Search Results for: ect

Have You Had ECT? Help Others and Tell Me Where

As many of you know I’m writing a book on electroconvulsive therapy (ECT).  This book will hopefully answer all the questions a person might have before undergoing ECT  treatment as well as share with them my personal experience and the experience of others.

And I’ve decided to include, at the back of the book a list of hospitals that offer ECT to help people who want the treatment with a starting point on how to get it.

There’s just one problem – there’s no central repository on who offers ECT treatment.

ECT-Offering Facilities

Please Help Me with the List of Hospitals that Offer ECT

So I’m asking for your help. If you know of a facility that offers ECT, please let me know in the comments below and I’ll add it to the list. You’ll be helping me and helping others as well. Please include hospitals in Canada and the US.

And, of course, if you have any questions about ECT, also feel free to comment on those and I’ll make sure the answers are here and in the book.

Thanks.

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Stopping Self-Harm Urges Using Dialectical Behavior Therapy (DBT)

If you feel you may harm yourself, get help now.

I talked about dialectical behavior therapy (DBT) in the last post. Dialectical behavior therapy is designed to work specifically with borderline personality disorder and part of this disorder is often self-harm so DBT uses specific techniques to try to stop self-harm urges and prevent self-harm.

What is Self-Harm?

Self-Injury and Cutting

Self-harm is a huge problem for many people. It is typically a sign of borderline personality disorder but it can occur with any disorder (or no diagnosis at all). Self-harm, also known as self-mutilation or self-injury, can be any form of self-abuse including cutting, burning, hitting and statistics often include those with eating disorders as well. Millions of people in the US practice some form of self-harm.

Self-harm is often practiced by teens and is more common in women than in men, but make no mistake about it, many adults self-harm and men do as well. It is a behavior to be taken seriously. Here are some techniques to stop self-harm urges.

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Dialectical Behavior Therapy for Borderline Personality Disorder

In spite of what some people intimate, I do endorse non-drug solutions and one of the best adjunct treatments to medications is psychotherapy. Many types of therapy can work for different people, but one current and research-backed therapy is Dialectical Behavior Therapy (DBT).

Now, don’t let the big words scare you – this is not a scary therapy. This is simply a therapy that works to use reason to integrate and synthesize to opposite points of view. Meaning, the techniques taught are designed to find a balance in emotion, behavior and acceptance.

Borderline Personality Disorder Group TherapyDialectical Behavior Therapy and Borderline Personality Disorder

Dialectical behavior therapy was designed specifically to treat borderline personality disorder; however, it has shown usefulness in mood disorders and research is currently underway to see if DBT techniques are also useful in other disorders. This therapy represents a huge breakthrough as the first indicated treatment of borderline personality disorder.

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Dr. Oz Show – The Shock That Could Save Your Life – Electroshock Therapy for Depression

As many people know the Dr. Oz show, did 30 minutes today on electroshock therapy. I’m going to talk a little about the Dr. Oz show’s representation of electroshock therapy and add a few additional facts.

First off, the Dr. Oz show is a source of entertainment, like anything else on TV, so he added drama that wasn’t particularly necessary. That is the way of the show, and TV, however. Specifically, the show started off with scenes of electroshock therapy being given pre-1950 which is when you see people having convulsions in the bad old days before people were anesthetized during treatments. This is not the best way to start a show that is supposed to educate about current treatment, but he does balance this later on.

The Good About the Dr. Oz Show

I was impressed really. They did do a lot of things right and they did share a lot of facts about electroshock therapy, now known as electroconvulsive therapy (ECT). What the Dr. Oz show did right:

  • Represented the modern procedure accurately and even showed the procedure being performed
  • Mentioned repetitive transcranial magnetic stimulation (rTMS) as an alternative therapy (rTMS uses magnetic waves rather than electricity)
  • Stated that almost all insurance companies cover ECT (to the best of my knowledge this is true)
  • Spoke that it should be used judiciously
  • Placed it in a reasonable historical context
  • Tried to reduce stigma and fear and increase awareness around the procedure
  • Mentioned memory loss (twice) as a side effect

The Bad about the Dr. Oz Show on Electroconvulsive Therapy (ECT)

As with all things in life, nothing is perfect. Some things you should know that weren’t altogether accurate about the show:

  • Only talked about right unilateral brief-pulse ECT – while this is considered the most modern form of ECT it is not the only type. Before getting ECT you need to know what type you are getting in order to accurately judge the risks.
  • Stated that ECT “reset the chemical messengers / receptors” in the brain – the truth is we don’t know exactly how ECT works, we only know that it does. It’s likely it works in multiple ways but “resetting chemical messengers / receptors” is mostly just a simplified concept and not medically accurate or at the very least, not medically complete.
  • Didn’t mention the other side effects of ECT – while memory loss is generally considered the most concerning, other side effects are also possible.

Altogether, I thought it was a good show, and if a tad flamboyant, represented ECT well but there are other things you should be aware of.

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Bipolar Spectrum Disorders – What is Cyclothymia?

Cyclothymia is neither bipolar depression nor unipolar depression but instead it is an illness that lies somewhere in the middle.

When psychiatric illnesses first started being recognized, some doctors felt that unipolar and bipolar depressions weren’t really the binary options for an illness but really just opposite ends of a spectrum. So then, one would have a spectrum where one could be a 100% bipolar depressive, or 100% unipolar depressive or they could lay somewhere in the middle. However, as illnesses need names and diagnostic criteria and not really vague percentages, bipolar and unipolar depression were defined separately.

Bipolar II – Within the Bipolar Spectrum

DSM-IV Criteria for Cyclothymia

Bipolar 2 though, is recognition of this false dichotomy. Bipolar 2 really sits in between unipolar and bipolar depression as more depressed than bipolar 1 but more hypomanic (emotionally dysregulatory) than unipolar depression. (See the difference between bipolar 1 and bipolar 2 disorders.)

And that’s fine as far as it goes. But there is also recognition from a lot of doctors that other states lie even more in the middle, and cyclothymia is one such disorder.

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Drug Trials, Antidepressants and Placebo Effect – Is it Bad?

When drug trials are conducted, the gold standard (and requirement for FDA approval) is a double-blind placebo-controlled study. In this kind of drug study participants are randomly assigned to receive either the medication or an inert (does nothing) pill known as a placebo. Neither the doctor not the patient knows whether they are getting the placebo or the real drug.

The study then compares what happens to those who received the real drug versus those who received the placebo and determines the efficacy of the real drug.

The Placebo Effect

This is critical because of something known as the “placebo effect.” The placebo effect is this odd scenario where people get better just because you give them a pill, even if the pill does nothing. Doctors and scientists don’t understand the placebo effect but not only will people get better on a placebo, but they will even experience side effects – something that isn’t possible given that the placebo is inert. But the brain is a powerful thing and something we don’t fully understand.

Treatment vs. No Treatment OutcomesAnd one of the problems with antidepressants (and many medications) is that sometimes they aren’t better than the placebo. Additionally, sometimes when they are better than the placebo, it’s only by a small margin. Drug companies have to prove that their drug is statistically significantly better than a placebo in order to get FDA approval but even this statistically significant amount can be very small.

However, this isn’t a piece about how effective are when antidepressants are compared to placebos. This is a piece about how effective antidepressants are compared to no treatment.

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Mental Illness Stigma Affects Psychiatrists Too – Who Wants to Be a Psychiatrist?

Recently I read Invisible Tattoos: The stigma of psychiatry by Dr. Henry A. Nasrallah in Current Psychiatry. Invisible Tattoos is and editorial piece on how the stigma of mental illness affects psychiatrists just like it affects the mentally ill. And my reaction?

Oh cry me a freaking river.

I thought the piece was a little whiny and navel-gazing. I mean seriously, these people are respected professionals making lots of money – they don’t have an illness threatening to kill them every day.

But then I got a comment from a medical student and I reconsidered my position. Maybe antipsychiatry poster-boy Tom Cruise doesn’t just fuck around with the way people look at me, maybe he fucks around with the way people look at psychiatrists too. And maybe stigma is difficult for psychiatrists to deal with.

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No Evidence of the Effectiveness of Psychotherapy? – 3 New Things

This week I learned three new things about psychotherapy and depression.

I’m a fan of psychotherapy for everyone. In fact, if we could get the mid-East folks to sit down for some good counselling, I think it would be more effective in bringing peace than anything you can do with a gun.

With that said, there are limitations to therapy and sometimes therapy is not all it’s cracked up to be. So this week, a look at three perspectives on psychotherapy:

  • Psychotherapy is no better than placebo in treating depression?
  • Which type of psychotherapy is better for depression?
  • How does psychotherapy change the brain?

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I write a three-time Web Health Award winning column for HealthyPlace called Breaking Bipolar.

Also, find my writings on The Huffington Post and my work for BPHope (BP Magazine).

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