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ECT THERAPY FOR DEPRESSION
ECT is usually brought out as a heavy hitter when standard antidepressants just aren't cutting it, or if someone is facing a serious suicide risk. The goal is to gradually lift that depressive fog and get the patient back to their normal self, which can actually be super successful in many cases. Before anything happens, doctors run a full physical checkup—think EKGs, lung and heart exams, checking the retina, and all that good stuff. It’s definitely not for everyone, though; things like high blood pressure, recent heart attacks, blood clots, or certain bone and heart issues are major red flags where this treatment shouldn't be used.
Besides getting the patient mentally ready for the procedure, those feeling extra anxious might be given an anxiolytic (like taking 5 mg of Valium about an hour before the shock). To keep saliva from becoming an issue, they'll give about 0.6-1 mg of atropine via an injection, then wait fifteen minutes. It’s also crucial that the patient has an empty stomach to prevent any vomiting or choking hazards. Plus, they need to use the restroom beforehand and take out any dentures—to prevent biting the tongue, a rubber mouthguard is placed between the teeth. The temples where the electrodes go are cleaned with saline or treated with a special gel to prevent skin burns and lower electrical resistance. We're talking alternating current at 100-800 A and 70-130 V for up to a second, which causes immediate loss of consciousness, full-body muscle spasms, breathing pauses, and some cyanosis. The patient wakes up briefly and then goes right back to sleep, usually experiencing some amnesia right around the time of the shock. Nowadays, we use anesthesia combined with muscle relaxants (modified ECT) and short-acting barbiturates. After that, a muscle relaxant is administered and the patient is oxygenated. This modern approach means an anesthesiologist always has to be on hand, and it actually prevents those intense convulsions. Besides the standard and modified versions, there's also unilateral ECT, where an electrode is placed only on the non-dominant side of the brain to help dodge side effects like confusion or memory gaps.
ECT sessions typically happen once or twice a week. On average, it takes about 6 to 12 applications to break through severe depression. Most experts consider this method pretty safe, with a mortality rate that's incredibly low (around 1 in 10,000), mostly due to cardiac issues. Occasionally, people might deal with temporary nervous system hiccups like aphasia, agnosia, weird reflexes, or involuntary movements. It's extremely rare to see seizures or status epilepticus. You might also see some low blood pressure, racing heart, arrhythmias, or endocrine shifts that mess with menstrual cycles or lead to weight gain.
David Nelson74 said:So, they kicked off this whole initiative five years ago aimed at stripping away the stigma and discrimination surrounding mental health issues. Does that mean in twenty years we won't even be allowed to say terms like "insane" or "crazy" anymore? I suppose you can still use them as endearments among friends, though.
John Doe, Jane Doe was telling me about some kind of gene therapy research lately—the idea that in twenty or thirty years, we might be able to just "wipe out" the specific genes responsible for schizophrenia. You’d walk out of the doctor's office feeling perfectly sane, maybe someone would just call you a "person with a non-psychiatric condition" instead.
honestly, I think that sounds terrifying, you know why?
think about it—you go in for that gene fix so you aren't "crazy" anymore, but if you've been dealing with stuff for 30 years, what happens when they suddenly rewire your brain?
do you even remember everything the same way?
and look, it's not like it's an optional thing, you'd basically have to do it if it's offered.
what if I'm 70 years old and suddenly I'm "normal"—what am I even supposed to do with my life then?????
as for the stigma, I know how it is for me
I mean, who would actually track all those mood swings and behavior changes anyway?
people just don't have the energy for it anymore.
at this point, I don't even know how they'd expect me to act.
it’s manageable here in the States, but imagine if you were stuck in some random, tiny town in the middle of nowhere.
around here, everyone's used to me just being my usual self at home.
so when I miss a friend or just drop by to hang out,
if everyone in my circle was constantly calling me crazy or a nutcase,
that might actually get to me—like, someone making a comment about how I can sleep whenever I want, though Flash did mention something about that once, and they don't exactly watch me every night to see how many pills I take.
to be real with you, I'm actually looking forward to my beach trip, I just hope I don't sleep through the whole damn thing.👍
Mental health is a huge part of your overall wellness. Honestly, it’s a total game-changer for living a happy, successful life and serves as such a massive resource for individuals, families, and the whole country. Sometimes, mental illnesses can cause temporary issues, but other times they lead to permanent disability. In those cases, a person might become permanently unable to work or support themselves.
Because mental health struggles are so common and often stick around for a long time—plus they usually start showing up during the teenage years or early adulthood—they’ve become one of the top public health priorities here in the US. Back in 1998, mental illness accounted for about 12% of all diseases, and we’re looking at that jumping to 15% over the next two decades.
People dealing with mental health issues actually face higher rates of physical illness and mortality. It's heavy to think about, but suicide rates—which are a major red flag for mental health—are actually higher than deaths from car accidents. About one in five Americans deals with a mental disorder, and one in twenty will end up hospitalized for psychiatric reasons at some point in their lives. Plus, all the stress coming from economic downturns and recessions really hits home for a ton of Americans. Mental disorders carry a stigma that causes massive personal suffering and drags down the quality of life for both the patients and the people around them. Taking care of these issues puts a direct financial strain on society, but there’s also an even bigger indirect cost because of lost productivity, sick leave, and disability. A lot of the drama we see in marriages, families, or even at the office is actually just the fallout from unrecognized mental health issues. So many people just can't wrap their heads around the fact that mental illness is a real medical condition just like any other, and there's absolutely nothing shameful about asking a psychiatrist for help. People are literally suffering and even dying because they're too embarrassed to reach out. Usually, people try to keep mental health struggles quiet, hoping the neighbors, friends, or even family won't find out. Mental health issues still carry this negative vibe in everyday conversation, and being labeled as someone with a psychiatric illness can still seriously mess with your chances at work or within your community.It's not just the person struggling who avoids the doctor; it's also the people around them who make it harder by claiming it isn't a "real" illness, but just a temporary crisis or a lack of willpower.
The biggest hurdle when it comes to preventing and treating these disorders is simply a lack of knowledge. Psychiatry needs to be right there in the community where these issues pop up so they can be caught, identified, and treated properly and quickly. Help has to be accessible to actually work. When you combine severe mental illness with discrimination and stigma, the results can be devastating for those suffering.
Back in 1996, the WPA launched a global initiative specifically aimed at fighting the stigma and discrimination surrounding schizophrenia.
Right now, the US is undergoing a bit of a psychiatry reform. The blueprint for national and regional development is moving toward community-based psychiatry, which basically means focusing on outpatient care rather than just institutionalization. There's a project run by the "Happy Family" association that focuses on the specific needs of patients and their loved ones within their own communities, using research and proven results to drive this local community-based strategy.
The "Happy Family" association is the only one of its kind in the greater Chicago area and one of only a handful of organizations in the entire country working as a non-profit to provide psychological support and improve the quality of life for those with mental illnesses. Since the national goal is to crush the stigma and discrimination tied to mental health by boosting awareness and education, this project is doing exactly that on a regional level.
The "Happy Family" association’s project aligns perfectly with our national mental health policy goals because what they're doing is really just helping the public get more sensitive to the struggles faced by people with mental illnesses and their families.
Stigma and discrimination are honestly such an unfair process that puts anyone dealing with a mental disorder at a massive disadvantage. This stigma acts as a huge roadblock to successful treatment and totally drags down the quality of life for those being stigmatized. If you look back at history, schizophrenia remains one of those rare areas in medicine where the general public still feels this weird sense of unease, fear, prejudice, and just wants to avoid it altogether (2,3). That stigma mostly comes from a mix of simple ignorance and straight-up fear, which basically creates the foundation for all these deep-seated myths and biases (2,4). A super common fallout of stigma is discrimination, which is a serious violation of basic human rights. Because of that discrimination, people with mental health issues often end up socially isolated and lonely, feeling like nobody truly gets them (3,4). You also see people with mental illness being unfairly labeled as dangerous, incapable, or irresponsible, which leads to them being shut out, struggling with substance abuse or alcoholism, facing homelessness, and falling into economic hardship (4,5). Based on what the World Psychiatric Association has released so far, it's clear that the consequences of stigma and the negative, discriminatory attitudes society holds toward psychiatric patients create major hurdles in treating them, making the illness last longer and slowing down the whole rehab and reintegration process (2,6). Back in 2002, a project called the "Program to Reduce Stigma and Discrimination of Mental Patients" was kicked off right here in the US. Research in the States confirms those same old stereotypes we see in studies all over the world (7). There's definitely a lack of knowledge regarding mental illness, along with a pretty distorted perception of people living with schizophrenia. In fact, 45% of respondents said they were actually afraid of someone with schizophrenia, which lines up with several international studies (4,8,10). Viewing mental health patients as "dangerous" triggers this fear and avoidance, which is really the core of how stigma works (10). Stigma is tied directly to social isolation, being rejected by society, financial ruin, and being over-hospitalized—all of which just kill any chance of recovery. Honestly, stigmatizing those with mental disorders isn't much different from how ethnic minorities or other races are treated. Advocacy for those groups has actually seen some positive results, whereas we haven't seen nearly as much change in the fight against mental health stigma. Maybe one reason for that is just that organized programs to fight stigma are relatively young. Our psychiatric professionals have recognized the need to map out a national program to tackle mental health stigma by pulling from their own experiences and global initiatives. Our national program is designed to fight stigma across all mental disorders, and the plan is to link the specific part of the program focusing on schizophrenia with the World Psychiatric Association (WPA) program. So, the schizophrenia anti-stigma efforts will be using WPA materials (11).
The "Happy Family" project is run by a team of pros who have the heart, the know-how, and the experience to pull off this National Program to Combat Mental Health Stigma within the local community. A national working group will provide the association with steady supervision and expert consultation.
Since the start of 2005, the "Happy Family" association has been providing psychoeducation and psychosocial support to people with mental illnesses and their family members. The projects at "Happy Family" are handled by a crew of experts who are genuinely passionate and experienced in working with mental health patients. This team actually works hands-on every single day with patients at the local psychiatric facility, similar to something like McLean Hospital in Massachusetts. Since the association is based right there at the hospital, they are always "on the ground" exactly where the help is needed most, staying tuned into the reality of the local community and remaining flexible enough to adapt to whatever their clients need.
Here’s a quick rundown on mood stabilizers:
* Lithium carbonate — Lithium is basically the OG mood stabilizer. It was actually the first FDA-approved one on the scene, and doctors still lean on it quite a bit today. Just a heads-up, you have to stay on top of therapeutic drug monitoring. You'll need to keep an eye on those blood lithium levels (aiming for a therapeutic range of 0.6 or 0.8-1.2 mEq/L) and watch out for any nasty toxicity signs like nausea, vomiting, diarrhea, or ataxia. You might also run into lithium orotate, which is just another type of lithium salt.
* Valproic acid (Depakene), divalproex sodium (Depakote), and sodium valproate (Depacon) — These come in extended-release versions too. One thing to note is they can really mess with your stomach, particularly if you're taking the valproic acid version. Doctors will want to monitor your liver function and CBC, and regular therapeutic drug monitoring is a must.
* Lamotrigine (Lamictal) — This one is super helpful, specifically for dealing with bipolar depression. Just make sure to monitor for Stevens-Johnson syndrome; it's incredibly rare, but it can be fatal, so stay vigilant.
* Carbamazepine (Tegretol) — You'll need to keep an eye on your CBC since it can drop your white blood cell count. Therapeutic drug monitoring is also necessary here. Even though it isn't FDA-approved specifically for bipolar disorder, it's been a staple in treatment for years.
* Gabapentin (Neurontin) — This isn't FDA-approved for bipolar disorder. While scientific studies suggest it isn't actually an effective treatment, plenty of psychiatrists still stick with it.
* Oxcarbazepine (Trileptal) — This one hasn't received FDA approval for treating bipolar disorder.
* Topiramate (Topamax) — Also not FDA-approved for bipolar disorder.
Low Potency Typical Neuroleptics
Promazine falls under the low potency category. You might know it best by its main U.S. name, Sparine, though you'll see it listed as Liranol, Prazine, Primazine, Protactyl, Prozine-50, Savamine, or Talofen too.
Then there's Triflurpromazine, which is another low potency option. In the States, it's mostly called Vespers.
Chlorpromazine is a heavy hitter in the low potency group with a rating of 100. Most Americans just call it Thorazine, but it goes by a ton of other names like Ampliactil, Artomin, Aspersinal, Chlomazine, Chloractil, Chlorazin, Chlorprom, Chlorpromanyl, Clonazine, Contomin, Dormazine, dozin, Esmino, Ethibernal, Fenactil, Hibernal, Intensol, Klorazin, Largactil, Matcine, Megaphen, Novochlorpromazin, Ormazin, Plegomazine, Promachlor, Promacid, Promactil, Promapar, Promaz, Protran, prozin, Romazine, Sonazine, Taroctyl, Thaorazine, Thor-Prom, Winsumin, and Wintermin.
Chlorprothixene is also rated at 100 potency and belongs to the low potency class. Its primary U.S. name is Taractan.
Thioridazine is another one sitting at 100 potency in the low potency tier. It's widely known here as Mellaril, but you might run into names like Aldazine, Calmaril, Dizine, Mallorol, Meallaril-S, Meleretten, Meleril, Mellaril, Mellaril-S, Melleretten, Melleril, Mellerettes, Mepiozin, Novoridazin, Ridazin, Sonapex, Thnin, Thiomed, Thioril, or Winteril.
Mesoridazine is a slightly milder low potency option with a 50 potency rating, usually sold as Serentil in the U.S.
Medium Potency Typical Neuroleptics
Droperidol is categorized as a medium potency neuroleptic. Its standard U.S. name is Inapsine.
Acetophenazine hits the medium potency mark with a 25 rating, commonly known in America as Tindal.
Loxapine is a medium potency choice with a 10 rating. It's primarily called Loxitane here, though some folks refer to it as Loxapax.
Molindone is also a medium potency drug with a 10 rating. You'll most likely find it under the name Moban, or sometimes Lindon.
Perphenazine is another medium potency option with a 10 rating. The go-to name in the U.S. is Trilafon, but it's also called Avomit, decentan, Etrafon, Fentazin, Perphenan, Triavil, Trilafan, Triomin, or Triptafen. Just a heads up—Etrafon, Triavil, and Tiptafen actually have Amitriptyline mixed in for anxiety relief.
Prochlorperazine sits at a 10 potency level in the medium category. While Compazine is the big name in the States, it also goes by Buccastem, Compa-Z, Cotrazine, Cotranzine, Nautisol, Nibromin, Normalmin, Novamin, Novomit, Paotomin, Stell, Stemetil, Steremal, Tementil, or Vertigon.
High Potency Typical Neuroleptics
Thiothixene is a high potency option with a 5 rating, typically known as Navane.
Trifluoperazine is another high potency drug with a 5 rating, mostly recognized as Stelazine. It carries a huge list of aliases including Calmazine, Clinazine, Domilium, Eskazine, Espazine, Flupazine, Jatroneural, Modalina, Nerolet, Novoflurazine, Pentazine, Psyrazine, Sedizine, Solazine, Suprazine, Terfluzin, Terfluzine, Triflurin, and Tripazine.
Fluphenazine is a high potency medication with a 2 rating. It's widely used as Prolixin, but you'll see it called Anatensol, Dapotum, Flunazine, Funazine, Lyogen, Moditen, Motipress, Motival, Omca, Pacinol, Permitil, Sediten, Selecten, or Siqualone. Interestingly, Motipress and Motival both include Nortriptyline to help with anxiety.
Halperidol is a high potency drug with a 2 rating. The most famous U.S. name is Haldol, but it's also linked to names like Brotopon, Depidol, Dozic, Duroperidol, Einalon, Eukystol, Halidol, Halojust, Halomed, Halopidol, Halosten, Haricon, Linton, Mixidol, Novoperidol, Pacedol, Peluces, Pericate, Perida, Peridol, Peridor, Selzyme, Serenance, and Serenase.
Pimozide is a high potency typical neuroleptic with a potency rating of 1. In the States, you'll most likely know it as Orap.
I'm not quite sure about the exact potency levels for these other typical neuroleptics, though.
Then we have Flupenthixol, which falls under the typical neuroleptic category. The standard US name for it is Fluanxol.
Next up is Methotrimeprazine, another typical neuroleptic. Most people here call it Nozinan.
And there's Pipotiazine, also a typical neuroleptic, usually referred to as Pipotril in the US.
Atypical Neuroleptics
When we talk about atypical (or "novel") neuroleptics—basically the "newer generation" stuff—the timeline really starts with the arrival of Clozaril. These guys work a bit differently by targeting specific dopamine receptors and sometimes even blocking or inhibiting serotonin re-uptake.
The big standout when comparing typical vs. atypical drugs is how atypicals can actually help with those negative symptoms of schizophrenia. Plus, there's a general belief that they carry a lower risk for developing tardive dyskinesia.
Atypicals also tend to cause fewer movement-related issues (EPS) and might not hit you quite as hard with sedation.
Right now, atypical neuroleptics are only found in tablet form, and you won't find any generics on the market just yet. Availability outside the US can be all over the map, too—some places get their hands on them way before the US, while others have to wait a lot longer.
In the US, the main atypical neuroleptics you'll see are Clozaril (Clozapine), Risperdal (Risperidone), and Zyprexa (also known as Lanzac) (Olanzapine).
Coming "soon" to a pharmacy near you are Seroquel (Quetiapine) and Serlect (Sertindole).
We also have a few more in the home stretch of testing, including Ziprasidone and Iloperidone.
Noah Sanchez7 said:🙂
So you're saying it's not just the orderlies??
Hey, something just occurred to me. I see you're quite the activist when it comes to breaking down prejudices (which I really support), so maybe we could organize some kind of protest against being restrained and those crazy straitjackets.
Human rights, man!! Or are psychiatric patients not considered people??!! 😠
We would just need to get a few experts in the field on our side. I don't think that would be hard..
By the way, have you seen that show "The Kingdom"? If not, give it a watch—if you don't know where to find it, we can just stream it online..
Basically, the series argues, in a very valid way, that patients aren't "crazy" in the sense we usually mean; they just think differently than the average person..
Yeah, I agree, human rights matter
but unfortunately, that’s just where medicine stands right now And don't even get me started on the lack of funding and all that mess
I don't think they're monsters just waiting to tie you up
Theoretically, there's always a chance a patient might actually smash a floor in a ward, for example
As for my own take, it hasn't really changed much
My family knows I definitely think differently, but I still function just fine in society
A Danish series? Then I'm gonna need subtitles
I'll see if I can download it, and if not, I'll let you know😘
Haha, magicians... honestly, I have no idea how they pulled that off😁
Noah Sanchez7 said:I’m not wrong here.
I think I saw a segment on some news network about specialized rooms lined with soft padding so patients can't hurt themselves.
Even in those extreme cases where someone just can't control their actions despite medication—which I know isn't common—they should just be placed in one of those rooms.
No matter how ill someone is, nobody should have the right to restrain them!
Besides, you don't need to be a genius to see that physical restraint doesn't help at all; in fact, it actually makes things worse.
Waking up tied down? Of course you're going to spiral even harder.
It’s an embarrassment to modern medicine!
Yeah, I'm with you on that.
Of course it makes you spiral more.
Every time I run into someone from the hospital, we end up talking about this exact thing.
And what am I supposed to do?
If they don't have you in a straitjacket, you might actually be able to get out. 🙄
But then you've got two burly orderlies rushing in to "fix" things.
What else are you gonna do besides freak out?
Thinking back, I've always been a little bit unhinged myself (ugh, I hate even writing about it.
I've been in such a bad mood ever since I can remember.
That's why I'm popping pills like they're candy. 😢
Noah Sanchez7 said:That really ought to be banned outright!!
I don't even know, man, things are just so messed up that everyone's terrified of these illnesses.
But honestly, people are just doing the best they can with what they've got.
If everyone started wandering around the halls of a hospital in the middle of the night, it would be pure chaos.
Plus, some folks just can't sleep, so they end up walking around anyway.
It’s pretty wild how medicine treats psychiatry like it's this totally unexplored frontier.
At the end of the day, a lot of it comes down to me personally too, since mood swings are part of the whole condition.
It’s all just one big cycle.
How are you holding up?
Look, I'm not defending those primitive methods, but there really isn't any other way!!!!!!! You feel me!!!!!!!
Girl, Interrupted (film) analysisCritical analysis paper: Girl, Interrupted
The movie Girl, Interrupted (film) tells the story of nineteen-year-old Susanna, living in the 1960s, who ends up at a psychiatric hospital, specifically McLean Hospital, for a supposed "rest" after a suicide attempt. Her doctor basically told her that her fling with a family friend—plus the fact that she thought washing down a whole bottle of aspirin with vodka was a fine idea—pointed toward borderline personality disorder. So, now she’s stuck trying to stay sane while being totally surrounded by people who are struggling just as much as she is.
While staying at McLean Hospital, Susanna gets close to several of the other residents. You've got Georgia (a total pathological liar), Polly (a burn victim who is constantly terrified), Daisy (who deals with agoraphobia and trauma from her past), and Lisa (a super charming but manipulative sociopath). Honestly, the Character analysis shows that Lisa was the only one who really nailed the portrayal of her specific disorder. Antisocial personality disorder involves chronic patterns of manipulating, exploiting, or violating the rights of others. As it says, “Individuals with antisocial personality disorder are often angry and arrogant but may be capable of superficial wit and charm. They may be adept at flattery and are very skilled at manipulating the emotions for their own personal gain” (
www.nlm.nih.gov). I actually thought they got Lisa's disorder spot on—even though she completely ignores everyone else's feelings (and safety), she still charms you because she's so brutally honest and just doesn't give a damn about anyone's opinion. Antisocial personality disorder seems to involve people having zero emotional connection to anyone or anything, rarely showing any remorse when they step on others' toes. Lisa’s knack for observing people gave her this creepy ability to spot weaknesses, which she definitely used to her advantage, just like most sociopaths would.
Then there was Daisy, an obsessive-compulsive agoraphobic whose history with her father left her dealing with a whole laundry list of different personality issues. Her character was a perfect look at a neurotic recluse whose disorders essentially hijacked her life, leaving her feeling like she had no shot at living independently from her abusive father. Other Characters include Polly, whose self-inflicted burns make her seem perpetually childlike, and Georgia, the pathological liar who rooms with the borderline Susanna. It was through interacting with this group that Susanna finally found the grit to face her own chaotic mental state.
Susanna’s character works well to help the audience see the internal thought processes of someone battling depression or personality disorders. Even though she definitely showed traits of borderline personality, I honestly felt like she leaned more toward depression. According to research, “A person with depression or bipolar disorder typically endures the same mood for weeks; a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day” (Zanarini 1998).
edit: haven't watched One Flew Over the Cuckoo's Nest yet, maybe this weekend🙂