Pharmacotherapy Following Electroconvulsive Therapy: JAMA, March 14
This new study in JAMA highlights something that has tried to focus attention upon from its first day on the net:

ECT is a short-term solution to a long-term problem.

You can read the study for yourself, but here are some highlights:

Basically, Harold Sackeim, Ph.D., took a group of patients recruited by his research organization and divided them into three groups: placebo; nortriptyline; nortriptyline and lithium.

Although he says in his opening paragraphs that ECT has a relapse rate of 50 percent or better, his own study shows a relapse rate of 84 percent - of those who responded to ECT in the first place. The group that received nortriptyline alone had a relapse rate of 60 percent, and the third group (nortriptyline and lithium) had a relapse rate of 39.1 percent.

It's not mentioned in the body of the article, but if you examine Figure 1, you'll see that of 290 people who completed ECT, 114 (40 percent) did not respond.

Additionally, the patients received 200 percent of the maximal charge output, requiring special machines (supplied by Mecta Corp.). This is an extremely high dose of electricity, and one that is not available to practitioners who are not participating in research studies.

That rate of 60 percent efficacy using a double dose of electricity is a far cry from the oft-quoted 80 to 90 percent efficacy rate of ECT.

Some questions about this study are now being raised by the media due to discrepancies from Harold Sackeim:

  • First there is the Mecta issue. By federal law, Dr. Sackeim was required to disclose to JAMA that he has financial ties to this manufacturer, yet it isn't mentioned. Linda Andre, director of the ECT survivor group Committee for Truth in Psychiatry has documentation to show that he is in fact a paid consultant to Mecta, despite his continued protests that he isn't.
  • Second, Linda has documents gathered under the Freedom of Information Act that include Sackeim's progress notes to NIMH, the funder for this study. According to her there are several discrepancies between the numbers in the published study and in his notes to NIMH. Hopefully Dr. Sackeim will publicly address these discrepancies, and would be willing to publish any statements from him, unedited.

My criticism of the study

From the Disability News Service: "My Turn: ECT Editorial Casts Shadow on Author and JAMA's Credibility"

Columnist Liz Spikol takes on the issue!
The full series

From the Associated Press - I'm sure this isn't quite the coverage that Harold Sackeim had in mind when he tried to promote his study. Study: Shock Therapy Faulted

The actual study

Report from CBS News highlights the problems when those with ties to the industry do the studies (in this case, drugs, but the major ECT researchers also run the device manufacturing companies. Harold Sackeim is a "consultant" to Mecta.)
"If I knew that a drug company had some role, whatever role, in sponsoring a talk, an article, a symposium whatever, I think I would be more on my guard to make sure that there was not any bias introduced."