Classics in ECT: Swartz LTE-"Programmed Seizures"
"Classics in ECT" brings you this LTE from the Green Journal in 1993:
ECT will stand on its own merits, and the name is but a minor part of the stigma problem.
ECT plus Antidepressants: a Review
Out on PubMed, from researchers in Rotterdam, The Netherlands, is this review: Influence of an adjuvant antidepressant on the efficacy of electroconvulsive therapy: A systematic review and meta-analysis. Pluijms EM, Kamperman AM, Hoogendijk WJ, Birkenhäger TK, van den Broek WW. Aust N Z J Psychiatry. 2020 Sep 8:4867420952543. doi: 10.1177/0004867420952543. Online ahead of print. PMID: 32900217 Here is the "Conclusion" section from the text: Our results suggest that an adjuvant antidepressant enhances the efficacy of ECT in patients with major depression. Although the included studies had some methodological limitations, effect sizes were consistently small to moderate. We speculate that modern-day controlled trials using adequately dosed TCAs and MAOIs will most likely result in larger effect sizes. From a clinical point of view, we prefer an adjuvant TCA to an adjuvant MAOI, since TCAs are generally safe to use with ECT ( American Psychiatric Association, 2001 ; ...
The below comment is from Dr. Max Fink:
ReplyDeleteProgrammed Seizures Jan 24, 2021
"A rose by any other name would smell as sweet."
The tragedy in our history of induced seizures as therapy was the ease of seizure induction by electricity. While the early therapists recognized the core benefits to come from the seizure -- its effects on the ictal and interseizure EEG, the changes in systemic hormones -- they knew that electricity was a switch, not essential or necessary to the behavioral outcome. They had experience with chemical (Metrazole, PM-1090) and inhalant (flurothyl) induced seizures. They recognized that memory effects were transient. "Seizure therapy", "convulsive therapy" were common professional terms.
When I published my review of 40 years research in seizures, I chose "Convulsive Therapy" for its title.1 In 1985 I launched the new journal "Convulsive Therapy". A year later the IPAAE changed its name to "Association for Convulsive Therapy."
A decade later, the psychologists' cries of "memory loss, memory loss", their attempts to reduce such effects (though recognized as transient and irrelevant to benefits) by fiddling with electricity, and the industry creation of TMS, tDCS, VNS as "forms of ECT without its memory effects" took over the Journal's name, the ACT name, the focus of interest from the EEG and endocrines to electricity.
So degenerated is the name for Meduna's treatment that the JECT just published an article from the Mideast that listed various names for the treatment, omitting "convulsive therapy" alltogether.2 (My puzzlement is how this article was favorably reviewed by JECT reviewers.)
The treatment has weathered the Covid epidemic, the denigration of clinical psychiatry by psychology, and is more accepted worldwide as an effective instrument in patient care, regardless of its name. I assume that ECT is as good a label as any, provided we recognized that the "E" is just the light switch, energizing the brain seizure/convulsion that is evidence of the neuroendocrine effects that alter patients' behavior.
Max Fink
1. Convulsive Therapy, Theory and Practice. NY: Raven Press, 1979
2. Sidhom E, Omar M. Nomenclature of Electroconvulsive Therapy. JECT (in press).