Talk:Electroconvulsive therapy

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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)

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)

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)

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)

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)

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)

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.^{[citation needed]} 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."^{[citation needed]} 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.^{[citation needed]} 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)