![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by TJO on July 29, 2003, at 8:51:04
Hi All,
I am just curious. If someone is a non-responder to ECT, will rTMS work? Any info would be appreciated.
Thanks
Tammy
Posted by Psychquackery on July 29, 2003, at 16:34:29
In reply to ECT/rTMS, posted by TJO on July 29, 2003, at 8:51:04
> Hi All,
> I am just curious. If someone is a non-responder to ECT, will rTMS work? Any info would be appreciated.
> Thanks
> Tammy
Tammy, as one who has personally completed a clinical trial of rTMS I can answer your question definitively. The answer is no, if someone is a non-responder to ECT, then its very unlikely someone will respond well to rTMS. ECT is a much, much more powerful treatment for severe and refractory mood disorders. Afterall the whole purpose of ECT is to cause a generalized grand mal seizure. The purpose of rTMS is to avoid one. rTMS is a much weaker somatic treatment for severe depression, due to the total lack of a generalized seizure.The seizure amounts to a massive, super potent anti-depressant/anti-manic and anti-psychotic theraputic effect. rTMS lacks this seizure, thus it lacks the potency of ECT.
On the other hand, itt is very likely that someone who failed to respond well to rTMS would respond well to ECT. ECT and rTMS are like apples and oranges, you cant really compare them.
Igor
Posted by linkadge on July 29, 2003, at 18:42:57
In reply to Re: ECT/rTMS, posted by Psychquackery on July 29, 2003, at 16:34:29
There is actually much debate over weather the seizure has anything to do with efficacy of of ECT.
A friend of mine with epilepsy and depression, had recurrent grand mal seizures which always resulted in depression. However, ECT worked wonderfully for him.
The electrical stimulation of both forms of treatemt have effects on electrical activity in the brain. I have had sucessful TMS treatments and bad ones. The placement, frequency, duration and intensity are all some of the variables that can result in sucess or failue of the treatment. TMS is a very preliminary procedure, which has definately not been perfected.
Scientifically, both have similar effects on rat brain cortisol, BDNF, NGF, serotonin receptor expression etc.
I would personally not limit TMS to be any more or less effective than ECT untill the procedure is better understood and/or perfected.
Linkadge
Posted by HenryO on July 30, 2003, at 2:13:10
In reply to Re: ECT/rTMS, posted by linkadge on July 29, 2003, at 18:42:57
What is rTMS?
Posted by SLS on July 30, 2003, at 6:22:07
In reply to What is rTMS, posted by HenryO on July 30, 2003, at 2:13:10
> What is rTMS?
repetitive transcranial magnetic stimulation
rTMS is basically the use of a powerful magnet to induce an electric current through brain tissue to stimulate it in a way similar to ECT.
http://www.psycom.net/depression.central.transcranial.html
- Scott
Posted by Psychquackery on July 30, 2003, at 7:29:44
In reply to Re: ECT/rTMS, posted by linkadge on July 29, 2003, at 18:42:57
> There is actually much debate over weather the seizure has anything to do with efficacy of of ECT.
LOL That is entirely untrue. No ECT doctor worth his salt would consider a session of ECT to be successful unless a full grand mal seizure was induced. There is ZERO argument within the psychiatric establishment regarding the importance of the seizure in successful ECT.
I would like to see this debate regarding the importance of the seizure...please post citations for that please.
>
> A friend of mine with epilepsy and depression, had recurrent grand mal seizures which always resulted in depression. However, ECT worked wonderfully for him.
>
> The electrical stimulation of both forms of treatemt have effects on electrical activity in the brain. I have had sucessful TMS treatments and bad ones. The placement, frequency, duration and intensity are all some of the variables that can result in sucess or failue of the treatment. TMS is a very preliminary procedure, which has definately not been perfected.This is not true. rTMS, due to its inherent lack of a grand mal seizure, just lacks the power that conventional ECT has. Some of these rTMS researchers are trying to prove that rTMS has the potential ECT has for treating truly severe, psychotic depressed conditions. However none of the studies have shown rTMS to be as effective as ECT for psychotic depression or mania...the most severe mood disorders.
>
> Scientifically, both have similar effects on rat brain cortisol, BDNF, NGF, serotonin receptor expression etc.ECT stimulates deep brain structures like the thalmus and pituitary gland. It results in profound neuroendocrine changes which kicks depression in the butt. rTMS does not have these capabilities.
>
> I would personally not limit TMS to be any more or less effective than ECT untill the procedure is better understood and/or perfected.I would rate it to be much less effect than conventional (bilateral) ECT.
I will give you one thing though. The side effect profile of rTMS is extremely benign. I personally found it to have zero side effects. None at all. But I dont think its as potent or effective as conventional ECT at treating severe mood disorders.
Igor
Posted by TJO on July 30, 2003, at 11:28:48
In reply to Re: ECT/rTMS, posted by Psychquackery on July 30, 2003, at 7:29:44
Posted by Psychquackery on July 30, 2003, at 14:13:04
In reply to Re: ECT/rTMS Thanks for replying (nm), posted by TJO on July 30, 2003, at 11:28:48
TJO, you are welcome for the answers. My advice to you is rather straightforward. If you have the severe form of depression or have bipolar disorder and are presently disabled, Id opt for ECT over rTMS. ECT is more of a sure thing, whereas rTMS seems to be more hit and miss and seems to work better for more mild to moderate depressive conditions. ECT is the single most potent treatment psychiatry has for severe mood disorders. Why waste time with rTMS when you can go straight to a guaranteed recovery with probably full remission as is typical with ECT?
On the other hand, if youve already had ECT I see no reason why you shouldnt go for rTMS if you have that option. You would probably learn a thing or two in the clinical trial. The doctors who run those clinical trials tend to be among some of the better psychiatrists. And oftentimes you get a free medical exam out of it along with a free SPECT or PET scan, which is useful to help confirm your diagnosis.
In short, you cant go wrong with either option really. But if youve never had ECT, Id opt for that first.
Igor
Posted by linkadge on July 30, 2003, at 14:54:13
In reply to Re: ECT/rTMS Thanks for replying, posted by Psychquackery on July 30, 2003, at 14:13:04
There is much debate over weather the seizure has anything to do with the efficacy of the treatment. You see the seizure petit/grand mal may only be an indicator that certain relative intensities of current have been met. But as to the seizure itself having any efficay that is actually highly debated.
Consider this. We have pro-convulsant drugs that can induce gran/petit mal seizures in the healthy person without the need for electrical stimulation. However, the have absolutely no efficacy in treating depression.
Linkadge
Posted by TJO on July 30, 2003, at 17:27:14
In reply to Actually no, posted by linkadge on July 30, 2003, at 14:54:13
Hi All,
I have bipolar disorder and am presently disabled. I am lucky in that right now I am responding well to my medication. I am concerned about what might need to be done if my meds should stop working all of a sudden since I can get psychotically depressed. ECT or rTMS are treatment options I have to keep in the back of my mind just in case. thanks for the info on trying ECT first, I would have thought to try rTMS first before I read that post.Tammy
Posted by Psychquackery on July 30, 2003, at 18:49:15
In reply to Actually no, posted by linkadge on July 30, 2003, at 14:54:13
> There is much debate over weather the seizure has anything to do with the efficacy of the treatment. You see the seizure petit/grand mal may only be an indicator that certain relative intensities of current have been met. But as to the seizure itself having any efficay that is actually highly debated.
Again, please put some Medline citations up here to support this claim you have. I dont agree with you and no ECT doc, nor any mainstream clinical psychiatrist would agree with you on the ECT-seizure relationship. There is a DIRECT relationship between quality of the seizure and the effectiveness of the treatment.
Why do you think its called electroCONVULSIVEtherapy? The convulsion, or grand mal seizure, is central to the whole thing. In fact these ECT docs even publish their own ECT journal and what its called? Its titled "Convulsive Therapy."
Some of these researchers involved in the MIBS (Minimally Invasive Brain Stimulation) modalities such as rTMS, VNS implant and Deep Brain Stimulation are trying to prove they can get the same results as conventional ECT can get. They want to stimulate the brain, but do it in a "minimal" and more specific fashion that doesnt result in a seizure. But so far, the results have shown none of these MIBS modalities have anywhere near the effectiveness for severe mood disorders as plain old fashioned bilateral ECT. Bifrontal ECT is also said to be very effective.
In fact, even some of these rTMS researchers are finally beginning to give into the basic fact that if it doesnt cause a seizure, its not going to be very effective for really severe conditions. They have begun experimenting using rTMS magnetism to induce grand mal seizures in refractorily depressed individuals. Its dubbed "MST" or Magnetic Stimulation Therapy." Notice they removed the Convulsive from the acronym, but their objective in MST is to induce a seizure, but with magnetism instead of electricity. They claim this has fewer memory side effects than ECT.
>
> Consider this. We have pro-convulsant drugs that can induce gran/petit mal seizures in the healthy person without the need for electrical stimulation. However, the have absolutely no efficacy in treating depression.
>That is totally untrue. The chemical approach to inducing seizures included insulin shock treatment and some other inhaled chemicals that induced a grand mal seizure. These were effective for the psychiatric conditions and basically resulted in the same results as ECT, but were medically EXTREMELY unsafe. Thats why they were discontinued. Insulin shock was made illegal about thirty years ago (for very good reason BTW) as was the chemical or inhaled methods. In short, it was discovered a long time ago that the safest and most effective method to artificially induce a grand mal seizure is simple electricity!
Petite mal seizures are of no use to treat any psychiatric condition BTW. It must be a generalized, "full body" grand mal seizure to have any worth or effectiveness.
Igor
Posted by linkadge on July 30, 2003, at 21:02:10
In reply to Re: Actually no, posted by Psychquackery on July 30, 2003, at 18:49:15
You are taking something that has scientists have absolutely no idea how works and you are trying to assign meaning and science behind it that just doesn't exist.
The reason they call it ElectroCONVUSIVETherapy is because thats what the procedure is, and thats how they've been doing it. Just because they've been doing it a certain way, with a certain procedure, does not mean the whole shibang is necessary.For instance we can induce seizures quite safely using a magnesium restricted diet and glutimate receptor antagonists. This is one approach that has been used to try and replicate the effect of ECT. It produces full Grand Mal seziures. The stradegy was abandoned because it did nothing for depression. ( only induced memory loss. )
Insulin shock therapy is again a totally different procedure that we separately don't understand. We cannot say that it works in the same way as ECT if we don't really know how ECT works now can we???
You are inserting information into the equation that just never existed. You ask any of the top scientists why ECT works and they'll tell you they don't have a clue.
We know some of the results of it though.
- Both ECT and rTMS decrease gluticorticoid
expression- Both ECT and rTMS upregulate NGF, BDNF, GDNF
and other nerve growth factors in rat brain.- Both ECT and rTMS alter 5HT1a/b autoreceptors.
- Both ECT and rTMS alter norepinephrine
expression.- Both ECT and rTMS increase bloodflow to left
prefrontal lobe.- Both ECT and rTMS have effects on substance P
NK-1 receptor expression.Infact find a observable brain alteration induced by ECT that is not also induced to a certain degree by rTMS.
If you think that ECT is the only way that we can safely evoke seizures these days, that is just not true. If scientists really thought that ECT's sole mechanizm was through inducing a seizure then the direction of our research would change completely. We would've abandoned this direction completely. Not only are many (specific) pro-convulsant drugs useless for psychiatric conditions, they also induce short term memory loss - so go figure - that accounts for one side effect.
Many scientists simply think that the seizure is just a marker, that certain neronal stimulation has been reached. How do you know that the theraputic effect is not reached moments before the seizure? There is no way to know (yet at least)How can you say rTMS is a weaker version of ECT when we don't know how either work? Again, you're inserting info into the equation. Most people who use rTMS agree that it is still in its intfant stages. I would agree with you when you say at 'this time', it is less effective than ECT, because that's just the statistics. For instance, certain frequencies facilitate neurotransmitter release, and other frequencies impede neurotransmitter release. Scientists are basically just poking around and recording what happens.
I know you want to make it into some solid and fully researched/understood procedure, but it is just not.
Some researchers believe that the sucess of ECT is based on its ability to modulate gluticorticoid expression. The drug RU-486 is the only drug to be fast-tracked for a psychiatric condition. It has extreme efficacy in severe and debilitating psychotic depression (Even in persons where ECT has failed)
Could it be that this is the common mechanism. (A mechanism that is equally pronounced in both ECT and rTMS). You cannot say no - because we don't know.
Linkadge
Posted by Psychquackery on July 30, 2003, at 21:38:51
In reply to Sorry, posted by linkadge on July 30, 2003, at 21:02:10
> You are taking something that has scientists have absolutely no idea how works and you are trying to assign meaning and science behind it that just doesn't exist.
HUH? No Im not Im just repeating what Ive read. That the seizure is the CRITICAL part of ECT. No seizure...no good antidepressant effect. Seriously Linkadge...go ask ANY psychiatrist...anyone anywhere if ECT will work if they just pass electricity thru the brain without inducing a grand mal seizure. I guarantee you the answer will be the same wherever you go. That "ECT" of that sort (no seizure) is essentially worthless.
>
>
> The reason they call it ElectroCONVUSIVETherapy is because thats what the procedure is, and thats how they've been doing it. Just because they've been doing it a certain way, with a certain procedure, does not mean the whole shibang is necessary.No...its because they have discovered that the seizure itself is the mechanism which causes profound brain changes, which decreases depression, mania, psychosis and even parkinsons. And a seizure is a convulsion. Thats a hard fact. They arent just passing an electric current thru your brain for no good reason, the shock docs are doing it to VERY SPECIFICALLY elicit a grand mal seizure. That is the sole objective of ECT...why do you have trouble understanding this basic fact?
Do you have a deep seated basic fear of ECT? Is that why you deny the basic facts surrounding ECT?
>
> For instance we can induce seizures quite safely using a magnesium restricted diet and glutimate receptor antagonists. This is one approach that has been used to try and replicate the effect of ECT. It produces full Grand Mal seziures. The stradegy was abandoned because it did nothing for depression. ( only induced memory loss. )Sounds silly to me. It was probably the magnesium restricted diet that created depression. Magnesium deficiency is known to create depression all by itself.
>
> Insulin shock therapy is again a totally different procedure that we separately don't understand. We cannot say that it works in the same way as ECT if we don't really know how ECT works now can we???No...its actually very similar to ECT. The only difference is HOW the seizure is created. With ECT electricity is used, with insulin shock...its the insulin injected into the body that creates a grand mal seizure. The end result is the same...a grand mal seizure. The end objective is the same...a grand mal seizure.
LOL Man you dont understand anything, do you?
>
> You are inserting information into the equation that just never existed. You ask any of the top scientists why ECT works and they'll tell you they don't have a clue.Thats not true. They have ideas how and why it works. If you read Max Fink's stuff he firmly believes ECT works mainly by "profound neuroendocrine changes" deep inside the brain. Around the thalmus and pituitary gland area. These changes are created by the seizure. No seizure and these changes simply do not occur...its just a hard fact. Get Fink's books and read it for yourself!
>
> We know some of the results of it though.
>
> - Both ECT and rTMS decrease gluticorticoid
> expression
>
> - Both ECT and rTMS upregulate NGF, BDNF, GDNF
> and other nerve growth factors in rat brain.
>
> - Both ECT and rTMS alter 5HT1a/b autoreceptors.
>
> - Both ECT and rTMS alter norepinephrine
> expression.
>
> - Both ECT and rTMS increase bloodflow to left
> prefrontal lobe.
>
> - Both ECT and rTMS have effects on substance P
> NK-1 receptor expression.And ECT does all of the above much more potently than rTMS does and ECT creates a more robust recovery than rTMS does. It is a HARD FACT linkadge, that bilateral ECT has the highest percentages of FULL REMISSION from psychotic depression of any treatment available in psychiatry. There have been so many studies to back this claim, I couldnt list them all. Go to Medline and look up "psychotic depression AND bilateral ECT" if you dont believe me.
You wont find the same results with rTMS. Go find one medline study that says rTMS has high full remission rates for psychotic depression or for bipolar mania. You wont find a single one Linkadge. And if by some small chance you do find one, it wont be replicated.
>
> Infact find a observable brain alteration induced by ECT that is not also induced to a certain degree by rTMS.
>
> If you think that ECT is the only way that we can safely evoke seizures these days, that is just not true. If scientists really thought that ECT's sole mechanizm was through inducing a seizure then the direction of our research would change completely. We would've abandoned this direction completely. Not only are many (specific) pro-convulsant drugs useless for psychiatric conditions, they also induce short term memory loss - so go figure - that accounts for one side effect.Well Linkadge, so far as I know convulsive therapy is currently revolving around two modalaties. Regular ECT...er the perfection of it. And the Magnetic Stimulation Therapy, which is just a spinoff of rTMS. In other words, even the rTMS researchers who once believed rTMS would have the same effectiveness as ECT have now realized rTMS just doesnt cut the mustard for severe mood disorders. So theyve decided to try and use magnetism to induce seizures. DUH!!
>
>
> Many scientists simply think that the seizure is just a marker, that certain neronal stimulation has been reached. How do you know that the theraputic effect is not reached moments before the seizure? There is no way to know (yet at least)The seizure is the marker. Thats exactly right. And without it, you aint got nothin. All that money you just spent with the shock doc is worthless if they dont give you a nice big ole grand mal seizure!
>
> How can you say rTMS is a weaker version of ECT when we don't know how either work? Again, you're inserting info into the equation. Most people who use rTMS agree that it is still in its intfant stages. I would agree with you when you say at 'this time', it is less effective than ECT, because that's just the statistics. For instance, certain frequencies facilitate neurotransmitter release, and other frequencies impede neurotransmitter release. Scientists are basically just poking around and recording what happens.rTMS IS a weaker version of ECT! Its much weaker than ECT. I even have had rTMS researchers frankly admit to me to my face its weaker. Thats why it doesnt have any side effects. Thats why it doesnt need anesthesthia...its WEAK!
Again...go on medline and try and pull up a rTMS study where they solidly concluded that rTMS is as effective for severe psychotic depression and/or bipolar mania as bilateral ECT is. You wont find any. And thats the bottom line, my friend.
>
> I know you want to make it into some solid and fully researched/understood procedure, but it is just not.Sure its not understood to the degree we'd like. But I think its a little bit better understood than you have stated on here. They do know the basics of it. Again, go read Max Fink's books, go read Medline. Compare rTMS versus ECT on Medline for severe mood disorders.
>
> Some researchers believe that the sucess of ECT is based on its ability to modulate gluticorticoid expression. The drug RU-486 is the only drug to be fast-tracked for a psychiatric condition. It has extreme efficacy in severe and debilitating psychotic depression (Even in persons where ECT has failed)Max Fink says that the way ECT works is by inducing a grand mal seizure that stimulates deep brain structures and creates neuroendocrine changes. Thus the anti-cortisol thing. ECT has been doing the RU-486 anti-cortisol thing for over fifty years! And it does it better than anything.
Keep in mind that the people who claim RU-486 works as good as ECT for psychotic depression are connected to the pharmaceutical industry. It may or may not be true that RU-486 is effective as ECT. I personally doubt it will come true, although I do believe RU-486 will probably eventually have some uses in psychiatry. But as or more as effective as ECT? I seriously doubt it.
>
> Could it be that this is the common mechanism. (A mechanism that is equally pronounced in both ECT and rTMS). You cannot say no - because we don't know.Its not equally pronounced Linkadge. If it was as equally pronounced youd be reading that rTMS was as effective for psychotic depression as ECT on medline. And you wont do that. Cause those studies simply dont exist, because the researchers KNOW that it wont work as good for really severe, nasty mood disorders.
The bottom line (this is a hard fact BTW) is that no somatic treatment for psychotic depression has as high a full remission rate as bilateral ECT does. Hard fact, my friend.
>Igor
Posted by Psychquackery on July 30, 2003, at 21:45:03
In reply to Re: Sorry, posted by Psychquackery on July 30, 2003, at 21:38:51
I just have one question. Where are those Medline citations backing up your claims that rTMS is as effective as ECT for severe psychiatric conditions ? Such as psychotic depression, catatonic depression, bipolar disorder, major depression accompanied by neuroleptic induced movement disorders, etc. etc.
You honestly think rTMS is going to fix that kind of stuff? I dont. Again, go to Medline and put some citations up here.
Igor
Posted by Dr. Bob on July 30, 2003, at 23:00:32
In reply to Re: Sorry...youre excused, posted by Psychquackery on July 30, 2003, at 21:45:03
> Again, please put some Medline citations up here
> LOL Man you dont understand anything, do you?
>
> Go to Medline
>
> Go find one medline study
>
> Again...go on medline
>
> go read Medline.> Where are those Medline citations
>
> Again, go to MedlinePlease pressure others or post anything that could lead them to feel put down, thanks.
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by avid abulia on July 30, 2003, at 23:13:05
In reply to Re: Sorry...youre excused, posted by Psychquackery on July 30, 2003, at 21:45:03
Hey, this is marginally off the topic... but I'd like to point out that virtually every known treatment for depression has pro-convulsive activity (some more than others, but even Lamictal can cause worsening of seizure disorders in some people... you want sources? Go look at any monograph for the drug, and you will see "exacerbation of seizure disorder" listed as a potential side effect)... so while it is true that not every pro-convulsant chemical has an antidepressive effect, almost every anti-depressive chemical has a pro-convulsive effect.
Additionally, I would like to ask: why is it that you are recommending ECT over rTMS just because ECT is (in your ever-so-humble-opinion) always less effective? To me, it seems a little bit like saying, hey, go for the morphine first and let's forget about trying the ibuprofen cuz it's just not as effective... I'd want to go for the one with fewer side effects first and see if that worked for me, before I went on to risk the dangers inherent in ECT (or morphine, for that matter).
Posted by SLS on July 31, 2003, at 5:50:06
In reply to Re: Actually no, posted by Psychquackery on July 30, 2003, at 18:49:15
Hi.
> Why do you think its called electroCONVULSIVEtherapy? The convulsion, or grand mal seizure, is central to the whole thing. In fact these ECT docs even publish their own ECT journal and what its called? Its titled "Convulsive Therapy."
I would just like to point out that it does not follow from logic that just because a seizure is necessary for the successful use of ECT that it also be necessary for the successful use of rTMS. One could make an argument that a seizure is necessary with ECT because the power of the discharge is not localized to areas of the brain that are involved with its therapeutic effects. As such, the spread of a generalized seizure would be necessary to include those areas. On the other hand, rTMS can be focused on individual brain structures.
- Scott
Posted by linkadge on July 31, 2003, at 6:42:14
In reply to Re: Actually no, posted by SLS on July 31, 2003, at 5:50:06
I don't want to argue about this because it is
fruitless. This is my last post on this topic.The bottom line is this.
1. ECT is probably the least understood of all
treatments for psychiatric conditions.2. Did you even hear what I said about rTMS? I
agree with you that it is not as effective
as ECT at the time being. Do you not
understand the concept of 'being investigated'?
Do you not understand the consept of 'under
investigation'? If you've got it fixed in
your mind that nothing will ever be better
than ECT than we're going to get nowhere
will we. It still doesn't work for some. We've
got room to improve.3. I am not trying to proove anything, all I am
saying is that we don't understand how they
work. The seizure theory us just 'proposed
mechanism'. Just like SSRI's. For years we
thought that raising serotonin *was* the key to
the therapudic effect of AD's. Now we have
a drug like Tianeptine that does the exact
opposite. It lowers serotonin levels. Yet, it
is as clinicaly effective as Prozac. You can
yell at me all you want about Serotonin this
or serotonin that but it's still just theory.
So what happened to all the theory that we
thought we had?? It's still there, because it
was just theory to begin with.6. You seemed to have completely changed the
humble tone of pschiatric research. The
tone that says 'we don't understand' but 'we
can accept that'.7. I'm not doubting you that there is good
research to support your claim. But to say that
this theory is factual 100%, is a grave,
detremental and dogmatic claim. We would get
nowhere if we boasted our theories as fact and
then closed our eyes to all other incoming
information.Linkadge
Posted by rod on July 31, 2003, at 7:21:06
In reply to Listen, I'm done here, posted by linkadge on July 31, 2003, at 6:42:14
"[Are convulsions necessary for the antidepressive effect of electroconvulsive therapy: outcome of repeated transcranial magnetic stimulation]"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9333558&dopt=Abstract
A note: Sismotherapy (ST)= electroconvulsive therapy...However, recent preclinical data using attenuation, and clinical findings using reiterated transcranial magnetic stimulation (rTMS), suggest that it may not be necessary to provoke a clonic convulsion in order to achieve the beneficial psychotropic and anticonvulsant effects of ST...
Posted by Psychquackery on July 31, 2003, at 9:13:29
In reply to Listen, I'm done here, posted by linkadge on July 31, 2003, at 6:42:14
> I don't want to argue about this because it is
> fruitless. This is my last post on this topic.
>
> The bottom line is this.
>
>
> 1. ECT is probably the least understood of all
> treatments for psychiatric conditions.
>
> 2. Did you even hear what I said about rTMS? I
> agree with you that it is not as effective
> as ECT at the time being. Do you not
> understand the concept of 'being investigated'?
> Do you not understand the consept of 'under
> investigation'? If you've got it fixed in
> your mind that nothing will ever be better
> than ECT than we're going to get nowhere
> will we. It still doesn't work for some. We've
> got room to improve.
>
> 3. I am not trying to proove anything, all I am
> saying is that we don't understand how they
> work. The seizure theory us just 'proposed
> mechanism'. Just like SSRI's. For years we
> thought that raising serotonin *was* the key to
> the therapudic effect of AD's. Now we have
> a drug like Tianeptine that does the exact
> opposite. It lowers serotonin levels. Yet, it
> is as clinicaly effective as Prozac. You can
> yell at me all you want about Serotonin this
> or serotonin that but it's still just theory.
> So what happened to all the theory that we
> thought we had?? It's still there, because it
> was just theory to begin with.
>
> 6. You seemed to have completely changed the
> humble tone of pschiatric research. The
> tone that says 'we don't understand' but 'we
> can accept that'.
>
> 7. I'm not doubting you that there is good
> research to support your claim. But to say that
> this theory is factual 100%, is a grave,
> detremental and dogmatic claim. We would get
> nowhere if we boasted our theories as fact and
> then closed our eyes to all other incoming
> information.
>
> LinkadgeI really think the problem here is you are afraid of ECT and thus are personally biased against it. I really believe that. Again, the bottom line (and this is a HARD FACT backed up in all the mainstream psychiatric literature) is that bilateral ECT has the highest percentage of full remission from psychotic depression of any treatment. Period. There are no ifs ors and buts. Thats the bottom f*cking line.
I had rTMS and my depression was very severe. I didnt think it had any "punch" or power to it at all. It was so weak...it was like pussy ECT. I wish I had just gotten shocked instead.
Igor
>
Posted by Psychquackery on July 31, 2003, at 9:22:01
In reply to Re: citation, posted by rod on July 31, 2003, at 7:21:06
> "[Are convulsions necessary for the antidepressive effect of electroconvulsive therapy: outcome of repeated transcranial magnetic stimulation]"
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9333558&dopt=Abstract
>
>
> A note: Sismotherapy (ST)= electroconvulsive therapy
>
> ...However, recent preclinical data using attenuation, and clinical findings using reiterated transcranial magnetic stimulation (rTMS), suggest that it may not be necessary to provoke a clonic convulsion in order to achieve the beneficial psychotropic and anticonvulsant effects of ST...You should have looked at who did that study. They are all rTMS researchers. One of them "George MS" is Dr. Mark George who is a Neuropsychiatrist from the Medical University of South Carolina. He is probably the leading overall proponent for the MIBS (Minimally Invasive Brain Stimulation) modalities for refractory depression. He is a very good psychiatrist...I have actually personally used Dr. George as my psychiatrist for a short period several years ago.
But very few would agree with that study. No ECT doctor would agree with it. In short, that study is false...seizures are required to get a really powerful theraputic effect from ECT. And thats just the way it is, like it or not.
Dr. George is personally biased against ECT. He even told me so in his office. He made fun of ECT, he said it worked but in his words "but oh my God the side effects of it." The guy is trying to find ways to treat severe and refractory depression with a better side effect profile basically without resorting to ECT. Which is very honorable and admirable that we have individuals doing research like that. But its very doubtful rTMS will ever achieve the totally proven efficacy of old fashioned ECT.
No seizure...it aint gonna work.
Igor
Posted by Psychquackery on July 31, 2003, at 9:32:20
In reply to Re: Listen, I'm done here, posted by Psychquackery on July 31, 2003, at 9:13:29
> > I don't want to argue about this because it is
> > fruitless. This is my last post on this topic.
> >
> > The bottom line is this.
> >
> >
> > 1. ECT is probably the least understood of all
> > treatments for psychiatric conditions.
> >
> > 2. Did you even hear what I said about rTMS? I
> > agree with you that it is not as effective
> > as ECT at the time being. Do you not
> > understand the concept of 'being investigated'?
> > Do you not understand the consept of 'under
> > investigation'? If you've got it fixed in
> > your mind that nothing will ever be better
> > than ECT than we're going to get nowhere
> > will we. It still doesn't work for some. We've
> > got room to improve.
> >
> > 3. I am not trying to proove anything, all I am
> > saying is that we don't understand how they
> > work. The seizure theory us just 'proposed
> > mechanism'. Just like SSRI's. For years we
> > thought that raising serotonin *was* the key to
> > the therapudic effect of AD's. Now we have
> > a drug like Tianeptine that does the exact
> > opposite. It lowers serotonin levels. Yet, it
> > is as clinicaly effective as Prozac. You can
> > yell at me all you want about Serotonin this
> > or serotonin that but it's still just theory.
> > So what happened to all the theory that we
> > thought we had?? It's still there, because it
> > was just theory to begin with.
> >
> > 6. You seemed to have completely changed the
> > humble tone of pschiatric research. The
> > tone that says 'we don't understand' but 'we
> > can accept that'.
> >
> > 7. I'm not doubting you that there is good
> > research to support your claim. But to say that
> > this theory is factual 100%, is a grave,
> > detremental and dogmatic claim. We would get
> > nowhere if we boasted our theories as fact and
> > then closed our eyes to all other incoming
> > information.
> >
> > Linkadge
>
> I really think the problem here is you are afraid of ECT and thus are personally biased against it. I really believe that. Again, the bottom line (and this is a HARD FACT backed up in all the mainstream psychiatric literature) is that bilateral ECT has the highest percentage of full remission from psychotic depression of any treatment. Period. There are no ifs ors and buts. Thats the bottom f*cking line.
>
> I had rTMS and my depression was very severe. I didnt think it had any "punch" or power to it at all. It was so weak...it was like pussy ECT. I wish I had just gotten shocked instead.
>
> Igor
> >
>I forgot to mention this but its something important I have read and been told a few times. With these MIBS clinical trials (rTMS, VNS, DBS) most of the time they do functional neuroimaging scans on your brain. Usually they do "before and after" brain scans using functional MRI, SPECT or PET scans. In fact for many of these rTMS researchers, the functional neuroimaging research takes overall priority over the rTMS.
My point is that its been claimed by some that these MIBS modalities are not much more than very safe, minimally invasive ways to stimulate the brain which will bring a person temporairly out of depression. But not for long. And these researchers are able to use MIBS in conjunction with functional neuroimaging to show "before" and "after" scans. They are just using rTMS to show what your brain looked like before depression and after the rTMS. But the problem is the rTMS doesnt last very long. Their research is really centered more around functional neuroimaging and the rTMS is just a tool they use to stimulate the brain safely for a short period.
Thus you are just being used as sort of a pawn in some of these guys research. If you want the sure thing though, youre usually better off going with ECT. Like if you are disabled and such, ECT is the better option.
Igor
>
Posted by KimberlyDi on July 31, 2003, at 17:08:05
In reply to Re: Listen, I'm done here, posted by Psychquackery on July 31, 2003, at 9:32:20
Igor,
Growing up, I always thought ECT was the last line of defense, for when no drugs worked, for times when there was no hope left. Shock the brain, reshuffle the deck, and maybe you'll get a better hand? ECT doctors would be put out of work if something safer came along, I imagine.I am curious. If someone was psychotic, and had ECT treatment, would he/she then be allowed to become a brain surgeon?
I don't doubt your intelligence or ability to list side effects from the ECT experience. I would not consider you the authority on the subject with the right to put someone else with a differing opinion down.
btw, you missed one improper word... *kitty*cat
KDi in Texas
Posted by jane d on July 31, 2003, at 18:53:53
In reply to Listen, I'm done here, posted by linkadge on July 31, 2003, at 6:42:14
Posted by Dr. Bob on July 31, 2003, at 19:16:09
In reply to Re: Listen, I'm done here, posted by Psychquackery on July 31, 2003, at 9:13:29
> I really think the problem here is you are afraid of ECT and thus are personally biased against it.
Please don't post anything that could lead others to feel accused or put down. I've already asked you to be civil, so now I'm going to block you from posting for a week.
Bob
This is the end of the thread.
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