ECT – New and Improved?

I’ve just come across a strange article on Mad in America.  It’s called Researchers look at therapeutic benefits of ketamine.  You can see it here.  It doesn’t identify an author, but it’s from the University of Manchester.

The opening paragraph says:

“The largest trial into the use of Electroconvulsive Therapy (ECT) in the UK in more than 30 years will look into how the use of the Class C drug ketamine might reduce the side effects of ECT for those being treated for severe depression.”

The research team is to be led by Professor Ian Anderson, a psychiatrist, who is quoted as saying:

“It’s a great opportunity to really study ECT and see how we can improve it. ECT is the most effective treatment we have for severe and Treatment Resistant Depression – but it can cause cognitive and memory difficulties as a side-effect.”

It’s to be a randomized controlled study.  They’re planning to recruit 160 participants who have been referred for ECT, and then randomly assign them to ECT alone or ECT plus ketamine.

COMMENT

I was struck firstly by the comment that this is to be the largest trial into the use of shock “treatment” in 30 years in the UK.  There are to be 160 people in this study, which doesn’t seem all that large given the level of controversy surrounding this “treatment.”

Secondly I was struck by Dr. Anderson’s statement that shock “treatment” can cause cognitive and memory difficulties as a side effect.  The term “difficulties” seems like an understatement.  There is ample documentation in the literature that the memory losses are often massive and devastating.  It is also the case that several authorities on shock “treatment” have stated very clearly that memory loss is not a side-effect, but rather is the main effect.  The rationale that has been presented is that the electric current alleviates depression by obliterating painful memories!

It has also been well documented, incidentally, that shock “treatment” is no more effective at alleviating depression than sham shock treatment, where the person is anesthetized but not shocked.

KETAMINE

But what surprised me most was the proposed use of ketamine as an adjunct to shock “treatment.”

Ketamine is a drug used as an anesthetic for animals, and in certain circumstances for humans.  Its effects in humans include anesthesia and hallucinations.  It is used recreationally as a psychedelic drug (street name: Special K), and is in the same drug class as phencyclidine (PCP), also known as Angel Dust.

Dr. Anderson expresses the hope:

“…that ketamine will reduce the longer-term loss of past memories, including autobiographical memory – which may include memories of childhood holidays, growing up and early life – that some people experience with ECT and which can be very distressing.”

CONCLUSION

I’m no neurologist, but it is my understanding that 450 volts of electricity coursing across the brain causes damage.  I find it hard to imagine how the concomitant injection of a hallucinatory anesthetic could have a mitigating effect on this damage.  I’m left with the suspicion that perhaps the researchers are hoping that the euphoric effects of the drug will reduce post-procedural complaints of headaches and feeling “wiped out.”

In other words, the drug might have some effect on what clients say about the treatment (i.e. fewer complaints), but it seems unlikely that it will reduce the amount of brain damage or memory loss.

  • Kermit Cole

    I appreciate your thoughtful analysis. I just linked to it from the discussion on MIA. You clearly picked up on the “strangeness” I hoped would be noticed when I posted it there. I hope you might join in the discussions there, as well; I depend on the comments of readers to explicate the dimensions of news items that I can’t.

  • Phil_Hickey

    Kermit,

    Thanks for the words of encouragement and the link you put on the MIA discussion. I have just gone in and added my own comment in that thread.

    Best wishes.