ECT and dementia

There are few long-term studies of electroconvulsive therapy (ECT). But in Sweden a group of 55 people who received ECT at Lund University Hospital between 1976 and 1983 (all voluntary patients of one psychiatrist) were given various tests over the next few years. At some stage they were divided into those who had developed dementia and those who hadn’t, and this has generated an article (A long-term longitudinal follow-up of depressed patients treated with ECT with special focus on development of dementia, by A. Berggren et al.) in the Journal of Affective Disorders. What the authors of this article were doing was comparing results on various previous tests of those people who went on to develop dementia (on average nearly 10 years after ECT) and those who didn’t. I didn’t find it easy to understand what exactly the time-scale was (who was being tested when), so that may not be a good summary.

I haven’t either been able to work out either when exactly it was decided to divide the survivors into those who had developed dementia and those who hadn’t, but by this time there were 49 people left in the study and 17 (35 per cent) of them had dementia. The authors give some rates of dementia in the population, and according to these, it only reaches about 35 per cent in people aged 90-94, which is a lot older than the ECT survivors. In people aged 70-79 (which I think is nearer to the age of the ECT survivors, from the mean ages given in the table) it is about 3 to 6 per cent. Are the authors worried? Not really, as they say that “Recurrent bouts of depression and the severity of depressive episodes seem to increase the risk of developing dementia”. They found that the people who went on to develop dementia were more likely to have experienced disorientation, confusion and amnesia after ECT, but conclude that this “may indicate an increased vulnerability due to the emergent progress of neuropathology”, without considering any other possible conclusions.

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10 Responses to ECT and dementia

  1. deeeo42d says:

    Psychiatric studies are usually poorly designed. It might be possible to find the incidence of dementia following Traumatic Brain Injury, particularly Repetitive TBI and compare the two.

    • Someone here http://www.ncbi.nlm.nih.gov/pubmed/22776913 says that “The best data indicate that moderate and severe TBIs increase risk of dementia between 2- and 4-fold.”

      • deeeo42d says:

        YES! Well known but discounted as an adverse effect. The dispassionate, detached attitude of these people chills me. Still they decided that the cognitive risks to their dying patients were a discouraging factor. No questions asked about the risks to perfectly physically healthy people. Even the neurologists have abandoned psychiatric patients to the butchers of medicine.
        British Journal of Medicine & Medical Research 3(4): 1798-1805, 2013
        SCIENCE DOMAIN international
        http://www.sciencedomain.org
        ECT as Used in Psychiatry Temporarily Opens the Blood‐Brain Barrier: Could This be Used to
        Better Deliver Chemotherapy for Glioblastoma
        Richard E. Kast1*, Piotr Lewczuk2, Marc‐Eric Halatsch3,
        Georg Karpel-Massler3, Eric L. Altschuler4 and Tom Bolwig5
        1IIAIGC Headquarters, Dean of Studies, 22 Church Street Burlington, VT 05401, USA.
        2Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and
        Friedrich‐Alexander Universität Erlangen‐Nuremberg, Erlangen, Germany.
        3Department of Neurosurgery, University of Ulm School of Medicine, Albert-Einstein-Allee
        23, D‐89081 Ulm, Germany.
        4Department of Physical Medicine and Rehabilitation, New Jersey Medical School,
        University Hospital, Newark, NJ, 07103, USA.
        5Department of Psychiatry, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
        Denmark.

      • deeeo42d says:

        YES! There certainly is a action on the blood brain barrier. It takes it down! This study contemplated using it for just this purpose, to allow anti cancer drugs that the brain barricaded out to get through to attack a deadly brain cancer. Well known but discounted as an adverse effect. The dispassionate, detached attitude of these people chills me. Still they decided that the cognitive risks to their dying patients were a discouraging factor. No questions asked about the risks to perfectly physically healthy people. Even the neurologists have abandoned psychiatric patients to the butchers of medicine.
        British Journal of Medicine & Medical Research 3(4): 1798-1805, 2013
        SCIENCE DOMAIN international
        http://www.sciencedomain.org
        ECT as Used in Psychiatry Temporarily Opens the Blood‐Brain Barrier: Could This be Used to
        Better Deliver Chemotherapy for Glioblastoma
        Richard E. Kast1*, Piotr Lewczuk2, Marc‐Eric Halatsch3,
        Georg Karpel-Massler3, Eric L. Altschuler4 and Tom Bolwig5
        1IIAIGC Headquarters, Dean of Studies, 22 Church Street Burlington, VT 05401, USA.
        2Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and
        Friedrich‐Alexander Universität Erlangen‐Nuremberg, Erlangen, Germany.
        3Department of Neurosurgery, University of Ulm School of Medicine, Albert-Einstein-Allee
        23, D‐89081 Ulm, Germany.
        4Department of Physical Medicine and Rehabilitation, New Jersey Medical School,
        University Hospital, Newark, NJ, 07103, USA.
        5Department of Psychiatry, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
        Denmark.

  2. This doesn’t look like a study, but a whitewashing PR exercise. The difference between 3 to 6% and 35% is absolutely massive, and to brush that aside without real questioning speaks of bias.
    Most research nowadays is commercially funded and therefore cannot be trusted – sometimes directly commissioned, but sometimes a large nebulous donation to an academic establishment, so the strings cannot be traced. And of course he who pays the piper calls the tune. Manufacturers of ECT equipment have loads of dosh to throw at the research – perhaps they paid for this ‘paper’, just to be able to say ‘oh yes there has been a long-term study which didn’t find any long-term ill-effects’ – even though it did, but they’ll hope few people will be suspicious enough to actually question the author’s conclusions.
    Apart from which it’s scary – I’m 68 and had ECT in 19771 – my prospects don’t exactly look rosy do they!

  3. The authors of the Swedish study weren’t the usual suspects. I think they were interested in the group of people in the study not so much because they had had ECT but because they were a group for whom pre dementia diagnosis test results (such as EEGs and cerebral blood flow) were available. But it is odd that they don’t discuss the implications of their findings more thoroughly.
    On the healthtalk.org section on ECT, there is an example of a psychiatrist reassuring a patient about the risks of ECT
    http://www.healthtalk.org/peoples-experiences/mental-health/electroconvulsive-treatment/side-effects-having-ect
    Scroll down to Sunil
    “I mean I did worry about whether there’s any long lasting effects of ECT like maybe brain damage or dementia or something like that, but my consultant psychiatrist has strongly reassured me that there is absolutely no evidence whatsoever that ECT makes you more likely to develop either Alzheimers disease or dementia, and in actual fact, she’s told me that’s there’s actual medical evidence, and published evidence, that untreated episodes of severe depression are much more associated with dementia than treatment with ECT. So if you don’t get adequately treated and you have long periods of recurrent depression which is severe, you’re much more likely to develop dementia.”
    Unfortunately there is no footnote so we don’t know what research she was talking about. Another recent article from the Journal of Affective Disorders
    http://www.sciencedirect.com/science/article/pii/S0165032716303883 was about a group of Portuguese people who had been followed up for years and an increased risk of dementia was found in those who had been in hospital with depression, but that is – presumably – treated rather than untreated depression. The authors didn’t discuss treatments though, or at least I don’t think they did – I didn’t read it that thoroughly.

  4. deeeo42d says:

    The aim has to be to connect ECT with TBI. Once you do that it is obvious to all that ECT causes brain damage. Present this simple fact to psychiatrists in public.
    1. A traumatic brain injury (TBI) occurs when an external force applied to the head causes a disruption to normal brain function. This may or may not involve a loss of consciousness.
    2. ECT applies an electrical force to the brain causing a loss of consciousness and a grand mal seizure. These are serious disruptions to normal brain function.
    3 Therefore ECT causes a Traumatic Brain Injury.
    So the consequences of ECT will be those of a TBI in EVERY case. This may include CTE.
    The trick is how to get the neurologists involved. I have done this and the neurologist agreed I have an Acquired Brain Injury as a result of repetitive TBI, (ECT). Produce an MRI brain scan and neuropsychological tests and ask to go to rehab. If enough do this we can be heard.

    • If there are enough ‘cases’ confirmed by neurologists, it may then be possible to interest a human rights organisation to fund a pro-bono class action – but it’ll have to be really substantial evidence. I suspect that only after a very high-profile court case – which the ECT manufacturers and professional bodies of psychiatrist will fought tooth-and-nail all the way – will there be a major policy shift – because in health care nowadays it’s money not care that talks –and only the fear of substantial damage will get them to see sense.
      I think we’re a long way yet – but absolutely – collecting evidence with professional evidence of neurologists has got to be a first step.
      Some years – like a few other ECT survivors over the years – I approached Amnesty to try to get them to recognise ECT without informed consent as torture – but although they could recognise that not all psychiatrists are good guys – eg use by Stalinist Russia to have a sectioned hundreds of dissidents –they wouldn’t touch it, and communication ended acrimoniously – they basically still believe ‘the exert’. But if we have tens of cases substantiated by another set of experts actually held in higher standing than psychiatrists amongst the medical profession (which neurologists certainly are, a re-approach to them, or Liberty etc, would be well worth while.

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