There remains much scientific, clinical, and ethical controversy concerning the use of electroconvulsive therapy (ECT) for psychiatric disorders stemming from a lack of information and knowledge about how such treatment might work, given its nonspecific and spatially unfocused nature. The mode of action of ECT has even been ascribed to a “barbaric” form of placebo effect. Here we show differential, highly specific, spatially distributed effects of ECT on regional brain structure in two populations: patients with unipolar or bipolar disorder. Unipolar and bipolar disorders respond differentially to ECT and the associated local brain-volume changes, which occur in areas previously associated with these diseases, correlate with symptom severity and the therapeutic effect. Our unique evidence shows that electrophysical therapeutic effects, although applied generally, take on regional significance through interactions with brain pathophysiology.
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Friday, February 07, 2014
Why electroconvulsive therapy works in mood disorders.
Dukart et al. make the interesting observation that the controversial procedure of electroconvulsive therapy causes changes in gray matter volume in the brain areas that are implicated as abnormal in refractory major depression and manic depression:
This can be explained rather easily.
ReplyDeleteHerb Wiggins, M.D.
It's easy to explain because of the same reason personality disorders are very stable and don't often respond well to meds. They are long term memory dependent, structurally stable, and because of that, meds will not modify them very much. The behaviors in PD's get so reinforced that they are integral to the stable personality traits, which are largely LTM.
ReplyDeleteOne of the major side effects of ECT and Insulin shock therapy I've seen & worked with can often be serious memory loss and brain damage. That breaks up the memory traces dependent upon synaptic, protein structures, and thus breaks down the major memory support to PD's. It's one of the reasons why ECT works on major, intractable depressions and psychoses. perhaps a very important factor.
I'm writing an article on "Brain Hardwiring" to explain this and related problems with aging, creativity, etc.
In major addictive drug treatment centers, a compound from W. Africa, called ibogaine, has been used successfully, altho it's very toxic, to treat severe drug abuse. We can a priori hypothesize that it'd have a profound effect on LTM, as well, in order to break up this kind of long standing behavior. And it does, including synaptic damage, plus other effects including profound but usually a temporary 6 hours loss of short term memory coupled with long read outs of LTM traces, very similar to what Penrose found when he tapped human brain cortex in several places with a microelectrode to see what it'd do. A bit of NGF release added to ibogaine's other effects and the person so treated can conform more to a drug-free recovery environment in a treatment center. It's an interesting drug. More effective than other treatments, and not so damaging as ECT. Some religious conversions can also work the same way, interestingly enough. St. Paul on the road to Damascus comes to mind.
Herb Wiggins, M.D.