Provides No Benefit to Patients
The very concept of evidence-based medicine is shown to be nothing more than a very bad joke—one in which the butts of the joke are people at greatest risk, those who have been defined by psychiatry through the magic of the DSM as suffering from nonexistent disorders.
by Heidi Stevenson
3 January 2011
Page 1
Does ECT Prevent Suicide?
Citing several studies that make the claim, the authors state, "The claim that ECT prevents suicide is a cornerstone of the case for ECT." There are, though, no placebo-controlled studies that demonstrate it. The New Zealand government reported in 2004 that they had found "no definitive randomised evidence that ECT prevents suicide."
There are no studies that compare suicide rates between ECT and placebo. Other studies that looked at suicides either found no benefit with ECT or had serious flaws. In one study, done during the 40s, only a third of the group with induced convulsions had been treated with ECT. Convulsions of the rest had been induced by a drug. In another, the untreated group had been diagnosed with far more significant mental illness. One NIMH study didn't address suicides; instead it looked at thinking about suicide (suicide ideation), a different issue, and even combined thinking of suicide with attempting it.
Two studies actually showed increased suicides in people who had been treated with ECT. However, the authors discounted those because treatment was not randomized, there was no placebo, and it was possible that the patients who had received ECT were more suicidal in the first place.
Studies have not demonstrated that ECT prevents suicide. It appears to be nothing more than wishful thinking in its supporters.
Does ECT Cause Death?
ECT can and does cause death. The authors are very blunt about the APA's claim that only up to 4 deaths per 100,000 result from ECT. They state, "This is false," and then go on to document just how false it is. They found the following:
Impastato study, 1957: 1 death in 1,000 treatments, 1 death in 200 treatments over age 60.
Frank study, review of 28 articles in which psychiatrists spontaneously reported deaths, 1978: 1 death in 1,447 treatments.
Shiwach et al, 2001: 1 death in 1,630 treatments. If 8 deaths of "cardiac events" within two weeks are included (typical ECT-caused deaths), it's 1 death in 627 treatments.
1980 survey of British psychiatrists to report ECT-related deaths: 1 death in 648.5 treatments within 72 hours of treatment. If additional 6 who died within a few weeks of ECT, including 2 from heart attacks and 1 from stroke (2 of the most common ECT-related deaths), the rate is 1 death per 371 treatments.
Norwegian study (Stensrud, 1958): 1 death in 298 treatments.
Does ECT cause death? The answer is absolutely yes.
Does ECT Cause Memory Dysfunction?
There is very little disagreement about the reality of memory loss from ECT, so it isn't a major focus here. However, it wasn't until 2007 that a large scale study was initiated, well over 50 years after ECT had been initiated and claims of memory loss were so common that it had become virtually common knowledge. It was done by Harold Sackeim, who is a major advocate of ECT.
The study documented significant autobiographical memory loss both immediately after ECT and six months later. The number of shocks was directly related to the amount of loss.
Anterograde amnesia, the inability to retain new information, occurs in nearly everyone subjected to ECT. Studies vary in how severe the damage is and how long-lasting, but it appears that long term and permanent loss are not rare.
There's a claim among ECT proponents that memory dysfunction is a factor of depression, not ECT. They call it "subjective" memory loss. This is, of course, based on a desire to believe it, since there's no documentation to that effect. The authors point out that only one study has found a connection between mood and memory loss, while several have shown no connection. Regarding the single study indicating a connection between depression and memory loss, the authors point out:
Even if there was a correlation the causal relationship might have been in the other direction. It can be depressing to lose one's memory.
Obviously, that's true.
Does ECT Cause Brain Damage?
As Read and Bentall point out, "Evidence that the adverse effects of ECT are not imaginary or subjective is provided by studies documenting brain damage (Breggin, 1984; 2008; Frank, 1978; Friedberg, 1976; 1977; Sterling 2000). They then point out that one report they describe as a "diatribe against 'the old myth about ECT and brain damage'" referenced only one human ECT study that, though it didn't find the only thing it looked for, ventricular enlargement, did find "an increase in subcortical hyperintensity due to cerebrovascular disease".
The authors then point out that the original belief about ECT in the '40s was that it worked by causing:
...brain damage and memory deficits. In 1941, Walter Freeman, who exported ECT from Europe to the U.S., wrote: "The greater the damage, the more likely the remission of psychotic symptoms. … Maybe it will be shown that a mentally ill patient can think more clearly and more constructively with less brain in actual operation.
The paper they quote from was titled, "Brain damaging therapeutics".
Autopsies in the '40s consistently showed brain damage, including necrosis. The Lancet wrote of ECT-induced hemorrhages, concluding that "all parts of the brain are vulnerable—the cerebral hemisperes, the cerebellum, third ventrical and hypothalamus".
The authors quote Karl Pribram, head of Stanford University's Neuropsychology Institute:
I'd rather have a small lobotomy than a series of electro-convulsive shock … I just know what the brain looks like after a series of shock—and it's not very pleasant to look at.
Finally, the authors point out that recent CT scans have revealed an increase in frontal lobe atrophy in ECT subjects.
Any Questions About the Safety or Efficacy of ECT?
Read and Bentall conclude:
There is no evidence at all that the treatment has any benefit for anyone beyond the duration of treatment, or that it prevents suicide. The very short-term benefit gained by a small minority cannot justify the significant risks to which all ECT recipients are exposed.
The continued use of ECT therefore represents a failure to introduce the ideals of evidence-based medicine into psychiatry. This failure has occurred not only in the design and execution of research, but also in the translation of research findings into clinical practice. It seems there is resistance to the research data in the ECT community, and perhaps in psychiatry in general.
Outside of industry-sponsored studies to promote the use of pharmaceutical drugs and related products, it's rare to see such blunt commentary. It's quite clear that electroconvulsive treatment is, at best, useless beyond the very short term, and at worst, it both destroys quality of life and life itself. There is no justification for such medieval treatment.
The very concept of evidence-based medicine is shown to be nothing more than a very bad joke—one in which the butts of the joke are some of the people at greatest risk, those who have been defined by psychiatry through the magic of their Diagnosis and Statistics Manual (DSM) as mentally defective.
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