FDA: Electroshock has risks but is useful to combat severe depression

[bananas]

Source: Washington Post

After years of consideration, the Food and Drug Administration has determined that for carefully selected patients with profound depression, the benefits of electroconvulsive therapy, long demonized, outweigh the risks of possible memory loss caused by its use.

<snip>

The devices that are used to administer ECT are regulated by the agency as Class III. That is the highest-risk designation, and it makes the equipment subject to the highest level of regulatory control. The FDA is proposing to downgrade that assessment to Class II for those whose depression has not responded to other treatments or is so severe that they need the kind of rapid response that only ECT can provide.

<snip>

An estimated 100,000 of the 3 million people in the United States with treatment-resistant depression undergo ECT each year, a figure that could rise if the proposed new designation is finalized. By generating a brief pulse of electricity to the brain, the devices induce a generalized seizure. For reasons not fully understood, the result is that many patients feel better afterward.

<snip>

If in fact finalized, the new assessment would bring to a close decades of wrangling over how best to regulate the controversial treatment. The FDA first proposed to classify ECT as Class II in 1978, before backing away after public opposition arose. It tried again in 1990 but did not finalize the change. In 2011, it invited an advisory panel to consider the issue yet again.

Following two days of contentious hearings, that panel voted, 10 to 8, against easing the classification, saying that not enough was known about the risks and benefits of ECT devices and that more research was needed.

Although the FDA generally follows the recommendations of its advisory panels, the agency finally decided against accepting that advice, publishing its proposal to ease the classification in the Federal Register on Dec. 28 of last year.

<snip>

Prior to the advisory panel’s meeting in 2011, the FDA said it had received more than 3,000 comments from patients, family members of patients, researchers and others. About 80 percent of those comments opposed an easing of controls, the FDA reported late last year. Among the most common possible side effects mentioned by patients, the agency said, were memory loss, cognitive complaints and brain damage.

<snip>

Read more: https://www.washingtonpost.com/national/health-science/fda-electroshock-has-risks-but-is-useful-to-combat-severe-depression/2016/07/18/4a109cbc-2f4e-11e6-9de3-6e6e7a14000c_story.html

[greymattermom]

1. My husband has intractable depression

and has no resemblance to the person I married. Now, I grieve a person who died but didn't die. The electroshock has helped a little, along with the drugs. His agitation is less, but he lives in assisted living now, even though he is still in his 60s. The truth is that they don't have any new treatments. My father, who was a psychiatrist, treated his patients over 50 years ago in the same way they are treated now.

[uawchild]

3. I have to say something

Thank you for sharing your personal story. I'm at a loss for words otherwise. Thank you again.

[Blue_Tires]

22. sad to read...

as someone who also suffers from lifelong depression, I hope your husband can find some kind of peace in his mind someday...

[bananas]

2. They're going against their advisory panel and the public. nt

[TexasBushwhacker]

6. I would prefer that the public not make decisions

about the safety and efficacy of drugs and treatments. As for the the advisorary panel, some of the nays came from psychologists, who are sometimes against antidepressant medications as well as ECT because it cuts into their business.

ECT will never be the first choice for treatment except in very special circumstances, like for pregnant women or people who are actively suicidal and cannot wait 6 to 12 weeks for antidepressant drugs to start working. That's IF they choose the right anridepressant the first time.

[Tursiops]

15. People who have been damaged by it have every right to comment on it

Psychologists don't like it because its very depressing having a patient with brain damage and/or long term memory problems, both long and short term. The people who have the real financial interests are the people performing the treatments.

[Rhiannon12866]

17. Thank you for weighing in on this and sharing your experience.

I once knew a couple of patients who underwent ECT and I have to question why it's still around when there are many better tested therapies and medications available. I remember being told that sometimes it works, sometimes it doesn't, but nobody knows why...

Welcome to DU!

[ZombieHorde]

9. The public is ignorant and should be ignored on matters of science.

People watch movies and think they know about electroshock therapy.

[klook]

4. I have a relative who was treated with electroshock therapy

in the 1970s. Did not help her at all. She eventually took refuge in fundamentalist Christianity, and that didn't help her, either. She's dead now and out of her misery.

[Skittles]

16. I saw my dad after he got that treatment

he didn't even know who I was

he killed himself years later

[klook]

20. ..

[progree]

5. I used to be in a Depression and Bipolar Support Alliance group, and the few people who had

electroshock therapy were all quite positive about it. Certainly better than severe depression when nothing else is working. Its not like in the 1950's movies. Though I remember one saying he had some memory loss for a time.

[TexasBushwhacker]

7. Yes, it is nothing like Cuckoo's Nest

The patient gets a short acting anesthesia and a muscle relaxer. They use less electricity than before and usually start out with the current going through one side of the brain only.

[BigDemVoter]

8. I'm a nurse, and I worked at a psych hospital that performed many ECT treatments.

It is the quickest and most effective way of treating depression. That does NOT mean that it is the treatment of choice or it has the fewest side effects. The side effects are considerable--including relatively severe memory loss that is thought to be temporary (?). Now that they have an anesthesiologist there to actually sedate the patient first has resulted in the elimination of fractures suffered during seizures, etc. The only way they can determine the patient is having a seizure is by movement in the toe, as the patient is heavily sedated first.

So. . . Great treatment for somebody who is so depressed that he/she cannot wait for an anti-depressant to kick in or somebody who cannot take medication.

A big drawback for ECT is that often it must be repeated, as the effects generally do not last.

[gratefultobelib]

10. Hmmm. I have personal experience.

I am scheduled for treatment number 14 next week. I have disagreed with my doctor that ECT is the right thing for me. I am NOT depressed nor have I ever been. I do, however, suffer from anxiety and sleep issues. I think I'm afraid to really go against my doctor for fear he will quit seeing me and I need my drugs to sleep. He is a new dr for me because my former dr retired to Tucson. This post sounds a little disjointed, but I'm trying to sum up a very big issue for me. Here's what I've decided after reading the posts here. I am going to call the hospital tomorrow and cancel my appointment for next week and let the chips fall where they will. Thanks for reading!

[Kurska]

18. Electroshock therapy is NOT a treatment for anything besides severe drug resistant depression.

I would highly recommend getting a second opinion. You're right to be skeptical. I won't claim to be a medical expert, but definitely seek a second opinion.

[ellenrr]

11. riigght

and if you lose your memory, oh well...

oh, and the FDA is a really righteous agency.
don't believe those rumors that it is bought and paid for by pharmaceuticals and medical devices.

[mdbl]

12. ECT can be very effective for some patients

I have personally witnessed the positive effects ECT can have. I have also seen different methods of administering the treatment and some were not done properly in my opinion. A person with depression so severe that hasn't responded to medication has nowhere else to turn, so the treatment should always be available. It is up to the patient, the psychiatrist, and in many cases the family members to make the decision to have this type of treatment. I am glad it will be recognized and regulated on a national level. It should make it a bit safer. I have seen psychiatric wards administer treatments that left burn marks on the patient. That should never happen. As far as Psychologists go, some of them are very naive to think ECT should never be administered. I have seen depression that no psychologist will ever talk through with the patient. If someone is incoherent, psychological treatments are ridiculous by themselves. ECT can change the synaptic responses in the brain to the point I have seen someone return from psychosis to reality in a couple of treatments.

[hollowdweller]

13. When I worked doing disability claims

I had a few claimants in the past that had it.

I don't remember it "curing" anybody, but it seemed like people who were so depressed they were suicidal it got them up above that level usually. Also where people were almost catatonic they were so depressed it brought them up to where they were somewhat functional.

[Tursiops]

14. I moderate a Facebook page for ECT Survivors.

All of them have lost major life event memories, including college educations. All of them have learning disabilities and have trouble with short-term working memory. All are told that these symptoms are part of their depression. All are disabled. Some are helped by ECT, but the fact remains that "safe and effective" is simply a false statement. The only long term study ever done found cognitive deficits in all 347 subjects. The study, done in 2007, has been largely ignored.

[mdbl]

19. It can be a better alternative

to constant torture and suicidal thoughts. No one said it's completely safe, but if you ever have to endure severe depression, you'll understand a little better.

[RobinA]

21. My Grandmother

experienced bilateral ECT back in the day. I was a kid, so I don't know much about what the deal was with her depression. This was before much in the way of antidepressants. She experienced a very scary memory loss, worse the second time. She didn't know anyone. She did appear to completely regain her memory and returned to being my grandmother, doing crossword puzzles, playing the piano - pretty much doing what she always did after awhile.

I now work in mental health and at one time worked at a hospital that did ECT - unilateral. The memory loss was there, but nowhere near what my Grandmother experienced. Most people were given it for extreme depression that wasn't touched by medication. It seemed to help them a bit and they felt it helped them.

You have to realize the extreme of some people's depression. There are people out there whose goal in life when depressed is to kill themselves. When not in that state they are fully cognizant of their illness and fight it with everything they've got. There but for the grace of god...