Talk:Electroconvulsive therapy

One vital fact is missing

I saw Cuckoo's Nest like a lot of other people. Poetic license be damned, that one book and movie has done great harm to those who could have benefited from ECT, but were frightened away by that movie. Like so many others, I accepted as fact with no evidence the idea that ECT was brutal and inhumane. I mean, electrocuting someone's brain and turning them into a flopping vegetable, that had to be terribly harmful, right?

I have a BS in Psychology. To earn that degree one class I was required to take was History of Psychology. In addition to "therapies" like lobotomy, leukotomy, lobectomy, and really bad ideas like the eugenics movement, one of the controversial subjects covered in the class was electroconvulsive therapy. I admit that I was surprised to learn that it was still used, and shocked to learn it was considered quite beneficial for a very short list of disorders and was never--never--brutal and inhumane and harmful as depicted in that movie.

I'd say that, as is, the Wikipedia page for this subject is thorough and useful and has most bases covered. However there's one vital fact that seems to be missing from the page, and that's the reason convulsive therapy originally emerged as a treatment for mental disorders. It's something I learned in that History class named above. And the only reason I'm not editing the page and adding it myself is because I simply don't have a citation to anchor it with. And having worked for some years as a paralegal I'm loath to state something as fact without a cite to authority to back it up.

The reason convulsive therapy arose as a treatment was because of a simple observation. Back in the bad old days where anyone seeming a bit off, or suffering from then-unexplainable disorders (e.g. epilepsy), could be and often was locked up in a sanitarium, essentially a jail in everything but name. There were, though, people working in some of them who were interested in the science of what the hell was wrong with these people. Having no real theories or the experimental background to do anything else, these people started with observation and documentation. The early modern science of the study of the mind and mental health started with that. Watching what happened and writing it down. After much observation, one idiosyncratic fact emerged, that was consistent among patients, observers, and institutions--and this is the fact the page needs to state explicitly.

People who suffered from severe "melancholy"(depression) who also had seizures or "fits" (epilepsy) often experienced a marked remission in their depression following a seizure.

Nobody knew why, though idiots like Freud often put forward cockamamie theories with no basis in science or fact to explain the phenomenon. And some didn't bother to care why. It was only a short logical jump from observing the phenomenon to experimenting with it by inducing seizures in people with depression who did not also suffer a convulsive disorder. And though early means of inducing these seizures was with various substances, none really safe, the phenomenon held and suddenly became a hypothesis. Inducing seizures in patients with certain mental disorders was frequently followed by a lessening or remission of the symptoms of those disorders. The most important one of course being depression which up to that point had never been effectively treated before, unless it was with the "talking cure" which worked for some with mild symptoms, or with opium or (later) one of its derivatives (like morphine or heroin). The opiates worked for many, of course, though they might not have realized the wonder-medicine they had been given was little more than a tincture of opium. After the Harrison act that line of treatment was choked off and de-legitimized in the US, and most of the so-called civilized world followed suit to one degree or another. Given the utter lack of any other effective pharmaceutical treatment options that left convulsive therapy and "the talking cure" (a form of which is Psychoanalysis, though you'd never get the few fossils in the field still perpetrating that fraud to admit it) as the only effective legal means of treating depression. And only one of the two was effective on severe, intractable depression (and sorry to all you Sigmund Fraudians out there it wasn't the talking cure) and given therapists desperate to treat suffering patients with something that had been shown to actually work, it's easy to see why convulsive therapy became so widely used.

If I can dig up my old textbook from that class, or if I run across any other supporting citations, I'll edit the page to add the fact. Unlikely though, as I don't work in the mental health field and don't spend much time reading its material any more. Too busy playing Battlefield, I guess.

And the rest, as they say, is Wiki. And can be found on the main page.

Joeledux@gmail.com 2602:306:333A:8650:106D:DAB1:1DF1:5545 (talk) 05:36, 27 September 2017 (UTC)

I agree with much of what you've said here, and will say that there is still quite a bit left to be improved in regards to the article. I'm an English education major, and I wrote a fairly detailed essay on ECT back in the day - not entirely uninspired by my own interpretation of "One Flew Over the Cuckoo's Nest." My psychology professor did not care for it... in any case, this is probably part of the reason why I am an English major, rather than a psychologist today. I think the "vital fact" that you mention remains unclear. Frankly, I think it is a common misconception today that the ECT procedure is something like the lobotomy: a medical practice that we associate with the distant past, that has been somehow been mediated and is quite rare now. Yet according to the resources available, it is still quite commonplace - not so nearly as horribly conceived as it was back then, but then - who knows? This article could certainly benefit from experts in the field who might illustrate to us under what circumstances this practice still occurs, and why, and under what voltage. <> Alt lys er svunnet hen (talk) 09:04, 3 November 2017 (UTC)

Only Used Shock Therapy?

This line: "and is the only currently used form of shock therapy in psychiatry" can't be true, because of the controversial aversive shock therapy used by the Judge Rotenberg Educational Center (which is legal in the USA as of April 10th 2018). Am I missing some qualifier here? Waitalie Nat (talk) 20:28, 10 April 2018 (UTC)

The linked article isn't referring to electroconvulsive therapy but to aversive therapy using painful electric shocks, which is entirely unrelated and of dubious legality. "Shock therapy" in this articles' context means other forms of convulsive therapy (such as metrazol) that are no longer in use. That line should probably be changed to avoid confusion - Syd (talk) 21:01, 10 April 2018 (UTC)

Right-- I understood that ECT, which isn't meant to hurt the patient, is VERY different from aversive therapy. That line just caught my attention because aversive shock therapy is still legal and being practiced, and I don't want people to think ECT is the only place in therapy that shocks are being used. As you said, it's important to avoid confusion. Would putting in "convulsive" instead of "shock" work? Waitalie Nat (talk) 15:56, 11 April 2018 (UTC)

That sounds like a good idea, it appears to be the correct terminology. This does reveal a problem with convulsive therapies being commonly referred to as shock therapies though, as it is an unintuitive use of the word "shock" when used with electricity. Aversion therapy is mentioned on the disambiguation page, but maybe "not to be confused with aversion therapy" should be in the header as well? - Syd (talk) 12:10, 12 April 2018 (UTC)

Pictures

I would suggest including pictures that portray modern day ECT. The pictures included in the current article are all historic in nature.73.206.158.9 (talk) 13:26, 20 April 2018 (UTC)

electro-therapy

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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Resolved

 – Corrected redirect for electro therapy, from electroconvulsive therapy to electrotherapy; here to here.―Biochemistry🙴❤ 21:00, 10 July 2020 (UTC)

Why the redirect of electro-therapy to here. There are alternative treatments for rheumatism etc., called electro-therapy which have nothing to do with ECT. The redirect should be removed. Broichmore (talk) 11:33, 24 June 2018 (UTC)

Agreed, although changing the redirect to Electrotherapy might be even better, as that page seems to cover many different uses of the term. - Syd (talk) 12:21, 24 June 2018 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Needs a more international view

This article primarily reflects American views (and a few other anglophone countries). Not much on its use in USSR and PRC.— Preceding unsigned comment added by 213.205.241.73 (talk • contribs) 20:57, 23 November 2019 (UTC)

Edit to "health effects" without discussion

An editor by the name of Saidmann changed my additions to "health effects" without discussion here on the talk page. This edit is biased towards the promotion of ECT. I do not want a reverting-edit war and ask for a neutral party to review the edit.--Mark v1.0 (talk) 18:53, 2 January 2020 (UTC)

@Mark v1.0: It appears that Saidmann removed content that was cited using primary sources (e.g. case reports and case series), which is appropriate.―Biochemistry🙴❤ 20:54, 10 July 2020 (UTC)

Medline index

This paper may be a reivew, but Annals of general psychiatry is not in the [Title+Abbreviation medline index]. We'll hve to leave it out. --Wikiman2718 (talk) 22:28, 9 September 2020 (UTC)

Sir:

First, the paper may not be a review. It is one.

Second, The journal is listed > 500 times in Pubmed.

So, there is nothing - neither a rule, nor anything else - that speaks againt the usage of this source in a medical article of WP.

--Saidmann (talk) 10:52, 10 September 2020 (UTC)

WP:MEDRS requires that the review be published in a Medline indexed journal. This one is not. —Wikiman2718 (talk) 12:03, 10 September 2020 (UTC)

What about reading WP:MEDRS? They require nothing of the kind. The only thing they say is: "Other indications that a biomedical journal article may not be reliable are its publication in a journal that is not indexed in the bibliographic database MEDLINE." So, this indexing status can never be a pretext to ban a source. Further, Pubmed's search engine draws from Medline und nothing else. So, as the source is found by Pubmed, it is, of course, listed in Medline. --Saidmann (talk) 15:14, 10 September 2020 (UTC)

Pubmed includes both Medline and non-Medline indexed journals. See my like in the first comment to note that the aforementioned journal is not in the Medline index. As an experienced medical editor, I can assure you that being in the Medline index is an essential requirement for reliability under MEDRS. —Wikiman2718 (talk) 19:49, 10 September 2020 (UTC)

No, it is not. It is a possible indication of reliability - among other indications. Your "assurance" here does not mean a thing. Relevant are the rules as laid down in WP:MEDRS. --Saidmann (talk) 15:46, 11 September 2020 (UTC)

Wikiman2718, I regret to say that you are wrong. This simplistic rule of thumb has played you false. MEDLINE is merely one indicator, and it is sometimes a poor indicator. It's true that Ann Gen Psy isn't indexed by MEDLINE. However, it's also true that Medical Hypotheses, which is basically garbage, is indexed by them. We should probably update MEDRS to provide more comprehensive guidance on how to identify a decent journal.

If you want to do a more thorough evaluation of this journal, then I suggest starting with https://www.scopus.com/sourceid/130125 Ann Gen Psy ranks better than 70% of other psychiatry journals (this gives us an apples-to-apples comparison, instead of a psychiatry-to-humanities comparison). There are good reasons to exclude (or at least to be very wary of) journals that rank in the bottom 20% of journals in a field on this metric, but there are no good reasons to exclude the top third. Their Impact factor is 2.2, which is well above the 1.0 that some editors promoted for years as the "magic number" for a potentially decent journal. The publisher is Springer, which is on the more reputable end of the spectrum of academic publishers. I think this journal is scoring well enough on all of the objective metrics that the journal should be acceptable.

I would recommend reading Wikipedia:Scholarly journal if you want more information about evaluating sources. WhatamIdoing (talk) 16:23, 11 September 2020 (UTC)

Thanks for the tips! I have often seen editors use the Medline this way. I guess I just assumed it was true. --Wikiman2718 (talk) 22:39, 11 September 2020 (UTC)

You're welcome. Also, congratulations: You now know more about evaluating medical journals than at least 90% Wikipedia's editors. WhatamIdoing (talk) 01:05, 12 September 2020 (UTC)

• I have responded at WT:MED (along the same lines as everyone else). On the question at hand, PMID 28406327 mentions that the literature was thoroughly surveyed in the 2013 book Electroconvulsive Therapy in Children and Adolescents.[1] That would probably make a good starting point for content, augmented with later MEDRS as necessary. Alexbrn (talk) 16:29, 11 September 2020 (UTC)
• The statements by Wikiman2718 about MEDRS are wrong, as well explained by others. By the way, here are more recent reviews (there are plenty).

• Withane N, Dhossche DM (January 2019). "Electroconvulsive Treatment for Catatonia in Autism Spectrum Disorders". Child Adolesc Psychiatr Clin N Am (Review). 28 (1): 101–110. doi:10.1016/j.chc.2018.07.006. PMID 30389070.
• Ghaziuddin N, Hendriks M, Patel P, et al. (May 2017). "Neuroleptic Malignant Syndrome/Malignant Catatonia in Child Psychiatry: Literature Review and a Case Series". J Child Adolesc Psychopharmacol (Review). 27 (4): 359–365. doi:10.1089/cap.2016.0180. PMID 28398818.
• Benson NM, Seiner SJ (2019). "Electroconvulsive Therapy in Children and Adolescents: Clinical Indications and Special Considerations". Harv Rev Psychiatry (Review). 27 (6): 354–358. doi:10.1097/HRP.0000000000000236. PMID 31714466.. SandyGeorgia (Talk) 20:22, 11 September 2020 (UTC)

• • WhatamIdoing perhaps MEDRS could be improved if some of your comments above were incorporated? I've also found people claiming that only review papers were MEDRS, which seems to have arisen from explaining about primary research papers and citing merely one alternative. We end up with some general and well documented article topics citing hundreds of reviews for tiny facts, rather than perhaps making use of a decent textbook. -- Colin°^Talk 09:56, 12 September 2020 (UTC)

    We should probably start making a list of things that could be clarified. WhatamIdoing (talk) 17:21, 12 September 2020 (UTC)

bipolar major depressive disorder?

In the lead, it states that: "A course of ECT is effective for about 80-90% of people with treatment-resistant major depressive disorder, whether it is unipolar or bipolar." As far as I understand, MDD is always unipolar; having had a manic or hypomanic phase would be grounds for exclusion of an MDD diagnosis (at least in the DSM 5). If they want to include MDD and bipolar disorder in one statement, it should say "mood disorders" instead (although this would also include some other disorders which the source might not support). Am I misunderstanding something?--Megaman en m (talk) 14:42, 3 January 2021 (UTC)

Thanks Megaman en m, made the change.--Iztwoz (talk) 15:36, 3 January 2021 (UTC)

Electroshock either needs its own category, or should be removed all together

Generally speaking, EST often is used in literature to refer to intentional pain causing in order to condition a desired response. Most of the negative reception to ECT comes from the association with electrical aversion therapies that had nothing to do with ECT.

https://www.huffpost.com/entry/shock-the-gay-away-secrets-of-early-gay-aversion-therapy-revealed_b_3497435 72.85.48.246 (talk) 13:39, 3 March 2021 (UTC)

The main image is a mirrored image

it's very distracting that the image has been horizontally flipped. The text is all backwards etc. Inktomi (talk) 04:46, 10 March 2021 (UTC)

Seconded. A. Rosenberg (talk) 14:36, 16 November 2021 (UTC)

New meta-analysis

[2] Among the findings: "There have been no ECT versus simulated ECT (SECT) studies since 1985." "The quality of most SECT–ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period... this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed." (t · c) buidhe 23:34, 15 March 2021 (UTC)

Anesthesiology techniques as described are outdated and inaccurate.

Propofol is the primary sedative/short acting anesthetic used for ECT since the mid 1990's. Atropine is no longer commonly used. When an anticholinergic is required, glycopyrrolate is the drug of choice because glycopyrrolate does not cross into the brain and it has less of an impact on raising heart rate. Increased heart rate raises risks of myocardial infarction. Myocardial infarction and related malignant arrhythmias are already the primary cause of death in ECT. Atropine raises that risk in susceptible patients. The intravenous non-steroidal-anti-inflammatory (NSAID) Ketorolac is commonly employed to prevent post-suxamethonium myalgia, and ondansetron given to prevent nausea. This can all be found in Basics of Anesthesia 4th ed, Stoelting, RK and Miller, RD, 2000, pages 401-403. A more adequate edit based on this source material or another equally authoritative source must be completed lest this article remain questionable in its dated historical inaccuracies. It is strongly suggested that a more experienced editor with a working familiarity with the anesthesiology literature improve said article. Currently anything related to the anesthetic treatment during ECT as it currently stands, is at best in the poorest quality state as a reliable source of accurate information on this subject.Kenjafray (talk) 16:18, 29 April 2021 (UTC)Kenjafray

EST and ECT used interchangably

The article uses the terms "electroconvulsive therapy" and "electroshock theraphy". Shouldn't the article stick to one term for clarity's sake? StolenStatue (talk) 01:49, 5 November 2021 (UTC)

Nevermind, it seems to have been fixed StolenStatue (talk) 01:51, 27 May 2022 (UTC)

Why are we mentioning voltage and current, but not impedance?

Please, to make the information more correct, mention the follow information. It's crucially important.

"However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance (Weaver et al., 1976)." https://assets.cambridge.org/97805218/83887/excerpt/9780521883887_excerpt.pdf