Category: treatment issues

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

Posted by Natasha Tracy | Jan 25, 2012

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.

Laura’s Law – Assisted Outpatient Treatment – Follow-Up

Posted by Natasha Tracy | Dec 28, 2011

Well now, that was quite the number of impassioned comments. I did realize that by writing about Laura’s Law (Assisted Outpatient Treatment) there would be some contention, but I didn’t realize quite how much. Thanks to everyone who wrote in well clear, thoughtful comments. (For those whose comments weren’t of that ilk, please review the comment policy here at the Bipolar Burble.)

Due to the number of responses, I have been unable to address them each individually, but I would like to point a few things out in general.

Laura’s Law – Forced Treatment, Saved Lives

Posted by Natasha Tracy | Dec 19, 2011

Some of you may have heard of Laura’s Law in California or Kendra’s Law (similar) in New York. These laws, and similar laws across 42 states, allow for court-ordered treatment of mental illness as a condition of community living.

In other words, they strong-arm people into treatment and this could be seen as treatment without consent. (It’s hard to argue consent when your ability to live outside a locked facility is in jeopardy.)

And this is a very good thing. It is saving lives (among other things).

Active Placebos, Depression Influencers and Depression Prognosis – 3 New Things

Posted by Natasha Tracy | Dec 14, 2011

Time to learn another three new things about mental health. This week we have:

Further discussion on Antidepressant Effectiveness (vs. Placebos)
Infographic on influential depression information sources
Depression prognosis over 10 years

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

Posted by Natasha Tracy | Dec 12, 2011

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.

And 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.

Personal Story of Medication Noncompliance

Posted by Natasha Tracy | Dec 7, 2011

It is politically incorrect to say medication “noncompliance.” I suppose this is because it gives the idea that the person taking medication is “complying” to some authority figure and not consciously making the decision on their own.

I get that. But whether you call it medication noncompliance or medication non-adherence, the result is the same – the person is not taking their medications as prescribed by a doctor.

And medication noncompliance can lead to devastating consequences not only in the short-term but in the long-term as well. One reader shares her experience in her own words.

Doctor Background Checks; ECT in Film; New Borderline Criteria – 3 New Things

Posted by Natasha Tracy | Dec 1, 2011

Today we return to my 3 New Things series so I can touch on three new pieces of information I’ve found this week. This week I talk about:

How to get a background check on a doctor
The sorry portrayal of electroconvulsive therapy (ECT) in film
The newly-proposed diagnostic criteria for personality disorders in the DSM-V

Defending Psychiatry

Posted by Natasha Tracy | Nov 28, 2011

I often find myself in the unenviable position of defending psychiatry. This, in spite of the fact that I am not a psychiatrist nor do I even play one on TV.

Nevertheless, I feel compelled to speak on psychiatry’s behalf. Maybe it’s because when left to their own devices, psychiatrists aren’t very good at it. Or more likely it’s simply because an unreasonable number of people attack psychiatry unreasonably and I think someone ought to bring the concept of reason into the discussion.

Antipsychiatry

There is a faction of folks out there who are antipsychiatry and every time I mention them I get hate mail. But here I am again. Antipsychiatry. Antipsychiatry. Antipsychiatry.