Talk:Electroconvulsive therapy/Archive 2

Reference to David Armstrong
Can someone help me fix the citation for David Armstrong? I was able to add the source details under "References" and the footnote number in the article under "Side Effects," but when the corresponding number in "Footnotes" is left blank.


 *   is not the easiest template to use. There is more info on http://meta.wikimedia.org/wiki/Cite/Cite.php but even that isn't easy to follow. Also, it helps to add new subjects to the 'bottom' of talk page - so make for easier archiving at a later date. Oh! and you forgot to sign your name on the this page so I don't know who I'm talking to. --Aspro 20:12, 24 August 2006 (UTC)

Thanks so much for helping out. Yeah, I keep forgetting to add the signature code. I wish Wikipedia could do it automatically like LiveJournal. Most of their coding is automated. Well, thanks again.

Chris Dubey 23:16, 24 August 2006 (UTC)

Question
Who added this sentence: "Some recent studies suggest the opposite; long term ECT treatment, like antidepressant treatment, seems to protect the brain from the damaging effects of depression." and why? What studies? Why the hell is this in here? I'm taking it out until it's properly sourced. Francesca Allan of MindFreedomBC 05:25, 15 November 2005 (UTC)

Sorry, I now see that you are referring to that study which you mention right afterwards. Still, one 1998 study doesn't translate to "some recent studies" very well. I'm going to find Peter Breggin's article and link it here. Last time I did so, a wiki-vandal took it out. Francesca Allan of MindFreedomBC 05:30, 15 November 2005 (UTC)

Hi, there are a few papers on neuroprotective action of ECT/ECS: cf. Nibuya M, Morinobu S, Duman RS. Regulation of BDNF and trkB mRNA in rat brain by chronic electroconvulsive seizure and antidepressant drug treatments. J Neurosci. 1995;15:7539-7547. Also http://www.cnsspectrums.com/pdf/art_360.pdf (this actually cites the above article). --81.179.80.131 15:34, 17 November 2005 (UTC)

As Peter Breggin points out in the article which is not allowed to be linked to this page, rat research has a very tenuous relationship with human research. The overwhelming majority of electroshock survivors report serious short-term memory disturbance and many of them report long-term difficulties. This isn't indicative of "neuroprotective action." In summary, I don't give a rat's ass. Francesca Allan of MindFreedomBC 02:00, 19 November 2005 (UTC)

Can you point me towards a controlled study that shows that "many" ppl objectively experience long-term memory loss? --81.179.80.131 10:13, 19 November 2005 (UTC)


 * Excuse me. Why do we need a controlled study to confirm that many electroshock survivors are harmed?  Why is psychiatry not held to the same standard?  Electroshock survivors (including myself) report devastating memory problems.  For about one year afterwards, I read the same book over and over because I simply could not retain what I read.  Why this wilful blindness to first-hand knowledge of electroshock?  Have you been electroshocked?  If not, perhaps you should drop the attitude.  Francesca Allan of MindFreedomBC 16:12, 1 December 2005 (UTC)

Oh, and BTW, "serious" memory loss for the day of/the hours around the time of treatment, yes. This is probably a combined effect of both the current and the anaestethic procedure. Unless, again, you have first hand experience or a study that proves otherwise. --81.179.80.131 10:17, 19 November 2005 (UTC)


 * Memory loss is much more involved than just around the treatment. The effects seem to last months, years, even decades.  Sadly, I do have first hand experience.  Francesca Allan of MindFreedomBC 16:12, 1 December 2005 (UTC)


 * I am sorry that your experience did not work out well for you but it really is not terribly relevant. The fact remains that research has shown that for the vast majority of people the memory loss is not experienced as you describe it. djheart 06:24, 2 December 2005 (UTC)

If it were just me, of course, it wouldn't be terribly relevant. However, I'm not alone. Many people are hurt in the long term by electroshock. Even though this may not be true for the "vast majority," it is still relevant. Psychiatric "research" has a way of excluding the experiences that count the most: that of the patients. Francesca Allan of MindFreedomBC 14:46, 2 December 2005 (UTC)

And another thing: I think the expression "...because of its brain damaging effects." is in serious need of being rephrased, as it implies that it is a given notion, backed by scientific research, which it certainly isn't. I would therefore suggest that we change it to: "...and claim it has brain damaging effects." or "...because they perceive it as brain damaging.". So unless I find a controlled study/bio-/neurochemical research paper cited here that shows the equivalent of the scientific community perceiving ECT as clearly brain damaging I will reenforce introduce this change myself in a week's time. --Ft. Jack Hackett 12:14, 19 November 2005 (UTC)


 * No, you were right the first time. You're a wiki-bully and you want to force your POV even if it destroys the article.  Francesca Allan of MindFreedomBC 04:19, 2 December 2005 (UTC)


 * Your faith in "controlled" neurobiological research is quaint. Let's not forget the horrors that peer-reviewed studies have brought us in the past.  Francesca Allan of MindFreedomBC 16:12, 1 December 2005 (UTC)


 * The scientific community is notorious for being blind to the obvious. The fact that psychiatrists don't care enough about their patients to investigate these claims is a reflection on the arrogance of psychiatry, and has nothing whatsoever to do with the validity of the patients' claims.  Electroshock is brutal and should be abolished.  Francesca Allan of MindFreedomBC 04:14, 2 December 2005 (UTC)


 * I revised risks section so that it no longer reads that ECT causes brain damage. Wikipedia has an anti-pseudoscience policy and as I already discussed at length on the psychiatry talk page there is no credible scientific evidence that ECT causes brain damage (and please don't use a Breggin quote again as defense, it's getting tiring).  I will delete any references to brain damage that don't qualify the statement by stating that the idea of brain damage is only supported by one a small minority of researchers (which I think is a generous thing to say since so far you have only fished out one guy). djheart 06:17, 2 December 2005 (UTC)

"Pseudoscience"? The whole of psychiatry is pseudoscience, at best. And why aren't we allowed to use Breggin as a source? Because you find it "tiring." I see. You're pretty tiresome youself, djheart. Francesca Allan of MindFreedomBC 14:49, 2 December 2005 (UTC)


 * I never said you can't use Breggin as I source, I'm just saying that it seems to be your only source (well Breggin and your own personal experience) and the only crutch you are standing on to support your ideas. On a side-note I won't continue this discussion if you continue with ad homenum (sp?) attacks.  djheart 01:42, 5 December 2005 (UTC)

Not just my own personal experience, djheart. Unlike yourself, I am keenly interested in what other psychiatric survivors have to say and take their complaints of memory damage and ongoing confusion very seriously. It's hard to say whether long-term memory problems constitute brain damage but it's certainly worth exploring. See Wendy Funk's book "What Difference Does It Make?" Read about Leonard Frank's experiences. If you want to engage in a civil discussion, then perhaps you should drop your sneering attitude. I don't need a "crutch" to support my "idea" that electroshock is harmful. Perhaps you need a crutch to support your idea that you're in a helping profession. I believe that all of psychiatry labours under a similar delusion. Francesca Allan of MindFreedomBC 05:56, 5 December 2005 (UTC)

In the textbook "Neuroscience" by Purves et al (2004) in the chapter "Memory" they discuss ECT as an example of something that causes memory loss! They take this as evidence that the long term memory is located in the cortex, since ECT mainly affects the cortex. They indicate to that the memory loss is due to that brain cells are stressed to death (excitotoxicity), see p. 746 and Box D in chapter 6. Killed brain cells I would call a brain damage. mikael4u 14:52, 20 August 2006 (CET)

References tidy up
Allowing for the mixed system of Harvard references with the citation details in the 'References' section and also use of the cite.php system, there were inconsistancies in how these were used and some duplication of full details in both sections. I have also had a go at some wikistyle issues, using the citation templates wherever possible: David Ruben Talk 03:39, 7 June 2006 (UTC)
 * Where cite.php reference used in the text, then converted to standard citation formating using citation templates - thus matching how the list under the 'References' section is marked up.
 * Cite.php link listing multiple sources:
 * No need to give a full citation template if item already exists in the 'Reference' section.
 * Likewise move any individual citation template across to the 'Reference' section
 * Some multiple item references just give main author and year, some also the PubMed abstract number. As all the details are then given in the 'References' section, this is unnecessary duplication and PMID number removed.
 * Some citations as 'name year', others in Harvard stye of 'name (year)' - switched to consistant Harvard style used for other citation links
 * Convert any book references to also use relevant 'template:cite book'
 * If a full citation is given both as a cite.php reference and in the 'reference' section, and is not mentioned elsewhere, then removed from 'Reference section'
 * Move citation links after punctuation.
 * Convert html italics  to wikimarkup ''
 * Where same reference used twice, use duplicate format of cite.php  
 * In cite:journal template, the PubMed link need only be given as  id=PMID number . there is no need enclose in curley brackets.

Removing dispute tag: poll
I'm not sure of the process for doing this, but I think the "Controversy" section is now reasonably neutral and pretty cast-iron factually accurate. Can anyone interested please say whether they would support removing the tag from the section?

Please sign your name using four tildes ( ~ ) under the position you support, with a brief comment if you wish. It would be helpful if longer comments / discussion could get their own section (click the "+" above!)

Remove the tag - the article is now neutral and factually accurate

Nmg20 15:13, 25 June 2006 (UTC)

Mmoneypenny 21:54, 21 September 2006 (UTC) (and very impressed with the NPOV taken throughout, somebody has obviously done a lot of work here!) (IMHO, the additional work needed does not justify having an "under dispute" tag.

Leave the tag - the article needs more work

Staug73 11:01, 30 June 2006 (UTC) There are still some factual inaccuracies and places where the article reads rather oddly.

Thanks.

Please remove the tag. I feel it is NPOV enough. absolutecaliber 01:36, 20 October 2006 (UTC)]

Involuntary ECT in England and Wales
I have replaced

In England and Wales the Mental Health Act 1983 allows the use of two ECTs in a life-threatening situation, at the discretion of the treating psychiatrist. This is most commonly invoked in the case of a patient who has stopped drinking fluids whilst suffering from a severe depressive illness. Further ECT, or involuntary ECT in less urgent circumstances, must be authorised by an independent psychiatrist, who, if in agreement, will usually give consent for a total of twelve ECT.

because the law doesn't actually specify 2 treatments or a life-threatening situation. Mental Health Act Commission Guidance for Commissioners

Regarding the bits about twelve treatments or stopped drinking fluids - if anyone wants them back in, could they say where the info comes from?

Actually I have found a reference to 12 treatments. In that same guidance it says that a maximum number of treatments must be authorised and the usual number is 12 although the number of treatments authorised may be more or less. As it is not a fixed number I wouldn't have thought it wasn't necessary to put it in, but if anyone disagrees....

This is the first time I have edited and if I haven't quite got the hang of it, apologies. In history the edit has come up as anonymous and 17 instead of see talk. I have worked out what went wrong. But could someone tell me how to get a link into a footnote?

Staug73 16:04, 2 July 2006 (UTC)

Electroshock Quotationary
Hello: My name is Wolfdeck (clearly a newbie) and I am a little upset with the state of this page. I didn't find a single reference to Leonard Roy Frank nor a link, although I added one at the end. I think that the most important and influential authority on the subject really ought to be visible at a glance. The intro takes a hitch ~3rd sentence, 2nd paragraph (like someone went into it and wrote graffiti. The side-effects section (scanned) appears to be well-stated. As Leonard is a walking encyclopedia himself, I don't understand why he isn't being better used to enhance Wikipedia in support of the inquiring masses. More importantly I feel this page is a dishonour to Leonard, although clearly some people have had to fight to maintain it to this level, which is commendable. For example: ABOUT LEONARD ROY FRANK

In the 1990s update to his terrific book, Electroshock: The Case Against, which offers summaries of activist resistance to electroshock over the last four decades of the 20th century, Robert Morgan offered the following acknowledgment of Leonard Frank.

His written work on ECT and advocacy against it have straddled the decades covered in this book. Initially disabled by ECT, Leonard devised some particularly ingenious organizational and memory techniques to overcome his resultant learning disabilities. He has devoted his life to addressing and correcting abuses of the psychiatric system, particularly ECT. Although he has been a strong and effective figure in this history over the decades, it is particularly now that he has emerged as a key figure. A tough, gentle, articulate and consummately effective organizer, he has probably done more to advance survivors' rights than anyone else. A former editor of the Madness Network News (survivors journal) and current primary leader of the opposition, both scientist/professional and survivor, he has been the role model and integrity for a very diverse coalition of independent individuals. Thanks to Leonard, a very well financed and credentialed initiative was defeated, at least in San Francisco, at least for now.

Leonard Frank has been strong, effective, gentle and tough with me over the last decade as he became a primary mentor and very close friend. He is best described, however, by the dynamics of love and truth. More than anyone, he has helped me to become more clear about language and the patterns of psychiatric oppression. When the idea to form the Coalition for the Abolition of Electroshock in Texas came into my head last summer, Leonard nurtured the idea with enthusiastic support, and helped us be clear about our Gandhian approach of active, transparent, nonviolent resistance. As we organized ourselves into existence this past fall, Leonard stepped up and has been an integral voice of wisdom, guidance and encouragement. I am grateful to be working shoulder to shoulder with this awesome man, in his fifth decade of activism against psychiatric oppression in general, and electroshock in particular.

The Electroshock Quotationary is the single best document available to learn about the reality of this horrific practice.

--John Breeding, PhD 4-28-06 (Wolfdeck 06:38, 24 July 2006 (UTC)Wolfdeck) (moved from top of page by zenohockey 19:00, 24 July 2006 (UTC))

Archive
I'm archiving the talk page, which is over 216 kilobytes long. This is my first time, so if I mess-up, please feel free to fix anything! =D  Jumping cheese  Contact 04:27, 21 August 2006 (UTC)
 * Looks good, but I moved the "Question" section back since there was a new posting just yesterday. --zenohockey 16:14, 21 August 2006 (UTC)

"Short term improvement?"
That phrase sort of bothers me; it implies that ect never provides long-term relief. Someone needs to provide documentation of this, or else remove that descriptor altogether. Asarkees 15:29, 12 September 2006 (UTC)


 * Medically, I think ECT is seen as a medium-term solution to the problem - but the frequency of repeat treatments suggests it isn't in and of itself a long-term one. That's not to say the relief it offers from debilitating psychiatric symptoms can't help effect changes in the interim - but I think that "short-term" is justified here, although "medium-term" might be fairer, or at least a suggestion of how long it works for. Referencing that would be excellent. Nmg20 23:58, 16 September 2006 (UTC)

Barbara C. Cody & Kitty Dukakis
Zenohockey recently replaced the quotation from ECT patient Barbara C. Cody with a quotation from ECT patient Kitty Dukakis. There is nothing wrong with adding the Dukakis quotation. However, completely deleting Cody's mention, just because she isn't as famous or because a Wikipedian disapproves of her comments is unethical in the context of Wikipedia.


 * I'd support reintroducing this. It might be better to include direct quotes from private individuals who've undergone ECT about their experiences in the "cultural depictions of ECT" section - although they provide some qualitative info about side-effects, I'd suggest they're more relevant there. Nmg20 23:20, 24 September 2006 (UTC)


 * Thank you, Nmg20, you have been quite a help. Like I was saying, the Dukakis quote is fine, because it's a real quote from a real person who really had the treatment. But, as far as we know, Cody is, too. If we censor discrepant information just because the information contains dissent, and not because the information is proven invalid, then Wikipedia will be a totalitarianism and not the apparent democracy that it is. I will readd the Cody quote and put the quotes together like you said.


 * Chris Dubey 01:17, 25 September 2006 (UTC)


 * And let me just add that at least Cody is a former Registered Nurse. No evidence is given that Dukakis even has a professional background in medicine, which would make her opinion even less valid in comparison. But both should be presented, unless they're proven psychotic, which neither is. All right. I'm done for now.


 * Chris Dubey 01:45, 25 September 2006 (UTC)


 * You don't even know my views (if any) on ECT; please remember to assume good faith in the future.
 * Regarding Ms. Cody...I probably didn't explain my reasoning well. I've no beef with her, nor any desire to censor dissent or turn WP into "a totalitarianism."  But Wikipedia's purpose, as I understand it, is to provide verifiable information using reliable sources.  A case study on any one individual, whether Barbara C. Cody, R.N., B.S., or Kitty Dukakis, only provides information on that person's experiences.  I felt that:
 * Dukakis's account is more representative of the average ECT patient's experience than Cody's (judging by the data cited in the article),
 * Your offhand remark "as far as we know," referring to Cody's authenticity, is key. Dukakis is a notable individual, but it's not just that; it's what it implies—that we, the general public, know that she exists and that she underwent ECT; were we interested in delving into her story further, we would know where to obtain information; and, let's face it, her status, and book deal, provide an incentive to tell the truth (cf. James Frey).
 * I guess the question is whether the story of a representative of each position, pro- and anti-ECT, should be given. There's certainly no inherent harm in it, but it seemed jarring to see a perfectly anonymous person (with her degrees and background listed, which smelled of an appeal to authority; at the very least it drew attention to the fact that there's no concrete evidence of Cody's existence and truthfulness) have her story quoted in the middle of an article teeming with references to the professional literature.  That's all the more reason to have a personal account, but still, I thought that Dukakis's account pretty neatly encapsulated both sides.
 * So how about this. If the consensus here is to put in an anti-ECT story, leave Cody's for now.  When I get the chance, I'll look for one in a print source (perhaps in something by Thomas Szasz or another antipsychiatry writer) and exerpt it here.  If it's deemed acceptable, we'll replace Cody's with it.  Fair? --zenohockey 02:32, 25 September 2006 (UTC)


 * Hello Zenohockey and thank you for your response. I see what you mean about verifiability and reliability, and of course I can admit that the Cody citation has little verifiability, if any reliability after that.


 * You stated, "Dukakis's account is more representative of the average ECT patient's experience than Cody's (judging by the data cited in the article)..." I think the verity of that statement is extremely contestable. A more accurate statement might be, "Dukakis's account is more representative of the average [formally publicized] ECT patient's experience than Cody's." Cody's may, in fact, be more representative of the average, if the average is quelled by medical and/or governmental authorities into keeping quiet about their true experiences and true feelings. That may sound like some quack, conspiracy theory, but, being someone who's actually seen an ECT Room and spoken with the patients, I know it's not entirely untrue. As I quoted doctor John Breeding in the article, for some patients, the experience is akin to the trauma of the Holocaust. Some patients experience trauma as a result, but cannot express it, because they know it could lead to more forced medical treatment against their will.


 * Furthermore, Newsweek only gives a short amount of scientific data, calling electroconvulsive therapy "a treatment that has improved dramatically since it was first used in the 1930s." Newsweek is a popular general news magazine, not a psychiatric journal, and that small amount of data was probably conjured up by some general reporter casually talking to a few doctors or flipping through some books in the library. While Newsweek may be a good source of American news, it is not a reliable authority on the efficacy of ECT. Nor is its information noted to be representative of the majority of ECT patients.


 * Another issue is that Dukakis's treatment seems to have been voluntary, while Cody's may have been involuntary. That small difference in circumstance could account for a huge difference in effect. It could mean that Dukakis's account is representative of voluntary treatment, while Cody's is representative of involuntary treatment.


 * You stated, "I thought that Dukakis's account pretty neatly encapsulated both sides." I disagree. Dukakis's account is very much in favor, which is in stark contrast to the Cody account you replaced it with. Dukakis's implication that, 'Oh, it's just no big deal. I'm glad to be alive and well,' is very different and unrepresentative of Cody's implication that the treatment caused her to lose her memory of being the mother of her children.


 * I'd rather not delete the Cody mention. If someone wants to paraphrase her, the way the Breeding quote was paraphrased after I added it, that would be fine. (I had already tried to edit out the explicitly subjective and non-partisan information in her quote, such as her statement that ECT is "a rape of the soul," a metaphor she is not the first to use.) But her account is dramatically different from any other in the article that I see, especially Dukakis's. If one of us wrote to the Web site where her account is publicized, and we were unable to get any verification, maybe then it would be ok. But I insist that the essence of Cody's account is not represented by any other in the article so far.


 * Again, thank you for your response. I will also respond to the comments on my talk page soon. Good day.


 * Chris Dubey 15:08, 25 September 2006 (UTC)


 * If you really feel that Cody's testimony offers a needed perspective, I'll relent...better to have too many sides to a story than too few, I guess. (The new organization makes it seem a better fit, I must say.) If I get the chance, I may look for a similar viewpoint in print, as I mentioned above. --zenohockey 21:05, 25 September 2006 (UTC)


 * Great. Thank you. I am now retired. Good luck with the encyclopedia.


 * Chris Dubey 22:46, 25 September 2006 (UTC)

Needed
Info on minors getting ECT... --zenohockey 18:33, 6 October 2006 (UTC)


 * Re: Kids and ECT.


 * The National Institute for Clinical Excellence is an independent organization responsible for providing national guidance on promoting good health and preventing and treating ill health. Being base in the UK where health care is free, it is about as unbiased and as carefully researched a report -that your likely to find. (not that I agree with all of it)http://www.nice.org.uk/page.aspx?o=44129--Aspro 20:31, 6 October 2006 (UTC)


 * NICE would govern UK practice. "The risks associated with ECT may be enhanced[...]in children and in young people, and therefore clinicians should exercise particular caution when considering ECT treatment in these groups." Nmg20 09:39, 7 October 2006 (UTC)

Intro edits
The opening of the article has been a point of contention recently, with User:Aspro making five changes I have reverted for the following reasons:


 * 1) "a vocal minority of psychiatrists" became "a growing number". The evidence in the article as it stands, coupled with the continued use of ECT by psychiatrists around the globe, supports that a minority of psychiatrists oppose its use. There was no evidence added to the article to support the claim that the numbers of psychiatrists opposed to the practice is growing, and so I don't believe we should allow a co-opting of the majority as has been attempted here.
 * 2) "and scientists" was added to the list of those opposed (and also qualified by that weaselly "a growing number"): I don't see any new journal articles, books, newspaper items, or anything else from scientists referenced in the article, and this is another attempt to lend an air of scientific credibility to the anti-ECT arguments.
 * 3) the procedure's "efficacy" has apparently come under fire. Again, no evidence was offered to back this up.
 * 4) what's more, apparently those untrustworthy sorts who first suggested it overplayed how well it worked!
 * 5) "and others" became "Still others", making it sound as if there are whole hosts of anti-ECT campaigners clamouring to be heard in the opening ten lines of the article.

In short, I felt the changes were without exception worsening the state of the article with regards to Weasel Words. Nmg20 01:54, 15 October 2006 (UTC)


 * Could someone tell me why it says "neurologically based disorders affecting mood" rather than "mood disorders" or "depression"?Staug73 16:04, 29 November 2006 (UTC)

Latest cut-and-paste job
Forgive me if I'm wrong, but the latest edit is as clear an example of someone finding an anti-ECT website, and cutting and pasting it onto the article without thought or reference to what's there as I've seen. Even if these points merited a place in the article - and I explain why they don't below - at least put the effort into fitting them in where they belong.

"It has been reported that at least one third of patients experienced permanent amnesia (Service Use Research Institute, 2002, Rose et al, 2003, Scott 2005)."

To deal with these in turn - neither google nor pubmed turn up a "Service Use Research Institute", so either it doesn't exist, or has an improbably low internet profile and hasn't produced anything worthy of publication anywhere. Searches for "Rose", "2003", and either "amnesia", "electroconvulsive", "shock", or "ECT" turned up nothing relevant on Pubmed - so this is either fictitious or wasn't published anywhere worthy of the name. Praise be, the Scott paper exists - the reference is Scott AI, Gardner M, Good R. Fall in ECT use in young people in Edinburgh. J ECT. 2005 Mar;21(1):50. . It is a communication to the journal of perhaps two dozen lines which doesn't mention amnesia, memory loss, or anything else which would support the claim in the latest edit. Using them as a reference is utterly dishonest.

"Some psychiatrists believe that memory loss is a condition of depression however numerous controlled studies show that individuals who are depressed but have not had ECT, do not suffer amnesia (Janis 1950, Weiner et al 1986)."

Spare me the 1950s references, please. I have had enough of digging these up from the library to prove they're inappropriately used as references - if whoever posted this would like to quote the parts of the article which support their claim, I'll go to the effort to find it and read it - but to my mind the onus is on you to prove it is worth including. "Weiner et al 1986" could be one of two papers: PMIDs [| 3458412] and [| 3458408]. Both are abstractless on Pubmed, however, and as above if you want them used in the article, quote why they support your claim here, please. Bear in mind also that they will have to deal with a huge number of patients to match the wealth of evidence associating depression and memory impairment - read any book on the subject, or see Bearden CE, Glahn DC, Monkul ES, Barrett J, Najt P, Villarreal V, Soares JC. Patterns of memory impairment in bipolar disorder and unipolar major depression. Psychiatry Res. 2006 Jun 15;142(2-3):139-50. Epub 2006 May 2. , or Christopher G, MacDonald J. The impact of clinical depression on working memory. Cognit Neuropsychiatry. 2005 Nov;10(5):379-99. , or Rose EJ, Ebmeier KP. Pattern of impaired working memory during major depression. J Affect Disord. 2006 Feb;90(2-3):149-61. Epub 2005 Dec 20. - or ask anyone who's suffered severe clinical depression. Your second claim, like the first, is inadequately referenced and frankly untrue.

"In Shock Treatment, Brain Damage and Memory Loss: A Neurological Perspective (John M Friedberg M.D.) published in the American Journal of Psychiatry September 1977 it is stated that findings showed ECT produced severe retrograde amnesia and questions whether doctors should be offering brain damage to their patients."

Two things. One, there's a heap of research in the intervening thirty-odd years, all referenced neatly in the article, which proves beyond reasonable doubt that the brain is not damaged in ECT, and that the initial concerns it was were based on structural abnormalities in the brain which are caused by psychiatric illness, not by its treatment. Two, this article does not exist on Pubmed, and Friedman has never written about ECT based on searches there. This is another invented reference, as far as I can tell.

The even earlier 1973 study you go on to deal with is already in the references section, and sourced directly. If you don't even read the references, and choose instead to cite it secondarily via a Friedman article which doesn't exist, then you are wasting everyone's time, basically.

"NICE also recommends the patient be re-assessed after every session of ECT and there should be ongoing checks for any signs of memory loss, and as a minimum, a check at the end of each course of treatment."

Yes - we know. It's mentioned under "current use", and referenced appropriately there - reference 6.

"In an article in the British Journal of Psychiatry, three psychologists said “The ECT patients’ was also found to be inferior on the WAIS (Wechsler Adult Intelligence Scale)” and “The ECT patients’ inferior Bender-Getalt performance does suggest that ECT causes permanent brain damage”

This is the 1973 article you have already mentioned via the non-existent Friedman article. Why bring it up twice? The explanation for the lower scores of patients who have ECT has been laid out in numerous articles since, many in the references - these people have extremely severe mental illnesses by definition, so of course they're going to score worse on neuropsych testing which is designed to be used on normals.

"Peter R Breggin M.D., Electroshock: It’s Brain Disabling Effects states “Professional people who have sought treatment for depression and had ECT have lost a lifetime of professional knowledge and skill to this so-called therapy”."

Is his book really called that? If so, he doesn't know the correct usage of "its" vs. "it's" - so I think we can safely ignore his "book", and his ludicrous idea that someone who looks dazed has brain damage. What are we going to do - wait at airports for people coming off long-haul flights and rush them all off to neurological rehabilitation centres so their "brain damage" can be dealt with?

In short, the latest edit didn't warrant a response of this length or detail - but I intend to revert any future edits which fail to do their own work referencing articles properly and actually proving what they say. It is a foundation of intellectual honesty and proper debate that you do so, and in future I will not spend this much time explaining the rationale behind removing rubbish like this. Yours angrily, Nmg20 16:53, 17 October 2006 (UTC)


 * Wow—so after a procedure done under general anasthesia, people look dazed?! No wonder this editor felt the need to point out Breggin has an M.D.
 * To be fair, the 1977 AJP article does exist; you must have misread the author. Abstract here.  But more to the point... Homework assignment for anonymous editor: Look at any medical journal.  Notice how few articles reference 29-year-old studies that (per the abstract) rely in turn on even older "reports" (which may or may not be controlled studies).  Then think of five reasons why this might be.
 * Also to be fair, the Breggin book's title is actually spelt properly. But no points for guessing what decade it was published in.
 * Well, good work in any case, Nmg20. --zenohockey 19:21, 17 October 2006 (UTC)


 * I think it should be "Service User Research Institute". Try searching for that. It should take you to the Kings College London / Institute of Psychiatry website.Staug73 16:38, 18 October 2006 (UTC)


 * Thank you both. The point is really that if something is posted on Wikipedia in an article which has been the subject of as much controversy as this, it's not acceptable to put in references half-heartedly, as here. However, I retract my criticisms of the 1977 article and of the Service User Research Institute. Nmg20 08:22, 19 October 2006 (UTC)

Best Way to Contribute?
Hello, my father (Dr. Nunez, MD PA Geriatric Psychiatrist) is very experienced with ECT, having performed many procedures at Winter Park Hospital, Orlando FL. He'd like to contribute somehow to this article, but being new to Wikipedia he isn't sure how best to be more helpful than hurtful in regards to NPOV.

Also, it might be beneficial for the article to note that ECT nowadays uses a bidirectional square wave (brief pole stimulus or "spiked" wave) as opposed to the sinusoidal AC with a constant current used back when ECT first started. This has done much reduce the a lot of the disorientation/confusion typically associated with the more antiquated version of ECT. The source of this information originates from the MECTA (Multiple Electro Convulsive Therapy Apparatus) Manual; (pg. 56 Figure B.1)

Any thoughts/contrary opinions? I am typing this on his behalf, so please bear with me :-).

Thanks :-) absolutecaliber


 * Welcome to Wikipedia! Technical info like that would be great to see in the article, particularly if referenced - I guess it would fit best under the "Types of ECT" section? Nmg20 08:02, 20 October 2006 (UTC)


 * I have added some technical stuff complete with references. I have called it Techniques and Equipment and replaced the Types of ECT section as it seemed to overlap with the previous section and I think the Sackeim article may be misquoted. In any case most was a quote from the Surgeon General's report (and so should, according to Wiki guidelines have been in quotation marks and accredited) leaving a few lines:"There are two basic forms of ECT: bilateral and unilateral, and bilateral ECT can be subdivided into bitemporal and bifrontal ECT. In bitemporal ECT, current is passed across the temporal lobes, between electrodes placed on either side of the head. With unilateral, the electrodes are only on the right side, and pass current mainly through the right temporal lobe." and "Bifrontal ECT is a modified form of bitemporal ECT in which electrodes are placed 2 inches above the lateral angle of each orbit. It has fewer adverse effects on memory than bitemporal ECT, and it increases the blood flow to the prefrontal cortex. " which I think have been covered elsewhere, although perhaps not bifrontal which isn't used much. Perhaps it ought to get a mention. Staug73 13:36, 24 October 2006 (UTC)

NPOV
I have never read a more sanitised POV oriented article in my life. The controversy section is inadequate, two paragraphs (I added a third touching on the fact it's a lobotomy via electrocution in as neutral a way as it could be put) is not adequate representation of a treatment that, admittedly by laymen, is considered barbaric, anachronistic and having no worthwhile effect.

It's effectiveness and the manner in which it addressed is clinical. Yes, it can fix a lot of things, but it does so by fragging your brain. Good trade-off? Many would disagree. The whole controversy in Western Australia that led to a film about the horrors of the treatment in psyche wards was based on the fact that the medical world didn't warn people before hand that they will -never- be the same again after treatment, that they will lose memory, that they will lose emotions, feelings, concepts of reality, and as many sufferers of the treatment would say, they lose themselves or their souls.

I'm flagging this as NPOV until we can get some ethical approach to reformatting this horrid article; I recommend that ethics be a primary focus, not a clinical numeric patient system of addressing 'this does x, y and x, it may have some side effects.' only. 211.30.71.59 07:00, 18 November 2006 (UTC)


 * Your post is very light on evidence; by all means add details of that Western Australian film to the article - there's a section on ECT in popular culture - but you'll need to provide actual evidence to support your opinion that ECT is "barbaric, anachronistic and [has] no worthwhile effect". Nmg20 19:03, 19 November 2006 (UTC)


 * I agree that the section on controversy is weak. I have been looking at the wiki guidelines on dealing with controversy and might do some work on it. It seems that the idea is to make it clear who says what, rather than censoring minority views or facts you don't like.Staug73 15:48, 20 November 2006 (UTC)

Current use
I have edited this section, putting in some facts and figures and replacing the unattributed quote from the Surgeon General's report with a link. Something on ECT use in the UK will follow, with Australia and New Zealand, Canada and the rest of the world to come (unless someone else has information about these countries?) Staug73 15:41, 20 November 2006 (UTC)
 * You put in some good stuff, but also took out some perfectly valid info (on minority patients, evidence-based treatment, and a couple of other things). I can't figure out why; I'll just put them back.  --zenohockey 21:16, 20 November 2006 (UTC)

I took out the bits that were cut and pasted from the Surgeon General's report and a New Zealand Ministry of Health website. I understand that the Surgeon General's report is in the public domain but I still think that any quotes from it should use quotation marks and an attribution (what do other people think?). Could people look at the "say where you got it" section (2.3) in ? Has anyone here actually read Rudorfer or Hermann? I put the populations in because it provides a way of comparing rates of ECT use. For example, Texas (pop approx 23 million) approx 1450 ECT patients; UK (pop approx 60 million) approx 12,000 patients. Therefore you can see at a glance that the UK uses ECT at about 3x the rate of Texas. But it doesn't matter. People can look them up easily enough if they want them.Staug73 14:55, 21 November 2006 (UTC)
 * I've read Potter & Rudorfer, Electroconvulsive Therapy -- A Modern Medical Procedure, and that link should work if anyone else wants to (articles more than six months old are free if you register). Rudorfer 1997 I can't find - I *suspect* the intended reference is "Rudorfer MV. Clinical research of the National Institute of Mental Health. Psychopharmacol Bull. 1998;34(3):233-5. " - but I didn't add the references, so can't be sure. Nmg20 20:13, 21 November 2006 (UTC)
 * Re populations: It was unclear to me whether there was a consistent dating system there—for example, Hermann apparently discussed ECT rates in the late '80s, when, of course, the US population was nowhere near 300 million, the figure mentioned in your edit. I could have looked up the historical data, but I was (and remain) too lazy.  That's the catch-22 of editing at weird times: It's the only time I have time to do anything, but I'm usually too tired to do anything.  If you follow.  --zenohockey 04:56, 22 November 2006 (UTC)
 * Re Rudorfer 1997: I added it to the References (not "Footnotes") section a while ago; it's a textbook chapter. I have access to it, if there's any question about anything.  --zenohockey 04:58, 22 November 2006 (UTC)
 * Re unattributed quotes: Oops. I didn't notice that... If I put any of that material back, by all means put quote marks and s around them.  --zenohockey 05:09, 22 November 2006 (UTC)
 * It was a bit shortsighted of me not to look in the, er, references for the Rudorfer 97 reference - apologies, and thanks for having found it originally! Nmg20 16:51, 22 November 2006 (UTC)
 * Well, it is counterintuitive to have some citations in References and some in Footnotes. If it's not incredibly important to have an alphabetical list of references (as it is, it won't be too useful to anyone...e.g., where's Fink?), I think we should just have -generated notes.  --zenohockey 04:12, 23 November 2006 (UTC)

I left in the bits about public v private and minority patients - everyone seems to agree about that and it checks out with the Texas statistics. I am using a more recent edition of Rudorfer et al. It is online and I have put a link in the footnote (thanks for cleaning up footnotes). I have not left in the bit about "concern" because I don't think that accurately reflects what Hermann et al actually said - they were fairly neutral. Obviously if there is wide variation you can choose whether to be concerned about overutilization or about underutilization.Staug73 17:42, 22 November 2006 (UTC)
 * I felt they were concerned because of the following lines:
 * "Rates of ECT use were highly variable, higher than for most medical and surgical procedures." As a medic you want clear definitions on when you should and shouldn't do things - good clinical practice is as consistent as possible between centres in a country. Variable rates of use are therefore a bad thing. Of course taken in isolation this could suggest it should be used *less*, not more - but I don't think that's borne out by the article, because they go on to say that:
 * "In some urban areas, access to ECT appears limited. Predictors of variation in ECT rates have implications for expanding access to the procedure." In other words, they did the study to establish what would predict variation in ECT rates in order to expand access to the procedure. That reads very much to me as if the authors were concerned that rates were low in urban areas due to poor access to services.
 * I haven't changed this back, however - if anyone else has a chance to read the article and comment, that'd be great. Nmg20 22:00, 22 November 2006 (UTC)

The paragraph I was looking at was: "Without knowing more about the prevalence and severity of psychiatric disorders in individual metropolitan statistical areas, it is not possible to determine whether ECT is overused in some areas. Studies have show that undertreatment of psychiatric illness is more the norm (ref to two articles not about ECT). In the many metropolitan statistical areas where we found little or no ECT, there appeared to be a lack of access to this procedure. This finding may have important implications for public health, particularly for severe or refractory depression and deserves further study." Perhaps they are veering a little towards being more concerned about under rather than overutilization, but in any case they are not "some" psychiatrists as only two of the authors are psychiatrists. Alternatively you could put in a direct quote from the Surgeon General's Report (with a footnote) "Indeed, concern has been raised that in some settings, particularly in the public sector and outside major metropolitan areas, ECT may be underutilized due to the wide variability in the availability of this treatment across the country" although I am not sure how the report arrived at "outside major metropolitan areas".Staug73 17:40, 23 November 2006 (UTC)

I have removed the reference to "extreme cases" as I cannot find it in the Surgeon General's Report which actually says: "Electroconvulsive Therapy. As described above, first-line treatment for most people with depression today consists of antidepressant medication, psychotherapy, or the combination (Potter et al., 1991; Depression Guideline Panel, 1993). In situations where these options are not effective or too slow (for example, in a person with delusional depression and intense, unremitting suicidality) electroconvulsive therapy (ECT) may be considered." I have added the Surgeon General's term "may be considered" to remove any ambiguity.Staug73 15:58, 29 November 2006 (UTC)

I have expanded the section about ECT use in the UK, with a bit about NICE guidance but in the process I have removed this sentence: The National Institute for Health and Clinical Excellence has laid down standards for its limited use in select circumstances, which are based on its examination of the evidence, adjusting the weight it assigns each study for its quality. Does anyone object? I think I have covered the same ground in more detail.Staug73 17:41, 29 November 2006 (UTC)


 * I think your latest edits are fine (some would argue that it's unnecessary to go into that much detail on local guidelines, but it's relevant to the debate on when and how ECT is used). I do take issue with:
 * "In the UK the use of ECT has traditionally been associated with low standards of care, being carried out by junior doctors, often with minimal training and supervision."
 * That is absolutely not my experience of ECT at KCH, and I don't think that it can stay in the article without something to justify the "traditional association" comment - ECT in the UK tends to be carried out at tertiary referral hospitals by registrars or consultants, and anaesthetists are always in attendance, and the "traditional associations" of any doctor who's seen it performed would be those. Thoughts? Nmg20 21:10, 29 November 2006 (UTC)

I will rewrite the sentence. Is the KCH the same as the Maudsley? If so it has an accredited ECT clinic which is rated excellent - one of only four out of more than 200, so you would expect unusually high standards. I am not sure what you mean by a "tertiary referral hospital". I looked up "tertiary referral" and it said "a referral made between NHS consultants to another trust outside local contract". Normally this wouldn't happen for ECT. A patient's consultant would prescribe ECT and it would be carried out at the same hospital, with the patient remaining under the care of their own consultant. I think there are one or two places in Scotland where patients have to travel to another hospital for ECT, but I think they still remain under the care of their own consultant. Perhaps it is different at KCH? I think ECT is very seldom actually administered by consultants - hospitals are supposed to have a consultant in charge of the ECT clinic but they don't often do the actual treatment. I agree about anaesthetists always in attendance, although a survey (probably about 10 years ago - perhaps things are better now) showed that ECT clinics had lower standards of anaesthesia than minor surgery clinics.Staug73 13:44, 30 November 2006 (UTC)

Thanks. Yep, KCH (King's College Hospital) includes the Maudsley (strictly they are different hospitals, but are both part of the same trust, and are across the street from one another, so I lumped them together!) - and I take the point about it being better than most. You've got "tertiary referral" pretty much bang-on - primary care is with the GP (family doctor), then secondary is your local (district general) hospital, who can then refer on to tertiary specialist centres. I know ECT is done at the Maudsley for all patients from Guys, St. Thomas', I believe Lewisham, and basically all the hospitals in the immediate catchment area. What you say about ECT rarely being carried out by the consultant is true, but it's also true of just about any other medical or surgical procedure you care to mention - the consultants oversee the work of their juniors, who do the prescribing / consulting / wielding of the scalpel. I need to find out exactly how the referral system works, and what the catchment area for Kings' ECT service is - will post again if/when I manage to! Nmg20 22:14, 30 November 2006 (UTC)

I changed the sentence about ECT being "traditionally" associated with low standards of care to be a bit more specific. By the way I take back what I said about agreeing about anaesthetists always in attendance - the anaesthesia survey found a small number of clinics had GPs not anaesthetists. Staug73 18:26, 4 December 2006 (UTC)

Involuntary ECT
I have added references to this section and removed the tag. The paragraph on UK already had refs. I have put in refs for WHO quote and MDRI quote. The bit on the USA was a quote from the Surgeon General's report. I have put in quotation marks and a ref. I took out "nearly all states" because it wasn't in original quote and replaced with "there are exceptions", leaving a tag because I have only heard about Oregon in an article by Elizabeth Newell which I don't think is published anywhere. Anyone? I have left the tag for Australia as I don't know where this comes from.Staug73 18:06, 4 December 2006 (UTC)

What about a comparison with other surgeries?
I'm a newby to Wikipedia. I ran across the ECT article as a link from the Thomas Szasz biography. But I had a mentally ill aquaintance who actually starved herself to death in a hospital last winter. It was explained to me the hospital had stopped doing ECT because its nursing staff had rebelled against giving treatments which "were unethical because they could cause memory problems". This smacks of a double standard as most surgery can cause memory problems and some surgery causes lots of them. I'd like to see a section on perspectives of ECT risks versus those of other types of procedures but would never be able to write it myself in such a hotly contested article. (reference) Regards to all. Trilobitealive 03:46, 6 December 2006 (UTC)
 * The problem is that the choice isn't between ECT and coronary artery bypass; it's between ECT and medication or psychotherapy or both or none, and none of these alternatives poses any risk of memory loss. Of course, ECT reduces the risk of suicide; I'm pretty sure that's stated in the article already.  Yours a valid argument that merits attention, but I'm not sure it should go in the article.  Other thoughts?  --zenohockey 05:11, 6 December 2006 (UTC)
 * I'm sorry to hear about your acquaintance; while nursing staff (and medical staff of all types) should never have to give a treatment they disagree with, it is a tragedy that the hospital couldn't find anyone willing to administer what was a potentially life-saving treatment. While I do agree with Zenohockey that the choice isn't between CABG (which has long been known to cause cognitive impairment, probably due to showers of microemboli - a lot of the original work here was done by Stan Newman and his team at UCL) and ECT, it may be worth saying in the article that heart bypass surgery is undertaken despite the risks of surgery because the risks of not having the procedure are so much greater, and that the same may be true of ECT. In the example you provide, clearly the risks of not having the procedure did outweight any potential memory loss.
 * The issue here is threefold: one, I don't know of any work offhand randomising psychiatric patients to either ECT or medical management and comparing mortality (or other morbidity) as endpoints. Two, the small numbers of people undergoing the procedure make the chances of detecting small differences between the groups would make any study liable to be underpowered. Three, the perennial issue of consent - if you have someone who is mentally ill, are they able to make informed choices about their treatment given the risks of having and not having a particular treatment.
 * I'd be happy to include something along these lines in the article if others think it worth including; I wouldn't make reference to your specific example, but I may have time later in the month to dig for trials looking at mortality reductions due to treatment - that's the sort of data I think we'd need to support a section along these lines. Thanks for posting. Nmg20 14:28, 6 December 2006 (UTC)

In the tragic case described above, wouldn't the more pertinent life-saving treatment have been force feeding? Re the "perennial issue of consent," it's interesting that even when the mentally ill are in remission, they're not allowed to make a legally binding advance directive (e.g. please don't electroshock me if I get depressed again). Unfortunately, an "informed choice" actually means "choice that your psychiatrist agrees with." As for the efficacy of electroshock, we have plenty of "sham ECT" research to disprove mainstream psychiatry's assumptions. As an electroshock survivor, I'm intimately familiar with the brain damage it causes. JuneTune 19:06, 9 May 2007 (UTC)


 * No, it wouldn't.
 * Here's the thing: medicine is not solely interested in preserving life. In plenty of situations, the most obvious being when patients are in the last stages of a terminal illness, medicine is actually interested in easing their pain, even if that means shortening their remaining life. There is a balance to be struck between quality and quantity of life.
 * In this instance, all force-feeding would have done would have been do have preserved the person's life without doing anything - anything at all - for their mental state. You'd effectively have condemned them to a continued existence which was so utterly devoid of anything approaching joy that they were starving themself to death. By contrast, ECT - however barbaric you may regard it as - would have offered a chance of a cure.
 * It would also, of course, have allowed the person a chance of returning to a state where they were able to take informed decisions about their own future treatment, something which I think it's safe to say someone in the process of starving themself to death is unable to do. The contradiction inherent in your discussion of advance directives thus emerges - and psychiatrists are legally obliged to obey advance directives which are made while the person is of sound mind, so please don't imply they are ignored.
 * Finally - and heaven knows how often I've asked this here - if you really, honestly have "plenty" of research which fits Wikipedia policy WP:NOR, WP:V, WP:RS, and which contradicts mainstream psychiatry's research (not assumptions: assumptions are what you have before you do the research), then please post them or stop resorting to cry-wolf appeals to uncited "evidence". Nmg20 00:33, 10 May 2007 (UTC)

Fascinating discussion. We were talking about "live-saving" measures and you assert that force-feeding wouldn't have met the bill but electroshock might have. Somebody starving themself isn't capable of making an informed decision? Do you feel the same way about political prisoners? Are they all insane, too? Should they be electroshocked? If you believe electroshock restores mental functioning, I can only conclude that you've never undergone the procedure. This "treatment" belongs in the shameful museum of no longer acceptable treatments, along with leechings, beatings, etc. Lastly, I'm at a loss to understand what you mean by "cry-wolf appeals." I'm not crying "wolf." I'm reporting accurately on what cutting-edge psychiatry has to offer. JuneTune 04:42, 10 May 2007 (UTC)


 * I think you brought the term "life-saving" into the discussion, no? However, you're quite right that I don't believe force-feeding would have met the bill: it's not addressing the root cause of the threat to life. All you're doing there is treating symptoms (weight loss) rather than cause (the patient's not eating because of their mental illness).
 * In terms of the circumstances under which someone is incapable of making an informed decision, I concede the example of political protestors - but they are not generally candidates for ECT, and so aren't terribly relevant to the article.
 * I know ECT doesn't always work - but I don't need to have undergone it to have seen the impact that it can have on patients with effectively no ability to function prior to treatment, and who have failed to respond to any other therapies.
 * By "cry-wolf science" I mean the tendency people have to make claims about research - as you did above - without ever actually citing anything. That makes it impossible for the neutral to ascertain for themselves whether your reports on psychiatry are in fact accurate. Nmg20 09:23, 10 May 2007 (UTC)

If somebody is starving to death, I believe that force-feeding them would prevent that. Re your comment about political prisoners, you should be aware that they have been subjected to neuroleptic drugging and electroshock. I hear your comments on citing research and I'll endeavour to do a better job in the future. In the meantime, I'd like to caution you not to disregard people's firsthand observations just because they may not have posted their life histories on the Internet. JuneTune 02:40, 11 May 2007 (UTC)

And, no, I did not introduce the term "life-saving" into this discussion. JuneTune 02:43, 11 May 2007 (UTC)

Mechanism of Action
The sentence "ECT also decreases the functioning of norepinephrine and dopamine ... causing more of each to be released." makes no sense. Does ECT decrease the action of these neurotransmitters, or does it cause more of each to be released, therefore enhancing their action? This should be rectified.. 58.160.150.148 18:31, 9 December 2006 (UTC)


 * Not an expert here, but actually the two statements are not contradictory. A simple way to express it is that the receptors for those two chemicals are reduced in sensitivity, and so the body responds by making more to compensate. Kazuaki Shimazaki 02:57, 10 December 2006 (UTC)


 * I think this was too detailed for overview so I started new section and rewrote overview to keep it simple introduction for people who won't read any further, and because there were a number of errors and some cut and pasted stuff. Staug73 18:07, 13 December 2006 (UTC)

Sackeim 2007
Despite the post at ECT.org, my cursory glance at the study does not reveal any wholesale rejection of ECT, especially not bilateral unilateral ECT.

I also think it should be mentioned further down in the article. While it looks important, no one study on anything is so definitive that it merits a place in the first or second paragraph of the WP article on it. --zenohockey 04:40, 26 December 2006 (UTC)

== I didn't get my information from ECT.org, nor did I cite from this website, nor the press releases regarding this study, such as http://www.medicalnewstoday.com/medicalnews.php?newsid=59631. Rather, I cited directly to Sackeim's study. And with regard to what you write above about "especially not bilateral ECT", bilaterial ECT is what this study was "especially" critical of, proving that you didn't bother to actually even skim the study as you claim, let alone read it and analyze it in depth like I did. And the study abstract is only a paragraph long, and you obviously didn't bother to read that either, as is evidenced by your "especially not "bilateral" ECT" remark. And there are two big reasons why this study is so important. Firstly, this is the FIRST large-scale study to even check for long-term adverse cognitive effects from ECT. Secondly, the leading researcher of this study, Sackeim, is the most published author on electroconvulsive therapy (and most well-known and cited author), and for nearly 25 years made the claim that ECT does not cause long-term cognitive dysfunction. It is considered rude in the extreme to do a "cursory glance" (a cursory glance???) and then click your mouse and wipe out a contribution from someone else who actually reviewed and studied the material in depth. You wrote in your editing comments that you "toned down" the addition, but in fact you did not, you erased it all together. If you thought it was better incorporated elsewhere or in a different fashion, you would have made such a change, but rather you erased it altogether and this reveals your bias. And with regard to your remark that no study should be referenced in the first two paragraphs (there was already another reference in the first paragraph), in this case this study actually contradicts quite a lot of what is written throughout the article, including a number of references to Sackeim himself in support of ECT, which is no longer valid. The first priority is to ensure accuracy and up-to-date information, and given that this study shakes up the foundation of what is written in much of the article, the best thing to do is to state it simply up front as I did until a more comprehensive re-write and incorporation of the information is possible.

Perhaps someone else would like to help me better incorporate and expand upon the findings of this study. The addition of this information is going to require revision of some other parts of the article that reference Sackeim, as well as the remarks about no comprehensive studies having been done in the last two decades to evaluate long term side effects of ECT, as this is no longer true. I'm willing to do this, but it may be a while before I find the time. Sackeim is the most-published researcher on ECT, and for decades had refuted claims that it causes brain damage or permanent cognitive dysfunction. He was, no doubt, the leading voice advocating ECT and refuting claims that it is harmful, and historically, most proponents of ECT have always placed great weight on his studies. This study is extremely important, and once it becomes widely known it may very well have a substantial impact on the future use of ECT throughout America, and the rest of the world. Danrz 10:31, 26 December 2006 (UTC)Danrz


 * Yes, I meant unilateral (RUL) ECT, not bilateral. See pp. 252-53 ("recent work suggests that high dosage RUL ECT delivered with an ultrabrief stimulus maintains efficacy and results in minimal retrograde amnesia even in the period immediately following the ECT course").
 * Anyway, please don't impugn other editors' honesty. We're all trying to make this the best article we can.  On that note, I'm sorry I implied (mostly in jest) that you had gotten your information from ECT.org or a similar source.  It's just that both your edit and the ECT.org posting used the word "reversal," and I still don't see that in the article.  If the article is going to accuse Sackeim of flip-flopping, it better specifically cite solid evidence, before and after.
 * Contrary to your edit summary, I didn't remove the study from the article at all. I moved the mention of it from the first paragraph of the article to the second and removed the reference about Sackeim "revers[ing] his position" on ECT (FWIW, I think his position has not changed—it has long been accepted that ECT frequently causes cognitive side effects; the evidence for this is now strengthened, but ECT, especially unilateral ECT, is no more dead than it was before the study.  Indeed, in the concluding sections of the study, Sackeim notes several bright spots in the existing data and suggests numerous avenues for future research.) .  An anonymous editor has since moved this sentence to the "Side-effect profile" section.  Both our edits were justified, the anon's because one study this young should not be waved like a red flag right at the top of the article, well before any other study is mentioned in the text.  All research is conditional, and four-month-old, unprecedented research in a relatively minor journal is especially so.  You are right when you point out above that Sackeim 2007 is the "FIRST large-scale [prospective] study to even check for long-term adverse cognitive effects from ECT."  This is exactly why the study should, until further notice, briefly be noted in a position commensurate with its actual and present—not future and likely, no matter how likely—importance.
 * I tenuously endorse your second paragraph above. This is an important study by an important researcher, and it likely will bear repercussions for ECT.  But—and I know how hard it is to keep this in mind today—this study has not yet appeared in print.  It's only been on the Internet since August 23.  Lots of people and organizations—Sackeim, Max Fink, hundreds of other ECT researchers, the Journal of ECT, the NIMH, the Church of Scientology, et al.—will have their say in the coming months and years.  But for now, it's one study, not yet in print, unreplicated and by and large unexamined.  Until further notice, ECT will continue to be administered much as if nothing happened, and I think the article, especially its opening paragraphs, should reflect its real-world status rather than editors' varying readings of a young study.  --zenohockey 05:22, 27 December 2006 (UTC)

Anaesthesia and muscle relaxants
I have changed the sentence: "They say that anesthesia and muscle-paralyzing drugs increase the risks of the procedure and thus its mortality rate" because the authors of the articles in ref 24 were definitely not critics of ECT. They were all, on the contrary, prominent supporters of ECT. Baker for example appeared as a witness for the defence in the Bolam case, which revolved in part around the safety or otherwise or muscle relaxants and anaesthesia. The defendants argued successfully that the remote risk of mortality with anaesthesia and muscle relaxants outweighed the remote risk of fractures without. Alternatively if you want to say "Critics say that anaesthesia...." then you could find a reference of a critic saying that, and remove the references to supporters of ECT. But the sentence and references need to match.Staug73 14:13, 2 January 2007 (UTC)
 * Ah, I see. The sentence before that was "However, critics argue that the differences might make the procedure more damaging, not less," so I thought this one referred to the critics' view as well.  Thanks for catching that.  --zenohockey 22:51, 2 January 2007 (UTC)

The Surgeon General's Report
I have gone through the article removing unattributed quotes from the Surgeon General's report, that is passages that were cut-and-pasted from the report without quotation marks or a reference saying where they came from. They were in the following sections: I have removed the source note as it is no longer necessary. People can now see which bits come from the Surgeon General's report. There are probably still a couple of bits in the Side-effects section - I haven't dared look. Taking out or unattributed quotes has also removed some of the footnotes which I think improves the article. According to the guidelines we are not meant to have second-hand references.Staug73 15:57, 11 January 2007 (UTC)
 * Effectiveness - this was almost entirely from the Surgeon General's report. I have paraphrased it and put in a footnote. There was one sentence about maintenance ECT that someone had written which I will put in another section.
 * Continuation phase therapy - this was entirely from the Surgeon General's Report. I have removed it because it wasn't specifically about ECT.
 * Historical usage - there were two paragraphs from the Surgeon General's report. One, about ECT being largely replaced with drugs, is covered in overview so I have removed it. The other about techniques is covered in Techniques and equipment section so I removed it.
 * Informed consent - this was copied from the report. I have paraphrased it and put in a footnote.

Controversy [1]
I have expanded this section. I took out a couple of sentences which I have covered in more detail, for example the sentence about most psychiatrists I have replaced with an example from a survey. Anyone know of a recent survey from the US? The bit about consent and consent forms I have moved to the section on consent.Staug73 18:11, 15 January 2007 (UTC)

Techniques and equipment
Someone had added "maximum" to the sentence about typical current strengths. I have removed it because 300 amps wasn't a maximum value. It was a typical value for someone with a head with average impedance. The whole point about the early machines was that they were constant voltage. The operater could set the voltage (and the duration) but the current would vary automatically with the patient's impedance. So if the impedance was low the current could be much higher - I have seen examples quoted of an amp or more. But that wasn't typical. If the person who put maximum in could explain what they meant, there might be a better way of putting it.Staug73 12:22, 20 January 2007 (UTC)

Overview
Someone had added norepinephrine, and I have changed this to noradrenergic system. Epinephrine and norephinephrine are the US terms for what in Europe are called adrenaline and noradrenaline. But the US uses adrenergic/noradrenergic (rather than epinephrinergic/norepinephrinergic).Staug73 10:20, 30 January 2007 (UTC)

Historical usage
I changed the week/meek patients into just more manageable ones to avoid an argument, but then I noticed that the whole sentence had been cut-and-pasted from another website http://www.zipworld.com.au/~aamca/cvag/cect.htm so I took it out. I am not even sure that it is true - that Cerletti was concerned with meekening/managing his patients. Meek was definitely the word though.Staug73 16:46, 30 January 2007 (UTC) Of course it wasn't necessarily copied - it could have been written by the person who wrote the piece on the other website. But in that case it needs a source.Staug73 16:48, 30 January 2007 (UTC)

I have written some more about Cerletti and have changed the section heading to "Origins of ECT" as, at the moment, it only talks about very early history.Staug73 15:28, 16 February 2007 (UTC)

Mechanism of action
I have replaced a brief mention of two primary sources (neither of which seemed particulary seminal) with a summary of a review of the research from a secondary source.Staug73 14:33, 16 February 2007 (UTC)

Introduction
I have done some drastic editing on the introduction. I think the last addition, about how ECT was controversial in the past but not now was probably vandalism - unless someone can give me a date for when it stopped being controversial. I have changed it to being a psychiatric, rather than a medical treatment, as its use outside psychiatry has been very unusual (although there have been a few doctors who have used it for non-pyschiatric disorders). I haven't put in a link to psychiatric treatment as it gets redirected to psychotherapy. I have taken out the bits about modified/unmodified, as they are all covered in the overview and section on anesthesia, and replaced them with a reference to an anaesthetised patient - rather reluctantly as in many parts of the world some patients still aren't anaesthetised (but that is explained in overview). I have also taken out the bits about vocal minorities, abuse etc as I think they really belong in the controvery section, although perhaps a brief mention needs to go back in. I think it is very important to keep arguments out of the introduction and to keep it simple. After all, its supposed to tell people who don't want to read any further all they need to know (it's a psychiatric treatment, its still used) and not put off too much those who might want to know more.Staug73 16:26, 16 February 2007 (UTC)

Fictional Depictions
ECT is administered to Denzel Washington's character in the remake of "The Manchurian Candidate." —The preceding unsigned comment was added by 206.66.168.45 (talk) 21:16, 19 February 2007 (UTC).