Thread by @psychunseen

1/12 THREAD on ECT:

ECT has been demonized for decades (thanks Miloš Forman) despite it being one of the most rapidly effective interventions in all of psychiatry, often when previous interventions are not possible or have failed.

2/12 Yes, ECT is a serious intervention requiring anesthetic support and medical monitoring. Memory loss is a common side effect and is sometimes long lasting.

But that must be balanced against the life-threatening nature of persistent severe depression and catatonia.

3/12 Some object to the basic premise of "electrocuting" the brain, but don't question the routine life-saving practice of electrical "shock" for cardiac resuscitation.

4/12 It is sometimes claimed that ECT causes "brain damage," citing persistent cognitive deficits as evidence in the absence of any neuropathological evidence.

See the recent debate on this subject in @bmj_latest here:

bmj.com/content/364/bm…

5/12 Similar claims that antipsychotic cause "brain damage" are based on studies showing association w/ decrease in cortical brain volume.

But reduced brain volume doesn't necessarily mean actual loss of brain matter:

jamanetwork.com/journals/jamap…

6/12 also, volume loss has been correlated w/clinical *improvement*

"Although short-term treatment... was associated w/ prefrontal cortical thinning, treatment was also associated w/ better cognitive control & increased prefrontal functional activity."

jamanetwork.com/journals/jamap…

7/12 Still, if taken at face value, that APD brain volume loss = brain damage, then guess what ECT studies show?

An *increase* in fronto-limbic brain volume!

So that means ECT promotes "brain growth," right?

8/12

The evidence:

Meta-analysis by Gbyl et al. 2018:

"MRI studies do not support the hypothesis that ECT causes brain damage; on the contrary, the treatment induces volume increases in fronto-limbic areas."

pubmed.ncbi.nlm.nih.gov/29707778/

9/12

Another meta-analysis by Takamiya et al. 2018 with the same finding:

pubmed.ncbi.nlm.nih.gov/29433612/

10/12

Now, moving on from side effects, does ECT work? Reflecting the lack of new ECT studies, the most recent meta-analysis is from 2003:

Conclusion: "ECT was shown to be superior to medication and simulated ECT."

pubmed.ncbi.nlm.nih.gov/12972983/

11/12 Another 2003 meta-analysis from UK ECT Review Group:

"Real ECT was significantly more effective than simulated ECT... Treatment w/ ECT was significantly more effective than pharmacotherapy... ECT is an effective short-term treatment for depression"

pubmed.ncbi.nlm.nih.gov/12642045/

12/12

And so, we can all agree that more/better ECT research needs to be done.

But the evidence indicates that the benefit for refractory depression & catatonia where few other options exist outweighs risk of serious adverse events. And evidence for "brain damage" is lacking.

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