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Aswad -> RE: Electro Convulsive Shock Therapy (ECT) (7/29/2012 3:00:47 AM)
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quote:
ORIGINAL: FullCircle
I've not really ever been sure what the science behind ECT is meant to be i.e. why did one person think one day 'let's see if these jump leads work on brains to'.
There is no science behind ECT. Some science has been applied to ECT, but the treatment itself is a case of "we've seen this work, so we keep on using it". Might even call it naturopathy, which tends to be based on the same principle. Anyway, the idea pretty much comes down to people noting that seizures tend to bring depressions to a halt, at least for a while, and that electrical shocks tend to induce seizures and/or convulsions. Thus, a few people were electrocuted to see if it might have interesting effects. Turns out it did. So we sort of stuck with it, and eventually started refining the process a bit.
In the history of medicine, there's a lot of stuff we've discovered in less than ethical ways. For instance, gynecological surgeries are a product of cutting up black slaves without anaesthesia. Some neurosurgery derives from a sadist having fun at a free clinic. What we know about some epidemics is primarily from biowar research. Explosive trauma gold standards of care are from the first Gulf War when civilians tried to dig up boobytrapped mines. Most privation and survivability data is from the Holocaust. Anatomy is a matter of dug up corpses, uncollected corpses, and so forth. Syphilis was studied in Tuguskee up to the 70s at least.
For a while, a lot of doctors were miffed about the growth of the antivivisectionist movement, while most now oppose vivisection of humans.
quote:
How can you direct electricity to anything other than the path of least resistance? Who knows how it's coursing through your brain?
It flows through fibers in the transverse plane, meaning it takes a sagittal (side-side) direction through the brain, with some of the current spreading out. Transverse fibers are thick nerve bundles that constitute a relatively short path with relatively low resistance to the current, and thus very little flows outside the major bundles. Large fibers are able to dissipate the heat and are merely being electrically disrupted by the jolt. Small fibers conduct too little current to be significantly affected. Intermediate fibers carry enough to heat up, and are too small to dissipate the heat, so some of those die off. As a result, the treatment provides a disruption of the current state of the brain, and repeated treatments progressively trim back "excessive" connections in the brain.
None of this was known until 2009 or so. Like most medical treatment, empirical effects on symptoms guide the usage.
Bear in mind that although we don't know the function of the "excess" connections, we do know that there are more connections in certain directions for patients with recurring depressive illnesses. In effect, this means the treatment does normalize something in the wiring. I'm loath to make an unsupported argument that "ignorance as bliss" is the source of efficacy, but it does seem to be a bit apropos. For the vast majority of patients electing to have ECT, such is not necessarily a bad thing. As dcnovice said about the drugs, without relief there often won't be a long term, so one might make an argument that nothing is ventured that wouldn't have been lost anyway. And we do know a lot of the drugs cause persistent changes, as well.
The long and short of it is: we have no very precisely targettable treatments.
We do, however, have a number of very effective treatments.
Side effects tend to correlate with efficacy.
IWYW,
— Aswad.
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