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Should we stop taking electroconvulsive therapy to relieve the symptoms of severe depression? Experts discuss the issue in The bmj aujourd & # 39; hui.
Electroconvulsive therapy (ECT) involves sending an electric current through the brain to trigger a seizure. The treatment is administered under general anesthesia with muscle relaxants, so that the body does not convulse during the crisis.
Nobody really knows how it works, but it is thought that it will change the way brain cells interact in parts of the brain involved in depression. The use of TCE in the UK continues to decline, but remains controversial.
Professor John Read of the University of East London, who has published several reviews of ECT research, and Sue Cunliffe, a patient with ECT, say that this drug does not present any benefit. long-term compared to placebo and can cause brain damage.
They argue that numerous evidence badyzes claim that ECT work is based on only five studies that have revealed a temporary improvement in mood during treatment alone, in about one-third of patients. In addition, none of them identify placebo-controlled studies showing that ECTs reduce depression beyond treatment or prevent suicides.
Some studies also suggest that electroshocks cause permanent and permanent damage to memory, although their advocates claim that this memory loss is caused by depression and not by electroshock.
"Despite this lack of evidence, psychiatry remains such an inflexible ECT job that no efficacy studies have been conducted since 1985," they write.
Sue Cunliffe, who was a pediatrician before receiving ECT, said that the ECT was safe, but that she had suffered a catastrophic brain injury, rendering her unable to To accomplish basic tasks. However, despite the diagnosis of electroshock brain injury, the psychiatrists rejected her complaint, denying her adequate support and preventing any closure.
However, Dr. Sameer Jauhar from the Institute of Psychiatry, Psychology and Neuroscience at King's College London and Professor Declan McLoughlin of Trinity College Dublin claim that evidence shows that TCE is safe and effective in depression and that unwanted side effects can be managed.
"The ECT is still used 80 years later because it has been proven that it is effective in treating treatment-resistant depression, often severe and sometimes life-threatening, as well as mania. resistant and catatonia, "they write.
ECT is approved for these indications by the National Institute of Health and Care Excellence (NICE) and by international guidelines, and around the world, about a million people benefit from a ECT every year, they add.
They state that Read's and his colleagues' badyzes of evidence included undernourished and erroneous studies, and argued that the scientific debate on the ECT had been over for decades.
They recognize that ECT is badociated with short-term memory and executive function deficits compared to pre-ECT performance, but states that "these disappear within a few weeks and most people have significantly improved their operation compared to before. "
They argue that there is no solid evidence that electroshocks cause brain damage at the cellular or macroscopic level, and that relapse rates after electroshock are similar to antidepressants and are a function of the disease, acute course of action. ECT. "
They also point out that ECT media representations "have been mostly negative and misinformed" and feel that such characterizations "perpetuate the stigma surrounding ECT and could contribute to depriving some of our patients the sickest of one of the most effective treatments ".
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