I worked at a public psychiatric hospital for 42 years with a variety of patients, but mostly acute emergencies requiring a standard of dangerousness for admission. Thousands of patients and hundred for whom ECT had been tried, was ongoing, or was offered/considered. I have way too much commentary, so will make it brief. I apologise for not putting in supporting evidence.
I am not surprised that the poor research base, but also not surprised that psychiatry has gone back to the recommendation even after it was politically toxic. It just plain works. When you hit the phrase "dose response" at about the 55 minute mark and almost got to the idea of "maintenance ECT's" you were getting to the answers to the critics. Data may not be the plural of anecdote, but "anecdotes" of over a million in the form of daily clinical records often showing response at the expected 6-8 treatments (remission after one treatment must be exceedingly rare. I have never seen it.) would certainly mean something to a good Bayesian!
Public hospitals never have enough beds and have to discharge to make room for more dangerous patients. We therefore do have some incentive in individual cases to see improvement that isn't really there. But in the larger scheme that is swamped by our complete impatience with treatments that don't work. ECT works so well that it was a victim of its own success. Doctors prescribed it for anything refractory, including completely inappropriate conditions like personality disorders, anxiety disorders, and schizophrenia. Also, there was an incentive to under-report side effects, hoping that the next treatment or so would be the breakthrough and no more memory would be imperiled. I worked with guys who would buzz anything they got impatient with. Very bad. It also works on manics, but they never consent to it. Miserable, desperate people consent to it.
The treatment got a toxic reputation and it was hard to find hospitals or clinics that would do it. But those who had seen it work persisted and gradually converted the skeptics. (I was one.) It is a particular boon to pregnant and nursing women who can't have medications.
The side effects are potentially terrible, and for the last twenty years doctors have had a low threshold for discontinuing ECTS when memory loss is a problem. In those cases, there is seldom a rechallenge. Most of the memory problems are only for the time periods just before and just after a treatment, the same as with any loss of consciousness. People don't forget their first kiss, though they may forget the one from their husband the night before getting buzzed. Sometimes maintenance ECTs are necessary, but these can be outpatient. Others have a course and never need it again. The events are dramatic, and can be tracked with objective data such as Beck's and other tests, hours out of bed, appetite, affect. You were right to be suspicious of some of the criticisms. They focus on the poor formal research base - fair enough, but limited - or their own anecdotes from earlier eras, as you saw at the debates.
As you talked about Acupuncture I thought about Chiropractors. One of those things I always suspected was fake but never dug in. Would love to hear an ep on it!
Sleep science, such as it is, distinguishes among sleep stages: deep, REM, core, with deep sleep supposedly important for rebuilding tissues or something? And taking in caffeine within n hours of your head hitting the pillow grants you fewer minutes of deep sleep than n+1 hours, according to various popular-medicine sites. But I can’t seem to find decent studies about this asserted relationship. Maybe you can?
I worked at a public psychiatric hospital for 42 years with a variety of patients, but mostly acute emergencies requiring a standard of dangerousness for admission. Thousands of patients and hundred for whom ECT had been tried, was ongoing, or was offered/considered. I have way too much commentary, so will make it brief. I apologise for not putting in supporting evidence.
I am not surprised that the poor research base, but also not surprised that psychiatry has gone back to the recommendation even after it was politically toxic. It just plain works. When you hit the phrase "dose response" at about the 55 minute mark and almost got to the idea of "maintenance ECT's" you were getting to the answers to the critics. Data may not be the plural of anecdote, but "anecdotes" of over a million in the form of daily clinical records often showing response at the expected 6-8 treatments (remission after one treatment must be exceedingly rare. I have never seen it.) would certainly mean something to a good Bayesian!
Public hospitals never have enough beds and have to discharge to make room for more dangerous patients. We therefore do have some incentive in individual cases to see improvement that isn't really there. But in the larger scheme that is swamped by our complete impatience with treatments that don't work. ECT works so well that it was a victim of its own success. Doctors prescribed it for anything refractory, including completely inappropriate conditions like personality disorders, anxiety disorders, and schizophrenia. Also, there was an incentive to under-report side effects, hoping that the next treatment or so would be the breakthrough and no more memory would be imperiled. I worked with guys who would buzz anything they got impatient with. Very bad. It also works on manics, but they never consent to it. Miserable, desperate people consent to it.
The treatment got a toxic reputation and it was hard to find hospitals or clinics that would do it. But those who had seen it work persisted and gradually converted the skeptics. (I was one.) It is a particular boon to pregnant and nursing women who can't have medications.
The side effects are potentially terrible, and for the last twenty years doctors have had a low threshold for discontinuing ECTS when memory loss is a problem. In those cases, there is seldom a rechallenge. Most of the memory problems are only for the time periods just before and just after a treatment, the same as with any loss of consciousness. People don't forget their first kiss, though they may forget the one from their husband the night before getting buzzed. Sometimes maintenance ECTs are necessary, but these can be outpatient. Others have a course and never need it again. The events are dramatic, and can be tracked with objective data such as Beck's and other tests, hours out of bed, appetite, affect. You were right to be suspicious of some of the criticisms. They focus on the poor formal research base - fair enough, but limited - or their own anecdotes from earlier eras, as you saw at the debates.
As you talked about Acupuncture I thought about Chiropractors. One of those things I always suspected was fake but never dug in. Would love to hear an ep on it!
Sleep science, such as it is, distinguishes among sleep stages: deep, REM, core, with deep sleep supposedly important for rebuilding tissues or something? And taking in caffeine within n hours of your head hitting the pillow grants you fewer minutes of deep sleep than n+1 hours, according to various popular-medicine sites. But I can’t seem to find decent studies about this asserted relationship. Maybe you can?
Thanks!