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If you follow me on Twitch, you know that I have a “gaming PC” that is a pile of junk that often freezes or freaks out in some way. The only solution is the classic one: I turn it off and then turn it on again. I don’t know why this works, but it does.
Interestingly, the same can be said for the human brain. Sort of. In people with severe depression, who have exhausted all other treatment options and are dangerously close to suicide, they may find relief by sort of resetting their brain. Electroconvulsive therapy, or ECT, involves a patient receiving a shock of electricity to the brain that causes a short seizure. After undergoing several of these treatments over the course of a few weeks, many patients will find that their depression is much, much more manageable.
It’s not like what you may have seen in horror movies (when it was more commonly known as electroshock treatment) with a patient writhing around on a table. They’re under general anesthesia so from the outside you can’t tell anything much is happening at all, but an electroencephalogram (EEG) will show a huge burst of activity in their brain. And instead of the movie trope of the patient having a complete removal of their personality and lifeforce, ECTs very often give patients back their life. They can once again socialize with friends, hold down a job, and get through the world without being in constant mental anguish. It is truly a life-changing intervention in the people who have the very worst depression imaginable. It is the only intervention left for these people, with the possible exception of ketamine, a therapy that is still undergoing testing and is sometimes used in conjunction with ECT.
All of which brings me to a surprising AM I saw on Reddit. AMA stands for “Ask me anything” and it’s a way for people to learn about interesting people (often celebrities) and for those celebrities to publicize projects. And one of the most joyous things is when an AMA is an utter disaster. Buckle up.
This particular AMA came from a lawyer named Connor Karen, who said that he sued an ECT device manufacturer because two of his clients claim that it gave them brain damage. A judge determined that the case could go to a jury trial, at which point the manufacturers settled out of court. They then updated their product information to state that some patients had reported brain damage from using the device.
Karen crowed that this was a huge win, as the manufacturers were “finally” admitting that the devices were dangerous.
All of this surprised me but I was very glad to see a lot of doctors, lawyers, and patients commenting on the post with well-thought out, fact-based criticisms. Let’s go over them.
First it’s worth noting that there are known side effects of ECT, notably memory loss and behavioral changes that are usually temporary. A psychiatrist must, by law, inform his or her patients of these potential side effects. Memory loss sucks, but if it comes down to forgetting a week of your life or literally killing yourself, most people will choose the former. That’s the sort of cost/benefit analysis everyone has to do when shit hits the fan — you’re in a bad situation and there’s never going to be a magical pill that will cure you. Chemo will absolutely ravage your body and mind, for instance, but for most people it’s better than dying of cancer.
However, there is no real evidence that ECT causes major, permanent brain damage. Karen’s case did not involve any brain scans that would show direct evidence that his clients’ brains were damaged — instead, he focused on circumstantial evidence like measuring their cognitive development related to their peer group. Can you spot the problem with that? That’s right, people who are literally suicidally depressed will also show poorer cognitive performance compared to their peers.
He also argues that ECT led to an increase in brain-derived neurotrophic factor proteins, which may be true but also those proteins may be good for us? Lower amounts of BDNF are correlated with depression, so maybe depressed patients are benefiting from their increase? But as a neuroscientist points out in the comments, it’s a really complicated issue and this lawyer (one year out of law school) and his handful of “experts” aren’t really up to snuff.
And yes, I know anyone can go online and call themselves a neuroscientist, but everything they said is on the mark and it IS an extremely complicated issue that Karen’s experts aren’t very good at parsing. And speaking of his experts, his primary expert is one Moira Dolan, an internist (i.e., not a brain doctor) who seems to make a living testifying about how horrible psychiatry is for Scientologists. Yep, it all leads back to that delightful modern medicine-hating cult.
With all of that known, how did he win this case? Easy! Litigation is expensive and doctors and others in the medical industry often settle so that they can move on with their lives instead of spending hundreds of thousands of dollars in the hope that a jury of 12 people will understand the nuance of treating desperate people on the verge of death. Ambulance chasers know this, and use it as a way to score easy money. Unfortunately, this leads to fear mongering in the general public AND a decrease in the number of doctors who are willing to take on these high-risk cases. It helps nobody except for the money-grubbing lawyers.
On the bright side, thanks to medical Reddit for turning up in force to make that AMA such a disaster that he was forced to delete it, possibly after being reported to the California board for unlawful advertising. Ah, the schadenfreude. Helps my depression!