Today, "Classics in ECT" presents this landmark paper by Max Fink and Jan Otto Ottosson from 40 years ago:
A theory of convulsive therapy in endogenous depression: significance of hypothalamic functions.
Fink M, Ottosson JO.
Psychiatry Res. 1980 Mar;2(1):49-61.
- PMID:
- 6106253
cogent and relevant today, among the few other competing, and complementary theories.
This paper harkens back to the time when the dexamethasone suppression test (DST) nearly became the first
laboratory diagnostic test in Psychiatry. Whether its failure was mainly political or scientific is debated
to this day.
to this day.
This comment is from Max Fink:
ReplyDeleteNeuroendocrine theory
In the 1970s the Kety/Schildkraut neurotransmitter and the Carroll neuroendocrine theories in depression were both active. They were in the shadow, however, of the conflicts between biologists and psychologists for the heart of psychiatry. DSM-III committees attempted to biologize the labels. Attempts to distinguish melancholia (biology) from anxiety/depression (neuroses) failed and the mixed class of MDD was created encouraging psychologic aspects of depression and assuring psychotherapy and medications created on the basis of neurotransmitters were the focus of interest. To assure that psychology survived, all tests were precluded -- no diagnosis was to be based on tests. Subsequent APA and NIMH political meetings assured the neuroendocrine tests were relegated to research, not to the clinic.
The neuroendocrine theory grew out of the efficacy of ECT in relieving melancholia, simultaneously normalizing the abnormal DST.
Studies of the mechanism of ECT are focused on brain imaging, neurostimulation, and changes in incidental biologic tests. JECT 30(1) in 2014 is dedicated the mechanism of ECT. The remarkable efficacy of ECT in melancholia, catatonia, and delirious mania is an ongoing challenge that warrants renewed interest.
Max Fink