tag:blogger.com,1999:blog-7772182113499451603.post6562552520367611668..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Anti-ECT Rhetoric ........George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-7772182113499451603.post-621237271525790262018-10-21T16:49:36.288-05:002018-10-21T16:49:36.288-05:00"Still I don't agree with your "equa..."Still I don't agree with your "equal blame" argument, because by this you are demanding "equality towards injustice" which is not the path to progress. Psychiatry still has problems that you won't find in other areas and that could be solved and I think by this psychiatrists at least partially created their own enemies."<br /><br />Not an "equal blame" argument.<br /><br />Just pointing out that the only way you can hold that argument is to devalue psychiatry while overidealizing every other medical specialty. Your example of "floaters" doesn't even scratch the surface.<br /><br />But I will leave it at that.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-45202392914563266902018-10-21T16:35:15.579-05:002018-10-21T16:35:15.579-05:00Concerning Clozapine you are not exactly right. Fo...Concerning Clozapine you are not exactly right. For the USA you may be correct, but at least in Germany it was on the market in 1972 under the trade name Leponex.<br /><br />I agree that there are some incremental improvements in psychiatry. SSRIs, SNRI and atypical antipsychotics may offer a different and for some people better side-effect profile. Recently Cariprazine was approved and seems to help a bit against the negative symptoms of schizophrenia. However the effectiveness of SSRIs has been called into question in the recent past. They often work at least for severely depressed people, but they do not really appear to be more effective than the older drugs. Reducing the treatment-resistant population is one of the most pressing problems of psychiatry and I do not really see much progress in the previous decades. In the last 20 years not many new drugs came out for mental disorders and most did little more than targeting the same monoaminergic pathways: https://www.centerwatch.com/drug-information/fda-approved-drugs/therapeutic-area/17/psychiatry-psychology<br /><br />Hopefully drugs which mimic the mechanism of action of Ketamine (e. g. Repastinel), some other new drugs and invasive surgery like deep brain stimulation is going to change this in the near future. But these prospects are not secure. My impression about TMS, at least the standard dorsolateral prefrontal cortex protocol, is that it overall is disappointing for treatment-resistant depression, especially for people like me, who have anhedonia as main symptom and feel like their brain stopped working. Even many psychiatrists do not appear to regard it as an alternative to ECT.<br /><br />I know there are also problems in other medical areas. For example you will see this in otolaryngology if you ever get tinnitus or in ophtalmology if you ever get floaters. I don't know what you have experienced, because I did not read all your blog posts. Still I don't agree with your "equal blame" argument, because by this you are demanding "equality towards injustice" which is not the path to progress. Psychiatry still has problems that you won't find in other areas and that could be solved and I think by this psychiatrists at least partially created their own enemies. Of course, this is not the only explanation why antipsychiatry exists, because antipsychiatry does not really rationally criticize psychiatry, but instead even denies the existence of mental disorders.<br /><br />Concerning ECT there are still some safer, albeit experimental, options for me. Should they not work out, I think I might try ECT. At least I have done my homework. I know what I can win, but also that I can loose the little rest I still have, especially if I need bilateral treatments and maintenance treatments. It probably will be the most important decision in my life. I might possibly try to get into a magnetic seizure therapy trial, which is an experimental type of electroconvulsive therapy, with less cognitive side-effects. It is planned to conduct one in Germany in the near future. Unfortunately they have problems to get funding, because no company appears to be interested to market this treatment.<br /><br />Generally my criticism is not meant as an attack. If you ever watched movies you probably know that some prisoners spend their time in the law library to find a way out. I'm much like that. Just replace prison with depression and law with psychiatry knowledge. Overall I must say that your blog is good and offered many insights to me. But this does not necessarily mean that everything is correct and you probably also don't want readers who blindly believe everything, but are willing to learn in order to change their fate for the better.A sceptic personnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-80322337767082644352018-10-21T14:43:20.063-05:002018-10-21T14:43:20.063-05:00I realize that you have a difficult decision and r...I realize that you have a difficult decision and researching the decision, maintaining a skeptical attitude and having detailed discussions with your psychiatrist is the best way to proceed. I have advised hundreds (thousands?) of people on that decision in the past 34 years. I sincerely hope that process works well for you – whether you decide to try ECT or not. Nothing in the rest of this post should intrude on that process. <br /><br />On the issue of memory loss versus neuropathology – ECT can cause persistent memory loss for some people. The type of memory is important as well as the context. The original 1978 APA guideline lists survey data on side effects including memory problems along with overall satisfaction with the procedure. There are detailed reviews of this issue but the proper theoretical framework to analyze these problems has only recently been proposed. It is likely previous studies did not take this framework into consideration. That is not to explain away cognitive side effects only to plainly state that the issue is complex. So complex in fact that I should probably generate a blog post about it.<br /><br />Needless to say that I completely disagree with blaming psychiatry for antipsychiatry for “unaddressed grievances”. The medication problems that you discuss were and are best researched by psychiatrists. <br /><br />Your characterization of my advice of how to address side effects as a “bit naive” really does not take into consideration how many times I have given this advice. It also does not take into consideration that at this point in my career I have stopped ECT treatments more often than I have started them. As I have written many times on this blog, there are no medical procedures that do not involve risk. I personally have experienced many adverse and, in some cases, life-threatening complications from medical procedures. I did not get any information of the possibility of those complications before I was administered the treatments and in a couple of cases was lucky to have survived. ECT consent forms should definitely list permanent memory problems/loss as a risk and it should not be minimized by qualifiers.<br /><br />I also disagree with your statement about the lack of “breakthroughs” in psychiatry. Your time frame is wrong. Unless my math is off 45 years ago takes us back to 1973. Clozapine was not available for prescription in the USA until 1990. I have a lot of experience with clozapine and it is a toxic drug that needs careful monitoring. Like most fields in medicine there are very few “breakthrough” therapies. There have been many incremental improvements including psychotherapies that psychiatrists are generally not given credit for and improved biological therapies. Current medications were invented to reduce side effects and they have been successful in that area. Tardive dyskinesia still occurs but it was a widespread clinical problem when I first started out. SSRIs and SNRIs have improved safety profiles and better coverage of other symptoms despite the withdrawal symptoms. All of the discussion about how psychiatrists ignore side effects misses the point that psychiatrists are a lead specialty in investigating drug interactions at the pharmacokinetic, pharmacodynamic, genomic, metabolomic, and transcriptomic levels. You did not say much about TMS but many consider it to be an alternative to ECT.<br /><br />I can tell you didn’t write this looking for my advice. I will just state what I have stated here many, many times before. The criticisms you have are not unique to psychiatry. Why aren’t all of those other specialties that actually kill people and nearly killed me twice receiving equal blame? I have posted the answers here in the past and that is why antipsychiatry exists. <br /><br />One of the reasons I write this blog is just to point out that fact. <br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-10691645638250741092018-10-21T07:11:50.182-05:002018-10-21T07:11:50.182-05:00Your article on ECT overlooks some criticial issue...Your article on ECT overlooks some criticial issues in my opinion. First the question on whether it causes damage or not boils down on what you define as "damage". While it does not appear to cause gross structural changes that would deviate from the norm in an MRI, the fact remains that it can cause persistent cognitive problems, more commonly retrograde amnesia, but also anterograde amnesia and shortterm memory loss. This has been validated by a huge number of independent accounts on the internet, but also in peer reviewed journals. Even my own psychiatrist admits that he has cases who have shortterm memory loss from ECT and never recovered from it. If the brain functions markedly worse after ECT I don't see how this cannot be regarded as damage. I also fail to realize what is the problem about regarding ECT as being "damage". Every surgery damages the body in a purposeful way to improve it's function. ECT would not be different in this regard.<br /><br />While I think that antipsychiatry is for the most part a quack cult, like anti vaxxers or AIDS deniers, in my opinion they have the most legitimacy. Psychiatry has a dark history of forcing ineffective treatments on people (e. g. lobotomy), using ECT improperly and denying problems associated with their drugs, like in the case of antipsychotics, SSRIs and benzodiazepines. There are still many outrageous problems, like for example the dissociative identity disorder scam, the complete ignorance of whole disorders (e. g. depersonalization disorder), the popularity of pseudoscientific psychoanalysis and the branding of physical disorders as psychogenic (e. g. chronic fatigue syndrome) despite there being no scientific evidence for this. These are the facts and no "rhetorical techniques". The existence of antipsychiatry is primarly a fault of psychiatrists themselves, because they allow avoidable grievances to exist.<br /><br />What you write in "What can be done to address ECT side effects if I get them?" is a bit naive. The explanation for patients receiving many sessions is simple: While stopping is an option, patients are told by psychiatrists that cognitive side-effects are temporary. They believe what their doctor says and if they try ECT they have terrible symptoms to begin with and the hope that ECT helps them, which is a strong incentive to carry on despite all problems. I suppose that psychiatrists share this incentive, because they also want their patients to be cured and move on. The persistence of profound cognitive impairment from ECT is per definition first noticed when the patient has the bad luck that their cognitive problems don't resolve after weeks or months. Is it so far fetched that they may feel duped in such cases, especially when they belong to the 50% of patients whose treatment-resistant depression does not respond to ECT?<br /><br />As someone who suffered from treatment-resistant depression the last 4.5 years and did not respond to more than 20 medications, I'm moving closer and closer to ECT. I realize that it has a fifty-fifty chance to help me. But I'm also seeing that psychiatrists continue to not properly address the problems ECT has, do not conduct adequate studies on what cognitive side-effects arise and how persistent they are and only very hesitantly attempt to find ways to reduce such side-effects. Approaches like using anti-dementia drugs as adjuncts to ECT or magnetic seizure therapy are only extremely slowly being studied, despite an urgent need for improved treatments for mental disorders. Generally medical advancements do not seem to exist in psychiatry. The last radical breakthrough in psychiatry was Clozapine and that was 45 YEARS ago. At least my hopeless is not only caused by my depression.A sceptic personnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-8312165272760970362018-10-01T07:44:13.776-05:002018-10-01T07:44:13.776-05:00From my 25 years of experience, it is likely to se...From my 25 years of experience, it is likely to see profound post ECT sequelae in a person who is primarily personality disordered receive it. Equally what one sees with the heinous polypharmacy provided in Axis 2 Patients as well. Ironic, eh, that biological interventions disrupt Personality Disorder, makes one wonder what is the possible biological factor we just can't figure out...Joel Hassman, MDhttps://www.blogger.com/profile/18428102819014299270noreply@blogger.com