Find out about ECT and how it's used to treat patients with mania or severe depression.

Commonly called shock treatment, electroconvulsive therapy (ECT) has received bad press since it was introduced in the 1930s. Over the years it has been refined, however, and may now even be safer than lithium. It may be particularly beneficial for the following patients:

• Patients who need immediate stabilization of their condition and who cannot wait for medications to be become effective.
• Most patients with mania. (It may be particularly important for elderly patients with severe mania.)
• Patients who suffer suicidal thoughts and guilt during the depressive phase.
• Patients who simply prefer ECT.
• Pregnant patients.
• Patients who cannot tolerate drug treatments.
• Patients with certain types of heart problems.
• Young patients.

In a review of studies, about 80% of ECT-treated patients experienced improvement, and for some, it is the only treatment that works.

The Procedure. Hospitalization is not necessary for the treatment. In general, ECT proceeds as follows:

• A muscle relaxant and short-acting anesthetic are administered.
• A small amount of electric current is sent to the brain, causing a generalized seizure that lasts for about 40 seconds.
• The response to ECT is usually very fast, and the patient often needs less medication afterward.

Side Effects. Side effects of ECT may include temporary confusion, memory lapses, headache, nausea, muscle soreness, and heart disturbances. Administration of the drug naloxone immediately before ECT may help reduce its effects on concentration and some (but not all) forms of memory impairment. Concerns about permanent memory loss appear to be unfounded. One study that used brain scans before and after ECT found no evidence of cell damage. In another small study of teenagers who had undergone ECT for severe mood disorders, only one of 10 reported memory impairment three and one half years after the treatment.

The Biologic Effects ECT on Bipolar Disorder. The precise mechanism by which ECT benefits bipolar disorder patients is not clear.

• Some research is focusing on changes that ECT exerts on the brains physiology. It may increase the permeability of the blood-brain barrier, produce an anti-seizure effect (similar to the effects of anti-seizure drugs used as mood stabilizers), and reduce blood flow in part of the brain correlated with improved mood.
• Another theory suggests that various hormonal changes that occur during ECT produce the primary benefits, with particular interest in changes in thyroid-related hormones.
• Yet another theory posits that the benefits of ECT stem from its effects on dopamine levels. This neurotransmitter probably plays an important role in bipolar disorder as well as other conditions for which ECT is sometimes recommended, including delusional depression.
• ECT appears to stimulate growth of neurons in the hippocampus (the area in the brain responsible for memory).

How is ECT used in treating bipolar disorder?

Electroconvulsive therapy (ECT) is often life-saving in severe depression and mania, but has received a lot of negative publicity. ECT is a critically important option if someone is very suicidal, if the person is severely ill and cannot wait for medications to work (e.g., the person is not eating or drinking), if there is a history of many unsuccessful medication trials, if medical conditions or pregnancy make medications unsafe, or if psychosis (delusions or hallucinations) is present.

ECT is administered under anesthesia in a carefully monitored medical setting. Patients typically receive 6 to 10 treatments over a few weeks. The most common side effect of ECT is temporary memory problems, but in many cases memory returns relatively soon after a course of treatment.

How ECT Works

Electroconvulsive therapy has a high success rate for treating both unipolar and bipolar depression, and mania. However, because of the convenience of drug treatment and the stigma sometimes attached to ECT therapy, ECT is usually employed after all pharmaceutical treatment options have been explored.

ECT is given under anesthesia and patients are given a muscle relaxant medication to prevent convulsions. The treatment consists of a series of electrical pulses that move into the brain through electrodes on the patient's head. Although the exact mechanisms behind the success of ECT therapy are not known, it is believed that this electrical current alters the electrochemical processes of the brain, consequently relieving depression.

Headaches, muscle soreness, nausea, and confusion are possible side effects immediately following an ECT procedure. Temporary memory loss has also been reported in ECT patients. In bipolar patients, ECT is often used in conjunction with drug therapy.

next: Experimental Procedures for Bipolar Disorder
~ bipolar disorder library
~ all bipolar disorder articles

Chapter 73 of the book Self-Help Stuff That Works

by Adam Khan:

YOUR JOB IS NOT a game. But when you approach it like a game, you'll enjoy it more and you're more likely to be successful at it.

Research at the University of Chicago shows that games produce a condition called flow, characterized by absorption in the activity (a lack of thoughts about anything else), a feeling of control, and enjoyment. And one of the most common characteristics of flow is that time seems to fly.

According to the principle researcher, Mihaly Csikszentmihalyi, one of the reasons games produce flow is that the outcome of the game is not important. We may really get into a game and the outcome may seem very important at the time, but we know nothing is really at stake. We won't lose the mortgage, nobody will die, the college scholarship for our kids won't be jeopardized.

But at work, there is something at stake. That means when we're working, we tend to pay attention to where the work is getting us. What this means is that work becomes a means to an end and that means the end of flow because a requirement of the experience of flow is an involvement in the activity itself - a lack of thoughts about anything else. When a person is looking at the clock or thinking about her position or promotion in the company, it's enough of a distraction to prevent flow. Even wondering if you're enjoying yourself is a distraction. Absorption produces flow.

Of course, when most people are working, they are working for money. So the work is done as a means to an end. Does that mean we can't experience flow at work? Luckily, no. Even when you do something as a means to an end, you can learn to become absorbed in the work and forget about where it is getting you while you're doing it.

If you want to experience more flow on the job, then, simply learn to become more engrossed in your work. Learn to "get into it."

If your job is stressful or boring, however, becoming absorbed is difficult. If what you've got is stress, that means the challenge of your job, either physically or psychologically, is greater than your skills. The answer is to find out what skill you need to improve and work on that. Increase your skill. That's the answer to stress.

At the other end of the spectrum is boredom. If your job is boring, you'll have to find a way to make the work more challenging, interesting, or creative. It may take you a lot of thinking to figure out how to do that, but keep at it and you can find a way.

For example, during his research, Csikszentmihalyi found a man working on an assembly line, doing the same thing over and over every day, who had found a way to experience flow in a potentially boring job. He approached the task like an Olympic athlete, carefully working out ways to trim the time it took him to complete each task. By timing himself and shaving off seconds, he had become the most competent man on the line, but more important for our discussion here, he enjoyed his work more than anyone on the line. And he wasn't focusing on trying to get a raise or gaining the approval of his supervisor. He was engrossed in beating his personal best.

Find a way to become absorbed. You'll enjoy your work more. Get so engrossed in your work that you forget about everything else, like where it's getting you. It'll get you a lot further that way.

Get so engrossed in your work that you forget about everything else.

This is a simple technique to allow you to get more done
without relying on time-management or willpower.
Forbidden Fruits

Here is a way to turn your daily life into a fulfilling, peace-inducing meditation.
Life is a Meditation

A good principle of human relations is don't brag,
but if you internalize this too thoroughly, it can make
you feel that your efforts are futile.
Taking Credit

Aggressiveness is the cause of a lot of trouble in the world,
but it is also the source of much good.
Make it Happen

We all fall victim to our circumstances and our biology
and our upbringing now and then. But it doesn't have
to be that way as often.
You Create Yourself

next: Self-Help

Chapter 20 of the book Self-Help Stuff That Works

by Adam Khan:

IN HIS BOOK Grinding it Out, Ray Kroc, the man who made McDonald's what it is today, wrote about his father. Kroc senior was a hard-working man who was doing well in real estate before the Depression, expanding his holdings and using credit to extend himself even further. "When the market collapsed, he was crushed beneath a pile of deeds he could not sell," wrote Kroc. "The land they described was worth less than he owed. This was an unbearable situation for a man of my father's principled conservatism. He died of a cerebral hemorrhage in 1930. He had worried himself to death. On his desk the day he died were two pieces of paper - his last paycheck from the telegraph company and a garnishment notice for the entire amount of his wages."

Bad stuff happens, and sometimes it's big. You don't want it to crush you. You want to be strong. So start now taking every small bad thing that happens as an opportunity to repeat this idea to yourself:

There will be an advantage in this. I will find it or I will make it.

Repeat it until you see or can make an advantage out of it. If you will do this, you will stand as a fortress of strength for your family in situations that would make lesser men and women collapse in hopelessness. This idea is not some namby-pamby, rah-rah, positive-thinking nonsense. It is a source of tremendous strength. It may save your life some day. For sure it will be good for your health. Ingrain that thought - make that pathway through your brain well-worn - and you'll be able to face up to difficulties that would make a mere mortal crawl and whimper.

Arnold Schwarzenegger is more successful than most people know. He's made a lot of money with his films and married a Kennedy, but he's also a smart and successful businessman outside of the movie business, with real estate, books, restaurants, and fitness clubs. He is hugely successful. In his autobiography, he wrote,

I didn't get certain things I needed as a child, and that, I think, finally made me hungry for achievement...If I'd gotten everything and been well-balanced, I wouldn't have had my drive. [Because of] this negative element in my upbringing, I had a positive drive toward success...

He held up under the strain and turned it to his advantage. He didn't let it crush him because of the way he thinks. This strength is within your grasp: Find or make an advantage in everything that happens.

Find a way to turn your problems into an advantage.

Why aren't we more positive naturally? Why does it seems our minds and the minds of those around us gravitate toward the negative? It's not anyone's fault. It is merely the product of our evolution. Read about how it came about and what you can do to improve your general positivity:
Unnatural Acts

Would you like to learn more about the fine art of positive thinking? Would you like to behold the power of positive thinking? How about the power of anti-negative thinking? Check this out:
Positive Thinking: The Next Generation

How can you take the insights from cognitive science and make your life have less negative emotion in it? Here's another article on the same subject but with a different angle:
Argue With Yourself and Win!

next: Meanings and Feeling

Focusing on the Emotions of Daily Life: A Self-Help Guide for Their Maintenance

or... How to Change without Trying Too Hard
by Ilan Shalif Ph.D.

New findings about daily emotions (moods, feelings, sensations, etc.) and problems related to them are available in this site. The texts are mainly about a new revolutionary way for the maintenance of the above. Included among them, a complete self-help guide, one can easily train oneself with. The revolutionary General Sensate Focusing Technique can be used to enhance self-growth and as a substitute for psychotherapy.

The new technique, supported by a systematic study, is based on Charles Darwin's theory about the emotions and their evolution, and on the modern concept of basic emotions.

The essence of this General Sensate Focusing Technique can be described as biofeedback WITHOUT instruments. I developed it, and for the last ten years, the training of applicants has been my sole occupation.

I found the emotional system, which is the sole creator of our joy and sorrow is very "economical". Only a small number of processes are responsible for everything in our life: what we do, what we feel, what we think, what we wish, etc. Thus, even a very small problem can cause great trouble. Luckily, even a small adjustment achieved with the new technique can bring about an unexpected improvement.

The General Sensate Focusing Technique is easy to learn and easy to train with. There is nearly no limit of age or problem. Nearly none of the problems of interpersonal relations found in traditional psychotherapy (between therapist and client) disturb the trainer-trainee relationship.

Everything you need is here in this site. Read it, make use of the technique and incorporate it into your life. See if it makes a significant improvement in the way you feel and live your life.

Welcome to my site.

Ilan Shalif, Ph.D.

next: About Me and Why I Wrote The Guide for Self-Help

Overview of homeopathy as an alternative treatment for depression and whether homeopathy works in treating depression.

What is Homeopathy Therapy?

Homeopathy is a system of alternative medicine which involves treatment with very diluted substances. People who practice this type of medicine are called 'homeopaths'.

How does Homeopathy Therapy work?

Homeopathy tries to help the body restore itself to health. Rather than seeing a person's symptoms as something to be removed, it sees them as a sign of how the body is helping itself. Homeopaths use substances that produce the same symptoms to further stimulate the body's healing. These substances are diluted in alcohol many times over, until there is little or none of the substance left in the alcohol. The resulting tincture is taken as a medicine. Homeopathic treatments are selected to fit each individual, so that different people with depression may not receive the same treatment.

Is Homeopathy Therapy effective?

Only one study has been carried out in which homeopathy has been compared to placebo (dummy medicine) treatment for depression. This study found that homeopathy was effective, but the study was of poor scientific quality.

Are there any disadvantages?

None known.

Where do you get it?

Homeopaths are listed in the Yellow Pages of the phone book.

Recommendation

Given the lack of good scientific evidence, homeopathy cannot currently be recommended for depression.

Key references

Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homeopathy. British Medical Journal 1991; 302: 316-323.

back to: Alternative Treatments for Depression

Overview of ginseng as a natural remedy for depression and whether ginseng works in treating depression.

What is Ginseng for Depression?

The roots of the ginseng plant are used as a medicine, particularly in Oriental countries. There are three types of ginseng plant: Chinese ginseng (Latin name: Panax ginseng), American ginseng (Panax quinquefolius) and Siberian ginseng (Eleutherococcus senticosus). Chinese and American ginseng are closely related plant species, while Siberian ginseng is a more distantly related plant. All are thought to have similar medicinal effects.

How does Ginseng for Depression work?

Ginseng is used to improve energy levels. It is also used to help the body cope with stress through its effect on the adrenal gland.

Is Ginseng for Depression effective?

There is no scientific evidence on whether ginseng works for depression.

Are there any disadvantages?

Like all herbs, ginseng can cause side effects in some people, although these are generally minor.

However, ginseng may interfere with your prescription medication. If you regularly take prescription medication, check with your GP or pharmacist before taking herbal supplements.

Where do you get Ginseng?

Capsules of powdered ginseng root are available from health food shops and most supermarkets. Ginseng is also available as a tea.

Recommendation

Given the lack of scientific evidence, ginseng cannot currently be recommended for depression.

back to: Alternative Treatments for Depression

Self-Therapy For People Who ENJOY Learning About Themselves

BASIC ASSUMPTION

Every physically healthy person has plenty of energy, so every physically healthy person has plenty of motivation. Nobody is lazy. We are all just motivated toward different things.

Calling someone lazy is like calling them any other name. It shows that we are angry at them and that we don't respect what they are doing, but it doesn't say much else. Calling someone lazy is a callous dismissal of them which makes problem-solving difficult.

SELF-TALK ABOUT MOTIVATION

Most of us call ourselves lazy occasionally. If we think we do too little or too much of anything (eating, sleeping, drinking, smoking, working, making love, visiting relatives, etc.), we may doubt our own motivation and call ourselves lazy.

Calling ourselves lazy is a callous dismissal of ourselves, just one of many ways that we pick on ourselves or "punish ourselves" in this guilt-ridden culture.

Whenever you catch yourself thinking you are lazy:

1. STOP IT! (You may need to try this over and over....)

2. Ask yourself what you LIKE about what you are doing. (Over and over?)

3. Ask yourself what other ways there are for you to get what you like.

It takes quite a bit of self-discipline to break through years of guilt-laden self-talk.

ILLUSTRATIONS

The best way to teach about this is through examples or illustrations, but please don't think that the SPECIFICS in each of these illustrations necessarily apply to you.

If you have a problem with smoking, for example, try to learn from the process outlined in example #4 - but don't expect that the specific insights in this person's life necessarily apply to you. (They may apply to you, but they probably do not.)

ILLUSTRATION #1: OVER-EATING

Sharon was extremely over-weight and called herself lazy, unmotivated and many worse names as she kept "trying" to lose. It took her many months before she could even stop calling herself these names, and many more months before she even cared enough about herself to care what she liked about over-eating and being obese.

Eventually she was self-caring enough and brave enough to think about how she actually felt as she sat at the table gorging herself. She found that what she liked about it was that if she ate enough she would eventually feel numb. So the question became: "What are you numbing out?" In her case, the answer was sadness and intense anger at men.

Why was she so sad and angry at men? Sharon "confessed" that as a teenager she had been sexually abused by her step-father and some of his drinking buddies.

Sharon liked being overweight because she thought this might keep her safe from being an object of violence at the hands of frightening men.

Sharon is still overweight, but she has lost as much weight as was reasonable and she no longer gorges herself. Most importantly, she is in a love with a safe man who desires and respects her.

ILLUSTRATION #2: GOING HOME

George's mother called him about three times a week and often tried to make him feel guilty about his infrequent visits.

George tried not to feel guilty and usually succeeded, but occasionally would call himself lazy "for not just getting up and getting over there like I should."

When he asked himself what he liked about staying away from his mother, the answers were obvious. He didn't like her guilt-trips and manipulations (which she refused to stop).

He visits her even less often now, but feels good about it.

ILLUSTRATION #3: MAKING LOVE

Bob and Sally have been sexual for eleven years. In the past two years Bob has never initiated sex, and in recent months he is even refusing sex when Sally initiates. They were both worried that Bob might be "undersexed."

When Bob asked himself what he liked about this situation, he eventually admitted that he liked "feeling more in control." This led to discussions with Sally about the details of their sex life, about her insistence that sex be done a certain prescribed "right way", and about Bob's growing feelings of inadequacy.

They learned that they both wanted much more spontaneity and experimentation in sex.

ILLUSTRATION #4: SMOKING

Simone had smoked for 23 years and was "always" trying to quit. She berated herself constantly for being "too weak" and "too lazy" to go through process of quitting.

When she asked herself what she liked about smoking she eventually said: "Cigarettes are like my best friends. They are always there for me when I need them."

When asked if there was anything else in her life that was so reliable, Simone mentioned her husband, her sister, and a best friend. She had started smoking when she went away to school and had no friends. Simone needed the added sense of security her cigarettes brought her then, but she doesn't need the added security, or the cigarettes, anymore.

next: Life's "Craziest" Beliefs

Self-Therapy For People Who ENJOY Learning About Themselves

Therapists are often accused of not being very practical. After we explain how some problem works, we frequently hear: "OK, Fine. But what should I DO About it?!" Therapists don't give a lot of practical advice because it usually doesn't work. People seldom change just by doing what someone thinks they "should" do. But sometimes an idea comes at just the right time. My hope is that today just happens to be your "right time." HOW TO USE THIS PAGE These suggestions in "Getting Practical #1" are so central that improvement in any one of these will automatically improve all other psychological aspects of your life! Don't try to improve in all of these areas once! Pick a few statements that "feel right" to you and notice your improvement each day for a while. Then come back and decide whether to keep these same goals or pick some new ones.

THE BASICS: SUGGESTIONS TO IMPROVE ALL ASPECTS OF YOUR LIFE

• Avoid physical pain and discomfort. Take excellent care of yourself at the first sign of discomfort.

• Eat, sleep, and exercise enough to feel relief - not too much and not too little.

• Get plenty of attention even though it means taking risks and sometimes being rejected

• Notice your own mental "self-talk." Improve it constantly as a lifelong project.

• Don't let life's "rough spots" accumulate. Get professional help when you need it.

• Do whatever it takes to be 100% sure that suicide is out of the question.

• Be physically safe at all times. Get all violence and threats of violence out of your life.

• Don't work or play or rest "too much." Aim at spending about the same number of awake hours on each of these.

• Never use alcohol for any reason except to feel a little better when you are already feeling great.

• Don't try to hide your feelings from yourself! Embrace your anger, sadness, scare, joy and excitement.

• ---

  
  

  ---

  When you are SAD, feel it through - and figure out what you LOST or what is MISSING from your life.

• When you are ANGRY, feel it through - and figure out what is BLOCKING you from getting what you want.

• When you are SCARED - notice it quickly and then decide what to do to PROTECT yourself.

• When you are HAPPY - feel it through - and, if you must think at all, figure out how to ENJOY YOURSELF EVEN MORE.

• When you are EXCITED - feel it through - and DON'T HURRY PAST IT!

• Fight all guilt and shame, alone or with a therapist.

• They are always unnecessary and counterproductive.

• Take responsibility for choosing what you do.

• Don't claim a person or a feeling "made" you do anything...

• Take responsibility for changing and for not changing.

• Remember that you can change anything it is physically possible to change.

• Learn and improve the kind of treatment you "invite" from those around you.

• 95% of the time you are treated the way you invite people to treat you.

• Acknowledge your anger or be depressed - and take responsibility for the choice.

• Use your anger energy as soon as you safely can. Don't let it pile up.

• Don't vow to stay angry.

• And don't stay in situations which create constant, overlapping anger in you.

• Don't make unnecessary comparisons.

• Each comparison you make should be a conscious choice based on the need to understand,

• not based on a subconscious habit of finding your "faults" or picking on yourself.

• Look for opportunities all the time, and take advantage of them.

• There is plenty of what you need in the world.

• Make a lifelong commitment to love and value yourself.

next: Getting Practical #2: Relationships, Couples, Families, and Careers

• Find out why failing at losing weight may be a good thing. Click here.
• How can negative thinking actually make you feel better? Click here.
• How can you make people like you for five cents? Click here.
• How can it improve your life to take less responsibility? Click here.
• How can you have more time (and less stress)? Click here.
• The ancient Hindus used the same technique as modern cognitive therapy to lessen human suffering. Curious? Click here.
• Is there a quick and easy way to stop yourself from feeling angry or annoyed? Click here.
• Count your blessings, appreciate what you have, and feel more satisfied with your life. Click here.
• There is an enormous body of accumulated scientific evidence that optimism becomes a self-fulfilling prophesy. Click here.
• How you can improve your health without spending money or breaking a sweat? Click here.
• The secret of success is persistence. But how can you become more persistent? There's a hard way and an easy way. Click here.
• Enhance the quality of your life using a technique developed in one of Hitler's concentration camps. Click here.
• How is it possible that pessimistic thoughts in your head could shut down your immune system? The evidence is in. Click here.
• Abraham Lincoln was probably the greatest, most profoundly moral president ever to be elected to office. Do you know what he thought about religion? Click here.

next: What is the Book About?

Chapter 120 of the book Self-Help Stuff That Works

by Adam Khan

EVERYBODY KNOWS WHAT IT MEANS to flinch. Example: You pretend you're going to slug me, and I twitch or blink. I flinched. Now let's expand and extend that idea in a useful way: Let's say flinching is any form of shrinking back, pulling away or turning aside, when it's done to avoid discomfort or difficulty.

Have you ever noticed that you have a strong desire to put your hands in front of your body when you're standing up and talking to several people who are all seated? Most people do. If you succumb to your desire to put your hands in front of your body, that's a flinch.

Or say you're telling someone something she doesn't want to hear. While you talk, maybe you shift your body's weight from one foot to another, pick at your fingernails or cross your arms. You flinched!

If you look at someone and they then look at you and you quickly look away, you flinched. Mumbling or speaking quietly is a form of flinching. Someone who is avoiding going to night classes because he's afraid he might not do well is flinching.

Flinching is an attempt to protect yourself, and it's very natural. Everybody does it. But there is one major problem with it: Flinching makes you weak. Notice I didn't say it was a sign that you are weak. The act of flinching itself makes you weak.

But when you have the urge to flinch and you don't, you gain a kind of strength. And when you look people right in the eyes with your arms hanging by your sides where they naturally hang and you speak truthfully without flinching, you have an unnervingly powerful personal presence.

And you don't have to spend years getting good at this; you can do it the very next time you talk to someone. It's easy to do (once you decide to), but when you do it, you will notice a temptation, a craving, a desire - almost an ache - to fidget or look away or at least put your hands in your pockets.

Refuse to flinch.

Make up your mind - as soon as you notice yourself flinching - that you will not flinch. You'll like the result. A fear just goes out of you. This is especially true if you consider yourself shy to any degree. Don't flinch, and suddenly the sense of shyness becomes somewhat wispy and transparent, and you'll start to wonder if there has ever been anything there but a shadow.

Don't flinch, and feel the power.

Then go on and expand this power by extending the practice into the psychological arena. When someone is "in denial," it means they are mentally or emotionally flinching; they are looking away or shrinking back or avoiding something real - some truth, some reality - and always in order to avoid discomfort or difficulty.

But always and forever, wherever you flinch, you will be weak. And wherever you refuse to flinch, you will be strong.

This is the "how" of courage. It's not that during a courageous act a person doesn't want to run away. What makes it courageous is that the person wants to run away but doesn't. Courage is refusing to flinch.

Extend your unflinching psyche into any area where you want more personal power.

If you want to be socially strong, don't flinch in social situations. If you want to be emotionally strong, don't flinch at emotional feelings or situations. You would benefit if you made this a lifetime practice, a spiritual regimen, a holy discipline.

Wherever you refuse to flinch, you will have power. This will, of course, increase your impact on people. People will admire your courage and look up to you. When this happens, don't flinch.

Resist the temptation to flinch.

Read about the most powerful principle for change in existence, and how you can harness its strength to gain self-confidence, personal power, courage, the trust of others, or any other worthwhile trait you can think of:
As Good As Gold

Mettle is a strength of mind that gives you the ability to withstand pain or difficulties with bravery and resolution. Gain self-confidence and personal power. Improve your self-respect and gain the respect of others while improving your integrity. Learn the Three Commandments of Mettle here:
Forging Mettle

next: Forging Mettl