Or, more accurately, not reporting to the researchers that you're feeling incredibly depressed.
The same skepticism can be applied to any study, depression treatment or otherwise. Practically, self reporting is highly effective and well correlated with effects, especially for depression.
Of course.
It's just that sometimes, the easiest and least confrontational way to stop a treatment with serious side effects is to claim that the treatment is no longer needed.
Studies should find ways to control for such problems.
Ketamine is a prescription medicine that can be taken oral, intranasal or IV drip. ECT is an inpatient procedure that need one anesthesiologist and one psychiatrist plus nurses to administer, two to three times weekly for three to four weeks. Who pays for the healthcare, definitely want to try the former and use the latter only if the former works poorly.
ECT, due to the potential side effects and Ketamine due to how recent it is are both near the "last lines of defence". IRRC both of them cannot compare to psychotherapy, which has far higher effectiveness at the cost of far more resources.
“The side effect profiles of the two treatments differed, with ECT more likely to cause headaches, muscle pain and memory loss, while ketamine was more likely to cause dissociative symptoms, vertigo and double vision.” I’ll take milder effects over pain and memory loss, thanks. No mention of longevity of effect, or specific studies and who paid for them.
The musician Townes Van Zandt underwent ECT and the loss of his memory haunted him his whole (very tragic) life. It's well-known how deep of an impact that had on him, and not for the better. As if the often pleasant, often interesting, often terrifying yet short term and proven harmless side-effects of Ketamine can even compare to the ECT! I would like to see how _much_ better ECT is, given all the factors. Addition…
According to Wikipedia it was insulin shock therapy, not ECT, that cost Townes Van Zandt his memory:
> ECT should be retired from use. I heard once that brain damage causes the brain to increase production of the steroid allopregnanolone. The beneficial effect of the SSRI's seem to also be related to increased allopregnanolone, NOT to boosting serotonin levels. That's a fascinating insight. Recent medical research implicates neuroinflammation in the pathogenesis of depression [0][1]. Steroids generally have anti-inf…
There's studies from the 80's & 90's showing direct destruction of neurons in mice and chimpanzees with depression like symptoms. Depression it seems literally eats away at the brain, at least in mammals, likely due to inflammation. What's perplexed me is why this mechanism would occur in evolutionary terms, or if it's really just a byproduct.
Did those studies show a causal direction of depression causing neural destruction? My current notion is that the causality is reversed - chronic oxidative stress and neuroinflammation cause physical damage to the brain, which results in depression-like symptoms (e.g. low mood, poor memory, loss of motivation etc.). If this turns out to be correct, then there is a clear physiological cause of depression which can be cured through neuro anti-inflammatory and antioxidant medication.
My friend figured out for herself, when she was in her 30's, that she's a poor methylator who can't turn the food fortification folic acid into a usable form of Vitamin B-9. She once told me that adding L-Methylfolate to her routine was like flipping a switch from "depressed" to "not-depressed". But the doctors had already decided she was being "stabilized" by the anti-psychotic prescriptions they forced on her, so t…
Interesting information... it prompted me to do more research. According to wikipedia, Vitamin B-9 is broken down by our bodies into a family of compounds called "THF", which: 1. Help synthesize DNA, 2. Help repair/modify DNA, 3. Help create the amino acid "Methionine", which is a precursor to other amino acids, and is thus important for the synthesis of many proteins inside the body, 4. Activate Vitamin B12. A defic…
Number 3 is very interesting - Methionine is a crucial precursor to producing glutathione, the body's "master antioxidant". If the inflammation / oxidation hypothesis of depression that I'm spruiking is correct, then B-9 supplementation may help alleviate depression by increase synthesis of glutathione which is turn would reduce the level of free-radical caused neuro-inflammation.
I'm all for your particle-level simulation of the human body, I've had thoughts along similar lines (but unfortunately lack the skills and knowledge to implementation something like this).
Whoa, I firmly believe the electroshock "therapy" was debunked a few times already, wasn't it?
ECT is a really mild form of what used to be electroshock therapy, and you have full agency over if and when to stop. It works for a lot of people.
The problem is the side effects. The memory loss is really rough. Based on my background as a software programmer, my psychiatrist (who has recommended and done ECT for other people) recommended very strongly against ECT for me and said I should try ketamine instead.
This article completely neglects discussion of side effects. Ketamine has almost none, whereas ECT can cause horrible degradations to quality of life. Any discussion of efficacy that doesn’t include side effects is quackery.
I'll give you that it's a short article, but: > The side effect profiles of the two treatments differed, with ECT more likely to cause headaches, muscle pain and memory loss, while ketamine was more likely to cause dissociative symptoms, vertigo and double vision.
I mean the point of ketamine is dissociation. That's where a lot of healing happens.
The vertigo and double vision last a little while, possibly the rest of the day. They're not long term or serious. The memory loss from ECT can be long-term for some people.
I've personally found ketamine to help a lot with my mental health issues. It's great and I'd highly recommend at least giving it a shot in a therapeutic setting. I'm sure it's interesting recreationally as well, though I've never tried it that way.
aren't the side effects of ECT quite severe though? "loss of creativity, drive and energy. difficulty concentrating. loss of emotional responses. difficulty learning new information."
Hmm, that is starting to sound like nerve stapling.
If you take away my creativity and ability to learn, you may as well just kill me. That sounds like a recipe for depression in itself.
You're depressed, which has already destroyed your creativity and ability to learn. Nothing has worked. Your option is to ECT, which may help, or have adverse side effects. Would you try it? If you've not got much to lose, why not? It's not as if suicide is suddenly no longer an option afterwards.
> which has already destroyed your creativity and ability to learn
aren't the side effects of ECT quite severe though? "loss of creativity, drive and energy. difficulty concentrating. loss of emotional responses. difficulty learning new information."
You already have all of those symptoms (and more!) if you have severe treatment resistant depression.