February 26, 2008

ECT Deserves A Press Release


ECT we try harder.jpg


Generally, most doctors think that ECT is a last resort treatment.  If the patient failed antidepressants, you could try ECT.  The assumption here is that the success rate with ECT would be higher (50%-90% according to studies) than with antidepressants (since they failed them.)

So ECT occupies a special slot in our brains-- stronger, but more dangerous and cumbersome.

Turns out, the 50-90% success is in uncontrolled studies.  In controlled studies, it appears that ECT is less effective in treatment resistant patients than in non treatment resistant patients. 

Well, duh-- they're the sickest people, so of course ECT will be less effective in them.  That's doesn't tell us anything new or useful.

A recent study in the Journal of Clinical Psychiatry, the largest of its kind, finds that prior treatment failure with antidepressants did not predict lower success rates with ECT.  Phew.

Well, if that was all there was, it would be a pretty pointless study.  And certainly not worthy of press releases.  You have to read them, to see how the authors spin the study:

They therefore conclude that given appropriate indications for ECT, "antidepressant medication resistance should not sway the clinician from providing this modality."

Read it again.  Just because you failed antidepressants, it doesn't mean you shouldn't try ECT.  Huh?  I thought that was specifically when you were supposed to use ECT?

"The implication of our study," lead investigator Dr. Keith G. Rasmussen told Reuters Health, "is that even if a depressed patient has not responded to one or more antidepressant medication trials, ECT still has acute success rates as high as for patients who have not had a medication trial before ECT."


That's some might nice sleight of hand.  Look how he phrases his comparison: "...ECT still has success rates as high as for those who have not taken meds."  See?  He's making your baseline clinical experience be all those patients you've put on ECT who have never been on meds, and saying that ECT in the medication resistant will be just as good.

That's the important part, read it again.

He is trying to implant in you the belief that there exists an entire group of patients for whom  you used ECT first line, before antidepressants.

---

Oh, I realize he's not doing it intentionally, nor is even conscious he is doing it.  But he is doing it nonetheless, because, as with all academia, the business isn't science, science is the business. There's nothing inherently wrong with what he is doing, but we should all be aware of it.


---

It's a product positioning strategy, Marketing 101.  You cannot take on a market leader head on, even if your product is "better" because, as the adage goes, "first beats best."  Royal Crown cola can't take on Coca Cola.   In order to succeed, you need to position your product as an alternative to the market leader.  How?  By admitting there is a market leader.

The classic positioning strategy described by Al Ries: "Avis: We're Number 2, We Try Harder" works for Avis because it sets itself up as an alternative to the market leader, as opposed to trying to take on the market leader.  In other words, the "We Try Harder" part-- the part everyone assumes is the reason they're going to be better-- is fluff.  The real positioning  is the first part: it admits it is not number 1, but consequently links it always to the number 1.  It forces your mind to create a mental slot for Avis that is as big as the one already occupied by Hertz.  It may be #2, but it carries as much weight as a brand in your mind as the #1.  And now you can't ever think about Hertz without immediately thinking about Avis.

Antidepressants occupy the "first line" position in the customer's (i.e. doctor's) mind. ECT can't compete directly with them.  But Rasmussen positions ECT as an alternative to antidepressants, one of equivalent value.  He doesn't say ECT is better than antidepressants-- a point which then becomes a debate-- he says there's no relationship to antidepressants.  It's an alternative to antidepressants, equal.  Go ahead and try, you have nothing to lose, they're all the same.






Comments

"Well, duh-- they're the si... (Below threshold)

February 26, 2008 3:48 PM | Posted by mark p.s.: | Reply

"Well, duh-- they're the sickest people, so of course ECT will be less effective in them."

Say Dr. how sick was the "patient" to start with (before seeinga psychiatrist and/or taking anti-depressents)? How do you measure that?

Did you explain to the patient that suicide is not a feeling?

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That is probably why I like... (Below threshold)

February 26, 2008 4:00 PM | Posted by Dr Shock: | Reply

That is probably why I liked reading this research. But it is also a counterweight to the research done by Sackeim who found ECT to be less effective in case of antidepressant treatment failure. Something we or other authors in Europe couldn't replicate. In our samples ECT wasn't less effective after antidepressant resistance. We thought it must be the patients selected or the health care system. But now research in the US also shows that antidepressant treatment failure doesn't mean less efficacy with subsequent ECT.
Regards Dr Shock

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Dont know where they came u... (Below threshold)

February 26, 2008 4:09 PM | Posted by AK: | Reply

Dont know where they came up with that study about antidepressants
being ineffective.

20 mg Celexa saved my ass. After months of feeling like shit, I am human again, and my emotions returned to normal range.

When a situation is sad, I feel sad. But I dont dive into utter abysmal despair.

If I'm angry or frustrated, I have the space to get curious about what's triggering these emotions and I can then start to utilize
CBT, where before I couldnt get enough of a grip on the emotions to even begin to apply the tools.

And, within 2 to 3 weeks of the Celexa, I resumed having dreams and they're tied in with my issues and yield clues that extend insight farther than before.

So..I may be an N of one, but they'll have to pry the Celexa from my cold, dead fingers.

And, I will gladly make a sworn and notorized statement that I am a private citizen and take not one cent from Big Pharma.

Glady you're back, LP. It was so long since we'd had a new article that I was afraid you'd been ill.

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Off-topic, but isn't ECT th... (Below threshold)

February 26, 2008 8:33 PM | Posted by Lucent: | Reply

Off-topic, but isn't ECT the equivalent of hitting someone in the head with a hammer, based on the side-effect profile? I always thought its intended use was for people who simply were too far gone to continue to exist as that person. Just keep zapping them to wipe out their personality and memories and such. Kind of like a death and rebirth but keeping the same body.

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Do you come up with these t... (Below threshold)

February 26, 2008 9:09 PM | Posted by Stephany: | Reply

Do you come up with these things while sitting in airports? I don't think Hertz when I see Avis I look for Budget when I see Hertz. Baseline for ECT vs. antidepressants.It's only efficacious when a patient believes in the treatment. Therefore, efficacy is questionable, based on choice. Same cars from Avis, Hertz, Budget. Equal outcome, person gets from point A to B. ECT & antidepressants, chemical altering of the mind or electric, same outcome, which could be good, better or best; or worse.

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hi... (Below threshold)

February 29, 2008 10:28 AM | Posted by Mr Spinks: | Reply

hi

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Hi I am an electroshock (EC... (Below threshold)

March 7, 2008 6:15 AM | Posted by Anonymous: | Reply

Hi I am an electroshock (ECT) survivor. I had 5 ECTs in 1973 given to me against my will. On my 5th ECT my heart stopped.

As a result of having had ECT, I now suffer from permanent memory loss and have difficulty learning anything new. Prior to ECT I had no difficulty in learning.

Dr. Peter R. Breggin wrote an article last year called "Disturbing News for Shock Doctors and Patients Alike". In this article Dr. Sackeim did a study proving that ECT always causes brain damage.
See the article at this link:

www.huffingtonpost.com/dr-peter-breggin/
disturbing-news-for-patie_b_44734.html

Dr. Breggin has a huge website at:
www.breggin.com He has lots of articles about the harm done ECT and articles about the harm done by psychiatric meds on adults and kids.

The Stats for ECT given yearly are:

Ontario, Canada - 14,000 ECTs
British Columbia - 46,000 ECTs given in the past 5 years
USA - 100,000 Americans get ECT
UK - 50,000 ECTs given
Worldwide - 1 to 2 million people get ECT

ECT is unethical, barbaric, inhumane and should have been banned many years ago as they are countless studies and reports that prove that ECT causes brain damage.

I have a blog called "The International Campaign to Ban Electroshock" (ICBE) which will lobby all governments all over the world to ban electroshock universally.

The URL for ICBE is:
http://icbe.wordpress.com

Everyone can become a member for free and help in this campaign.

Other websites exposing ECT are:

www.geocities.com/sueclark2001ca/1.html
www.ect.org
www.breggin.com
http://endofshock.com
www.banshock.org
http://capa.oise.utoronto.ca
http://capacanada.wordpress.com
www.wildestcolts.com
www.mindfreedom.org
http://www.idiom.com/~drjohn/ect1.html
http://suzyo.wordpress.com

Sue Clark-Wittenberg
antipsychiatry & anti-ECT activist
Ottawa, Ontario, Canada
Email: [email protected]

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I've had 22 ECTs so far. Fo... (Below threshold)

July 7, 2008 11:38 PM | Posted by Ontarian: | Reply

I've had 22 ECTs so far. For 20 years I tried everything else; nothing worked in the least. If it weren't for ECT, I'd be dead. I can't remember feeling even half as human. Fortunately, my memory hasn't been affected too much, although it certainly has - I can't remember whether I should've used 'affected' or 'effected' in this sentence.

As for "research done by Sackeim", he's a charming (not to mention handsome) man, but I wonder how many of his statistics are as 'impressionistic' as his infamous 1/200 anterograde memory one? His latest studies seem more grounded in fact than his earlier ones.

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DO WHATEVER YOU CAN TO GET ... (Below threshold)

September 16, 2008 9:36 PM | Posted by Anonymous: | Reply

DO WHATEVER YOU CAN TO GET RID OF ANY KIND OF MENTAL HEALTH PROFESSIONAL OR SERVICE PROVIDER. THATS THE ONLY ANSWER.

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First of all:Moder... (Below threshold)

December 29, 2008 5:09 AM | Posted by Jake: | Reply

First of all:

Modern ECT is roughly 30 times less powerful than what they used before. (though they still may use the old stuff) The old stuff obviously should have made long-term problems, to deny that is delusional behavior.

BUT, this means that for almost anyone who got it recently, they'd have to prove that the new ECT is harmful, not the old one.

To be blunt, no double blind/"controlled" studies have shown any regional/specific/long-term/short term damage from brief-pulse direct-current unilateral ECT AT ALL. There has been none observed in studies that are published in reputable journals. Check any "modern" study that claims damage or something, they're almost always high cost to buy(with no data in a summary/abstract) or at minimum, in a foreign journal.

I'll say obviously, depression/bipolar hasn't been found to be anything specific, so saying there's no observable damage afterwards isn't saying anything except there's no holes/bleeds/lesions.

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"I have a blog called "The ... (Below threshold)

March 3, 2010 1:23 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

"I have a blog called "The International Campaign to Ban Electroshock" (ICBE) which will lobby all governments all over the world to ban electroshock universally.ICBE"

You have no right to campaign to block a treatment that has helped many, many people throughout the world based on your very skewed, very limited, non-clinical experience.

I am choosing to have ECT done due to severe, relentless depression that has stolen my life. I deserve the right to choose this course of treatment without it being threatened by an uneducated, jaded individual such as yourself.

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That's perfect that people ... (Below threshold)

May 7, 2010 1:37 AM | Posted by LINDSAYDale32: | Reply

That's perfect that people can take the www.lowest-rate-loans.com and it opens up new chances.

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I'd have to say that being ... (Below threshold)

December 13, 2010 2:44 PM | Posted by spider: | Reply

I'd have to say that being forced to receive ECT until your heart stops is quite "educated", without a doubt clinical, and gives one the right to be pretty jaded.

Maybe its because you're depressed you can't drum up an iota of compassion or perspective.

Would be pretty funny if ECT fixed that for you. Good luck.

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