Showing 96 of 96 comments.
I didn’t see it either Julie.
I can take what the Daily Mail says about lids on cell membranes with a pinch of salt but I actually found the Guardian article quite seductive.
Now psychiatrists are experimenting with ketamine on children
“What’s more, it works much faster than SSRIs, and appears to last longer to move congestion in the brain that may be hampering the patient’s freedom of thought and feeling. It’s widely agreed that patients with depression appear to have dampened connections between certain neurons, caused by a build-up of proteins on top of cell membranes. In healthy brains, cell membranes are free and open to receive signals. In patients with depression, an overwhelming amount of G proteins pile up on top of lipid rafts – kind of like lids which sit on top of cell membranes.”
So now we know.
Yes, in February he was quoted:
‘Andrea Cipriani, from the university’s Department of Psychiatry, said: “Under-treated depression is a huge problem and we need to be aware of that. We tend to focus on over-treatment but we need to focus on this.” ‘
The million more came from John Geddes.
Anyone seen the headlines today?
(it is actually a Times story but The Times has a paywall)
Andrea Cipriani quoted as saying “‘People are prescribing antidepressants to people who don’t really need them, who have low mood. ‘It’s important people are aware that antidepressants aren’t a quick fix.’”
There was someone in the 1980s who won a legal case for abrupt withdrawal of benzos. I don’t know if it is more or less difficult to win a case nowadays. It is not a subject I know much about. I just thought I would add that as further evidence that people were aware of the problems in the 1980s.
I am genuinely curious to know how articles are selected for this section, given that every day there must be a lot of articles published about psychiatry and mental health. This article was published in a psychiatric journal edited by Robert Pies and the first paragraph reveals the authors’ belief in mainstream psychiatry “she stopped taking her prescribed psychotropic medications…” There is then a lot of vague stuff about poverty before we get to the well, what can they do about it, having admitted that screening for poverty isn’t much use unless you can do something about it. On an individual level it doesn’t seem to go beyond signposting for housing and benefits help. Finally they call for psychiatrists to come out onto the streets to demonstrate for higher taxes. How many are going to answer that call? One of the authors has actually spoken at some parliamentary committee so perhaps it is not just rhetoric. Okay I like the bit about higher taxes even if it is a bit unrealistic but for me the good bits are outweighed by the vignette and screening tools and biological psychiatry stuff.
Despondent, but that is one hundred per cent. And someone who is in need of practical help might, rightly or wrongly, may feel that their chances of receiving that help are better if they accept the treatment.
Doesn’t seem at all critical to me. The authors are promoting drugging, assertive community treatment or whatever it is called, etc. It is almost as if they are turning poverty into a symptom, with a screening tool, which incidentally seems to be at least partly about budgeting.
Why is this article here?
Couldn’t find any in the first three pages of google, even searching “psychiatrist manslaughter”.
I was thinking they may be on the hook for other things but not often for patients dying as a result of prescribed drugs. As far as the UK is concerned, I googled “psychiatrist struck off” and looked at the first three pages. It was sex, plagiarism, sex, sex, sex, sex, inappropriate behaviour and inappropriate behaviour and lying. One mention of a historic case where a psychiatrist who had been working I seem to remember with addicts had prescribed drugs to someone who then died. I had another go for “psychiatrist convicted” and it was illegal drugs (the Royal College podcaster), sex, sex and sex, plus one mention of a historic case of sex. Sex in these convicted cases meaning something criminal whether you are a doctor or not.
Were psychiatrists ever on the hook?
Some very good points John. Where is the talk?
I never cease to be amazed at the vast sums of money that are spent on psychiatric research. And wonder if any of it has ever been useful. So much seems to be of the “bleedin’ obvious” variety (problems at work make you depressed etc.) or just of the “what’s the point of that?” variety (I remember seeing an article from the 1940s British Journal of Psychiatry about moustaches – or have I dreamt that up?) and then millions and millions spent on the rat brain stuff.
In the UK I have noticed in a very general sort of way (just reading newspapers, etc.) the term schizophrenia being used less and psychosis more. But as rasselas.redux says with an important exception – horrible crimes. Then it is “a paranoid schizophrenic”.
Great article. But I couldn’t find anywhere in the link it saying how many prescriptions each person gets. In this link
it says “There were 349,900 people (1.6% of the Australian population) who had at least one PBS subsidised prescription for an Antipsychotic medication filled in 2011.” That figure went up to 20 per cent in people aged over 75. Over half of the people were also getting prescriptions for antidepressants.
Thank you Tina for this report. I was interested to see what the person from the UK had to say. But it looked like he had wandered into the wrong meeting. As you say, he was just promoting the current legislation/review. He even talked about having been given a statement (who by? I don’t know much about how these things work). And said twice that his father is a forensic psychiatrist. And what is so marvellous about the Scottish Mental Health Act? A few facts he didn’t mention: increasing numbers of people in Scotland (population 5.3 million) detained (5422 in 2016/17); increasing numbers of people given drugs without their consent for more than two months (1559); increasing numbers of people given ECT without their consent (176 of whom 71 per cent were “resisting or objecting”, in theory all are supposed to lack capacity). And the safeguards? That just means they have to get another psychiatrist to approve it and they don’t often say no and, if it is similar to the system in England, it is a lucrative business.
Has anyone been following the Evening Standard’s series on opioids and the Sackler family? I was unaware of it until yesterday when I spotted a headline on a newstand.
I had never heard of FTAC. I had to look them up. Why do they have a .com website rather than a .org or .gov.uk?
Thank you Akiko for this article. I read the report and felt it didn’t really say anything useful. Theresa May became aware that detentions under the MHA are rising and disproportionately affect people from some ethnic minority communities so decided a review of the law was called for, although it may not be the law that is at fault, and then puts Simon Wessely in charge of it although he is hardly going to argue for less power to psychiatrists. The report says that the reasons for both the above (rising detentions and BAME groups being more likely to be detained) are “complex”. Well, obviously. And as for treating people with dignity and respect – can you make a law that says that you have to?
As for the disappointing numbers of people responding to survey, etc., could it be that having to identify as a “service user” might have put some people off, especially those who weren’t going to be appreciative of their treatment? I may be behind the times here – is “service user” a term that nowadays is universally, or near universally, accepted by people?
Not even a mention of ECT in the report. Although, to be fair, the law was changed for ECT in 2007. And how about legislating for DBS?
I got through to the end of the glossary and was surprised to find SOADs defined as second opinion associated doctors. I thought they were second opinion appointed doctors. Has it changed? It is pointless anyway the A was only inserted to avoid calling them SODs.
An item about Asperger was on the front page of the BBC website today
Hans Asperger ‘collaborated with Nazis’ in WWII
(I wonder why the quotes)
So the circuits have a center and are still in there with a sporting chance. I read the spinning trial results report. It goes on in the UK (DBS for depression) but isn’t much talked about. A couple of people who had undergone psychosurgery in England in recent years did so after having DBS.
As for Carmine Pariante you can’t avoid him. He was in the Times today. Can be read here https://www.raconteur.net/healthcare/debate-antidepressants-work
There was also John Geddes from Oxford with his line about GPs being “squeamish” about prescribing antidepressants. Is it about 60 million prescriptions a year now? And about 40,000 GPs? So that is about 1,500 prescriptions for antidepressants per GP per year. Squeamish?
Perhaps they are just speaking with one voice. There is another thing I find odd about the whole business: didn’t amitriptyline come out top? And yet they seem to be silent on that. Nothing about how they should drop SSRIs and go back to amitriptyline.
I had never heard of Carmine Pariante before this. Looking for his quote I came across lots of stuff and at first sight it does look seductive – all this cutting edge science, prestigious institutions, visits from royalty, etc. And they have it all worked out – inflammation, small brains, etc. Inflammation seems to have taken over from chemical imbalances but what happened to brain circuits? And then I got a sobering thought: the world is still just the same, just as many depressed people and also I looked at his conflict of interests list and the fact that he is pals with Charles Nemeroff.
That was a feeble reply you got auntie from the SMC. I remember years ago they were promoting Helen Mayberg and her deep brain stimulation. What happened to that? But I don’t know much about SMC. The one I am following with interest is MQ.
I can’t find an example either. Pariante is definitely the putting to bed quote and Cipriani the final answer quote. Everywhere. Now Pariante is complaining about being taken out of context but it isn’t even his quote.
I have found the quote now:
“Lead researcher Dr Andrea Cipriani, from the University of Oxford, told the BBC: “This study is the final answer to a long-standing controversy about whether anti-depressants work for depression…””
So it was one of the others who used the expression “final answer”.
Carmine Pariante is now saying he was quoted “out of context”.
“At the time, I was widely quoted as saying this was the “final answer” on the subject – a comment that was taken very much out of context.”
Wasn’t it Michelle Obama who said that, not Barack?
As for the Royal College of Psychiatrists, I have never understood why they have charitable status.
I might not have spotted the parody if I hadn’t read the comments first. But it was funny. The bit about the water mattress tester reminds me of a follow up study (not a parody) of people who had undergone leucotomies and the only one who returned to work at their previous level was a tea-taster.
Something magical obviously happens to us on our eighteenth birthdays.
Over 60,000 detentions in a year. Yet I could only see the CQC report getting a mention in the Mirror and the Huffington Post, while for the anti-depressants it was a case of “hold the front page – someone has done a meta-analysis”. As John Naish said, you would think they had won a Nobel Prize. The CQC report did get some discussion in Parliament though.
“…it confirms that these drugs are safe and effective” (from Carmine Pariente’s comment on the SMC website). Where does the review of the literature deal with safety? Did I miss something?
Great cartoon auntie!
Another case in South Carolina
One of the guideline authors had nearly a page of disclosures. It is a pity the critical article in the BMJ doesn’t seem to be available to read.
In Scotland (one of the few places to publish detailed statistics on the use of ECT) the largest single group is indeed women in their fifties. It is graphically illustrated by the figure on page 3 of this report
And, yes, various surveys have found men more likely than women to prescribe ECT.
In the Netherlands ECT nearly disappeared in the 1970s but now it is back again, along with psychosurgery and deep brain stimulation.
I think its important to show people that is misleading to talk about “small electrical impulses”. I was looking for a video of ECT which shows, for example, that the shock is strong enough to cause grimacing because of its direct action on facial muscles even if the person is anaesthetised and their muscles are paralysed. If you look at this video
at 3.20 minutes it shows the shock being given and the man’s arms fly up. How does that happen – when he is anaesthetised and paralysed? I also thought that he seems to be having quite a violent seizure, considering he has been given muscle paralysing drugs. I recently saw someone having a spontaneous seizure and it didn’t look worse than that.
A reply to Luc
As Connor pointed out to me, the million figure comes from the defendants (the ECT machine manufacturers) and is obviously absurd.
Yes, a possible explanation would be that they are getting confused between treatments and people. Or perhaps they are trying to convince people that ECT is an incredibly common treatment, or they may have extrapolated from one hospital that uses an unusually high amount of ECT.
The figure usually quoted by psychiatrists in US is 100,000 a year but this is a very old estimate. No-one knows how many people actually undergo ECT in the US because most states don’t keep count. Texas (pop about 28 million) is an exception and collects and publishes figures – about 2 to 3 thousand people a year. But it would be dangerous to extrapolate to the whole US, as ECT is characterised by wide variation in its use.
Could I just point out a couple of things about your reasoning. In the US, ECT is used predominantly as a treatment for depression – you don’t have to have been diagnosed as psychotic (and there is an almost limitless number of people who can be diagnosed as depressed). Of course it is used on people with other diagnoses as well – schizophrenia, children with autism, older people with dementia. Another point to bear in mind is that people often have multiple courses of ECT, or are on maintenance ECT, so will appear in the statistics for more than one year.
There’s me fallen at the first hurdle – spotting the difference between the plaintiffs and the defendants! Can you challenge them if they are talking rubbish? A million a year is patently absurd. Where do the get it from? Even 100,000 a year is I think a very (decades) old estimate. If you look at Texas, where they actually count, it is a much lower rate. Does California keep statistics?
Another bit of rubbish the defendants say: “ECT is a medical procedure performed under general anesthesia in which small electric pulses are passed through the brain… ” Would it be possible I wonder to modify an ECT machine to deliver a shock exactly like in ECT but turned down to a level where it is a slightly painful shock but not dangerous – like say 8 milliamps instead of 800 milliamps? And then ask the defendants what it feels like? I don’t think you would feel pulses because they come at typically 70 a second which would feel continuous I think. And then ask them to imagine it one hundred times bigger, which is what ECT is.
Connor, bottom of page 7 of the Joint report: “In the United States, over one million patients are estimated to receive ECT each year.” What?! I think psychiatrists say one hundred thousand a year in the US, although even that is just a wild guess rather than based on any actual figures. I have seen them say a million in the world every year – another wild guess. Or maybe they are talking about the number of individual treatments per year in USA, that is, each person having about 10 treatments?
No, don’t waste your time explaining to me. Just win the case!
I’m not sure I understand all the legal stuff but best of luck anyway.
About anaesthesia raising the threshold. That would explain why less energy was being used in the examples I gave.
Maybe what Stephen Gilbert said in the first place is true
“What I’ve read about modern day shock is that it’s actually much more dangerous than in the old days because of the anesthetic that they use now. Supposedly it raises the threshold that is required for the actual seizure to take place, meaning that it takes more electricity to get beyond the threshold.”
“Colleagues in various departments suggested alarming possibilities, which included some alteration to the type of fit; over-heating the tantalum plate and so, as it were, cooking the brain; bending the plate during the fit, and also depositing tantalum around it electrolytically”. None of these seemed sufficiently likely to contra-indicate treatment…”
Anyway – another example: “the usual dosage in this series was 18 joules…. the usual duration of the shock is variable, lasting about 0.35 sec…” R.Kauntze and G. Parsons-Smith 1948 Cardiovascular changes following electro-convulsive therapy. Heart vol 10 pp 57-62.
According to his website he is on (or at least he was in 2013) an SNRI antidepressant and a mood-stabiliser. http://www.stephenfry.com/2013/06/only-the-lonely/
When he was younger it was cocaine and alcohol.
What rational_moderation said was “In the old days they just took current directly from the wall, 60 hz alternating current, to deliver ECT. Now they actually give a series of brief electrical pulses so it’s much less energy.” Energy is measured in joules, and I found some examples from 1940s and 1950s of shocks using 10 – 20 joules of energy. If you want to see how much energy modern machines deliver go to the Thymatron specification page http://www.thymatron.com/downloads/somatics_color_low-res.pdf
maximum output 99.4 joules (or double with double-dose model). Psychiatrists are advised to set %energy dial to patient’s age, which would be more than 10-20 joules for adults.
Or perhaps rational_moderation could find an example of someone in recent years being treated with “much less energy” than 10-20 joules?
A reply to rational_moderation’s questions. In order to convert joules to millicoulombs (energy to charge) I was using Charles Kellner’s co-efficient of 5.7. Yes, the resistance is unknown, so the co-efficient is based on assuming an average resistance (Charles H. Kellner, Electroconvulsive therapy, in Brain stimulation in psychiatry, Cambridge 2012 pp 3-16). The 1950s example I gave is from an article published in the Journal of Mental Science in 1951 vol. 97, An account of E.C.T. given to a patient with a tantulum plate in his skull, by Humphry Osmond pp 381-387. The man was given seven treatments with 17, 12, 10, 10, 10, 10, 10 joules.
All else being equal, brief-pulse currents are accepted as more efficient at producing seizures than sine-wave. But all else isn’t equal; other parameters have changed. For example, nowadays people receive shocks lasting several seconds while in the early days they lasted a fraction of a second. Is sine-wave for half a second better or worse than brief-pulse for 6 seconds?
I pointed out that a minority of New York hospitals were using sine-wave equipment into late 90s early 2000s to show that it is not a simple question of olden days v modern times. Some countries of course still use sine-wave equipment.
It is not the case that modern ECT uses “much less energy” than before. If anything it is more energy.
Correction: it is charge not energy that is measured in millicoulombs. Energy is measured in joules.
At the end of the article that you quoted the authors give two examples of calculating the electrical charge – one of 63 millicoulombs and one of 163 millicoulombs. Those are both fairly low charges but the second one a fairly typical one. Now let’s look at the charge used in the 1950s. One article for example described a patient as receiving ECT with energy of between 10 to 17 joules. Slight problem – we have to convert joules to millicoulombs. Charles Kellner (and for once I will believe him) says to multiply by 5.7, which means 1950s patient got about 60 to 100 millicoulombs. So less energy in the 1950s than nowadays. Why – if the waveform is more efficient? Mainly I think because the duration of the shock has increased considerably since the early days of ECT. Nowadays people usually get shocks lasting several seconds while in the early days it was usually a fraction of a second.
Interestingly, in a survey published in 2001, some hospitals in New York were still using sine-wave machines even though brief-pulse ones had been available for at least two decades.
rational_moderation where have you looked into it (the “much less energy” claim)?
I think what rational_moderation is referring to is the difference between machines that deliver an electric shock with sine-wave current and those that deliver an electric shock with brief-pulse current. They are both electric shocks, although some people misleadingly describe the latter as if they deliver a lot of little shocks rather than one big shock.
As far as energy is concerned, modern ECT delivers just as much, if not more, than olden days ECT. The convention is to measure ECT energy in millicoulombs and the number of millicoulombs has not decreased over the years.
The proof of the pudding is in the eating, and when people have done experiments with the different wave-forms there has not been an enormous difference between sine-wave and brief-pulse, less for example than between bilateral and unilateral electrode placement. Which is probably one of the reasons why psychiatrists took so long to switch wave-forms and why in some countries sine-wave is still used. And of course people who have ECT today experience similar effects on memory, etc., to those who had ECT many decades ago.
Thank you Philip for this article. I have just checked out the editorial board of the Journal of ECT. Forty men and eight women. They did some years back publish an article by someone who had experienced memory loss after ECT. I can’t remember her name but I do remember she had met Mother Teresa and couldn’t recall it after ECT. I wonder if they would say now that they shouldn’t have published that article? By the way it is the late Ian Reid https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046795/.
A very interesting report. And so sad about Jim. I have only read the abstract to the Lancet article as I don’t have access to the whole article but I am wondering why it took 30 authors to write the article. I know it was multicentre but I don’t think there were any centres in UK were there? yet Keith Matthews from Dundee in Scotland is listed as author.
I once won a competition and the prize was a ticket to a David Nutt lecture. I remember he was talking about ecstasy and said it had never killed anyone. A member of the audience queried this statement and Nutt said it wasn’t ecstasy that killed but drinking too much water. I didn’t find that very convincing.
As for Scott’s article, I couldn’t see how MDMA is going to be different from any other drugs. Perhaps, Scott, you could make it a bit clearer?
Thinking of ER (number 8) has anyone seen this article by the director of NIMH?
I find it rather frightening. Supposing someone who had broken their ankle said “Well since you ask…” what would they do?
Thank you for this article Don. I have noticed that most of the big names in ECT seem to be men. In the early days of ECT perhaps there weren’t that many women psychiatrists, but I would have thought there were more nowadays.
Thank you Philip for providing me with such a laugh. I had seen the abstract and was struck by the admission that they are trying to change thoughts and behaviour, rather than curing or even treating diseases, but I hadn’t got around to going down to the library to read the whole thing. Presumably that 4 per cent of medical graduates include those who don’t cut the mustard in other disciplines or want an easy ride to a consultancy. I wonder if there are many people who actually start out wanting to be psychiatrists?
“Twelve weeks after the last session, LISTEN participants reported reduced loneliness, enhanced social support, and decreased systolic blood pressure compared with baseline. On the other hand, the control group reported decreased functional ability and reduced quality of life.” And what did the control group get? Ten hours of “educational information about aging”. No wonder they weren’t feeling too good afterwards.
It is already taking on the language of mental health. People “have loneliness”, it is “treated”, they “recover”, etc.
Couldn’t you dismantle the pill and swallow the microchip? I read somewhere that it was 1 millimetre long and 0.3 millimetre wide so you might need a magnifying glass.
Thank you Kat for this moving piece of writing. It is opportune at a time when we are supposed to think there are only two things wrong with psychiatry – not enough money being spent on mental health services on the one hand and on the other stigma preventing people seeking help.
I wasn’t sure if you were highlighting this work as a good or a bad example. I read the report, the last link, and it seemed to be more about the author’s theories about conduct niches and performance niches than about children in spite of all the drawings and quotes (and bits in annoying font that were difficult to read). Half the children were from the US and the report was written in US English. One child from the UK was described as living in a lower middle class neighbourhood and I am still trying to work out what that is.
Nice theory John but actually the 1,300 is a three-month figure not an annual figure so there was no low point and then increase. It just kept going down.
The researchers – all twelve of them – considered the point that there was an association between drugs and sitting down and admitted that it may be due to “fatigue as a medication side effect”. But then they reassure themselves: “On the other hand, a psychotropic medication prescription might as well be a measure-of-proxy for illness severity.”
The researchers said that people in hospital reported being more active than people out of hospital. How does that work? Do you have gyms, etc., in hospitals?
You see truth the sharkfins may have more signatures but they haven’t got a novel or a class action have they?
Congratulations Bonnie on the publication of your novel!
“The Royal College of Psychiatrists believes strongly that our first role as Doctors is to do no harm…. It is with openness, kindness and humility that we hold our hands up, open our doors, and fight tirelessly to provide the ethical, evidenced-based mental health treatment that all of us deserve.”
Oh yes? Now why am I a little bit sceptical about that?
Yes, it means hospitalised without consent, or detained. It is a relatively recent expression, dating I think from the 1983 Mental Health Act, and is used because people are detained under a section of the Act. It replaced the term “being certified” which was used in the past. About 58,000 people are sectioned in England a year. Otherwise the word “section” in English has a similar meaning to its meaning in French.
Thank you truth. 200. That is admirable perseverance.
Who is behind the class action? Not the CCHR I hope?
Thanks John for your research and podcast. Yesterday was the 140th anniversary of the birth of Ugo Cerletti. And I missed it.
On the subject of ECT research and perhaps psychiatric research as a whole I have been wondering if there is any one piece of research that has actually led to improvements for people having treatment?
Perhaps the lack of comment here is related to the recent very sad news from MIA? And more generally people have more experience of drugs than ECT.
Why the water buffalo I wonder.
Thumbs up from me too! Might splash out on your book.
I think this article is a little optimistic. A lot of people are excluded from the programme, for example, people who have been diagnosed as having a personality disorder or being bipolar, or people who are thought to be at risk of self harm or neglect, or people with drug or alcohol problems, people who have been abused, etc. Different areas can make up their own exclusion criteria, for example, one area doesn’t want people “with multiple life problems having an impact on everyday functioning which reduces ability to engage in therapy”, people who are in a “current mental health crisis or distress” or who have a “history of recurrent treatment failure &/or recurrent lack of engagement with treatment services” which doesn’t sound very friendly or welcoming. If you get through the phone screening process you will most likely get about half a dozen sessions of CBT, either phone, face-to-face, group or computerised. The next most likely thing on offer is guided self help. A lot of people don’t go back after the first session, leaving only about 40 per cent of referrals to complete a course of treatment with completion rather generously defined as having more than one session. In deprived areas it is even lower. Recovery is defined as going from above the cut-off line for “caseness” on a depression and an anxiety rating scale. Meanwhile the use of drug treatment for depression and anxiety continues to rise.
Nice to see an article that interviews John Read and doesn’t then produce a psychiatrist to contradict everything he says. And nice too to see a picture of John Read instead of Jack Nicholson (although they rather spoil it with a stock photo of a man in a white coat). But….
Although the statistics are true (I will take their word for the latest ones) they have presented them in a slightly misleading way, comparing an unusually low year with an unusually high year (blip or beginning of a trend?)
It didn’t mention this in the article but Northern Ireland is the only part of the British Isles (England, Wales, Scotland, Northern Ireland and the Irish Republic) that still allows psychiatrists to use ECT on patients who are categorised as “capable” and have decided they don’t want ECT. Neither did it mention the fact that in Northern Ireland ECT is almost always bilateral.
The Independent article was published on 5 July. On 10 July (coincidence?) the Daily Mail published an article http://www.dailymail.co.uk/health/article-4683390/Do-live-work-narcissist.html
by Dr Max Pemberton all about how personality disorders are nasty diseases but never mind there are treatments available. The Daily Mail unfortunately has a lot more readers than the Indie.
Interesting point. In the UK it always used to be the case that ECT was prescribed by consultants and then administered by trainee psychiatrists often with very little training or supervision – almost like an initiation. By the time they got to the position of being able to prescribe it themselves did they think well it must be harmless or otherwise they wouldn’t have let me loose on patients with no training? Perhaps nowadays they get bit more training, but I think it is rare for consultants to be involved with the actual administration of ECT.
I haven’t actually listened to it as my computer doesn’t have sound. But here are a couple of interviews with Tania which may explain more.
I don’t know if she is still having maintenance ECT but since she has had maintenance ECT over quite long periods it would suggest that treatment, or at least courses of ECT, have not completely resolved the problem. In both articles she says that she has bipolar disorder.
Here is another one from a few days ago
That is England where it is nearly half. In the US it is much lower. I think in Texas (one of the few states where statistics are available) it is only a very few people who are treated without their consent. Although of course you can wonder about how valid the consent of the majority is.
Thanks for inspiring article Niall. And the one you linked to is even better. Gob of snot – is that the patient or the psychiatrist? Just a slight quibble: I think it is a little premature to talk about a “comeback” in England, where ECT use has been declining for at least four decades. Maybe the decline is levelling off but early days yet. The odd thing about ECT use in England, compared to for example US, is that nearly half of ECT patients don’t consent to it.
Talking of white coats – is that the review author in the photo? Wearing a white coat to give a powerpoint presentation?
A very interesting article. Is there any chance of getting anything corrected in the review?
In England over half people given ECT are detained under the Mental Health Act. A few of them consent to ECT but most of them don’t. In total about 40 per cent of people who undergo ECT in England don’t consent. They are supposed to all be incapable of consenting. The law changed a few years ago so psychiatrists couldn’t give it to people who were capable and didn’t consent. Interesting information about Queensland.
In a recent ECT study there was another person who had seizure and status epilepticus (and survived).
Though interesting what he says about people reporting memory loss. The recent ketamine and ECT study in England asked four months after ECT how it had affected their memory – better, no change or worse. 3 said better, 16 no change, 18 said worse.
Thanks Peter for highlighting this article. I can only see first page but the author seems to being saying much the same as other psychiatrists. There is a bit about NICE guidelines in England but no mention of fact they are ignored. Maintenance ECT is used here. And I notice the author’s English hasn’t been corrected. Is it considered bad form nowadays to correct English or do journals no longer employ proof-readers or sub-editors?
Sylvain if you go here http://www.thymatron.com/downloads/somatics_brochure.pdf
to an ECT machine manufacturer’s brochure and scroll down to the one-page advanced ECT course (!) it gives a list of electrical parameters.
And here is a list for 1939-1973 from an ECT machine manufacturer (RJ Russell in England) writing in 1988 about how his machines have improved since early days.
Assuming 300 ohm load
pulse width 3ms
peak voltage 198
current amps 0.66
frequency 100 per sec
time 1 sec
Wave form was sine, nowadays brief pulse.
I had a run-in with this team years ago – it must have been an earlier study – about their methods of recruiting children from schools. I always had my doubts about them.
I have just read the article in Schizophrenia Bulletin and I didn’t pick up that he was making an apology; it seemed more like a “my interesting career” article. And it is still all about D2 receptors whatever it is that messes them up. Nothing about people. Did he have patients? Or was his work purely laboratory? What did he get a knighthood for?
Thank you Rai for this article. I haven’t seen the documentary but I did read some reviews of it at the time. Another of Alain Gregoire’s patients is featured in the Daily Mail today:
” ‘I will probably be on medication for the rest of my life. ‘I’m happy about that if it makes me a good mum.’ ”
Read more: http://www.dailymail.co.uk/femail/article-3981260/Brighton-mother-sectioned-post-birth-psychosis-left-convinced-medics-trying-steal-son.html#ixzz4RUVlkx8Q
Has anyone seen a documentary from about 50 years ago called Towards Tomorrow featuring William Sargant? It would be interesting to compare the recent documentary with that one and see what has changed and what hasn’t. I have only seen short extracts but I seem to recall William Sargant telling a young woman to keep taking her medication.
Kermit are you going to do a follow up to this story?
I am having difficulty understanding the significance as well. If you look for example at the submission by Steve Seiner and colleagues at McLean Hospital
they say they give over 10,000 treatments a year. So being in level 3 obviously isn’t restricting its use at McLean Hospital, or indeed, other hospitals that use ECT.
By the way, who is paying the lawyer for the citizen’s petition?
Thank you John for mentioning this book. I hadn’t heard of the author but looked her up and have now read one or two newspaper interviews she gave. What quite surprised me is that when she turned up at a NHS hospital she was taken off most of the drugs, rather than being seen as having “treatment resistant depression” and needing ECT.
In the UK there are still plenty of people who are prescribed benzodiazepines for longer than 2-4 weeks, in spite of the official advice:
“between 20 and 25% [of about 11 million prescriptions by GPs annually] of hypnotic prescribing is for quantities greater than 28 units and appears to be at odds with the advice to limit the duration of benzodiazepine hypnotic treatment to two to four weeks.”
Some people have been on them for years. Apart from anything else, aren’t they thought possibly to increase the risk of dementia? Not that anyone can be sure about it.
“Hitler quoted the Eugenic Societies of the United States when he concluded that the creation of progeny should be based on what would be injurious to the racial stock. ”
Is this sentence missing something?