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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Netch on April 6, 2010, at 9:47:52
Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial.
BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for major depression. Optimising efficacy and minimising cognitive impairment are goals of ongoing technical refinements. AIMS: To compare the efficacy and cognitive effects of a novel electrode placement, bifrontal, with two standard electrode placements, bitemporal and right unilateral in ECT. METHOD: This multicentre randomised, double-blind, controlled trial (NCT00069407) was carried out from 2001 to 2006. A total of 230 individuals with major depression, bipolar and unipolar, were randomly assigned to one of three electrode placements during a course of ECT: bifrontal at one and a half times seizure threshold, bitemporal at one and a half times seizure threshold and right unilateral at six times seizure threshold. RESULTS: All three electrode placements resulted in both clinically and statistically significant antidepressant outcomes. Remission rates were 55% (95% CI 43-66%) with right unilateral, 61% with bifrontal (95% CI 50-71%) and 64% (95% CI 53-75%) with bitemporal. Bitemporal resulted in a more rapid decline in symptom ratings over the early course of treatment. Cognitive data revealed few differences between the electrode placements on a variety of neuropsychological instruments. CONCLUSIONS: Each electrode placement is a very effective antidepressant treatment when given with appropriate electrical dosing. Bitemporal leads to more rapid symptom reduction and should be considered the preferred placement for urgent clinical situations. The cognitive profile of bifrontal is not substantially different from that of bitemporal.
Posted by Phillipa on April 6, 2010, at 10:50:41
In reply to ECT remission rates, posted by Netch on April 6, 2010, at 9:47:52
I've read to many bad things here to consider it. Phillipa
Posted by bleauberry on April 6, 2010, at 17:15:17
In reply to ECT remission rates, posted by Netch on April 6, 2010, at 9:47:52
>
> BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for major depression.Well, that statement is not really true. It depends on the definition of "effective", which was not defined. For example, ECT has an extremely high relapse rate that occurs within weeks or months. If you were lucky enough to be one of those 50%-60% remission patients, and you relapsed 3 weeks later, 3 months later, is that really effective?
What was the definition of "remission"? It doesn't say. To you and me, we know what remission is. In a clincal trial, it is determined by numerical scores on a multiple choice questionaire. You could score great on issues such as sleep, eating, activity, social comfort, etc, but have total anhedonia with zero motivation/joy/pleasure, but you would still be classified as remission because your total score was under a certain threshold.
Abstracts like this are hard to make good judgements from, without seeing the entire article.
>Cognitive data revealed few differences between the electrode placements on a variety of neuropsychological instruments.
Unfortunately, they didn't say how bad the cognitive data was. They skipped right over it as if it was not a huge issue.
>CONCLUSIONS: Each electrode placement is a very effective antidepressant treatment when given with appropriate electrical dosing. Bitemporal leads to more rapid symptom reduction and should be considered the preferred placement for urgent clinical situations.
Mine was bitemporal. It did not kick in until the 12th treatment...one month. About the same time as an antidepressant. About 28 days slower than Ritalin or other faster acting mood brighteners. I would not say ECT is any better than drugs for what they termed "urgent". Except perhaps for dumbing the patient down quickly. An antipsychotic can do that just as well without the permanent memory loss.
How about this. Another article from the same source shows that the combination of Milnacipran and Risperdal brings remission in 3 out of 5 treatment resistant patients, improvement in 1, and nothing in 1. In another, Milnacipran with Pindolol had 85% success rate. In another, Milnacipran 150mg versus 100mg had 87% responders.
See how these abstracts can be misleading? What exactly was a responder? Remission? Success? How long did it last?
In any case, I am on the side of the debate that strongly supports the use of herbs, medicines, and further diagnosis of unsuspected or ignored physical conditions responsible for depression. I have never heard of anyone enjoying long lasting results from ECT. In almost all cases of ECT, drug therapy is required afterwards. So the drug game is not over.
The cost has to be considered. Well over $20,000 for one course. I would expect gold plated 100% remission for that price.
Anyway, some people have had their lives saved by ECT. For me it was like closing an old chapter and opening a new one. The new one was not much better than the old one, but different, and that was a good thing. Just wish I could remember the 1/3rd of my life that is vanished.
Posted by linkadge on April 6, 2010, at 18:14:32
In reply to ECT remission rates, posted by Netch on April 6, 2010, at 9:47:52
50-64%. Hmm. Well that is looking a little more believable than the ol' ECT cures 90% of patients nonsense that some "shock docs" still seem to quote.
Keep in mind a few things. ECT relapse is very high. ECT tends to work better in patients who have *not* failed many other antidepressants. (Don't ask me why you would do ECT if you havn't failed other treatments but)
Linkadge
Posted by Laney on April 12, 2010, at 10:34:34
In reply to Re: ECT remission rates, posted by bleauberry on April 6, 2010, at 17:15:17
What meds would be included in this list besides the ritalin of course?
"About 28 days slower than Ritalin or other faster acting mood brighteners."
Thanks! Laney
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