Customer Reviews

Electroconvulsive Therapy

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Electroshock therapy, or ECT as it is called these days, dates to early in the 20th century and has a reputation for being, well, bad for patients. Abrams' book is apparently the definitive textbook for physicians/ psychiatrists/ psychologists looking to learn the techniques and trappings. The third edition was published in 1997 and is still current. Primarily, the text describes the use of ECT in elderly patients with histories of psychosis or depression previously unresponsive to chemical treatment. Critics have questioned the motive behind this text, suggesting it is purely financial and to encourage a practice in which he has personal economic interest. (Abrams has also led seminars on the subject, and rumor has it he controls a portion of the company that manufactures ECT equipment.)

Concerning the content of the book: Abrams knows what he's talking about. He is the acknowledged expert in ECT, and if anyone is qualified to write a book about it, it is he. However, the text does not touch heavily enough (in my opinion) on the downside of ECT - the potential for very serious side effects and complications, including permanent memory loss, organic brain dysfunction, and even death. The clinical information is pertinent, and the format is understandable and logical. I didn't see the earlier editions of this text, but the chapters noted as being new do indeed contain relevant information.

For any professional interested in ECT in practice or even in theory, this is a valuable resource, but it should be balanced with a dissenting voice. Unfortunately, research on this issue tends to be lopsided and incomplete, with experts like Abrams claming very high success rates, and former patients giving anecdotal evidence of severe and long-lasting aftereffects.

I... that Dr. Abrams is an expert in ECT and his book is well written. However I would argue that the critique on not being "balanced with dissenting voice" has no scientific/logic base.

Our society is so poisened by political demands (correctness) that the scientific truth is often submerged by mass desire. When we evaluate a medical procedure, we must base our argument on scientific data. I have read literature in this field extensively, and I have not yet found any solid research data showed that ECT imposed danger of "permanent memory loss, organic brain dysfunction, and even death". To me, case reports are no data, anecdotal opinion is no data. For only the sake of discussion, please consider this: if we did ECT on 1000 patients, and 2 of them dead, 3 of them got brain injury, and the families of these 5 patients went to the press. All we may hear now is that ECT killed or damaged people. However, the hidden truth might be: without ECT 10% of the 1000 patients would have killed themselves, 20% would have health damage out of malnushiment due to financial difficulty (e.g., loss job), alcohol and substance, other medical conditions that were worsened by depression, and 5% of them were killed by chemical treatment, and etc. ECT may have dramatically improved the life quality of 70% of this 1000 patients. We will never know the truth if we stop at the anecdotal information provided by the 5 cases.

Anecdotal, according to American Heritage Dictionary, means: based on personal observation, case study reports, or random investigations rather than systematic scientific evaluation. I am not a zealous advocator of ECT, but I trust only scientific evidence. If anyone would tell me ECT caused brain damage, please show me the scientific evidence. Don't tell me you or your uncle or your sister was damaged by ECT. Don't tell me how many psychiatrists admitted the "downside" of ECT. Show me the well designed research, show me the well controlled data.

Truth is never "balanced dissenting voice". Truth can only be found through scientific research. Three hundred years ago, the balanced dissenting voice said the earth is the center of the universe. The man argued against the balanced dissenting voice was killed. However, the truth was, as it was 1 million years ago, as it is today, as it will be 1 million years later, that the globe is not the center of the universe. How do we know that? Through scientific research!

The book is very informative, but can be quite technical for the non-medical person. Also, with the FDA approval of vagus nerve stimulation for chronic depression, I would recommend a great book about this medical breakthrough procedure: "Out of the Black Hole: The Patient's Guide to Vagus Nerve Stimulation and Depression". It is written by a patient for patients. Apparently this new therapy has none of the side effects of ECT.
Depression is still dismal, so anything that offers hope other than ECT sounds good to me.

this is a medical book, providing the informations necessary for the good practice of ECT. there is no room for ideology in this type of text. all a doctor can expect.

Helbert Campos, psychiatrist, Brazil