June 23, 2011

Electroshock Therapy -- Don't Be Shocked, It Works!

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June 23, 2011
Bottom Line's Daily Health News
In This Issue...
  • Is Your Sunscreen Stealing Your Health?
  • Electroshock Therapy -- Don't Be Shocked, It Works!
  • The Truth About Prescription Drugs
  • New HPV Test for Cervical Cancer Saves Lives
  • Arthritis Abolished in Minutes by Doctor's Astonishing Speed Cure

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Electroshock Therapy -- Don't Be Shocked, It Works!

Think of Jack Nicholson’s portrayal of McMurphy in the movie One Flew Over the Cuckoo’s Nest. It brought electroconvulsive therapy (ECT) and the controversy surrounding it to the cultural forefront back in the 1970s. Well, the subject is once again in the news. Many people, including patients and psychiatrists, believe that ECT can be an invaluable tool in the recovery from clinical depression, while others criticize it as unsafe, extreme and even unhelpful.

Earlier this year, a cadre of influential mental health organizations, including the American Psychiatric Association and the National Alliance on Mental Illness, teamed up to urge that the FDA downgrade the risk rating of ECT devices to medium-risk from high-risk, a move that would put them in the same risk category as syringes and surgical drills. After reviewing the request, an FDA advisory committee in March recommended against taking this action -- not because the procedure is known to be unsafe but because there’s little research that proves it is safe, particularly long term. Proponents of ECT argue that this will make it difficult for many patients who would benefit by having access to ECT, with some saying that such a ruling even may make the treatment unavailable altogether.

Safety Testing Hasn’t Been Done

Though ECT has been around in one form or another since the 1930s, you may be surprised to learn that it has never undergone rigorous clinical trials. Because of its long history of use, it was grandfathered into FDA regulations in 1976, when the agency was given more authority to regulate medical devices. At the time it was categorized as "high-risk," primarily because of the memory loss and other cognitive problems suffered by recipients. But keeping it in that category going forward may mean that manufacturers would be required to perform expensive and time-consuming tests to prove safety -- which device makers claim they cannot afford.

As agency officials ponder their decision, I put in a call to Charles Kellner, MD, a professor of psychiatry at Mount Sinai School of Medicine and a leader in ECT research. He told me that the technology does have some history of abuse -- such as when patients at psychiatric hospitals received ECT simply for not being cooperative... or when ECT was used as a punishment for troublesome inmates in prison -- and acknowledged that as a result there is a stigma surrounding it. But he believes that evidence shows today’s version of ECT is safe, painless and effective for people with severe depression who have found no relief from other therapies.

Is ECT Dangerous?

About 100,000 American adults undergo ECT each year. It’s typically prescribed for patients who haven’t been helped by medications and psychotherapy, and 60% to 90% are helped by the treatment. It’s believed that ECT works by triggering changes in brain chemistry that reverse at least some of the symptoms of serious mental illness, often within days.

The main criticism of ECT is that it causes memory loss -- and it does -- but Dr. Kellner cited three reasons he believes the concern is exaggerated...
  • Modern techniques, such as lower doses of electricity and application to only one side of the brain, have greatly reduced memory loss in comparison to past methods of administration.
  • The memory loss that does occur varies greatly by individual and is usually only temporary -- typically lasting for a few weeks.
  • When you have a potentially life-threatening disease that can lead to suicide -- the eleventh-leading cause of death in the US -- the vast majority of psychiatrists believe that the benefits outweigh the risks.
What Patients Experience

ECT can be administered on an outpatient basis and typically involves six to 12 treatments over three to five weeks, each costing $1,000 to $2,000. Some insurance companies pay for the treatments, others don’t.

Each treatment begins with the patient being given a muscle relaxant... a foam bite block... and general anesthesia through an IV line, which renders the patient unconscious and unaware during the procedure. An electrode pad is placed on his/her forehead, through which a mild electrical current is passed, triggering a seizure that lasts about 45 seconds. The patient wakes up within 10 minutes or so, is taken to a recovery area to be monitored for any problems (such as increased heart rate and blood pressure) and goes home, usually about an hour after the treatment. Many patients experience temporary confusion and disorientation, which typically doesn’t last more than a few hours and usually just a few minutes. Other possible transitory side effects include nausea, vomiting, headache, jaw pain and muscle aches or spasms.

Take the Bad with the Good?

Serious depression is often a lifelong illness, Dr. Kellner noted, and although ECT alleviates current symptoms, it cannot cure the underlying disease. Therefore, if they are not already taking it, patients also are given antidepressant medication to prevent the next depressive episode. Some 20% of patients also receive prophylactic maintenance ECT -- a once-a-month repeat treatment to forestall future occurrences of depression.

Dr. Kellner compares ECT to serious medical interventions in other health crises -- for example, coronary bypass for people with heart disease and chemotherapy for those with cancer. They’re not easy or risk-free treatments, but they can and do save lives. He pointed out that many people fail to understand that severe depression also threatens survival -- and for patients with this disease, ECT can likewise be lifesaving.

Source(s):

Charles Kellner, MD, professor of psychiatry and director of the division of geriatric psychiatry, director of the ECT Clinical Service, Mount Sinai School of Medicine, New York City. Dr. Kellner is a leader in the field of electroconvulsive therapy research. He is the coprincipal investigator of a multisite study of maintenance ECT for geriatric depression and has led the collaborative ECT research group, Consortium for Research in ECT (CORE), in the performance of NIMH-sponsored multisite research protocols.


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New HPV Test for Cervical Cancer Saves Lives

The FDA has approved a new way to screen for warning signs of cervical cancer -- good news indeed as more than 12,000 American women develop this life-threatening disease each year, and some 4,000 die from it. On a global scale, the World Health Organization estimates that there are 470,000 new cases of cervical cancer annually -- a figure that translates into 275,000 deaths. Now, finally, a significantly more sensitive version of the test -- called cobas HPV -- has arrived, and it is sure to bring about a major reduction in those frightening numbers.

The new cobas HPV test, developed by Roche, identifies 14 strains of the human papillomavirus (HPV), the sexually transmitted virus that causes nearly all cervical cancers. In combination with regular Pap smears, this test can help you get an earlier and more accurate diagnosis.

A More Sensitive HPV Test

A single Pap test can detect a precancerous lesion only 50% to 80% of the time. In contrast, current HPV tests can tell us whether or not a woman has one of a dozen cancer-linked HPV strains (indicating a possible precancer) but is not able to specifically identify the strains. This new level of analysis afforded by the cobas HPV test detects more than 90% of existing precancers, notes Mark H. Stoler, MD, a professor and associate director of surgical pathology and cytopathology at the University of Virginia Health System. He told me that the test specifically identifies the HPV-16 and HPV-18 viruses -- the two highest-risk varieties of HPV that are responsible for seven out of 10 cervical cancers. The test can also identify 12 other high-risk types as well (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68).

While doctors have successfully used Pap tests to detect the possibility of cervical cancer for more than a half-century, cutting its incidence rate by up to 75% in the past 50 years, the new cobas HPV test provides even greater accuracy in detection (and thus protection) because it analyzes specific HPV genotypes that put women at highest risk. In their analysis of data from the Roche ATHENA trial (Addressing THE Need for Advanced HPV Diagnostics), the largest registration study ever conducted for cervical cancer screening and encompassing more than 47,000 women in the US, Dr. Stoler and his colleagues found that 25% to 30% of women who tested positive for HPV-16 or HPV-18 had a precancerous lesion even though their Pap test results were only minimally abnormal. In other words, these women were at a much more significant risk than was previously appreciated. These results were published online in a recent issue of the American Journal of Clinical Pathology. This is just the first in a series of reports to be published from the large-scale ATHENA study, so stay tuned.

Get an Early and More Accurate Diagnosis

Now that it has been approved, Dr. Stoler expects the cobas HPV test to become widely available over the next several months to a year. He anticipates that insurers will cover the cost (which will probably run $50 to $100), since they already cover current HPV tests in that price range.

At present, the FDA has approved the cobas HPV test for adjunctive use with Pap smears in women 30 and older and to help sort quickly through those Pap tests that appear abnormal. If you test negative on both the Pap and the cobas HPV, Dr. Stoler says you can wait at least three years to be screened again. If you test positive for HPV -- especially HPV-16 or HPV-18 -- your doctor will order further testing, such as a cervical exam (colposcopy) or a cervical biopsy, to confirm or rule out the possibility of cervical cancer.

Many advances in cancer screening have disappointed in recent years. Against this backdrop, I’m happy to be able to tell you about this major new success. By combining the cobas HPV test with a Pap, we have what seems to be a safe, accurate and reliable tool that represents a real step forward in cervical cancer screening practice.

Source(s):

Mark H. Stoler, MD, professor of pathology, cytology and gynecology, associate director, surgical pathology and cytopathology and director, gynecological pathology fellowship program, University of Virginia School of Medicine, Charlottesville, Virginia.

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Be well,


Carole Jackson
Bottom Line's Daily Health News


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