The sham ECT literature: implications for consent to ECT.
ABSTRACT The author reviewed the placebo-controlled literature on electroconvulsive therapy (ECT) for depression. No study demonstrated a significant difference between real and placebo (sham) ECT at 1 month posttreatment. Many studies failed to find a difference between real and sham ECT even during the period of treatment. Claims in textbooks and review articles that ECT is effective are not consistent with the published data. A large, properly designed study of real versus sham ECT should be undertaken. In the absence of such a study, consent forms for ECT should include statements that there is no controlled evidence demonstrating any benefit from ECT at 1 month posttreatment. Consent forms should also state that real ECT is only marginally more effective than placebo.
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ABSTRACT: No consensus has been reached on the mode of action of electroconvulsive treatment (ECT). We suggest that two features may aid in the delineation of the involved mechanisms. First, when effective, ECT would be likely to affect brain functions that are typically altered in its primary recipient group, people with severe depression. Central among these are the frontal and temporal lobes, the hypothalamus-pituitary-adrenal (HPA) stress axis, and the mesocorticolimbic dopamine system. Second, the involved mechanisms should be affected for a time period that matches the average endurance of clinical effects, which is indicated to be several days to a few weeks. To identify effects upon frontal and temporal lobe functioning we reviewed human studies using EEG, PET, SPECT, and fMRI. Effects upon the HPA axis and the dopamine system were assessed by reviewing both human and animal studies. The EEG studies indicate that ECT decelerates neural activity in the frontal and temporal lobes (increased delta and theta wave activity) for weeks to months. Comparable findings are reported from PET and SPECT studies, with reduced cerebral blood flow (functional deactivation) for weeks to months after treatment. The EEG deceleration and functional deactivation following ECT are statistically associated with reduced depression scores. FMRI studies indicate that ECT flattens the pattern of activation and deactivation that is associated with cognitive task performance and alters cortical functional connectivity in the ultra slow frequency range. A common finding from human and animal studies is that ECT acutely activates both the HPA axis and the dopamine system. In considering this evidence, we hypothesize that ECT affects the brain in a similar manner as severe stress or brain trauma which activates the HPA axis and the dopamine system and may compromise frontotemporal functions.Frontiers in Psychiatry 01/2013; 4:94.
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ABSTRACT: IntroductionAnimal-assisted therapies involve interaction between patients and an animal with the aim of improving mental wellbeing and diminishing anxiety and agitation in patients. To date, few pilot studies focusing on animal-assisted therapeutic effects have met minimal standards of research design and have included standardized outcome variables or physiological measures, depicting the need for scientific research on animal-assisted therapy.European Journal of Integrative Medicine 10/2009; 1(3):145-148. · 0.65 Impact Factor
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ABSTRACT: toabstract thinking and judgment. The ECT-induced persistent brain dysfunction was global. In addition to the loss of autobiographical memories, the most marked cognitive injury occurred in “retention of newly learned information,” “simple reaction time,” and most tragically, “global cognitive status” or overall mental function. In other words, the patients continued to have trouble learning and remembering new things, they were slower intheir mental reaction times, and they were mentally impaired across a broad range of faculties. Probably to disguise the wide swath of devastation, the Sackeim study did not provide the percentages of patients affl icted with persistent cognitive defi cits; but all of the mul- tiple tests were highly significant (p< .0001 on 10 of 11 tests and p< .003 on the 11th). Also, the individual measures correlated with each other. This statistical data indicates that a large percentage of patients were significantly impaired.Ethical human psychology and psychiatry 08/2007; 9(2):83-86.