Does anyone know anything about transcranial magnetic stimulation? It's a treatment for depression which involves wearing a device that uses magnetism to create a small electrical current in the brain. I noticed while writing a blog post that it's just been granted a licence for use on people with severe depression in the US. What happens over there tends to make it over here eventually so I wondered what people thought about this new approach to treating depression.

That feels much better. I can agree with you on something get1.

ECT is a brilliant treatment if properly targeted - even if we don't quite know how it works.

It's unusual to hear such unchallenged support for ECT - it usually generates something of a controversy, with some strong support and others pointing to memory loss and only a temporary antidepressant effect. I don't know enough about the science to know exactly how TMS relates to it, but as I understand it TMS is more along the lines of a regular but tiny charge to the brain to stimulate certain chemical activity rather than the "re-boot" produced by ECT. 

There's some research being undertaken by the the Institute of Psychiatry which may tell us more in time. 

Here's an interesting footnote about TMS - it's been used to partially rouse a man from a coma, apparently.

simeon2:

It's unusual to hear such unchallenged support for ECT - it usually generates something of a controversy, with some strong support and others pointing to memory loss and only a temporary antidepressant effect. I don't know enough about the science to know exactly how TMS relates to it, but as I understand it TMS is more along the lines of a regular but tiny charge to the brain to stimulate certain chemical activity rather than the "re-boot" produced by ECT. 

There's some research being undertaken by the the Institute of Psychiatry which may tell us more in time. 

I would like to mention here that my support for ECT was for properly targeted ECT - not for the indiscriminate use of this treatment that is so often criticised.

Having been involved many times in the administration of ECT over the years I am convinced that several people I know would be dead now without it. However that doesn't mean that it is without it's problems. It's simply that for some forms of apparently endogenous depression it seems to be the only currently available treatment that actually works. I wouldn't advocate it's use in psychosis as some do but in profound 'endogenous' depression it can work wonders.

Please remember that it is only 2008. We don't know everything yet (we never will) and until better alternatives arrive (perhaps trans cranial stimulation will fit the bill) it's not good to throw the baby out with the bathwater.

Cheers,

Stuart

I don't like ect so many people say yes to it because they desperately want to get better and the professionals are advocating it so they think the professionals must know best, and they don't know enough about the side effects and live to regret their decision. These people are pawns in the hands of others. They need to be given all the information and be offered choices imo

BBHG:

I don't like ect so many people say yes to it because they desperately want to get better and the professionals are advocating it so they think the professionals must know best, and they don't know enough about the side effects and live to regret their decision. These people are pawns in the hands of others. They need to be given all the information and be offered choices imo

These are all very reasonable points BBHG. But tell me, how is any of that different from other forms of treatment for depression?

It seems to me that you're complaining against a sloppy process of obtaining informed consent that applies to all forms of treatment (and a lot more besides).

What makes properly targeted ECT any worse than antidepressant medication which, let's face it, can be fatal, can affect libido, stop menstruation, cause impotence, cause extreme weight gain and some would claim cause people to commit suicide as well?

Stuart Sorensen:

These are all very reasonable points BBHG. But tell me, how is any of that different from other forms of treatment for depression?

What makes properly targeted ECT any worse than antidepressant medication which, let's face it, can be fatal, can affect libido, stop menstruation, cause impotence, cause extreme weight gain and some would claim cause people to commit suicide as well?

1)  I've not known of any cases where people were given ect as the sole treatment, so you are using ect as well as the other forms of treatment so are increasing your side effects

2) Side effects of other treatments such as medication usually last for the duration of the treatment, or sometimes for a short while at the start of the treatment whereas with ect the side effects are often permanent

3) The benefits of ect are often temporary and usually provide benefits for a limited time only and you are then back to square one

 BHHG,

I think we both agree that there is an issue about informed consent that is common to all treatments. At least you didn't contradict me when I made that point so I'll assume you accept it. That leaves us with....

You said....

1)  I've not known of any cases where people were given ect as the sole treatment, so you are using ect as well as the other forms of treatment so are increasing your side effects.

This is because ECT is not a front line treatment. If properly used it is a 'last resort' treatment so of course we'll continue other anti-depressants because it's designed to kick start their effects. It is used in cases of profound depression to effectively 'kick start' the brain chemistry to allow people otherwise moribund or suffering from psychomotor retardation to begin to benefit from more traditional treatments. Why discontinue something that will take a month to return to therapeutic levels when the whole point is to boost the therapeutic effect of that antidepressant in the first place? To give ECT without concurrent antidepressants would be pointless and therefore cruel precisely because it is "the sole treatment".

2) Side effects of other treatments such as medication usually last for the duration of the treatment, or sometimes for a short while at the start of the treatment whereas with ect the side effects are often permanent.

Which side effect do you mean BHHG? Is that the short term memory loss. So there are a few hours of profound depression that I will never be able to remember. Guess what - most people don't remember every moment anyway and certainly not when profoundly depressed. But, given that memory loss does occur for the few hours around ect administration let's consider just what is lost. A few hours of misery are forgotten as the price to pay for a lift out of depression that allows a person to permanently regain their life - you see the positive effect can be permanent too but only if combined with other treatments such as either anti depressants or psychotherapy or both.

Incidentally your assertion that side effects of other medications are temporary is badly flawed. Actually with the exception of not remembering a few miserable hourts of profound depression you are much more likely to suffer permanent side effects from pharmacology than form ECT.

3) The benefits of ect are often temporary and usually provide benefits for a limited time only and you are then back to square one

This isn't specifically the case for ECT. Some people recover permanently from depression and some relapse. Why single out ECT for this criticism. The actual problem here is that no treatment guarantees a permanent cure for depression. To attempt to make a single treatment responsible for a wider problem is disingenious and smacks of the sort of prejudice fuelled by newspaper reports and works of fiction such as 'one flew over the cuckoos nest'.

Anyway - ETC isn't designed as a long term treatment (actually it was never really designed at all but that's another story). ECT is used as a short term kick start to allow other treatments to work.

I'm not an advocate of the biomnedical model by any means but there is a genuine problem here. Profoundly depressed people kill themselves. That's bad. For some people there is no realistic treatment other than ECT because there depression is so profound.

ECT may not have a nice reputation but that doesn't mean it is barbaric whatever the Daily Mail says. And it does save lives.

Can I suggest that you see if you can get a placement during your training that will allow you to observe administration of ECT. I think you'll be surprised at the rather less than barbaric process involved. You might also find the change in the patients' mental states quite inspiring too.

 Cheers,

Stuart

People can lose months of memory around the time of ect administration and if their children are babies and children and the memory of them disappears it is distressing. That distress as the memory never returns is ongoing, people can lose long periods of time worth of memory, not just hours. I have seen ect administered and seen the results, and the result I saw may have been temporary improvement but I have seen the long term effects of the loss of memory. I think professionals can be unaware of the long term effect as the contact with the service user is lost as they are discharged or move on.

You make some fair points there BBHG. Especially the notion of losing touch - what we call 'the clinician's illusion' where we assume that what we see is all there is to see. This is a very real phenomena.

However there is still a genuine difficulty here. There are some people for whom other treatments just do not work.

I agree that ECT should be a properly targetted last resort approach but given the difficulties of motivating a moribund person or even ensuring traditional medication adminsitration in these circumstances what alternative would you suggest?

I'd imagine that the psychiatric last resort of ECT is comparable to the social workers' last resort of removing children from families. It's a response to a problem we haven't caused but we have a duty to try to deal with when nothing else seems to fit the bill.

Does that make sense?

What else would you suggest in these sorts of extreme circumstances?

Cheers?

Stuart

Stuart,

First of all I'd like to thank you for 'hearing me' when my views are different from yours.

I'm not saying that ect should never be used, I think if used as a last resort, and literally that when everything else has been tried for a good period of time, and lives are in danger then yes, try it. The people I know though who have had ect were never offered any talking therapies or counselling at any stage, so the ect was not the last resort for them.

I think ect is often seen as a quick remedy, and a cheap one at that so is given way before the last resort that we should desire it to be.

Going back to the op maybe this Transcranial magnetic stimulation would have a similar perhaps slower or lesser effect but nevertheless an effect, but without the memory loss side efects - who knows.

Thankyou also for hearing me.

Actually I don't think we really disagreed at all b