Lost in a sea of abbreviations

If you go to a doctor and say you feel depressed you might be diagnosed as having MDD (major depressive disorder) and prescribed an SSRI (selective serotonin reuptake inhibitor). If that doesn’t work there is ECT (electroconvulsive therapy), or VNS (vagal nerve stimulation) or DBS (deep brain stimulation), or TMS (transcranial magnetic stimulation), or NMD (neurosurgery for mental disorder). ECT might be UL (unilateral electrode placement) or, more commonly, BL (bilateral electrode placement). American psychologist Harold Sackeim has taken out a patent on something called FEAST (focal electrically-administered seizure therapy) and then in China there is a treatment for depression called FOREST (oops, no, that actually involves sending patients to stay at a site in a forest).

On the psychological front, there is CBT (cognitive behavioural therapy) or IPT (interpersonal therapy). And now there is BAT (behavioural activation therapy). Actually BAT has been around for a while but recently got some publicity when the University of Exeter put out a press release. For example, the i paper ran a headline in their health section on 23 July: “Getting out more ‘as good as therapy’ for depression”.

“A therapy which encourages people with depression to get out more and do something enjoyable is as effective as the much more expensive top-of-the-range treatment provided by doctors, says a new study.”

The article went on to explain that a new study led by Professor David Richards that “the NHS could make huge savings by adopting BA”, on the basis that it was 20 per cent cheaper than CBT. Apparently the study had found that BA therapy was as effective as CBT.

So what does this behavioural activation therapy consist of? The article explains:

“Patients undergoing Behavioural Activation (BA) therapy are encouraged to seek out ‘positive activities’ such as dancing, gardening, rambling, and going to the theatre. Pastimes such as reading or sewing could be equally important, researchers believe, as long as the patients enjoy them.”

All very well, but, I ask myself, who is going to pay for the theatre tickets? Or is there perhaps a poor-doors version of behavioural activation therapy? It doesn’t take long to find it. An article published in Advances in Psychiatric Treatment in 2007 (Behavioural activation for depression by David Veale) reveals a rather different version: “Goals should include a return to normal work and social roles as soon as possible” and the avoidance behaviours that have to be tackled include “watching rubbish on television” and “excessive exercise”. So you can ramble but don’t go too far.

All these abbreviations have made me wonder when electroconvulsive therapy acquired its name and common abbreviation. After all, Ugo Cerletti and Lucio Bini didn’t invent something called ECT. They invented something called elettroshock. Looking through some English-language articles from the 1940s and 1950s there seemed to be a tendency for American authors to talk about electric shock or electroshock treatment while British authors preferred electric convulsive or convulsion therapy or electroplexy. By the 1950s the abbreviation E.C.T. had become common in Britain, although article titles often expanded the abbreviation, for example an article in the Journal of Mental Science in 1958 had the title: “Electroplexy (E.C.T.) techniques in current use”. In the United States the term electroshock therapy, abbreviated to EST, remained popular, at least into the 1960s, although nowadays it is frowned upon by psychiatrists (except when they are talking about animal experiments) and the term electroconvulsive is preferred, even though, with the use of muscle paralysing drugs, patients no longer convulse whereas they are still given an electric shock.

I forgot TRD. If the drugs don’t work you might be diagnosed as having TRD (treatment resistant depression).


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One Response to Lost in a sea of abbreviations

  1. Yes, nowadays they only convulse wildly in the movies, which show the worst possible side of ECT! No wonder people are put off!

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