska M, McLoughlin DM. Objective cognitive performance associated with

electroconvulsive therapy for depression: a systematic review and meta-analysis.

Biol Psychiatry. 2010 Sep 15;68(6):568-77. doi: 10.1016/j.biopsych.2010.06.009.

Epub 2010 Jul 31. Review.

15: Chakrabarti S, Grover S, Rajagopal R. Electroconvulsive therapy: a review of

knowledge, experience and attitudes of patients concerning the treatment. World J

Biol Psychiatry. 2010 Apr;11(3):525-37. doi: 10.3109/15622970903559925. Review.

Dear Lara, I am old enough to have seen long-term consequences of ECT directly.

Anyway any ECT application involves some cell damage even some researches emphasizes the increase of NGF. When repeated, especially with short briefs, the damages increases with a hyperbolic curve. The most evident clinical effects are proved on the memory, but in general, a cognitive global impairment is more or less an inevitable consequence. You can find literature on this. The most relevant works were published in Europe between 1980 and 1990 when the guideline of the use of ECT here where strictly restricted to Depression in Pregnancy, Catatonia, Resistant Depression. I

In Italy, we are very experienced in ECT because Professor Ugo Cerletti, who directed the Psychiatric Clinic of the University of Genoa from 1928 to 1935, together with Doctor Bini invented this kind of brain bio stimulation in 1938 in Rome. Before 1960, when psychotropic drugs dramatically changed the course of psychiatry, it was used in a wide and not proper manner, with devastating effects on thousands of people.

Best regards

Sergio Mungo

On a more personal note, I have a close friend who has suffered permanent frontal lobe damage. In addition to memory loss, she has an inbalance in equilibrium and falls constantly, Her hands shake almost to the point of being able to fill out a check at the store

This is from years of ECT spread out through her adult years. She is now 60 years old and emotionally has come to see herself as an absolute idiot. She has gone from being a successful psycho-therapist to an individual with medical documentation of the ECT rendering so much damage to her brain that she will never be able to work again.

This is just my subjective opinion - and it is not based on research, but only on what I observed many years ago: As a student (still at school), many years ago, I worked (during school holidays) in an "insane asylum" (as the mental hospitals were then called where I grew up) as a "nursing assistant". ECT was "the" treatment and I was there to hold / strap the patient down. I thought that ECT was totally barbaric then - and I still feel so today. ECT and lobotomies must surely go down in history as some of the worst "therapies" that could have been inflicted upon our fellow human beings. I am not a psychiatrist - only a counsellor - but I have seen what people look like when they have undergone ECT "treatments". My apologies to the proponents of ECT (they are entitled to their opinions), but I believe that this is a grossly inhumane way of "treating" people.

I am always surprised that these discussions continue to go on, but of course should not be. First of all the medicalized rhetoric regarding one of the many physical techniques to create brain trauma that have historically been used in the name of psychiatric treatment have been documented in detail and to call them therapy is the history perhaps the only consistent history of psychiatric "treatment." As many may recall in a more honest era of psychiatry in the 1960s the mainstream research freely admitted that the psychotropic medications were nothing more than chemical straight jackets. In historical terms fear was promoted as a way to scare the mad into "normalcy" and many were. I am attaching a recent chapter addressing some of these issues regarding coercive interventions. Of course there are always folks who may wish to be invasively treated and they (the very small minority) if done totally voluntarily should be free to obtain it. The well know term masochism was coined for that minority.

I totally don't agree with these point of view about ECT.

As Sergio Mungo said it is useful in very selected clinical cases and in these is a lafe-saving therapy. We do really need (in psychiatry) to be able to cut up with ideologies and look at any kind of medication or treatment without any prejudice.

Carlo:

The opinions voiced by any one of us as private individuals are one thing, the factual evidence on the invasive brain damaging interventions including in addition to ECT all the physical and torturous methods used by psychiatry in its history for example as carefully documented in Peter Breggin's 2007 Brain Disabling Treatments of Psychiatry (http://www.amazon.com/Brain-Disabling-Treatments-Psychiatry-Psychopharmaceutical/dp/082612934X/ref=sr_1_sc_1?s=books&ie=UTF8&qid=1388422452&sr=1-1-spell&keywords=peter+bregin+brain+disabling+treatments) that we should rely on as researchers and professionals are another.

No question that by smacking around brain cells you will impact cognition (after all boxers appear to be better, more skilled and savvy boxers as they continue to win fights while being pummeled, and only much later develop visible manifestations of serious movement disorders.) So claims for only using ECT (another form of brain cell pummeling) in special cases really translates to me to mean the age old response of frustrated professionals that we can't think of anything else to do professionally but feel we must do something since in theory we should be able to.

The truth is the claim that such interventions when used are life saving are anecdotal. No large sample rigorous studies document "life saving" results of ECT.

I observed, many years ago, two cases with memory loss after application of ECT: one case manifested transient global amnesia but with significant improvement after one year; the second, in consequence of multiple ECT, manifested very long term negative effect on episodic memory.

Lara:

The more you can review the empirical critical literature the better informed you will be regarding the alleged "therapeutic" and what are in my judgement by far the greater adverse effects.

Best.

Tomi

Tomi, thanks for your chapter. All the best for 2014. John

Some remarks to the discourse:

In science one has to provide data to support a theory. Data is usually not subjective feelings, personal beliefs, ideological phrases and (polemical) “opinions”.

It is a commonplace that every clinical relevant therapy has effects - and side-effects. If we focus on ECT, the basis for applying ECT is defined to the humanly possible best in our times – and it is also defined when we should avoid ECT. Apart from that, there is a regrettable lack of evidence-based alternatives in severe and/or chronic cases. Against this background, before having “opinions” in science it is honest both to avoid reiterating well-nursed antipsychiatric prejudices (implicitly promoting – amongst others - the ongoing stigmatization of patients with mental disorders) and – most importantly – to take note of the relevant literature.

Having said this, e.g., in a systematic review about “Quality assessment and comparison of evidence for electroconvulsive therapy and repetitive transcranial magnetic stimulation for schizophrenia” the authors state: “For ECT, high quality evidence suggests a short-term small, significant effect for improvement in global symptoms, for people with or without concurrent antipsychotics (RR=0.76). There is no evidence for longer-term therapeutic or adverse effects of either treatment” (1). In catatonia, “available data supports the efficacy of benzodiazepines and electroconvulsive therapy (ECT) in the treatment of this condition, but the treatment response is limited by the chronicity of symptoms”(2) . In a Cochrane Review of “Electroconvulsive therapy for schizophrenia” the authors conclude: “The evidence in this review suggests that ECT, combined with treatment with antipsychotic drugs, may be considered an option for people with schizophrenia, particularly when rapid global improvement and reduction of symptoms is desired. This is also the case for those with schizophrenia who show limited response to medication alone. Even though this initial beneficial effect may not last beyond the short term, there is no clear evidence to refute its use for people with schizophrenia. The research base for the use of ECT in people with schizophrenia continues to expand, but even after more than five decades of clinical use, there remain many unanswered questions regarding its role in the management of people with schizophrenia” (3). In 2003, one could read in “The Lancet”: “ECT is an effective short-term treatment for depression, and is probably more effective than drug therapy. Bilateral ECT is moderately more effective than unilateral ECT, and high dose ECT is more effective than low dose” (4). The NICE Guideline “The clinical effectiveness and cost effectiveness of electroconvulsive Therapy (ECT) for depressive illness, schizophrenia, catatonia and mania” clearly states: “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 is considered to be potentially life-threatening, in individuals with: • severe depressive illness, • catatonia, • a prolonged or severe manic episode. 1.2 The decision as to whether ECT is clinically indicated should be based on a documented assessment of the risks and potential benefits to the individual, including: the risks associated with the anaesthetic; current co-morbidities; anticipated adverse events, particularly cognitive impairment; and the risks of not having treatment” (http://www.nice.org.uk/nicemedia/live/11494/32597/32597.pdf).

1. Matheson SL, Green MJ, Loo C, Carr VJ. Quality assessment and comparison of evidence for electroconvulsive therapy and repetitive transcranial magnetic stimulation for schizophrenia: a systematic meta-review. Schizophrenia research. 2010;118(1-3):201-10.

2. Weder ND, Muralee S, Penland H, Tampi RR. Catatonia: a review. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists. 2008;20(2):97-107.

3. Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. The Cochrane database of systematic reviews. 2005(2):CD000076.

4. Group UER. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003;361(9360):799-808.

I appreciate the value of research as do all of the topic conversants, but with all of this positivist data crunching the presumptive assumption is that we are using some targeted medical intervention with no other issues at play. I think there are several rarely addressed.

First, how can we claim that bringing on grand mal seizures (epileptic fits) is a treatment when elsewhere it is a critically serious medical illness? Two, we have no interesting scientific theory to explain its alleged therapeutic activity. Three, remember that it impacts all people regardless of being diagnosed or not the same way (it is not disease specific nor even only impacting on illness but erases memory of all who receive such electric shock). And finally, and most importantly it is mostly given involuntarily, that is against the will of the persons so subjected.

Coercion is the critical issue. If an adult voluntarily seeks any intervention useful or otherwise (after all psych meds are about as effective as placebos but with added often severe adverse effects) we should have no concerns if such individuals are fully informed. But to be coerced is to be punished not treated. So the most important question is to ask Cui Bono (who benefits and from whose point of view)?

Happy New Year to all the followers of this question.

I sincerely hope that none of you will ever undergo ECT "treatment".

A sobering thought - not so long ago lobotomies were done "left, right and centre" - and this was considered to be good "treatment". I wonder how many still think so?

For a another view of long-term effects of ECT and an alternative convulsive therapy as a last-resort therapy for treatment resistant depression, please you might find this article interesting and relevant to your topic:

Comparable seizure characteristics in magnetic seizure therapy and electroconvulsive therapy for major depression. by S. Kayser et al: http://www.ncbi.nlm.nih.gov/pubmed/23820052.

Since this request is for personal reasons rather than for a study, I suggest that you see this video by Mr. Sherwin Nuland that he gave at one the TED events: http://www.ted.com/talks/sherwin_nuland_on_electroshock_therapy.html

There are no easy answers for long term effects of ECT. It has to be balanced by the effects of untreated illness. A severe depressive disorder is usually the reason for use of ECT these days. Typically an acute course of ECT (6-12 treatments) is used to achieve either a complete remission or significant improvement so as to mitigate some sort of acute risk. Apart from immediate to short term effects of such an illness such as risk of suicide, physical deterioration there are significant mid- to long-term effects too (loss of employment, loss of relationships, increased risk of cardiac disease etc). As with any other treatment, the potential for adverse effects have to be balanced by the effects of the treatment, in this case, an acute course of ECT. With modern ECT the most common adverse effect is cognitive impairment, specifically memory impairment. It is most evident soon after one treatment of ECT. There is varying degree of anterograde amnesia in the succeeding days up to 4 weeks in some patients. However, the more common and difficult problem is of autobiographical memory impairment. Autobiographical memory must be assessed at baseline and then regualarly through the course of the acute course. If present, then either the treatment type should be altered or ceased.

Dukart J, Regen F, Kherif F, Colla M, Bajbouj M, Heuser I, Frackowiak RS, Draganski B.

Electroconvulsive therapy-induced brain plasticity determines therapeutic outcome in mood disorders.

Proc Natl Acad Sci U S A. 2013 Dec 30. [Epub ahead of print]

Abstract:

There remains much scientific, clinical, and ethical controversy concerning the use of electroconvulsive therapy (ECT) for psychiatric disorders stemming from a lack of information and knowledge about how such treatment might work, given its nonspecific and spatially unfocused nature. The mode of action of ECT has even been ascribed to a "barbaric" form of placebo effect. Here we show differential, highly specific, spatially distributed effects of ECT on regional brain structure in two populations: patients with unipolar or bipolar disorder. Unipolar and bipolar disorders respond differentially to ECT and the associated local brain-volume changes, which occur in areas previously associated with these diseases, correlate with symptom severity and the therapeutic effect. Our unique evidence shows that electrophysical therapeutic effects, although applied generally, take on regional significance through interactions with brain pathophysiology.

Significance

"Electroconvulsive therapy is controversial: How does a major electrical discharge over half the brain result in recovery in disorders such as refractory major depression and manic depression, which are apparently different diseases? We find local but not general brain anatomy changes following electroconvulsive therapy that are differently distributed in each disease, and the areas affected are those implicated as abnormal in each disorder. An interaction between electroconvulsive therapy and specific pathology appears to be responsible for the therapeutic effect. Our results have implications for other electrically based brain treatments, such as deep brain stimulation and transcranial magnetic stimulation." (http://www.pnas.org/content/early/2013/12/27/1321399111.abstract)

Ultra brief pulse, which is given unilateral can be tried first as it has minimal cognitive side effects. Bilateral ECT has more severe memory side effects.

With all due respect, there is no reasonable way that one could argue that the so called therapeutic effect of ECT is not actually the result of the brain trauma caused by inducing a grand mal seizure (of course in any other circumstance considered the sign for a severe medical disorder, epilepsy) and very damaging. I strongly recommend for the relevant overview of research that y'all review psychiatrist Peter Breggin's material on ECT research in the 2nd edition of his 2007 book Brain Disabling Treatments in Psychiatry.

Best.

Tomi

In lighter vein - not so long ago "blood-letting" also worked quite well... I say this tongue-in-cheek, but surely damage is damage?