Taking a break...

I’m taking a vacation. One week. I feel I need it.

My two recent posts on ECT, DBS, VNS, rTMS for TRD required a great deal of research and generated some very heated reaction in my email box – but not in public comments.

I spent the whole weekend writing personal emails and fielding insults from angry and hurting people who don’t agree with what I wrote, and have had very different experiences from mine.

Disagreement is fine. I want you to disagree with me. That’s what comment boxes are for and what blogging is all about. It’s turns an opinion into a dialogue or as the headline said, “A Charged Debate.”

This was different. The public debate I expected fizzled. It went into my in-box where it dies.

Only one person, Susan, had the courage to comment. She is an award-winning journalist from New jersey, with her own excellent blog and her own horror story about ECT.

Yet she thought my story “was good” and that I “did a good job,” she wrote in her comment.

None of the others would post publicly, and what I really couldn’t understand is how they refused to acknowledge my own personal experience with ECT. In the 1960s and 1970s I had several courses of between six and 12 treatments of bilateral ECT administered at The Clarke Institute of Psychiatry.

Here's the problem I think these people had with me. Those ECT treatments did not damage my brain.

It was all on the record.

I always joke to my husband, that if it had damaged my brain, beforehand, I must have been absolutely brilliant – and I wasn’t. My only side effect was a tiny bit of temporary memory loss. It all returned within a few months.

One person, who will remain nameless, insulted me, attacked my journalism and then in his response to my email to him, admitted that he had never even read my blog.

This man is a leader in the anti-psychiatry movement. I’m speechless.

I asked my good friend Tanya Shute her thoughts on all this.

Tanya is an activist, “survivor” – a label I don’t like but will settle for here because it’s relevant – and executive director of The Krasman Centre for Community Mental Health in Richmond Hill.

Here’s what Tanya said: “ECT is one of those topics that really fires people up. I think that people think the consumer survivor movement is all anti-ECT. The people who I have a lot of respect for in the mental health community have spoken about the positive outcomes for them with ECT, as well as many who have had negative experiences.

“The point for us is that people have informed consent and choice, not whether we agree with the modality. Many people who I have seen have serious criticisms of the mental health system but are positive about their experiences of ECT.

“I think it is one of the most controversial topics in our field – and you became a scapegoat for this guy’s anger about ECT. Don’t forget, just because people are psychiatric survivors doesn’t mean that there aren’t assholes among us. Recovery is about dissent, resilience, rebellion -- keep yours up, and your chin too just in case you get sucker-punched again.”

Thank you, Tanya. I knew I could rely on your support and wisdom.

One more thing… I made a mistake in my July 25 post when I wrote that ECT was invented in Germany in the 1930s. It was invented in Italy in 1938. I spotted it yesterday.

Curiously, in all the criticism I received by email, no one pointed this mistake out to me.

Have a great week and stay well.

Cheers,
Sandy

ECT vs. TMS. VNS vs. DBS. Huh? (Part Two)

I had no idea I was wading into a mysterious minefield of acronyms when I started comparing ECT and DBS last week.

All weekend, I mulled over this "charged" debate between Electroconvulsive “Shock” Therapy (ECT) versus Deep Brain Stimulation (DBS).

The more I thought about it, this more this “either/or” proposition bothered me.

CHARGED, CONTROVERSIAL, CONTENTIOUS

It's charged, all right. Very controversial and political. Consider the history of ECT.

Add all the agitprop Hollywood and other moviemakers have infused into the emotional discourse that swirls around ECT, morphing a psychiatric treatment into an instrument of cinematic horror – and no wonder ECT is so contentious.

Finally, a 20-minute phone-chat with my psychiatrist, Dr. Bob, cleared things up.

You'll see what I mean when I spell out the following acronyms of four approaches that all play a part in this "charged" debate.

ECT AND DBS AND VNS AND rTMS for TRD

ECT is Electroconvulsive "Shock" Therapy – for years it's been proven to work in many cases.
rTMS is repetitive Transcranial Magnetic Stimulation – similar to ECT, but less invasive, does not cause a seizure, but is still experimental.
VNS is Vagus Nerve Stimulation – newest of these procedures, surgical, not as invasive as DBS, but similar. Doesn't involve drilling holes into the brain. Not yet widely available.
DBS is Deep Brain Stimulation – most invasive surgical procedure, considered the last resort. ECT is a prerequisite. Still undergoing trials.

ECT, TMS, VNS and DBS all fall under the general category of Psychiatric Neuromodulation – procedures that use either electrical or magnetic currents on the brain to treat debilitating psychiatric conditions – mainly treatment resistant depression TMR – long term, chronic depression or constantly recurring depression which does not respond to standard treatments like medication or psychotherapy.

Dr. Bob explained that ECT and DBS are like apples and oranges. They don't compare as well as ECT vs. rTMS. And VNS vs. DBS.

NOBODY UNDERSTANDS WHY OR HOW "PSYCHIATRIC NEUROMODULATION" WORKS

Nobody really understands how and why these procedures work and the only one with any real track record is ECT.

Veteran CBC and CTV radio and television broadcaster Helen Hutchinson calls ECT her "ace-in-the-hole."

In 1994, after years of numbing, debilitating depression, and more than five years of psychotherapy, a series of antidepressants, four hospitalizations and two suicide attempts, Hutchinson agreed to try ECT. One course. Six treatments.

"I welcomed it when I finally decided to have it," she told me in January 1995, during a Toronto Sun interview. "After all, what can I lose – a few brain cells?"

After her first ECT treatment, "It was like the light went on, like a blind suddenly flapped open. Instead of being in a tunnel with just a tunnel at the end, I was released," she said.

Earlier this week, Hutchinson, now-73, sounded vibrant and excited to hear my voice after 13 years when she picked up her phone.

SHE NEEDED ONE COURSE. SIX TREATMENTS. NO MORE.

"I'm just fine," she said. That one course of ECT did the trick.

Hutchinson still sees her psychiatrist regularly, takes an antidepressant and knows if ever her depression threatens, ECT is available on an outpatient basis.

“That’s never been necessary,” she said.

For Deanna Cole-Benjamin, more than 80 ECT treatments did nothing for her devastating depression.

"For a short time, there seemed to be a glimmer of hope that it would work, but it never did," the Kingston, Ontario public health nurse said recently on the phone – happy to interrupt a quiet summer evening in her backyard with her husband and four children.

In April 2006, Cole-Benjamin, a public health nurse, now 44, was the subject of a riveting Sunday New York Times Magazine feature called A Depression Switch?

ECT IS A PREREQUISITE FOR DBS

Her depression seemed to come out of nowhere and for no reason in late 2000. Antidepressants were useless. Eventually, she had to stop working and was hospitalized for 10 months. Her depression proved completely resistant to all drugs, psychotherapy and all that ECT. For the next four years, she was in and out of hospital many times and often contemplated suicide.

In 2004, she was asked to participate in the first clinical trial of Deep Brain Stimulation, radical new brain surgery for treatment resistant depression. It was developed in Toronto by neurologist Dr. Helen Mayberg and her neurosurgeon collaborator Dr. Andres Lozano whose small DBS trial at the Toronto Western Hospital was recently published in the journal Biological Psychiatry.

"I feel very well," Cole-Benjamin told me.

The battery in the neurotransmitter in her chest (a pacemaker-like devise) needed to be replaced once, "but that's just day-surgery. Now I just go to Toronto periodically for check-ups," she said.

DBS – VERY, VERY INVASIVE SURGERY

“The initial surgery was very, very invasive," she recalls. It involved drilling holes into her skull and then deep inside her brain, so two electrodes could be inserted into Section 25, a procedure that has already been performed on 30,000 people with Parkinson's Disease.

She was awake during this two hour operation, under a local anaesthetic so she could report any changes she felt.

Today, Cole-Benjamin jokes about her brain bionics.

"My head's a little bumpy from all the electrodes," she said, laughing. "My hairdresser always says that – and when I'm travelling, I can't go through airport security scanners."

A small price to pay to have your life back.