Harold Sackeim reverses position in upcoming study

by Linda Andre
Director, CTIP

The Cognitive Effects of Electroconvulsive Therapy in Community Settings

NIMH-funded research study published in the January 2007 issue of Neuropsychopharmacology

Author and primary investigator: Harold Sackeim

Funding: NIMH grants

#35636, Affective and Cognitive Consequences of ECT, funded since 1981 for a total of approximately ten million dollars so far (grant has been renewed through 2009)

#59069, ECT Practices in Community Settings—Evaluating Outcomes, funded since 1999 for a total of approximately 3.5 million dollars so far

Summary: After 25 years and millions of dollars of federal funding to research the adverse cognitive effects of ECT—25 years in which not one single longterm followup study was ever published—self-proclaimed “world expert” on ECT Harold Sackeim has now reversed his position, admitting that ECT routinely causes permanent memory loss and deficits in cognitive abilities. His new study—the first to be published in which he followed patients as long as six months, and one of his only studies to use controls—validates a generation of patient reports of permanent iatrogenic disability, and disproves Sackeim’s previously published claims that these reports were simply symptoms of mental illness. Other findings: there is no evidence that ECT increases intelligence, as Sackeim has previously claimed; and women are much more likely than men to experience severe permanent amnesia.

Significance: Harold Sackeim has been called the Pope of ECT, and for good reason. He’s published more on ECT than anyone in the world, has received more money to research it than anyone in the world, and is the author of the American Psychiatric Association’s patient information statement and consent forms, which are used by most hospitals in America. Through his writing, teaching, testimony—and positions on peer review, editorial, and funding boards, including NIMH grant review panels—he has more influence on what the profession and the public believe about ECT than anyone in the world. What Harold says goes.

Conclusion: This study could have been done at any point in the past 25 years. If it had, a generation of patients could have been warned of the likelihood of permanent significant memory and cognitive deficits before, instead of finding out after, ECT. In fact, there is evidence—from Harold’s own statements—that over the years he has in fact conducted studies following up ECT patients for a long as five years…but never published the results. Why not? Why did it take 25 years and over ten million dollars to validate what patients have been saying all along? In other words: What did Harold know, when did he know it, and why wasn’t it revealed?

Quotable quote from the study: This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.

For a detailed critique, see below.

For the past 25 years, patients who received electroconvulsive therapy (ECT) have been told by the nation’s top ECT doctor that the controversial treatment doesn’t cause permanent amnesia or cognitive deficits and, in fact, improves memory and increases intelligence. Psychologist Harold Sackeim of Columbia University also taught a generation of ECT practitioners around the world that permanent amnesia is so rare it could never be studied. Sackeim was the popularizer if not originator of the position that former patients who said the treatment erased memory were simply mentally ill and thus not credible.

His newest and perhaps last ECT research study disproves his tenaciously held claims about the treatment’s harmlessness. It is, in effect a stunning self-repudiation of a 25-year research career…one in which he accepted federal research money with one hand and consulting fees from shock machine companies with the other.

See, for instance, the key finding:

This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.

Similarly, from the abstract:

Despite ongoing controversy, there has never been a large scale, prospective study of the cognitive effects of electroconvulsive therapy

Sounds like the research team is congratulating itself for being “the first,” as if they’d made a discovery before anyone else, doesn’t it? You might think that…if you didn’t know that Sackeim has held the only available NIMH research grant to study ECT’s adverse effects, titled “Affective and Cognitive Consequences of ECT,” continuously since 1981…and if you didn’t know what Sackeim promised the federal government in his original application for grant funding:

“The major objective of the proposed research is to examine the effects of bilateral and right unilateral electroconvulsive therapy on affective and cognitive functioning. The consequences of the two treatment modes will be studied in regard to neuropsychological functions that have previously not been studied…Drug-free inpatients presenting major unipolar depressive disorder will be tested before, during and after treatment and a matched normal control group will be tested at comparably spaced times.”

Instead of doing this, however, he used his grant money largely to compare different types of ECT to each other, not to examine the effects of ECT; and only less than a handful of his 200+ published studies used normal controls, an absolute necessity to isolate the effects of ECT.

Why did it take 25 years to conduct one large, long-term controlled follow-up study? And in the absence on this research, why did Harold so confidently assure professionals, patients, legislators, and the public that ECT was safe?

A closer look at the study shows us that, in fact, Harold and his team are still not being honest with us, still not revealing all they know. They tried their damnedest not to find out what ECT really does…but failed. Here they reveal only the minimum information they had to concede after using every trick in the book to bias their research in favor of not finding negative effects of ECT.

What tricks did they use here?

1) The assumption that ECT does not cause permanent amnesia and cognitive deficits was built into the design of the study. How so? The study allowed subjects who’d had ECT before, as recently as two months prior, to be counted as the “before ECT” patients–meaning before this course of ECT. It assumed that any effects of ECT resolve within two months. 43% of the subjects had had prior ECT, so that at least half of the data involved comparing the effects of ECT to the effects of more ECT–not isolating the effects of ECT.

2) The outcome measures used to measure amnesia and cognitive function are irrelevant and inadequate to measure the known effects of ECT. Yet even deliberately using measures that would result in underestimating deficits, these deficits were still found to be profound and persistent!

For a critique of the tests used by Sackeim, see Robertson and Pryor’s article, Memory and cognitive effects of ECT: informing and assessing patients, in Advances in Psychiatric Treatment (2006), vol. 12, p. 228-238. For example, the Mini Mental Status exam used by Sackeim is a test that screens for dementia, the grossest and most glaring form of cognitive disability, and is useless for detecting the kinds of deficits caused by ECT.

Sackeim uses a memory test he invented himself, the Autobiographical Memory Inventory. This test is unpublished, not publicly available, not validated, and is not used except by ECT advocates. Robertson and Pryor note that the majority of questions are not relevant to the types of information forgotten by ECT survivors, nor can the test detect amnesia beyond a one-year period. A string of references in Sackeim’s new article attempt to provide support for the claim that the AMI “has shown strong reliability and validity as a measure of retrograde amnesia.” Not only do they not show this, but all the referenced articles were written by Sackeim himself!

3) Patient IQs were estimated pre-ECT using a method that underestimates intellectual ability especially with much higher than average IQs; no attempt was made to ascertain actual IQ. No one looked at these patients’ IQs post-shock to see what happened to them; why not?

Sackeim et al. conclude, based on inaccurate assumptions and no data from these or any other patients, that “Individuals with greater premorbid abilities can better compensate for the impact of ECT on cognitive functions” (references claiming to support this point have nothing to do with ECT but are articles about an unproven theory of “cognitive reserve”).

Even if the researchers didn’t choose to seek out survivors of ECT who once had very high IQs, or to respond to the many survivors of formerly superior IQs who have contacted them, there is a substantial record of accounts by persons who had extremely high or genius IQs who have spoken and written publicly of the devastating effects of having those IQs lowered by ECT (Jonathan Cott, Linda Andre, Anne Donahue, and Marilyn Rice are four such individuals.) None of these accounts suggests that people with “greater premorbid abilities” have an easier time after ECT; in fact, they strongly suggest the opposite.

In addition to these tricks, the researchers used one of the most reliable methods of biasing results: concealing data.

1) “A substantial number of secondary cognitive measures” are said to have been administered along with the named tests, yet the researchers nowhere reveal what they were and what the results were.

2) The names of the seven facilities in the New York City metropolitan area are not revealed. While this isn’t necessary for evaluating the results of the study, it means the facilities with the worst outcomes can’t be held publicly accountable, nor can the millions of city residents protect themselves from the worst offenders.

3) The results of the cognitive tests on the 24 control subjects are not revealed, nor is how they compared to the people who had ECT.

It’s a very big deal for the Sackeim team to use matched normal controls; in 25 years and hundreds of studies they have not done so. Normal controls are essential to ethical and valid research. This article states that “The comparison sample completed the same neuropsychological battery at time points corresponding to the assessment period in patients.” But you search in vain to find out how the controls did on the five named tests of memory and cognitive functioning and the unnamed “secondary measures”, and how they compared to the ECT patients immediately and six months after ECT. It’s not in the text, and it’s not in the tables. So why have the controls take the tests at all, if you’re not going to reveal the results?

Only one thing is revealed: The normal controls did much better than the bilateral ECT patients on the (flawed) measure of amnesia:

“The average decrement in AMI-SF scores in patients treated exclusively with BL ECT was 3.4 and 2.8 times the amount of forgetting seen in the healthy comparison groups at the post-ECT and 6-month time periods, respectively, suggesting that the deficits were substantial.”

4) Sackeim does not reveal—has never revealed in hundreds of published articles—his financial ties to the shock machine companies Mecta and Somatics. Yet in sworn testimony, Sackeim admits he has worked for Mecta for at least twenty years. He designs their shock machines for them. Not only is disclosure required by journals such as Neuropsychopharmacology (ironically, the subject of a recent scandal in which authors and even the journal’s editor did not reveal their ties to another company which has hired Sackeim, Cyberonics), it is also required by state law (because Sackeim is an employee of New York State) and federal law (because Sackeim accepts NIMH money).
Sackeim flaunts these laws by not disclosing the money he makes from the shock machine manufacturers.

This article is a damning critique of work done over 25 years (and at the expense of millions of taxpayer dollars) by this very team of researchers.

If you know that Sackeim’s been funded for decades to do this research and chose not to do it, the following statements read very differently than the researchers intended. Instead of self-congratulation, they read as condemnation.

“Empirical information about ECT’s long-term effects derives mainly from small sample studies conducted in research settings, with follow-up intervals limited to two months or less…These studies could not adequately assess the severity and persistence of long-term deficits.”

The use of small samples and short-term follow-up characterizes all of Sackeim’s work until now, and was their choice, deliberately made so as not to know (officially) about “the severity and persistence of long-term deficits.” These researchers single-handedly had the wherewithal to address these belatedly-acknowledged flaws in their own research at any time since 1981.

“We conducted the first large-scale, prospective study of cognitive outcomes following ECT.”

Why the first study only after 25 years? What of the generation of patients—two and a half million people according to their own estimate—who have received shock in those years without knowing the long-term consequences?

“Severity of depressive symptoms showed little relationship with the cognitive measures. At the post-ECT time point, none of the 11 measures were related to concurrent HRSD scores. Findings were also negative for 8 of the 11 measures at the six-month follow-up.”

Translation: patients aren’t just imagining or lying about their cognitive and memory deficits because they’re crazy. Yet in many published articles written on the NIMH dime, and over and over in public testimony and in court, that is exactly what Sackeim and Prudic have claimed. And they have influenced countless others to believe it.

DAMNING FINDING #1: amnesia is substantial and permanent

“The average decrement in AMI-SF scores in patients treated exclusively with BL ECT was 3.4 and 2.8 times the amount of forgetting seen in the healthy comparison groups at the post-ECT and 6-month time periods, respectively, suggesting that the deficits were substantial.”

“At the six-month time point, there continued to be a significant relationship between the number of BL ECT treatments and the extent of retrograde amnesia.”

“Greater amnesia for autobiographical events was significantly correlated with the number of ECT treatments received 6 months earlier.”

DAMNING FINDING #2: cognitive deficits are substantial and permanent

“Compared to baseline performance, at the postECT time point the total patient sample showed deficits in the mMMS, sensitivity of the CPT, delayed recall of the BSRT, delayed reproduction on the CFT…” (All are measures of memory and cognitive ability).

“This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.”

DAMNING FINDING #3: ECT permanently affects reaction time

“Although psychomotor function is of practical importance with respect to driving and other motor activities, the impact of ECT on this domain has rarely been examined…”

(Once again: Whose fault is that?)

“The fact that relative reaction time deficits were observed at the 6-month follow-up indicates a persistent change in the speed of information processing, motor initiation, or response levels…The findings here raise the concern that this form of stimulation has deleterious long-term effects of elemental aspects of motor performance or information processing.”

DAMNING FINDING #4: Bilateral ECT is no good

“For decades, BL ECT represented the gold standard with respect to ECT efficacy…A majority (of US ECT practitioners) administer mainly or exclusively BL ECT…
There appears to be little justification for the continued first-line use of BL ECT in the treatment of major depression.”

(More than 90% of the ECT given in the U.S., and at least as high a proportion in other countries, is bilateral.)

DAMNING FINDING #5 They lied when they wrote in the APA consent form that ECT improves your memory

What this team has said in numerous published articles—and what Sackeim wrote into the American Psychiatric Association guidelines on ECT, the “bible” used by all rank and file shock doctors—that ECT improves memory and intelligence, is not true.

“It is noteworthy that most cognitive parameters were substantially improved at 6-month follow-up relative to pre-ECT baseline, presumably because of the negative impact of the depressed state on baseline performance…It cannot be concluded, however, that the extent of improvement in any group returned to premorbid levels.”

DAMNING FINDING #6: A much greater percentage of women than men are damaged by ECT than men: 81% vs. 18%.

“There was a gender difference, with a greater preponderance of women (81.6%) compared to men (18.4%) in the persistent deficit group.”

No doubt Sackeim and his handlers will try to “spin” this study as a scientific breakthrough, and hold him up as a reformer and patient advocate. Nothing could be farther from the truth.

Where is the apology to the generation of people who were lied to, who will never regain their memories and their cognitive abilities?

Full study

Comments (49)

SallyTNovember 24th, 2006 at 6:50 pm

This just makes me ill. I cannot fathom how someone can get away with what he has for as long as he has. And all the damaged people he has left in his wake.

We are his legacy.

TomasNovember 25th, 2006 at 8:50 am

Great article, Linda!

I think “substantial number of secondary cognitive measures” refers to the outcome measures other than mMMS scores, Buschke Selective Reminding Test delayed recall scores and AMI-SF retrograde amnesia scores, that is, refers to

Simple Reaction Time (SRT)
Choice Reaction Time (CRT)
Stroop Reaction Time (Stroop RT)
Stroop Color-Word Interference (Stroop Effect)
Continuous Performance Test (CPT)
Complex Figure Test (CFT)

The context of the “substantial number of secondary cognitive measures” quote is

“The primary outcome measures, Modified Mini- Mental State exam scores, delayed recall scores from the Buschke Selective Reminding Test, and retrograde amnesia scores from the Columbia University Autobiographical Memory Interview–SF (AMI– SF), were evaluated shortly following the ECT course and 6 months later. A substantial number of secondary cognitive measures were also administered.”

SueNovember 27th, 2006 at 5:08 am

I’m not sure I like the way he is saying we get memory loss cos we’re thick.
Interesting how the other risk factors – advancing age and female gender are just the factors that make you more likely to get ECT.

Carol ZimmermanJanuary 29th, 2007 at 4:03 pm

I recently had ECT treatments while in the hospital. I had a total of 6 ect’s. My physician is wanting me to continue having an ECT every month. I am amazed at how so many of my memories are lost. I have slow thinking when it comes to storing information. I almost feel like a different person. In a controlled setting such as inpatient you don’t realize the impact the treatments will have on your life. It temorarily 2 times made my depression lift…otherwise I am still very depressed yet not suicidal. I wish I would have never had the ECT.

morley goldbergFebruary 3rd, 2007 at 1:20 am

My daughter has been hospitalized for 10 months in an extended psychiatric care unit. She is 23 years old. She has told me that her doctor is going to try ECT on her as her depression seems unchanging. My daughter is frightened. I am aganst ECT but am only now ( this very night ) trying to find out the benefits/drawbacks of ECT. Sackheim’s work is scanadalous but that is not my issue. I had heard that ECT has come a long way. Your information dispels that fact.Any information oyu can provide for me would be very helpful as it seems that I will be having an interview with the doctor. Your information above is very damning of ECT. I want/need to be accurate in my opinion when I speak against ECT. I live in Canada. Please help.

Sue HaleyFebruary 4th, 2007 at 4:50 pm

I also live in Canada and for nearly 2 1/2 years have been advocating with doctors for a dear friend in hospital who has had ECT. I have done a lot of research on mental health law and psychiatric treatments. I would like to help Mr. Goldberg if you can put me in touch with him. Please send him my email address.

morley goldbergFebruary 5th, 2007 at 3:02 am

to Sue- Email addresses are likely not shared on this site. As much as I would dearly like to be put in communication with you, it seems that this site is not the way. I don’t blame the site as protection of contributors is of paramount importance.
to the website manager, it would be appreciated if you would pass my email address on to Sue Haley , and Sue alone.

Carol ZimmermanFebruary 7th, 2007 at 3:13 pm

It has been yet another week since my ECT treatments. Still no improvement in my cognitive abilities. I have even became aware of jumbled speech at times..like a loss for the right word. I never had this problem prior to ECT.

TomasFebruary 17th, 2007 at 6:16 am

Morley, try visiting the forums att http://www.zaprap.org.

HenryFebruary 18th, 2007 at 12:13 pm

First, your article is filled with hyperbole, which indicates heavy bias, which indicates cherry-picking of the research cited in support of your thesis. More importantly, some memory loss is not much of a price to pay for a chance to escape the hell of chronic, drug resistant depression.

I did have some short term memory loss surrounding the period of treatments – memories, by the way, that were best cast off into the ether. Also, I suspected that I had left a few IQ points on the table. But a battery of psychological testing, including problem-solving, comprehension and retention, belied that notion.

The treatment is traumatic; however, not nearly as much as spending most of your waking hours figuring out the best way to off yourself. It does not approach the trauma caused by watching the people who love you live in utter despair due to your condition. And the valid research overwhelmingly supports the efficacy of ECT.

If you required chemotherapy to survive cancer, you wouldn’t bat an eye when making your decision to swallow deadly poisons. I find your arguments stilted and your conclusions highly suspect.

BuddyFebruary 18th, 2007 at 3:11 pm

ECT obviously didn’t help you with your anger problem, dude.

Why is it that some people get so worked up when people point out the obvious, that ECT causes memory loss. Just because you, Henry, were glad to have some memory erased doesn’t mean everyone wants it.

The difference between chemo and ECT is that oncologists are pretty up front about the nasty side effects. Psychiatrists aren’t so open. If you read more stuff written by this Sackheim dude you’ll see he says that’s because psychiatrists are defensive.

HenryFebruary 18th, 2007 at 8:46 pm

I see . . . you must be a psychiatrist then. Notwithstanding, not all psychiatrists are defensive and secretive; just as some oncologists are defensive and secretive. You may be irked by ECT successes, but they occur nonetheless. And Sackheim clearly demonstrates that there are sufficient data available to support either of his opposing positions, depending on when you catch him.

Sue HaleyFebruary 21st, 2007 at 8:13 pm

Another very important difference between chemo and ECT is that ECT is often given to people WITHOUT their consent. If you are an involuntary patient in a mental hospital or psych ward, you may be given ECT to manage your behavior, even if you are not depressed. This has happened to my best friend and other people I know of.

John L. BarrellaMarch 5th, 2007 at 6:20 pm

This is indeed very sad. The irony is that I was already injured by neurosurgeries prior to ECT. therefore the doctor (cannot mention his name and thus need to protect these as——), easily lied on my papers attributing my paranoid schitzophrenia to before the neurosurgeries and the shocks thus protecting himself and the other doctor. I signed no consent. No consent forms were ever found. When I had an adverse reaction to the shocks continued with the treatment. When I was still able to think and I begged my mother and my exwife to take me out of there they didn’t. They had trust in the doctor. I didn’t, I had realized I was being hurt. I become terrified yet there was no way out. He finished the job quickly. I never complained again. I was gone. He had murdered me. In the middle of Manhattan. In the middle of a “great democracy”. Advised no rehabilitation…but time. Time so he could get old and retire before I would have the opportunity to look into his face and call him what I had called the neurosurgeon…”A quack”. Sad indeed in such a great country as this. Sad that it happened in New York City. As I received rehabilitatin 11 years later in the Rusk Institute of cognitive remediation, this treatment is basically unknown. My passing advocacy on the treatment was refused by the same support group that meets in the same room where my mother had taken me to get help. It is also very sad that one of my cognitive doctors came to the group one time and when I asked about the assistance for head injuries she never mentioned the treatment…cognitive remediation…I had received the same day…from her in that same room. That’s also sad. Later on she had asked me to speak about head injury in the Rusk. Take a walk. Another sad thing is when the supervisor of the treatments. The main doctor in the Lobby of the Rusk when I had to see him in Bellevue, he wasn’t there and when I told the doctor there the treatments I was receiving in the Rusk I had to explain it to him. When I finally had an appointment to see the doctor later on. The first thing I said to him is that I had tried to see him in Bellevue and I recounted what happened there. He tells me…”Ninuccio, you are here now”. He was right. I was there now. I shouldn’t have been close to a self centered individual like him who as I figure had an unwritten alliance to murderers in the medical system. All the rest who may be good doctors in giving the treatment but are a waste of human flesh in this world. I will die with the damage done me…but I hope someday this human crap will be acknowledged and if these doctors who have done it were not stopped at least changes can be made. They have turned this great country, this great medical system, into a complete waste. It is something like the code of Hammurabi…egyptian pharoh years back…”Survival of the fittest”…Ninuccio. It has finally been acknowledged of the severe injustice committed against me…yet they got away with it with me…I wonder how many others…God help them…they have overstepped their bounds…Ninuccio.

TimMarch 29th, 2007 at 1:45 pm

Dear all:

I would like to start by saying that I am NOT in favor of ECT and would NEVER get it myself, despite the fact that I do suffer from chronic depression. However, I must say that this article is a less-than-objective representation of Sackeim’s article, to say the least. It makes some valid points, but oversteps the facts tremendously.

Read the report. What it actually says is that CERTAIN METHODS (namely bilateral application and sin-wave rather than square-wave pulses) have statistically significant (though by no means certain) risks of long term impairment. PROPER PRACTICE, however (right side unilateral stimulation with appropriately dosed square-wave pulses), actually result in IMPROVED mental function. No, not because the electric shocks supercharge your brain like some have suggested, but because depression actually impairs your mental function more than the damage from a properly performed ECT.

That being said, I’d still rather try something else than take the risks. I just hate this tabloid-style journalism.

[...] patients, clearly lacking any insight into how this feels for the patient, as well as the long-term effects, offering up a profuse regurgitation of class notes delivered as hard [...]

Ellen LiversidgeOctober 28th, 2007 at 7:15 pm

My father was killed by ECT in its early days, 1943, which pretty much ruined my family. Strong genetics caused both my children to have bipolar disorder, starting at age 20. Along the way, both had courses of ECT. What else does one do with acute suicidality when everything else has failed? Imagine how I felt being part of a decision that in my father’s case, resulted in death. I did not see either of them have any obvious memory loss or other cognitive deficit. Instead, my son was killed by Zyprexa, a twenty-first century psychiatric killer.

I do not argue with ECT haters. I don’t have the energy and have never had an answer to my question of what was I to do when one then the other of my children wanted to kill themselves.

rem,mdFebruary 3rd, 2008 at 2:37 am

As a practitioner who offers ECT to my patients who suffer untold suffering from treatment resistant depression and bipolar disorder, I have always discussed the very real and common side effect of treatment related memory loss with my patients. The degree and permanence of memory loss ranges from virtually none to profound, and is difficult to predict. Advances in the application of Ect in recent years (eg. frontal electrode placement and ultrashort square wave pulse transmission) have helped to mitigate treatment associated cognitive impairment. While I agree that rigorous research regarding the cognitive side effects of ECT has been insufficient and long overdue, Ms. Andre’s negative spin on the Sackheim paper and her personal attack on Sackheim continues to stigmatize a legitimate and potentially life saving treatment modality for those that suffer disabling mood disorders that medications and therapy fail.

All medical treatments entail risks which need to be assessed in relation to the hoped for benefits. Neither should be underplayed or overvalued. It has been my experience that the overwhelming majority of my patients that chose ECT found the (usually) modest and circumscribed memory loss a small price to pay for the misery they could otherwise not escape.

I hope this new data will spur on further refinements in the delivery of ECT while we await new, safer, and less intrusive treatments.

DonaldFebruary 24th, 2008 at 11:04 am

I had a course of 12 ECT treatments (bifrontal) in Jan-Feb 2007, and a further six treatments in October. I have no doubt at all that a) ECT was remarkably effective in alleviating my depression, and b) the treatment affected both short term and medium term memory. On balance, though, I know that the treatment was, in my case, beneficial.

My psychiatrist has suggested that I continue with “maintenance ECT” about once every six weeks. I had the first such treatment a few weeks ago. I request that this time the ECT be unilateral rather than bilateral. There is no doubt that this form of treatment had very significantly fewer adverse memory effects than the bilateral treatment.

John L. BarrellaMarch 9th, 2008 at 9:35 pm

This problem very intricate and when such a problem arises the best thing is to look at it face to face. There is no mention by anyone of assistance from shocks. I really wonder why. If shocks are detrimental who is there to assess them?…Well anyway continuing on of course some places are more competent than others. It may be interesting to some folks here…maybe…who knows…that my last testing was neurosychological testing given at a facility in Manhattan. It determined a short term memory loss. Interesting. However I had already had on an index card my TRUE INJURY. Diagnosed within three years of cognitive remediation classes in the Rusk Institute. Ironically it read eight symptoms of which short term memory loss was just one. SO…would any one here declare that neuropsychological testing is what is needed. Given within 5 hours. OR would someone actually take the three years of treatment to achieve a proper result. I had always been told to get a job by everyone…until after the Rusk assessment I was told I would never be able to work. Hmmmhmmm. Where was this Sackeim guy. Where was his genious in shocks. Are shocks…yes…for some people…but who will be there on your side if you get injured. I was lucky my mother was there to keep me alive. My mother was also recently murdered by bad medications a few months ago. I suggest all better insight into shocks. I do not suggest you to go to the Rusk…you see the Rusk is not talking. They do not divulge their information…for some strange reason. When one time I went to the support group one of my cognitive doctors were there. She never mentioned the same treatment she had given me the same day…in the same room…of cognitive remediation. She never mentioned the treatment even as I asked her. The top doctor in the Rusk I went to see in Bellevue. He was not there that day. I saw another doctor who when I mentioned to him cognitive remediation he didn’t know what it was. When I went back to the Rusk to see the doctor for an appointment I had I told him what happened in Bellevue…he tells me…”you are now here Ninuccio”…this is OUR medical system. Corrupt to the extreme. Tried to tell Mrs. Clinton. She dind’t want to hear. Tried to tell quite a few people…they all didn’t want to hear. Something is definetely wrong out there…and hopefully someone will fix it one day…I was injured 25 years ago. Rehabilitated appx. 12 years ago…and still today noone is aware of shock damages…and simply they just don’t care…Ninuccio.

J CaleMarch 10th, 2008 at 6:12 pm

It is not an strange stance (that is in frequency terms) the radical statement by Ms Andre. Psychiatry, dealing with such a delicate matter as mental health, is used to fierce, yet not always infalible adversaries.

Psychiatry does not make the claim to define what normal is for everyone, it respects diversity; nor does it claim that treatment is without risks. It deals with people aching, every medical intervention has side effects and dangers; we just decide that it is reasonable to take the chances in order to gain some relieve. By we I mean the therapeutic community and the patient and his/her close ones. Risk is taken everytime Tylenol is given to a patient, everytime someone has surgery, etc.

There are some clear cut indications for ECT, such as catatonia, etc.

Encouraging a mental health McCarthism such as the one that is encouraged by Ms Andre does not only difficult the access to a possibly life saving therapy for patients, it will also damage research on ways of brain stimulation that carry less side effects.

TimMarch 10th, 2008 at 10:39 pm

What the heck is a “mental health Mcarthism?”

Despite the fact that English isn’t your first language, dude, McCarthyism was a serious time in American history. Maybe read up on it.

Someone speaking out as Ms. Andre does is hardly anything close to communist blacklisting.

While you’re studying, read up on Godwin’s Law. It might apply here.


Propaganda för EL-CHOCKER!May 25th, 2008 at 4:22 pm

[...] Harold Sackeim reverses position in upcoming study The Cognitive Effects of Electroconvulsive Therapy in Community Settings [...]

EricJune 15th, 2008 at 9:33 pm


I really agree with you.

haroldNovember 15th, 2008 at 4:21 am

wow what a completely misrepresentative interpretation of this study. The study itself is available online for free if anyone actually wants to read it for themselves rather than have this person try to work you into an indignant fury. As noted by others the worst effects were associated with the rather primitive sine wave ect whereas there was more autobigoraphical memory loss with bilateral vs unilateral electrode placement. However at 6 months after ECT most test scores had IMPROVED over baseline with only autobiographical memory still negatively impacted with bilateral pulse therapy. With unilateral pulse therapy on the other hand EVERY test score including autobiographical memory was improved over baseline. Anyway read it yourself and make your own mind up or listen to this person quote out of context for the purpose of their own agenda.

Jack R. McNeillOctober 23rd, 2009 at 3:25 pm

I was administered ECT at University Hospital in Augusta, Georgia in 1972 by Dr. Corbett Thigpen (Co-author of “The Three Faces of Eve”). In reading my hospital chart years later, I read that I became “quite violent”, so after 3 treatments I was transferred to another physician. I was administered 21 treatments in 21 days, according to my chart.

To this day I have amnesia in re the events prior to ECT. It has bothered me a lot in these ensuing 37 years, and continues to do so.

I congratulate Linda Andre for her courageous work.

Jack R. McNeillOctober 24th, 2009 at 7:36 am

This is a continuation of my comments of 10/23/2009.

In an effort to bring less “heat” and more “light” to the subject of ECT, I’d like to make the following personal observation: I believe that for me, memory is crucial to emotional healing. I have found this to be true when vague recollections of what happened prior to ECT have returned to me. I’m not sure to this day if they are true memories or “false memories”. I believe that this ECT-induced amnesia is the primary reason ECT has caused such long term harm to my emotional health.

I wonder what research has been done in re memory’s importance to emotional healing.

LennartNovember 18th, 2009 at 3:58 pm


There were no controls in the study. I mean there were no real controls. What would have happened to those patients that got ECT if they had just waited 6 month? Would not all cognitive parameters have gone better then?

Sackeim says in the study that

“It is noteworthy, for example, that
most cognitive parameters were substantially improved at
6-month follow-up relative to pre-ECT baseline, presumably
because of the negative impact of the depressed state on
baseline performance.”

But others have said that it is likely that without treatment the depressed state has lifted after 6 month.

So there is, due to the lack of real control objects, nothing in the study that says that you get better from ECT.

On the other hand people recieving ECT lost memories in the study. We all know that we loose some memories over time, but we also no that we have a better memory when we are not depressed.

So the negative results, the damage found seems valid, while the so called positive outcome is not.

Jack R. McNeillNovember 18th, 2009 at 6:33 pm

So that’s what’s wrong with me—”ECT-induced long term cognitive impairment”. I always wondered what to call it and never knew until I read about Harold’s research published in 2007(even if 25 years overdue). ‘Course, we won’t find that diagnosis in the DSM-IV. After all, until Harold’s research, it didn’t exist. Right? I do congratulate him on getting more honest, though, however belatedly.

I just got Linda’s book last week. It struck me when I read that the public relations mantra of the APA is “safe and effective”. That’s because I had recently found an article by a Dr. Gabrielle Melin of mayoclinic.org in re ECT entitled “Safe and Effective.” I posted a comment there yesteday asking Dr. Melin if she considers Linda Andre a reliable source, since I see the Mayo Clinc assures and reassures prospective ECT patients that ECT is both “safe and effective.”

I think this ect.org is going to be fun.


amanda albergDecember 31st, 2009 at 6:56 am

Dear Linda,

I would appreciate if your ansvered by mail: amanda.alberg@gmail.com

In Sweden they just did a tv-program about the memoryloss after ect, and lack of information. They intervieved you and Sackeim. They intervieved me (anonymous) because I have severe memoryloss after 21 ect 2007. I live in Stockholm, Sweden.

10 years and more is totally gone. I dont remember my childrens birth and childhood, marriage, studies, travels…

What I did after ect is also very vage. And my shorttime memory is a disaster.

My question: Is there any treatment at all that can improve memory -and kognitiveloss?

Best regards,

Jack McNeillJanuary 6th, 2010 at 3:33 pm

This post is in response to Amanda Alberg’s above post.

First, my heartfelt sympathies to you. I had ect in 1972 and understand personally what it means to suffer from ECT-induced amnesia and cognitive impairment.

After reading Linda Andre’s book “Doctors of Deception: What They Don’t Want You To Know About Shock Treatment(Rutgers University Press, 2009), I e-mailed her with the comment, “Now that
some are at last admitting that ECT does cause long-term cognitive impairment, it seems to me that the question now becomes, “How do we(ect recipients) recover from ect-induced long-term cognitive impairment?”

She responded to me, “It’s the right question, but nobody’s asking it.” Well, Amanda, it sounds like you’re asking it too now. I think rather than further arguing as to whether ect causes amnesia/cognitive impairment, the time has come to seek help for the ect-induced cognitive impairment. And if the professionals aren’t interested in helping us, maybe weect recipients can help each other.

In 2005 I asked a psychiatrist for help in recov-ering from my ect-induced cognitive impairment. His response was to offer to prescribe for me a psychiatric medication. I responded to him that “pills treat the symptoms (anxiety and agitation over the amnesia), but don’t touch the CAUSE of the symptoms. He had no comment.

I have since reached out to friends who were important in my life at the time of my ect. Some have been very helpful. I can tell you, Amanda, that I have made much progress in working through my ect-induced long-term cognitive impairment.
As I have begun to put together vague recollections of the events in my life prior to my ect—and to understand their meaning—much relief has come.

God bless you in your efforts to work through the damage the ect has done you!

We recipients of ect need to stick together in trying to help each other. oObviously the doctors couldn’t care less about the harm they do.

amanda albergJanuary 8th, 2010 at 3:17 am

Dear Jack,
Thankyou very much for your kind answer and for sharing your experiences. I have answered you by email.

Jack McNeillJanuary 8th, 2010 at 3:13 pm

Dear Amanda,

Thank you for your empathetic e-mail(see above post). It was immediately obvious to me that you understand from personal experience what I have suffered from ect-induced cognitive impairment, in a way that would be impossible for someone who has not experienced ect–whether professional or not.

It reminded me of surgeon Dr. Bob Smith’s(co-founder of Alcoholics Anonymous) report of his first encounter with Bill Wilson, the other co-founder of AA, in 1935. He said he quickly realized that this Bill Wilson knew what he was talking about. Dr. Bob had read a great deal about alcoholism and had heard the opinions of fellow professionals who had treated alcoholics. But Bill was the first person he had talked with who knew from his own experience what alcoholism was. “In other words, he talked my language,” said Dr. Bob. “He knew all the answers, and certainly not because he had picked them up in his reading.” (from “Pass It On—Bill Wilson and the AA Message”, page 143)

I suppose that’s how I felt when I read your e-mail. I knew intuitively that you knew what you were talking about. Thank you for sharing!

Jack McNeillJanuary 20th, 2010 at 8:08 pm

This is a follow-up of my post here of November 18,2009. I had written of an article on ect by a Dr. Gabrielle Melin of mayoclinic.org enti-tled “Safe and Effective”. Because I was reading Linda Andre’s book “Doctors of Deception” I was aware of the fact that the American Psychiatric Association advocated that the media employ this
mantra whenever writing on the subject of ect.

I had posted there about Harold Sackeim et al.’s 2004 “first ever large scale research(347 sub-
jects)” on the efficacy of ect. It was found that only 30%-47% of subjects went into remission,
and of those who did remit, 64% relapsed within 6 months. I then asked, “On what basis does the Mayo Clinic, without equivocation, counsel prospective ect patients that ect is “effective”?
Although there was no response, my post was was allowed.

Then later I wrote a post to the same article on Harold Sackeim et al.’s 2007 “first ever large scale research on the effect of ect on cognition.” Here it was found that ect “routine(ly)” causes long term cognitive impairment. I then stated that I have suffered ect-induced long term cognitive impairment since 1972. I conclud- ed by asking of the Mayo Clinic, “How do we recovery from ect-induced long term cognitive impairment?” That was the 81st post to the article. The next day, I noticed that while the article “Safe and Effective” was still on the net, all 81 posts had been deleted. My thought was, they’re still assuring us that ect is “safe and effective’, but not allowing any dissent to this claim.

The next day, the article–there since 2007—had been removed.

My conclusion is that when members of the Committee for Truth in Psychiatry confront lies with the truth, it can be effective.
even the Mayo Clinic

Jack McNeillJanuary 28th, 2010 at 4:23 am

To follow up on the above comments, I would now like to quote Dr. Joseph Goebbels: “If you tell a lie often enough, it becomes the truth.” It has been remarkable to me, in my “googling” on ect, how often I have come across the American Psychiatric Association’s recommended mantra to the media whenever writing on ect, “safe and effective.”

Jack McNeillFebruary 1st, 2010 at 5:57 am

In reference to the above quote of Dr. Joseph Goebbels, it’s not just the Mayo Clinic that has repeated the American Psychiatric Association’s recommended mantra for the media, “safe and effetive”, whenever writing on ect.

Dr. Kirsten Wilkens of the Yale Medical School(!) did a survey of literature in 2008(four years after Dr. Sackeim et al.’s “first ever large scale study” of the efficacy of ect, in which less than one half of the 347 subjects went into remission; and a year after Dr. Sackeim’s above quoted “first ever large scale, prospective study” on the effect of ect on cognition and memory, in which he found that ect “routine(ly”) causes long term cognitive impairment).

Nevertheless, Dr. Wilkins wrote that ect is “well established as safe and effective…”

Have they no shame?

Jack McNeillFebruary 9th, 2010 at 9:04 am

Continuing in re the American Psychiatric Association’s recommended mantra for the media, “safe and effective”, whenever discussing ECT.

I Googled up Dr. William McDonald/The Emory Clinic/ABC News/ECT “safe and effective”

I got this boldface question: “Is electroconvulsive therapy(ECT) safe and effective for the treatment of depression?”

Dr. McDonald answered, “ECT is one of the most effective treatments for depression. ECT can be up to 80% effective.”

One wonders if Dr. McDonald is aware of Harold Sackeim et al.’s 2004 first ever(after 65 years) large scale(347 subjects)study of the efficacy of ECT in which only 30%-47% of subjects entered into remission.

Dr. McDonald did not address the question of ECT’s safety. Perhaps he is all too aware of Sackeim’s above discussed research on the deleterious effect of ECT on long term cognition.

Jack McNeillFebruary 9th, 2010 at 9:22 am

Following up on the above comments in re Dr. McDonald of Emory Clinic and ABC NEWS. Now we address the question of ECT and bipolar disorder.

Boldface question: “Is electroconvulsive therapy(ECT) safe and helpful for the treatment of bipolar disorder?”

Well, as Conway Twitty might put it, “Is a bluebird blue? Does a cat have a tail?”

Dr. McDnonald writes, “ECT is very effecgtive in the treatment of bipolar disorder, both for the manicd and the depressive phases.”

Once again, Dr. McDonald ignores the question of ECT’s safety.

Jack McNeillFebruary 11th, 2010 at 3:11 am

The “safe and effective” public relations ploy promoted by the American Psychiatric Associa- tion’s task force on ECT is also supported in spirit by its counterpart in Great Britain, the Royal College of Physicians(RCP).

An abstract was published in the British Medical Journal (BMJ)in 2003 entitled Patients’ perspectives on electroconvulsive therapy: systematic review”. The objective was to ascertain patients’ views on the benefits of and possible memory loss from electroconvulsive therapy.


Conclusions: The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvul- sive therapy and that MEMORY LOSS IS NOT CLINICALLY IMPORTANT IS UNFOUNDED.

Or, put another way, according to the BMJ, when it comes to ECT, the RCP is as FOS as the APA.

Have a good day, fellow CTIPers.

Jack McNeillFebruary 15th, 2010 at 3:49 am

Yesterday I sent a post to Dr. William McDonald of Emory University Medical School in Atlanta/ABC News.

I posted to ABC News: Dr. Harold Sackeim of Columbia University is a member of the American Psychiatric Association’s Task Force on ECT.

In 2003 he et al. published “the first ever large scale(347 subjects) study on the EFFICACY of ECT. He found that instead of the 70%-80% remission rates he had expected, the remission rates were only 30%-47%. Moreover, of those who remitted, 64% relapsed within 6 months. By my math, that means less than 20% went into remission and stayed in remission for even 6 months.

Then in 2007 Dr. Sackeim et al. published the first ever large scale(again, 347 subjects) pros- pective study on the SAFETY of ECT in regard to its effect on memory and cognition. He found that ECT “routine(ly)” causes long term cognitive impairment.

My question to ABC News is, “How does this hard scientific research jibe with ABC News’ oft-repeated claim that ECT is “safe and effective?”

Fellow ctip-ers, I wait to see what, if any, will be the response.

BobNovember 12th, 2010 at 2:24 pm

My mother had a long history of bipolar depression and suicide attempts. The doctors started changing her meds in 2002 and she spiraled downwards until they recommended ECT as a last resort in 2003. After the stint in a state hospital where ECT was administered, she would tell me that she had lost the ability to “feel” emotion. She seemed very “neutral”; something was different about her. She ended her life one morning in July 2004 by taking a whole bottle of her psyche meds.

EngyFebruary 2nd, 2011 at 4:50 am

What is the publication date of the article?

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Håkan AnderssonNovember 6th, 2011 at 4:48 pm

I had severe Tinnitus after ECT in ST:Lars hospital , Lund Sweden in January 2011.

After not sleeping good in 3 months after a tough separation I was hospitalized with anxiety and depression.
I had never had any contact with psychiatry before. I had only had small amount of antidepressive pills for 2 weeks before entering the hospital. The doctor told me that if you take ECT and pills simoultaneously you will became well faster. Unfortunately I relied on the doctor.
The third day at the hospital I received my first ECT. I got 6 ECT:s in total

My tinnitus is now chronic and has ruined my life totally.

I have found more cases of Tinnitus after ECT on the Internet. I dont think its a common side-effect but for those it hits its very serious.
My tinnitus is very loud and somteimes pulsating. I cannot live a normal life with it, and there is no cure for tinnitus today.

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Deepak VaidJune 25th, 2012 at 1:25 pm

Some say Harold Sackeim is evil. Some say Linda Andre is a woman with a vendetta. IMHO the situation can be succinctly summarized thus:

On the effectiveness of hammer therapy

Hammer therapy is a form of treatment for depression which involves hitting the patient on the head with a hammer. Studies indicate that hitting the soft tissue of the brain with a sharp blunted instrument can induce unpleasant side-effects in a large fraction of patients. However, studies also show that some patients indicated marked improvement in their sense of self despite the dull ache left in the wake of being hit on the head by a hammer. Long term studies of hammer therapy are inconclusive. Thus, along with treatments such as the “chillies-in-hot-oil” method, the “frying-oil” protocol and the “stinging-bee” therapy, hammer therapy should remain part of the toolkit of the practicing psychiatrist until it can be conclusive proven that hitting a person on the head with a hammer can induce long-term brain damage.

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