David Healy: The Stealth ECT Psychiatrist in Psychiatric Reform

[compsports]

I realize that no psychiatrist, even our friends, are perfect. But I do think people need to be aware of David Healy's role with ECT.

 

http://www.huffingtonpost.com/dr-peter-breggin/electroshock-treatment_b_1273359.html?ref=fb&src=sp&comm_ref=false#sb=1114766,b=facebook

[compsports]

My apologies if I have offended anyone with this post.

 

I realize Breggin has alot of failings also. '

 

Like I said, no one is perfect and it is a matter of whose profile you prefer the most.

 

CS

[Barbarannamated]

CS,

I'm glad you opened the topic. I was very surprised when I read the Draft of his new recommendations/position paper. He mentioned ruling out other medical conditions/drug effects if no response to certain psych meds according to type of depression or anxiety. Disturbing.

[compsports]

CS,

I'm glad you opened the topic. I was very surprised when I read the Draft of his new recommendations/position paper. He mentioned ruling out other medical conditions/drug effects if no response to certain psych meds according to type of depression or anxiety. Disturbing.

 

Hi Barb,

 

Sorry, I am having brain fog big time.

 

You're talking about Healy? Do you have a link to what you are referring to?

 

Thanks!

 

CS

[compsports]

CS,

I'm glad you opened the topic. I was very surprised when I read the Draft of his new recommendations/position paper. He mentioned ruling out other medical conditions/drug effects if no response to certain psych meds according to type of depression or anxiety. Disturbing.

 

Hi Barb,

 

Is the paper?

 

http://davidhealy.org/wp-content/uploads/2012/02/DBM-Draft-Position-paper-on-Antidepressants-for-Prescribers.pdf

 

I haven't found what you are referring to as an FYI.

 

CS

[Altostrata]

I want to see Dr. Healy's response to Breggin's charges. It's appalling, if true -- but it might not be the whole story.

[Barbarannamated]

www.davidhealy.org/we-need-data-for-data-based-medicine

 

Antidepressants for Prescribers and Antidepressants for Takers

[Barbarannamated]

www.davidhealy.org/we-need-data-for-data-based-medicine

 

Antidepressants for Prescribers and Antidepressants for Takers

 

Sorry CS - didn't see last part of question. I will find what page it's on.

 

PG. 7 bottom -- "For significant melancholic depression or depression with psychosis, ECT is effective."

 

Having trouble switching screens and pasting. Wording may be slightly off.

[Altostrata]

Thanks, Barb.

 

(To aid in discussion, you might copy and paste the sections you're referring to from the paper.)

 

Healy's draft contains these points:

 

For severe depressions, in trials from the 1980s tricyclic antidepressants were significantly more effective than SSRIs. For depressive psychoses adding an antipsychotic to a tricyclic antidepressant has been shown to help. For patients with a significant melancholic disorder or depressive psychosis, ECT is effective. SSRIs and other newer antidepressants have not been shown to work for melancholia.

Healy is talking about a specific type of depression, the most severe type. This still may not justify use of ECT, but he is restricting it to this very extreme condition.

As the disorder becomes more severe (melancholia/ depressive psychoses) the evidence for a benefit of tricyclic antidepressants over placebo gets stronger, and ultimately ECT. SSRIs, other antidepressants and talk therapies do not work for melancholic depressions.

 

If a condition becomes more enduring, the treatment options become more complex and may vary all the way from changing work or relationships to a full investigation of contributing physical factors. Consideration should always be given to the role that current medications may have in stalling recovery – for every 9 people out of 10 who have the expected response to a drug, there will be 1 out of 10 who has just the opposite response. The only way to assess this is to stop treatment.

As I read this, I think it's confusing. The earlier paragraph is referring, again to extreme cases.

 

The later paragraph seem to refer to something else. Maybe it's an editing error in this draft version. This needs to be clarified. It certainly doe not make sense to rule out a medical condition after ECT has failed.

 

The paper contains other statements about adverse effects, withdrawal, and pharma coverups that I think are very valuable.

 

 

Barb and others -- if you don't agree with Dr. Healy's draft, you can comment on http://davidhealy.org/we-need-data-for-data-based-medicine#comment-74 His e-mail address is also available on the site.

[Barbarannamated]

I did comment on blog about Data Based Medicine. Also preparing more complete history to submit.

 

I agree 100% about ruling out medical conditions before initiation of ANY pharmacologic treatment unless absolute emergency/danger. When did that fail to be stardard of care? I realize that there are many things that can contribute to depression and not everything can be tested for, but is a metabolic panel and hormone levels outrageous?? It has become standard to treat PMS/PMDD and post partum depression w/SS/NRIs. Would it not be reasonable to attempt to work with the hormones at the root of the problem?

 

And please explain how a severely depressed patient who has not responded to treatments is going to handle making a major life change such as finding new job, moving, etc.?? GEEEZ!!!

 

Sorry. I've had a rough week.

[Altostrata]

Duncan Double of the UK's Critical Psychiatry Network also takes Healy to task here http://criticalpsychiatry.blogspot.com/2012/02/peter-breggin-falls-out-with-david.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+CriticalPsychiatry+%28Critical+psychiatry%29 and here http://www.critpsynet.freeuk.com/Healy.htm

 

However, he doesn't mention ECT.

[compsports]

http://www.healyprozac.com/AcademicStalking/ShockTherapyControversy.htm

 

I think this article is quite interesting as Dr. Healy doesn't seem to deny that he isn't against ECT.

 

I would also scroll down to the 4th paragraph and click on the link that will open up a word document of email exchanges between him and Linda Andre, who authored the book, Doctors of Deception, regarding what she felt were the deceptive practices of ECT.

 

Perhaps I didn't read the exchange carefully but Dr. Healy seemed to be minimizing the side effects of memory loss and didn't think there was a way to test for it.

 

Dr. Healy also makes the point that the reason you don't hear about the success stories is that people who have had ECT don't want it known they have had it. I can't argue with that point because we make the same claim when arguing that people with schizophrenia have succeeded without meds.

 

But if it worked that well, wouldn't Healy and company be rushing to do studies that proved that it did? I haven't seen any.

 

Anyway, I have very mixed emotions about this. Our movement needs all the allies it can get, particularly psychiatrists. But are we that desperate that we need someone who is in favor of ECT and doesn't seem to take the side effects as seriously as he does with meds?

 

I honestly don't have a good answer.

 

CS

[Altostrata]

I think you would have to read the book to see exactly what his position is on ECT.

 

The page you've linked to reviews a bunch of infighting about whether he profits from recommending ECT.

 

Dr. Healy's argument seems to be in contrast to antidepressants, there is good evidence ECT works, but there's no money in it, so it's been demonized. This is not inconsistent with his position on antidepressants. If you want to debate his belief in the effectiveness of ECT, you'd have to look into the science.

 

It certainly has a bad reputation among patients. My impression, from some articles that came out some time ago, is that there is a wide variation in the machines used for ECT, some deliver dangerous amounts of voltage, and some are not properly maintained. So this may be another situation where it may be more safe in theory than in practice.

 

There have been many, many studies on ECT.

 

I note according to Dr. Healy:

 

If the rate of ECT being delivered in the US (which is unknown) is close to the current rate in the UK then the true figure is probably in the order of 30,000 people a year, or slightly over 10,000 new patients per year – it is quite possible that the US rate is a lower than this as a third of teaching hospitals do not have an ECT service, a situation that would not be possible in the UK.

There are about 30 million people in the U.S. on antidepressants. 30,000 is .1% of that number. ECT is inflicted only for major depression, or for people unlucky enough to fall into the hands of doctors who mistake their condition for major depression.

 

(Major Depressive Disorder (MDD) is an extreme condition. Unfortunately, it's definition has been blurred (by the DSM-IV) to the extent all kinds of depression are considered the same.)

 

Dr. Healy references the following review of his book in Slate by Barron Lerner, MD January 3, 2008 http://www.slate.com/articles/health_and_science/medical_examiner/2008/01/the_body_electrics_new_look.html

 

The Body Electric's New Look

Why shock therapy deserves its mini-revival.

 

By Barron Lerner Jan. 3, 2008

 

The history of electric shock therapy would seem to lend itself to a rather straightforward tale of last-ditch, gruesome treatment of mental illness. After all, we've all seen One Flew Over the Cuckoo's Nest.

 

But in their new book Shock Therapy, Edward Shorter and David Healy say this version is almost entirely inaccurate. Shorter is a historian who has written extensively on psychiatry, and Healy is a psychiatrist who has been highly critical of the marketing of psychopharmacological drugs. They believe that electroconvulsive therapy is incredibly effective. And yet for decades, a severely depressed patient—even one on the brink of suicide—might not have been offered the therapy, or if her doctors had proposed it, she or her family might well have declined it. In explaining why, the authors demonstrate that though we may assume medical treatments get adopted or rejected based on objective statistics, in fact data are often misinterpreted and manipulated by outside influences that end up overpowering them.

 

....

By the 1940s, Shorter and Healy write, ECT "had become part of the therapeutic apparatus of nearly every mental hospital" across the globe. In 1959, Group Health Insurance, a company that insured New York City employees, proudly announced that it would cover "ten electroshock treatments, in or out of the hospital," for all of its subscribers.

 

But within a decade, ECT would become stigmatized as dangerous and even sadistic, "a fearsome last-ditch remedy to be used only under extraordinary conditions and under the most elaborate legal safeguards," as the authors put it. This is the best-known part of the story. ECT fell out of favor for several reasons. When phenothiazines, the first pills that could treat schizophrenia, became available in the early 1950s, pharmaceutical companies marketed them as better and safer than shock therapy even though they did not always work and often caused jerking movements and other side effects. This marketing dovetailed with the social upheaval of the 1960s, which led to the formation of the so-called anti-psychiatry movement, a loosely based coalition of activists, disenchanted mental health professionals, and patients. They charged that psychiatric hospitals, through procedures such as ECT and lobotomy, were punitive as opposed to therapeutic—a la the 1962 novel One Flew Over the Cuckoo's Nest, which was made into a film in 1975. When the hero, Randle P. McMurphy, receives damaging ECT and a lobotomy, it is essentially to prevent him from saving the other patients. And this link between shock therapy and the second, much more dubious procedure made it seem all the more frightening.

 

Also influential was a 1974 New Yorker article by renowned medical writer Berton Roueche, who claimed that ECT caused permanent memory loss. Because the woman featured in Roueche's essay was not a representative case, her story exaggerated the importance of a real, but limited, side effect. The anti-ECT sentiment culminated in the passage of a 1976 California law that actually tried to prevent physicians from prescribing it—a rare instance of direct legal interference with medical practice.

 

Meanwhile, what did the data about ECT actually show? Research from the mid-20th century was more susceptible to bias than more recent work, but hundreds of studies from a wide variety of institutions claimed it was effective. Shorter and Healy also argue that proponents of ECT were always concerned about the treatment's real side effects. By the 1950s, the use of better anesthetics and muscle relaxants helped control the seizures and made the procedure less violent. Other improvements sought to minimize memory loss. But the persistently suspect characterizations of ECT meant that many patients with mental illnesses who were unresponsive to drugs never received the treatment. As a result, some worsened and some died. This surely represents a lot of potentially avoidable pain and suffering. The backlash against ECT, Shorter and Healy make clear, somehow led to a collective denial about what it could accomplish.

 

This selective reading of scientific data has been the downfall of many treatments besides ECT. In the 1930s, researchers published studies suggesting that removal of a portion of the breast plus radiation was as effective for treating breast cancer as disfiguring radical mastectomy, which necessitated removal of the breast, local lymph nodes, and both chest wall muscles on the affected side. Yet especially in the United States, where surgeons monopolized control of the disease, these data were ignored for decades. After women began demanding less extensive operations in the 1970s, additional studies validated the earlier findings.

 

In other instances, the reverse has occurred: therapies not justified by the data have achieved wide popularity. One example was hormone replacement therapy, which became popular when gynecologist Robert Wilson characterized menopause as an estrogen-deficiency disease in his 1966 book Feminine Forever. Ingesting synthetic estrogen, Wilson argued, would make women feel younger and also prevent osteoporotic fractures and heart disease. Although some critics questioned HRT from the outset, its harms became apparent only in the last few years, with the publication of definitive long-term studies. For decades, the combination of Wilson's salesmanship, drug company advertising, and the pathologizing of a normal stage of life led to the widespread adoption of a treatment not supported by the science.

 

These historical examples of science misused or ignored helped to usher in the now-powerful movement known as evidence-based medicine, which argues that treatments must be evaluated by the most sophisticated biostatistical and epidemiological tools. At the forefront is the randomized controlled trial, which eliminates many of the biases seen in older studies. And evidence-based medicine has come to the world of electroconvulsive therapy. Beginning in the 1980s, a series of expert task forces reviewed the existing data and concluded that in certain cases of mental illness, ECT is not only an acceptable, but a highly advantageous treatment. Its use is again on the rise, helping to alleviate the symptoms of certain patients with severe psychiatric diseases.

....