ECT statistics For anyone who is interested in ECT statistics can anxiety panic attacks cause high blood pressure

This month’s edition of the new yorker features an article about the writer dan mallory: “A suspense novelist’s trail of deceptions” by ian parker. Mallory, writing under the name of A.J. Finn, is author of best-selling thriller the woman in the window, published in 2018. (I haven’t read it). The article describes how mallory has invented various stories about his own life, including claims that he had cancer and that he had a phd from oxford university. It also describes how mallory has spoken about having undergone ECT on more than one occasion:

Mallory said that once, in order to alleviate depression, he had undergone electroconvulsive therapy, three times a week, for one or two months.

It had “worked,” mallory noted, adding, “I’m very grateful.” he said that he still had ECT treatments once a year. “you knew he was telling us something that was really true,” scott recalled. In the room, there nanoxia project s was “a huge surge of sympathy.”

Mallory had frequently referred to electroconvulsive therapy before. But, in those instances, he had included it in a list of therapies that he had considered unsatisfactory in the years between 2001, when he graduated from duke university, and 2015, when he was given a diagnosis of bipolar II disorder, and found relief through medication. In a talk that mallory gave at a library in centennial, colorado, soon after his nanoxia deep silence 3 book’s publication, he said, “I resorted to hypnotherapy, to electroconvulsive therapy, to ketamine therapy, to retail therapy.””

Nearly forty-five years ago the new yorker published a long article about ECT by medical writer berton roueché (annals of medicine: as empty as eve, 9 september 1974). The article described the experience of a government economist who had become depressed following disastrous dental treatment and undergone a course of ECT. The treatment left her with memory loss and she was unable to resume her work. The article lets the woman who had undergone ECT speak for herself, through interviews and extracts from letters she had written while in hospital. The author gives some background about ECT and quotes from the writings of several psychiatrists showing a lack of agreement on the extent of memory following ECT. The article ends with the following words about memory loss: “if I hadn’t been a professional woman – if I hadn’t been a woman with a highly specialized and demanding job – I might never have realized the extent of my amnesia. I would have thought that I was still perfectly whole and complete”.

On 31 january 2019 the british medical journal published a report on the recent maudsley debate on electroconvulsive therapy (ECT). I have discussed the debate in a previous post. As soon as the british medical journal published the debate, the science media centre sprang into action, with four “experts” weighing in with a quote – all in favour of ECT.

The science and media centre is a charity, which aims to “promote for the benefit of the public accurate, evidence-based information on science and engineering in the media brain anoxia recovery, particularly on controversial news stories”. The charity’s latest annual accounts (for 2017/18), available on the charity commission website, show an annual income of £627,000. The accounts do not tell us where this money comes from. However the charity’s website lists their funders, the major ones being the government and the wellcome institute.

The report however does not tell us who those organisations are. From the list of funders diffuse axonal brain injury treatment the following organisations can be identified as having a specific interest in psychiatry: mental health research UK, alzheimer’s research UK, alzheimer’s society, MQ transforming mental health, royal college of psychiatrists, institute of psychiatry, psychology and neuroscience (ioppn), and the maudsley charity. There are many more funders – universities, pharmaceutical companies, cochrane, NICE, etc. – whose interests will include psychiatry.

I have only been able to positively identify one funder – the maudsley charity. On their website they say that they provided a grant to the science media centre towards the cost of “supporting an independent press office to enable and encourage mental health researchers to engage with the media on key mental health issues. Helping secure accurate coverage of controversial, messy and complicated issues”.

Given that psychiatrist sir simon wessely is a trustee of the science media centre, and given the nature of its funders, it is hardly surprising that the charity should, when it comes to matters concerning psychiatry, look like an extension of the royal college of psychiatrists social anxiety disorder icd 10’ press office. Hardly surprising too that all four of the “expert comments” produced for the item on ECT come down firmly on the side of ECT.

“despite this lack of evidence for ECT-induced brain damage, many people experience cognitive problems, including memory difficulties after ECT. These cognitive problems are real and should not be disregarded. In fact, we know that long-term memory and concentration difficulties are a core feature of neuropsychiatric disorders themselves and thus exist before ECT is commenced. This highlights the need for novel treatments that can improve cognitive function in people who have suffered from neuropsychiatric conditions like depression.”

I have not been able to make head nor tail of this. First, she seems to be acknowledging that ECT causes cognitive and memory “difficulties” although she wouldn’t class these as evidence of brain damage. But then she appears to backtrack and say that these “difficulties” are in fact caused by depresssion. As for the last sentence – what on earth does it mean? In an attempt to answer this question I decided to look for other evidence of miskowiak’s views on ECT.

I didn’t have to look far. Miskowiak is currently carrying out a trial in denmark: “erythropoietin as an add-on treatment for cognitive side effects of electroconvulsive therapy: a study protocol for a randomized controlled trial.” the title says it all: “cognitive side effects of electroconvulsive therapy”. But if this isn’t enough there are numerous mentions in the text of ECT-induced cognitive deficits and the cognitive side effects of ECT. So why has she changed her tune for the science media centre, with an attempt to shift the blame for cognitive deficits on to “neuropsychiatric conditions like depression”? Perhaps she thought life expectancy after anoxic brain injury that this was more in line with the requirements of the science media centre.

In october 2017 the scottish ECT accreditation network (SEAN) published a leaflet about electroconvulsive therapy (ECT). It claims to present “the latest evidence” but in fact it is a reprint of a leaflet published in 2000 with a few numbers changed. But not enough numbers have been changed; for example the leaflet starts off by claiming that “ECT has been used in scotland for half a century”. That might have been more or less true in 2000 but by 2017 ECT has been used in scotland for over 70 years – hardly “half a century”. The leaflet continues:

Then comes a brief but rather bizarre “history of ECT”, unchanged since 2000, which makes the claim “a great deal is known about how it works”. A section on “when is ECT used?” remains largely unchanged, in spite of the significant decline in its use, while a section on “what safeguards are there?” has added a mention of guidelines on the use of ECT by the national institute for clinical excellence.

The next sections, dealing with the law and ECT, you might think would be very different as, between the 2000 and 2017 versions, the law was changed to give anoxic brain injury survivors patients deemed to have capacity the right to refuse ECT. But in fact the earlier version of the leaflet blurred the issues around consent, so the addition of “capable people cannot be given ECT against their will” does not appear to make much difference.

The rest of the leaflet is more or less unchanged and attempts to convince readers that ECT doesn’t cause brain damage and to dismiss controversy over ECT as down to “misinformation”, with, ironically, a warning about not believing everything you read on the internet. Exactly! A booklet claiming to be “designed to give an impartial presentation of the current evidence and advice on ECT” may in fact be a rehashed version of a leaflet that is more than fifteen years old. There is nothing, by the way, to alert readers to the fact that this leaflet was first published in about 2000, neither is it clear who the author is. The previous version listed a the SEAN management team and thanked ian kellagher for “his work in the drafting of this booklet” while the more recent version simply lists the current SEAN management team.

Three recent pieces anxiety attack treatment nhs news from the united states have highlighted the controversy surrounding electroconvulsive therapy (ECT). While the food and drug administration (FDA) has downgraded ECT machines from class III to class II risk in certain circumstances, and the national institute on aging (NIA) has awarded researchers a $11.8 million grant to experiment with ECT to control behaviour in people hypoxic brain injury after cardiac arrest with dementia, the maine legislature is considering a bill to restrict the use of ECT.

I have written before about the history of the FDA and ECT machines (for example here). In december 2018 the FDA announced that it was reclassifying ECT machines “ for the treatment of catatonia or a severe major depressive episode associated with major depressive disorder or bipolar disorder from class III (higher risk) to class II (moderate risk) with special controls”.

The NIA grant to study the use of ECT in the control of agitation and aggression in dementia is being divided between mclean hospital, emory university, mayo clinic, pine rest christian mental health services and northwell health. I have written before ( here) about the use of ECT to control behaviour in people with dementia at mclean hospital, pine rest christian mental health services, and at emory university wesley woods geriatric hospital.