Theories of ECT's Mechanism of Action
Tuesday and Wednesday were both good days. No mood shifts or mood issues at all (once I got the phone call to my now former employer (the one day job) out of the way.) Did some serious work around the house. I rebuilt the fence in my backyard which is designed to keep the dogs off of my newly seeded lawn (the bar spots caused by dog traffic.) We’ve been playing this game for weeks. I build the fence, they find a way under/around it. I patch the hole, they find another way under/around. The fence was made of chicken wire and those little green metal fence posts. I went nuclear on them today and bought a roll of that orange plastic construction zone fencing. I think I’ve won this time (again.) Its me against the dogs in this intellectual battle, and I seem to be losing.
Someone, David from my climbing adventure on Sunday, asked me what my manic or OCD spells feel like, if they feel good or bad, and how I recognize them. As I’ve mentioned, until recently, I couldn’t recognize them until long after they had passed. Now, I can catch them. After some thought, the best analogy is that mania feels like being a moth trapped in a jar. My mind flutters wildly from one task, one thought, one idea or one urge to another, never landing firmly on anything or finding a way to focus on one thing, banging into the boundaries of one thing and switching to another, and then back to that first thing again later. I never seem to get anywhere with any of it. Its frantic, but not panicky (most of the time.) It feels hyper-productive, like I have all of these great ideas and things I want to pursue. Later, after the manic spell, those things all seem trivial and not worth my time or the frustration. I am learning to realize or identify these manic periods and to be able to make myself write down all of the ideas I have and wait a week before pursuing any of them (by the end of the week, the mania is gone and I can evaluate the ideas with a clearer head.)
Grandma keeps writing about “brain damage” from ECT. Brain damage is ONE of many theories on how ECT works. I tend to favor option (c) below, as it makes most sense to me and the way I feel following my course of treatment. The problem is that there is scientific evidence that ECT is effective in the treatment of depression and other mental illnesses, but no one knows why or how. Here are the primary theories: (a) Neurotransmitter: ECT has effects similar to anti-depressants, altering brain chemicals like serotonin, dopamine, etc., but in a more “permanent” manner; (b) Anti-convulsant: ECT conditions the brain to become more convulsion-resistant (over the course of treatment, seizure threshold increases and seizure duration decreases due to increased transmission of brain GAMA [sorry, couldn’t find a meaningful definition for this acronym] and opiods resulting in marked improvement in depression and mania symptoms); (c) Neuroendocrine: ECT affects the hypothalamus, the part of the brain that controls important functions like sleep and body temperature. The disruption in homeostasis forces the hypothalamus to “reset or “re-regulate” the body, correcting the imbalance causing the mental illness ("The evidence that E.C.T. affects the hypothalamus is mostly indirect, though the uniformity with which the hypothalamus reacts to almost every form of stress leaves little doubt that E.C.T. will act similarly." (W. Ross Ashby, 'The Mode of Action of Electro-Convulsive Therapy,' J. Ment. Sci., 1953); and (d) Brain Damage: ECT causes damage creating the illusion of stability. (Based on the findings that differences in responses to Rorschach’s test were similar after ECT or diffuse brain damage. This theory has been heavily criticized because the type of “damage” hypothesized does not explain common behavioral changes, no substantive evidence of brain chemical change has been documented and because using various radio-imaging techniques as well as human autopsy methodology, no substantive evidence of brain structural alteration was found.) For a very thorough, albeit very medically technical, paper on these theories and the background for each, see “Theories on Mechanism of Action of Electroconvulsive Therapy” at http://www.gjpsy.uni-goettingen.de/gjp-article-grover2-ECT.pdf (also added to the “Links” section in the right sidebar to this blog.)
Someone, David from my climbing adventure on Sunday, asked me what my manic or OCD spells feel like, if they feel good or bad, and how I recognize them. As I’ve mentioned, until recently, I couldn’t recognize them until long after they had passed. Now, I can catch them. After some thought, the best analogy is that mania feels like being a moth trapped in a jar. My mind flutters wildly from one task, one thought, one idea or one urge to another, never landing firmly on anything or finding a way to focus on one thing, banging into the boundaries of one thing and switching to another, and then back to that first thing again later. I never seem to get anywhere with any of it. Its frantic, but not panicky (most of the time.) It feels hyper-productive, like I have all of these great ideas and things I want to pursue. Later, after the manic spell, those things all seem trivial and not worth my time or the frustration. I am learning to realize or identify these manic periods and to be able to make myself write down all of the ideas I have and wait a week before pursuing any of them (by the end of the week, the mania is gone and I can evaluate the ideas with a clearer head.)
Grandma keeps writing about “brain damage” from ECT. Brain damage is ONE of many theories on how ECT works. I tend to favor option (c) below, as it makes most sense to me and the way I feel following my course of treatment. The problem is that there is scientific evidence that ECT is effective in the treatment of depression and other mental illnesses, but no one knows why or how. Here are the primary theories: (a) Neurotransmitter: ECT has effects similar to anti-depressants, altering brain chemicals like serotonin, dopamine, etc., but in a more “permanent” manner; (b) Anti-convulsant: ECT conditions the brain to become more convulsion-resistant (over the course of treatment, seizure threshold increases and seizure duration decreases due to increased transmission of brain GAMA [sorry, couldn’t find a meaningful definition for this acronym] and opiods resulting in marked improvement in depression and mania symptoms); (c) Neuroendocrine: ECT affects the hypothalamus, the part of the brain that controls important functions like sleep and body temperature. The disruption in homeostasis forces the hypothalamus to “reset or “re-regulate” the body, correcting the imbalance causing the mental illness ("The evidence that E.C.T. affects the hypothalamus is mostly indirect, though the uniformity with which the hypothalamus reacts to almost every form of stress leaves little doubt that E.C.T. will act similarly." (W. Ross Ashby, 'The Mode of Action of Electro-Convulsive Therapy,' J. Ment. Sci., 1953); and (d) Brain Damage: ECT causes damage creating the illusion of stability. (Based on the findings that differences in responses to Rorschach’s test were similar after ECT or diffuse brain damage. This theory has been heavily criticized because the type of “damage” hypothesized does not explain common behavioral changes, no substantive evidence of brain chemical change has been documented and because using various radio-imaging techniques as well as human autopsy methodology, no substantive evidence of brain structural alteration was found.) For a very thorough, albeit very medically technical, paper on these theories and the background for each, see “Theories on Mechanism of Action of Electroconvulsive Therapy” at http://www.gjpsy.uni-goettingen.de/gjp-article-grover2-ECT.pdf (also added to the “Links” section in the right sidebar to this blog.)
posted by DeMental at 9:33 PM
4 Comments:
Mike,
I'm sorry but you are wrong when you say that "no substantive evidence of brain structural alteration was found". There have been many published reports of findings by means of MRI, CT and autopsy, both in humans and animals. Unfortunately I was only able to find two of the ones I have read but here are links to them:
http://www.idiom.com/~drjohn/amjpsych.html
http://www.wildestcolts.com/mentalhealth/shock.html
(many citings in appendex under “Brain Damage”)
I believe that it HAS been substantiated that this does not occur in 100% of ECT patients. But it does and has happened.
In other arenas of medicine, they go to great lengths to eliminate seizures because of the potential for brain damage. Yet in Psychiatry, it's considered OK to induce potentailly brain damaging seizures. And then deny there is any damage. I don't get it.
Mike, you're wrong on all three of the assumptions you make after "criticized". It's just not that simple. But explaining would take more room than I've got here.
I would just start by saying that people have commented ever since ECT was invented that the behavioral effects are, indeed, those which in another context would not be mistaken for anything but brain damage. Lots of references on this, and the others.
"I'm" not wrong about anything. I took the words from sevral different sources. And you're right, its not "that simple." The Brain damage theory, the only one you seem to lean on, just doesn't provide a well rounded explanation of the side effects of ECT to fill the bill. If we get the human brain figured out such that we can get to a simple explanation for everything that fits everyone, we will be miles ahead of where we are now.
Mike, your link among the other links takes me to microsoft.com.
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