Let's say you had/are a person who has a chronic, severe mental illness. You've tried a vast amount of medications over years, and your symptoms are crippling you from functioning "normally" (everyone's normal is different). Or maybe you're pregnant, you have a severe mental illness, and you can't take medication. Maybe you just want to free yourself from medication, or even if your medication is controlling your symptoms, but the side effects are horrible...
Electroconvulsive Therapy (ECT) has evolved from a tortuous "cure" to an option for treating severe mental illness in a procedure that is pain-free for the patient. It's not legal in every state, but it is in mine (West Virginia). I've been inpatient with a total of 3 people receiving it (I never noticed any side effects in the patients while they were receiving it.)
The most common side effects are confusion and memory loss After reading the few situations I typed out, would you consider going through ECT if it were presented as a treatment option to you?
If I had a sever mental illness, I might not be in the right frame of mind to evaluate the pros and cons of such treatment. Essentially, the therapy purports to improve brain function by damaging the brain a little bit. That doesn't sound good to me. You can Google doctor Peter R. Breggin, a noted critic of the method and see what he has to say. But I'm glad that the patients you observed were doing well.
Well, I was in the hospital with them while they were undergoing it, and while I'm happy I didn't see any side effects then, you never know what could happen once they go through the entire treatment sadly. I will definitely be googling Dr. Breggin. I'm not for it nor am I against it, but I am wanting to learn as much as I can about it so thank you for the tip on an actually noted critic.
Not in a million years. I'd rather die than take a chance at frying my brain. Especially when their argument in favor of it is that, in the doctors' opinions, it worked on some people. It hasn't been scientifically tested and proven both safe and effective. They say it's the seizure that helps the person, yet depression rates are higher than average in people with epilepsy. ?
I do have a severe mental illness, which is bipolar disorder. Having friends who have undergone this I ponder. The greatest complaint I remember them having is the memory loss and subsequent confusion it brought upon them.
As far as allowing this procedure I am not sure. Maybe if my writ giving an 'another' power of attorney and/or power of medical attorney would this occur upon 'anothers' decision - dun'no.
A hidden, buried, stale memory of grabbing the lawn mowers' spark plug cable fed by a magneto at the tender age of, say 11, feeds a fear saying, "I don't think voluntarily" this would be in my future. Cognitive-behaviorism and meds, or vice-versa work pretty good for me. I'll stick to that, unless, it is out of my hands . . .
I've heard nausau can be a side effect too...and headaches
I'm not sure the risks of EcT would be any less during pregnancy than most medications but I digress. I've seen psych patients treated with EcT that have been helped but I've always kind of seen it as a fast cure who's long-term risks far exceed the benefits. The same things can be accomplished-although it takes much longer- with therapy and medications. No memory loss, no loss of sensation, and far less risk of severe medical complications.
P.S. I'm a West Virginian too...
I threw that pregnant option in there because while I was a patient at Chestnut Ridge in Morgantown, my roomate was pregnant and undergoing it because of the harmful side effects of medication on a fetus. I'm assuming that she had to pick between the lesser of two evils. I very much agree with you on medication. It took a couple of years for me, but I'm finally on the right combo and right strength to control my symptoms. But at the same time, I could see why these patients agree to it. They feel like there is no hope and anything, even memory loss, would be better than depression. That's a really sad thing to have to type. Doctors can study ECT all they want, but there is NOT a way to predict how every patient will turnout after the treatment. Like I said, I'm just trying to learn as much as I can and I'm happy someone responded from WV with their opinion. Thank you!
If there was hard data that it had a good record of helping with my severe health problem, certainly, I would do it.
The damage is permanent.I had one treatment during which my optical nerves were accidentally fused with my anal nerves...now I have a sh#ty outlook on life.
In a practice in which I worked, we saw two patients that received several EcT treatment sessions in a hospital setting.
For the first patient, the relief was only temporary, a few months.
For the second patient, the EcT resulted in a bright university student that was producing important work for the medical community being plagued by severe long-term depression not present prior to treatment, memory loss, failing grades, termination from the university, and a life on public assistance.
I am not a medical doctor, but I can't recommend EcT.
Mrs. Dukakis, from MA, did a talk about it at McClean Hosp in Belmont, MA. I was there, she wrote a book called "Shock" about how it helped her and was the only thing that worked after many years of clinical depression which was very disabling........She says it works for her, and she does it like once or twice a year. Maybe she's an exception, but this is the only positive thing I've heard but I'm not for it..
I'm with those who wouldn't risk damaging their brain under any circumstances. I don't know anyone personally who has had it, but I'm close to someone who knows some who has. The individual (I'll call him, "Tom")had a long-time history of depression when my friend met him. He couldn't work and wasn't "OK", but my friend said he'd "be around and doing things", including watching TV, having projects, having hobbies, and driving. He was in a whole cycle of medication-changing, etc., and eventually developed heart problems. The whole business spun out of control, so he eventually has had more than one ECT treatment. My friend said the difference appears to be that "Tom" is quiet afterward, rather than complaining about things going on; and then months after the treatment "Tom" has started being miserable again and the whole cycle continues. In the meantime, my friend has watched "Tom" going from being someone with a mental disability to being someone who barely functions.
It's not possible to look at someone (like roommates), not see any problems that may have resulted from ECT; and then know know whether "all is fine" with them now, just based on appearances. The difference of the potential of their brain now versus the possible potential before ECT cannot necessarily be seen just by watching someone go about their day-to-day living.
People are far too often misdiagnosed and/or over-diagnosed with any number of medical and/or mental-health conditions. When my teenage son went through a difficult time with my divorce (and people pulled the rug out from under him by making him question the one person he'd always felt sure with), he ended up getting mental-health care and over a period of a few years he was diagnosed with everything from bi-polar disorder to depression to ADHD, with each new diagnosis being "overturned" as a yet different one took its place. Eventually, the last diagnosis was ADD, and he lived on medication for that until it started to cause him health problems. ADD, of course, is a matter of not being able to concentrate - and yet, gee, funny he can concentrate now; the same way he so often could concentrate when he was a child. (In other words, I don't really think he's ever had ADD "with some unknown cause". I'm fairly certain he's had inability to concentrate as a result of too much stress and life upheaval, which, when extreme, can make a person have trouble concentrating.) Of course, when I'd tell my something like, "I don't really think 'bi-polar disorder' sounds right to me," he'd respectfully (and sensibly) say, "Well, I'm going to believe the doctors - not you." Finally, at one point, one my son's counselors said to me, "He's not doing anything a lot of other kids his age don't do, my own daughter included - and we don't have the divorce thing complicating things more."
It's not just what happened with my son, though. I've seen all kinds of people being treated for stuff, only to later "have it all change" when a doctor figures out what the real problem is. I know there's lots of sound, solid, information and treatment going on for people with mental-health issues. I know everyone and everything in the mental-health field isn't incompetent or over-zealous. Too many inaccurate diagnoses go on, though; and too much goes on with one thing being believed to be helpful, only to later be discovered to cause more problems. Once someone's brain has been damaged there's no going back. I'm not knowledgeable enough or qualified to have an opinion about treating some things like severe psychosis to have an opinion; but I do know that if I were enough in touch with reality to be able to even think about a decision I wouldn't have it.
Lisa, as someone who has worked for over 30 years in the UK's psychiatric system, I think your observations are spot on. Unreliable diagnoses, pathologising normal human distress, and assuming a biochemical disturbance is the primary cause of mental health problems regrettably characterizes western psychiatric practice. Things needs to change.
I think if you want to help your son, since I used to be convinced the doctors were right too, is to read up on Peter Breggin's books (Doctor Peter Breggin) who is called the conscience of psychiatry and beleives chemical imbalances, rather states, they have not even been proven.
His books are great reading: Toxic Psychiatry, Your Drug May Be Your Problem, etc.
It's great info and important to know both sides....... i would hope if you research it (and I'm not implying you haven't already, cause you may have already done all you can ) but it's a suggestion.
I came to the reality myself when I read Dr. Breggin but didn't know how to go about it. It's very complicated and it was only Lamictal which replaced Lithium and getting off Lithium after which has completely changed my outlook and mood. Lithium made me angry and sucidal and I'm not anymore.
This is true evidence.
Good luck!! (a most sad situation thou. )
That is difficult. I watched a documentary on a woman with very severe suicidal depression. She had tried everyting
under the son for years, many suicide attempts, etc. She finally did the ET and they showed her getting it. It was painless, and it was simple and brief, but not only did it not work, her memory loss was pretty bad. Some people respond more positively. I would have to say I would not get it. It's just exchanging one malady for another. Struggling with the memory loss causes yet more stress.
It is not a treatment I would opt for.
A balanced look at the research studies of the effectiveness of ECT leads to the conclusion that although it can improve mood for some very depressed people, the benefits don't usually last longer than 4 weeks. Memory loss is a big problem, with increasing evidence that the impairment can be long term.
Not for me.
The criteria for ECT was rather very strict.
Your question can be irrelevant in many situation as quite a few people lose their capacity to decide in such situations.
Yes flightfighter you are correct; the best practice guidance recommends that ECT should only be considered in a small number of clinical situations. However, in practice it is used much more widely, particularly with older people.
It is true that some severely depressed people may lose capacity to give informed consent. Optimally, if they have been depressed before, the patient may have written an advance decision to indicate whether or not they wish to receive ECT; in these circumstances, if the patient has formally requested they do not want it, the psychiatrist must respect this decision (except in an emergency). Regrettably, very few patients (at least in the UK) complete advance decisions.
I'm sorry but I have to disagree that it is used widely in elderly people. The risk of mortality is particularly increased in the old age group. Memory problems tend to be particularly worse. Old age treatment is leaning towards non pharmacological.
With advance directives, you cant give ECT even in emergency. No different from blood transfusion, cant give even in emergency if one has advance directives.
It has been well established that older people are disproportionately targeted for ECT. Even the Royal College of Psychiatrists' ECT Handbook acknowledges that "people aged over 65 are major users of English ECT services." In the same document it cites surveys showing that of all those receivng ECT in England 44% of the women and 33% of the men were over 65 years old. Similarly, a Welsh study found that people over 65 were over twice as likely to be given ECT than their younger counterparts. The situation is broadly similar in the USA. All this despite, as you correctly say, the increased risks of mortality and memory problems.
As for giving ECT against the stated wishes in an Advance Decision, my reading of the Mental Health Act (Section 62) is that it can still be given in "emergency situations ... for treatment that is immediately necessary to save the patient's life." So although it is more difficult to proceed with ECT against the wishes expressed in an Advance Decision than it is for forced medication (where being on a section of the Mental Health Act trumps everything), it can still be done. So it is different from blood transfusions.
Clinicians are obliged to follow the content of an advance decision to refuse a specific treatment or risk litigation. However, for those patients being compulsorily detained, the Mental Health Act does explicitly give the Responsible Clinician (almost always a psychiatrist) the option to over-rule the expressed wishes if they believe there are pressing reasons to do so. As stated in my previous post, it is more difficult to do this for ECT than it is regarding specific medications, but the capability of over-ruling an advance decision is there enshrined in the Mental Health Act.
Regrettably, so few advance decisions are made in mental health services (at least not in the UK) that the scenario rarely arises.
Far from scaring patients, I believe it is better to fully inform them of the facts; this is the most effective way to empower them to have more influence within what is currently a paternalistic , "doctor knows best" system. Ultimately, let's hope that the fundamentally discriminatory nature of the Mental Health Act (that gives people with mental health problems less rights to refuse care than their counterparts with physical health problems) is revised in the not too distant future. It is an absurdity that you or I could make an advance decision today refusing life-saving medical treatment fully confident that our wishes would be implemented; in contrast, if we today specify in an advance decision a particular anti-psychotic medication that we do not wish to receive our wishes could be legitimately scuppered if we find ourselves compulsorily detained under the Mental Health Act.
Responsible clinician is usually from a medical profession. Provisions have been made for non doctors to be a RC but not seen one actually becoming one.
Advance directives for treatment whether ECt or blood transfusion are treated with almost same weight.
I think you are terribly misinformed about the Mental Health Act and ECT.
If the patient lacks capacity then ECT must be certified as "appropriate" and must not conflict with an advance decision (which the registered medical practitioner concerned is satisfied is valid and applicable) or with a decision made by a donee or deputy or by the Court of Protection.
Advanced directives can't be overruled by MHA. if we need to overrule advance directives, we have o ask the court to do it.
As previously stated, it is more difficult to give ECT without a person's consent (c.f. medication) but Section 62 of the Mental Health Act states that it can be given in emergency situations where treatment "is immediately necessary to save a person's life" or where treatment "is immediately necessary to prevent serious deterioration". I accept that the process is relatively convoluted (agreement of 2 doctors, a social worker and an independent specialist).
Giving ECT without consent is not a rare occurrence. A Freedom of Information Act request to the Care Quality Commission revealed that in 2010-2011 the Care Quality Commission psychiatrists were asked to authorise ECT on 1229 occasions; given that they rarely disagree with the local clinical team, it is is reasonable to assume that last year over 1000 courses of ECT were given against the expressed wishes of the patient.
advanced directives and consent are not the same.
can't type just lost the game:(
Granted, advance decisions and consent are not the same thing. Given that hardly any patients in the psychiatric system have drawn up advance decisions, the scenario of someone under section with an AD rarely arises; it will be interesting to see how it pans out when ADs become more commonplace. What cannot be disputed is that there is provision within the Mental Health Act (section 62) for them to be over-ruled.
If the game you refer to involves the England football team, I share your angst!
Treating someone with known medical directives against it = assault.
Sorry won't reply at the moment. Going for a tournament.
In the Netherlands (where I live) it is considered a viable option for severe cases of depression where no other treatments have proven effective.
This is truly a tough question. This is my second post here. The first I still am in agreement with. Yet, since, with all that life has offered me I would say, "this is a very complex question when Loved ones come into the picture." There are so many factions coming into play. Trust becomes evasive with the pros and cons being offered.
The media played with this and one may ponder two books "One Flew Over the Cukoo's Nest" and "Catch 22." Then pondering having the capacity to read those controversial books contemplate "Fahrenheit 451." Lastly the line between saying yes or no is could be likened to one degree or as in this video if allowed 212: The Extra Degree I ask to ponder the question proposed with this forum question.
The dance is with subjectivity and objectivity and the social organism. Left alone fate tells the story if in a wilderness. Now a movie about depression some may have seen, yet not realized is titled "Jeremiah Johnson" with Robert Redford in the staring role. Another of Mania is "Phenomenon" though told another way. Familiar truths will be discovered, like the garden scene with the obsessive hoeing taking place contrasting with the wind called Mirah or Maria by some. Those who are intimate with both Depression and Mania may say, "yeah" while others enjoy the story not really knowing, yet a glimpse is shared.
A key element is the burden associated with it within the confines of social structure. Personally, I have one major goal in this life. I do not want to be a burden to my family with this blessing I have with a diagnosis of bipolar disorder type I that dances with depersonalization and derealization. For explanations Google it.
Persons of this temperament know, that is just a fact, they know. There are libraries dedicated to depression. So, I ask who has read all those books? Then one who does not know says, "I am an expert, listen to me." OK, they in the world of religion are a theist, yet not gnostic. The gnostic is a theist, yet have a yearning to share the gnostic. OK, that was an analogy. I have to be careful you see, a burden of sorts, since religiosity is a symptom of BP. Or, in the land of literature and cinema - lions, tigers, and bears, oh my . . .
I am neither depressed nor manic. Maybe a tad of hypomanic, yet not really. I am moving from theta toward alpha. Yes, I can tell because I practiced and practiced and practiced and some more to recognize it facilitating a site, which can be found here BrainWave Generator
But, realizing I may have written a hub off the cusp, sort to speak, maybe I have laid groundwork for the inquisitive mind of more authority and knowledge than I-eye, captain. That is a result of still having a degree of theta, not BP, get it! Then comes into play the knowledge of the video shared of that one degree of difference between theta and beta. In other words give me a math problem now and WTF comes to mind. But, ask me to write and I'm off and running. Sometimes it just is not moods, which are not emotions - see Plutchik's wheel of emotions for reference, it is riding the wave that will not go away like a surfer at Tamarak Beach or anywhere.
And, suddenly, someone says, give them ECT, that will work. Is that a cry of desperation of those who are afraid of difference when one grows I ask? Bring that person back, we just don't understand is cried. A question is then proposed by the person of question. Do I agree with the social organism and be what they want me to be or do I say F'it and head away with a mighty leap or it is just too much to decide so, su***** becomes the answer. How sad is that?
Destructive behavior may ensue at that point seeking relief not of emotion or mood, but of the question? TG I'm a diabetic. God gave to me a little blessing. I don't have to use a knife to check if I'm alive, ha,ha, I just poke myself 4 or more times a day, yup there is blood, I must be alive, question solved, move forward.
OK,now becomes the biggest question of all. Do I dare post this here at a hubpages forum question knowing social responsibility and all that stuff. Will what I wrote cause others to be mixed and betwixt. Or, will it cause another, maybe one to seek help with those questions as Eric Clapton described saying, "running round my brain." Isn't it funny how many times persons of BP are asked to take a random drug test, ha,ha . . .they just don't get it, it is a natural occurring event to be happy. It takes work to cause it to go away. It is much easier like to be a baby of a few months giggling and laughing. We are taught to be sad. It is not natural. And, then the cure for happiness is ECT.
Saddness or depression is the result of questions with no answers. Simple enough. Help them discover the answer and don't tell them. I'm off on a rant, I ask your forgiveness. Now this is a free writing exercise, as I call it. The question remains - do I post it and share?
OK, what was the question, lol, I'm closer to beta now. Less spontaneity regarding creativity. And, the question becomes do I move the other way and take a nap then head to delta. Be assured to function now means more coffee or suck down a 5hr energy.
Yet, those who are learning, rummaging through all this word association stuff, ponder this question? Think of all the audible noises of a city. They each have an affect leading to an effect. Mix that with the visual of zippppp zappppp zippppp in town traffic is now what 40mph. The speed of a thought only goes about 3mph. The other senses are mute, kinda' then someone thinks they are smart, talks on a phone, going 70mph, sucking on a soda, now we have taste, remember now how fast a thought goes, wow did you see that, no its gone, before you know - crash. Please be careful when you drive and text!
OK, decision made. I'm posting this. I thank any who read for the indulgence of their time. Did I answer the question. If loved ones are concerned, my love for them would lead me to say, yup I would, If I was alone like today, nope I wouldn't I know how to survive and be a successful BP'er . . .thank you
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