Depression Treatment News
Controversial Shock Therapy Works for Depression
Natasha Tracy and the Bipolar Burble welcome Steven Schwartz, the BiPolar Badger as a guest blogger this week. Steven will be speaking from the point of view of someone who has chosen to get electroconvulsive therapy treatments and is in the middle of his current series of electroconvulsive therapy treatments.
Electroconvulsive Therapy Primer
Electroconvulsive therapy (ECT) is the second most controversial medical procedure. (Abortion is the first.) Certainly when I write about ECT it seems to prove the controversy of this topic. And it doesn’t matter what I say about ECT, even if it’s not pro or con, people insist on expressing very strong viewpoints on the use of ECT.
And generally the strong viewpoints are anti-ECT. They are from the ECT-is-torture crowd. A prevalent crowd online, to be sure, but someone needs to actually talk about the facts of ECT.
ECT Saves Lives
ECT saves people absolutely nothing else can. And if you have ever looked down the long, dark, hallway of treatment only to see a black hole, you would know how essential it is to have it as an option.
I know people don’t want to hear this, but ECT saves lives. ECT brings people out of the deepest, darkest depressions that no medication can touch. ECT saves people who are suicidal. ECT saves people who are determined to kill themselves while in the hospital.
It is critical this be an option, no matter how untenable it may be.
ECT Kills Brain Cells
That being said, electroconvulsive therapy induces a clonic seizure in the brain. You won’t feel it, you’ll be under anesthesia and other medications, but the whole point of treatment is to produce a seizure. And seizures cause brain damage. A friend of mine who’s epileptic will tell you how that goes. He spends an awful lot of time trying to prevent brain-damaging seizures.
ECT can cause memory loss and cognitive deficit. Mind you, there’s not a lot of science to back that up the kind of dramatic stories typically touted online.
ECT Can Offer Hope. ECT Can Cause Problems.
In the end, ECT is a gamble. You are doing something unpredictable to your brain. Bad things could happen. Very bad things, in fact. But nasty treatments for severe, intractable depressions are like that. If depression could be cured with lollipops it wouldn’t be a problem, but to the best of my knowledge, lollipops don’t have a very high success rate.
Modern ECT is Safe and Effective
There is no point in comparing modern ECT with ECT from 30 years ago. Everything has changed.
Which is to say modern ECT is safer and more effective than ever before (safety and efficacy are relative). Every year we learn more about the brain and how to target specific areas for treatment. It is now common to see ultra-brief-pulse unilateral ECT rather than bilateral ECT. This means the current runs through a small portion of your brain comparatively. Still a gamble, no doubt, but we’re getting better.
Anti-Psychiatry and Anti-ECT People Are Vocal
I have no doubt ECT has gone very wrong for some people. I have no doubt it has been terrible. It may very well be the case ECT has caused long-term problems. But this small handful of people are the ones filling up all the space on the internet. One person’s experience, good or bad, cannot be the basis for the opinion of a treatment in general. Chemotherapy and radiation kill people. But people do it because they are facing a horrible disease. Just like those who choose ECT.
People Who Have Received ECT Are Ashamed
People who have received ECT are scared to say so.
People who have had electroconvulsive therapy are scared of being judged. They are scared of all the vocal people mentioned above. They are scared of all the people who think something brutal, inhumane and akin to rape saved their lives. I don’t blame them for being scared. Standing up to loud opponents about such a delicate and fragile subject is tough. People have enough problems.
People Shouldn’t Be Ashamed of ECT
But of course people shouldn’t be afraid of admitting they had ECT. They shouldn’t feel bad about a treatment that did (or didn’t, for that matter) help them.
There are people with positive experiences with ECT even if they aren’t shouting it from the rooftops.
Guest Blogger: Steven Schwartz, the BiPolar Badger
Which brings me to next week’s guest author: Steven Schwartz – the BiPolar Badger. Steve is in the middle of a series of six ECT treatments and he’ll be writing about his experiences thus far. Steve has had ECT in the past, has found it effective, and has chosen to do it again.
More on the BiPolar Badger:
Steven Schwartz is a former journalist living with BiPolar disorder and Borderline Personality Disorder. Writing about his personal experiences of life with Mental Illness to reduce its stigma, shame and misconceptions. Steven writes in a open, frank, humorous and sometimes brutally honest style as a way of showing the human side of living with Mental Illness.
I hope you’ll all join me in reading his guest post this week, for a view within shock therapy.
Online Messaging Provides Effective Follow-Up Care For Depression
Online messaging has been shown to be effective in providing follow-up care to patients suffering from depression, U.S. researchers say.
UPI reports that follow-up online messaging by trained nurses resulted in less depression among patients being treated for depression.
Dr. Gregory E. Simon, a Group Health psychiatrist and Group Health Research Institute senior investigator, says the study involved a randomized controlled trial of 208 Group Health patients.
Half had three online care contacts with a trained psychiatric nurse, and were significantly more likely to feel less depressed, take their antidepressant medication as prescribed and be more satisfied with their treatment for depression.
The patients in the trial were starting antidepressant medication prescribed by their primary care providers.
“While more Americans are taking antidepressants, the quality of care for depression remains among the lowest scores on the U.S. health care report card,” Simon said in a statement.
Online Messaging Provides Effective Follow-Up Care For Depression
“Especially in primary care, where most treatment for depression starts, not enough patients receive follow-up contact or take their antidepressant medication as prescribed.”
In previous studies, Simon and colleagues delivered organized care for depression via telephone calls.
Organized depression care includes systematic contact with patients, assessment of their depression and whether they are taking their antidepressant medication as prescribed, and guidelines for evidence-based care.
One such guideline is suggesting that the primary care provider change the dose, or add or switch to another medication, if depression or side effects bother a patient after a standard trial period.
For each phone contact with a patient, clinicians wasted a half hour playing “phone tag,” Simon said.
According to the authors, unlike phone calls, online messages require no simultaneous live contact, so they may boost the convenience and affordability of follow-up care.
Simon and colleagues found that secure, asynchronous messages within Group Health’s existing EMR can improve care of chronic conditions, and that patients being treated for depression are particularly likely to use online communication with their healthcare providers.
“We worried that patients might need live voice contact in real time to be understood and feel supported,” the researchers concluded.
“But this online care management helped these patients, even though they never met the trained psychiatric nurse in person or talked with her on the phone.”
The findings are published online ahead of print in the Journal of General Internal Medicine.
Elderly Depression – Key To Treating Depression Among The Elderly Disclosed
The numbers are, well, depressing: More than 2 million people age 65 and older suffer from depression, including 50 percent of those living in nursing homes. The suicide rate among white men over 85 is the highest in the country — six times the national rate.
And we’re not getting any younger. In the next 35 years, the number of Americans over 65 will double and the number of those over 85 will triple.
So the question becomes, how to help elderly depressed individuals?
Researchers at UCLA turned to a gentle, Westernized version of tai chi chih, a 2,000-year-old Chinese martial art. When they combined a weekly tai chi exercise class with a standard depression treatment for a group of depressed elderly adults, they found greater improvement in the level of depression — along with improved quality of life, better memory and cognition, and more overall energy — than among a different group in which the standard treatment was paired with a weekly health education class.
The results of the study appear in the current online edition of the American Journal of Geriatric Psychiatry.
“This is the first study to demonstrate the benefits of tai chi in the management of late-life depression, and we were encouraged by the results,” said first author Dr. Helen Lavretsky, a UCLA professor-in-residence of psychiatry. “We know that nearly two-thirds of elderly patients who seek treatment for their depression fail to achieve relief with a prescribed medication.”
In the study, 112 adults age 60 or older with major depression were treated with the drug escitalopram, a standard antidepressant, for approximately four weeks. From among those participants, 73 who showed only partial improvement continued to receive the medication daily but were also randomly assigned to 10 weeks of either a tai chi class for two hours per week or a health education class for two hours per week.
All the participants were evaluated for their levels of depression, anxiety, resilience, health-related quality of life, cognition and immune system inflammation at the beginning of the study and again four months later.
The level of depression among each participant was assessed using a common diagnostic tool known as the Hamilton Rating Scale for Depression, which involves interviewing the individual. The questions are designed to gauge the severity of depression. A cut-off score of 10/11 is generally regarded as appropriate for the diagnosis of depression.
The researchers found that among the tai chi participants, 94 percent achieved a score of less than 10, with 65 percent achieving remission (a score of 6 or less). By comparison, among participants who received health education, 77 percent achieved scores of 10 or less, with 51 percent achieving remission.
While both groups showed improvement in the severity of depression, said Lavretsky, who directs UCLA’s Late-Life Depression, Stress and Wellness Research Program, greater reductions were seen among those taking escitalopram and participating in tai chi, a form of exercise that is gentle enough for the elderly.
“Depression can lead to serious consequences, including greater morbidity, disability, mortality and increased cost of care,” Lavretsky said. “This study shows that adding a mind-body exercise like tai chi that is widely available in the community can improve the outcomes of treating depression in older adults, who may also have other, co-existing medical conditions, or cognitive impairment.
“With tai chi,” she said, “we may be able to treat these conditions without exposing them to additional medications.”