Yesterday I learned this Patient Safety Petition was highlighted in an Israeli Newspaper article entitled "I lost direction, forgot the way home"  by Daniel Bronstein.

Important to note that Israel's Ministry of Health provided inaccurate information to the journalist. Neuropathology of electrical injury is clearly seen under a microscope at autopsy using appropriate staining. Damages include: Gliosis, myelin shealth damage, and micro hemorrhaging (see references 1-10 below).  ECT's electrical injury also causes permanent damages resulting in channelopathies (see references 11-16 below.)

The article includes personal testimonies from people with a history of ECT who had both positive and negative outcomes. Here's the English translation of "I lost direction, forgot the way home" (via Google Translate): 

"I lost direction, forgot the way home"  by Daniel Bronstein.

In the face of experts and doctors who recommend electric stimulation as a solution to serious mental disorders, accumulating evidence of irreparable damage is accumulating. Now the victims are struggling.

"What is the logic in destroying my brain, erasing my memory, which is a fortress, and getting me out of action? The treatment was brilliant, but we lost the patient." These were the words of American author Ernest Hemingway to writer and biographer AA. Hotchner shortly before he took a shotgun and shot himself in the head in 1961. Hemingway committed suicide following the end of a series of psychiatric treatments - "daring," and in the vernacular - electric shocks. Some claim that none of Hemingway's difficulties during his life - including a plane crash, World War I horrors, painful divorce and prolonged depression - failed to break him until the side effects of psychiatric treatment came.

Electroshock therapy has existed in the world of psychiatry for 80 years, and is now considered the most effective and safe against life-threatening mental disorders. The treatment is designed for patients with deep and chronic depression, severe psychotic and catatonic conditions and manic conditions. According to professional literature, its purpose is to cause epileptic seizures by a series of electrical pulses, which produce a large electrical outbreak in the brain cells, and especially in the anterior lobe cells. This electrical outburst, according to researchers, causes changes in brain function - it activates genes involved in the production of brain-secreted substances, the main ones of which are serotonin, dopamine and norepinephrine, which they say is impaired in patients suffering from depression. The treatment is actually given to those who have become drug resistant, when there is a suicidal or significant risk of harm to others. 

Nothing was left of the promises

Psychiatrists around the world recommend electric power and claim that despite the fact that the mechanism of action is unknown, the result in the field is that it is "working" and "proven." However, there are also other voices of patients who have undergone treatment and claim to have experienced serious side effects. There are various websites on the Internet, including a support group and testimonials from former patients and their families, including Internet petitions dealing with the requirement to intensify medical device supervision.

In addition, government documents dealing with the long-standing regulatory issue by the official body (US Food and Drug Administration (FDA)) reveal that there are thousands of reports of damage at various levels, some related to brain damage and even death. 

"This treatment destroyed my life," describes a broken voice (50), a resident of the north, a clinical psychologist in her training. She was diagnosed with bipolar disorder, also known as manic depression, a disease in which patients move between "high" and inexhaustible feelings of deep depression. After receiving various doses of a variety of drugs and suffering side effects - including tens of pounds in weight, eight consecutive nights of sleeplessness and muscle tremors - and since drug therapy only helped for a few months, she was offered the last resort for electric power therapy.

"I was told by the various psychiatrists I consulted, and from what I read on the Internet, that there is a possibility of minor impairment in concentration and memory, that it is a functional and inorganic, that is, temporary, one that will last within six months at most. Only in practice - I have lost entire parts of my life."

How did it come to fruition?

"My autobiographical memory is simply erased, as is my professional and general knowledge. I remember sitting with a psychologist two years after the treatment, seeing Freud's book on the shelf and realizing that the name was familiar to me, but did not remember one detail of his teachings that I had studied for years. In my life like the wedding, the birth of my daughter, places of residence, friends, family history, I even forgot about my late father and mother.

"Events like Rabin's murder and the twin catastrophe I didn't recognize even when I saw videos. I mean, not only was the retrieval of information from my memory impaired, but also the identification. At one point I didn't even remember the way from our house to school and back to take the girl, and I needed a caregiver to help me "I put in operas for nine months when I was being treated, because I couldn't remember how to do simple homework like cooking and washing, and even using a computer and cellphone."

And what is your current situation?

"Even today, five years later, I am unable to function and care for my child without the help of a therapist. Alongside the cognitive impairment, I suffer from mental trauma that accompanies me both days and nights." 

You stopped taking the 35th treatment, but to your words right from the beginning, you experienced significant damage. Why did you go on?

"I continued with treatments because I was repeatedly promised that these were normal symptoms that would pass, and that there was no alternative in my condition. I became submissive and obedient. Whatever cognitive impairment was so severe that I could not exercise judgment." 

Estimates are estimated to be given to over one million people worldwide each year (of which about 100,000 are in the United States)***, but the exact number of patients is unknown. According to the Ministry of Health, in 2005, approximately 6,000 people were treated with electricity. Man, but at this time no recent data from recent years.In the distant past, the treatment was performed without anesthesia and without muscle relaxants, and patients suffered from convulsions and even bone fractures, and is currently under full anesthesia and lasts up to ten minutes. 

Unlimited treatments

The treating staff includes a psychiatrist, nurse and anesthesiologist. The patient is connected to a monitor to measure blood pressure, sturgeon (blood oxygen level) and heart rate, as well as electrodes that monitor the electrical activity of his brain (EEG). Electrodes connected to a special stimulator are coupled by two methods, one-sided or right-sided, with the electrical stimulation being powerful (between 250 and 460 volts) but short (less than one second in length). At the end of the procedure, the patient is monitored for recovery for about half an hour and released to his home.

As mentioned, despite the widely held view that this is the most effective and safe treatment, there are studies and experts who claim the results of significant, and sometimes irreversible, damage as a result of the treatment. 

Professor Harold Zackheim (sic), who is considered a major researcher in the field and who has promoted the treatment of electrical disorders, admitted that it took the psychiatric establishment time to take into account the adverse effects of the treatment. In 2007, Professor Zackheim (sic) published a large-scale study that first tracked a large sample of hundreds of patients from various centers across the United States and determined that the treatment of electrical tremors could cause ongoing memory impairment and cognitive impairment, affecting patients' functioning. 

The procedure itself has undergone changes over the years, even with regard to how the electric current is transmitted to the brain (the type of electric wave), which the proponents of therapy say has reduced the side effects. On the other hand, many variables exist in relation to its performance, as Professor Zackheim (sic) himself testified, as a weak point and a source of criticism, arguing that this is the source of the possible damage and thus preventing it.

The source of the damage is difficult to find 

Over the years, the medical device through which the treatment is performed does not require pre-market approval, ie controlled clinical trials to prove safety and efficacy (testing the treatment with a control group to evaluate its results, D). Economic, bureaucratic, and ethical (a lengthy process that could have prevented access to care.) The issue of how medical device supervision in this context has drawn ongoing debate in the United States between the treatment specialists and its critics. Finally, last year, the regulator ruled that medical devices would be classified as having a "moderate" level of risk for treating depression and catatonia, while relying on research literature in the field, which proves to be of sufficient effectiveness and safety. This is to the displeasure of patients claiming damages. 

The demand for stricter supervision over how to treat and monitor side effects has given rise to protests on the network of patients and their families, to which thousands have so far signed. In this context, it should be noted that there is no limit to the number of treatments that can be performed, which is objectionable in patients who claim long-term and irreversible damage as a result. 

A case of this kind can be found in the story of California resident Sarah Hancock, a tremendous lead author of a petition circulated online last month. Until about a decade ago, Hancock received a series of 116 treatments, claiming ongoing brain damage and neuromotor impairment, which led to speech problems. "Until the treatment of electric shocks has standardization and strict regulation, doctors, nurses, medical staff, patients and their families will not be able to understand and take into account all possible risks of treatment," the petition reads. 

Regarding the safety issue of treatment, petitioners argue that "the use of the word 'rare' to describe the risk of brain damage and loss of memory due to power sores is misleading, because without a standard and universal protocol for supervision and performance, and without routine assessment and monitoring of any patient, "There is never a clear indication of the prevalence of brain damage. This is in addition to the fact that researchers have never followed patients for more than six months from the end of treatment to detect or detect cognitive impairment." One of the key requirements of this petition is to conduct comprehensive pre- and post-treatment testing to detect any adverse effects ahead of time and to prevent serious or irreversible damage. 

A painful door slam
T. says that the psychiatrist and staff who performed her treatment knew she was leaving them in a state of trauma, with a complaint of cognitive impairment, and yet no physical, emotional or cognitive status was monitored. "If any of them bother to make statistics, I wouldn't be surprised if I'm considered a success," she says.

"Today I know that the protocol does not require follow-up treatment, so as far as I understand, I was not an exceptional case. The protocol in Israel also does not require comprehensive cognitive testing before treatment. Of the patient, and the way of the world is to believe in the doctors and not the "crazy ones." 

For the past two years, Th has been engaged in extensive research on electric power and has been in contact with some of the world's leaders in the struggle - former patients and therapeutic professionals, some of whom require the treatment of the law. She said, "Everyone agrees that there is a need for regulation, which does not exist today." The campaign that Th is planning will be called "power outage," and is currently setting up a Hebrew site that will concentrate on all evidence-based research in the field, including legal advances. 

Patients sign a consent form before performing the treatment.

"True. But not all possible side effects are included in the informed consent form. One year ago, Somatics - from the companies that manufacture the device through which treatment is performed - had to publish the list of side effects. Here are some not to mention: motor injury, aggression, heart complications, stroke, Cerebral pneumonia, coma (floor) and highlight - the symptoms that treatment should prevent, namely exacerbation of psychiatric symptoms such as mania, hypomania, depression, psychosis and increased risk of suicide. " 

"Addiction to treatment," Actress Carrie Fisher 

And yet, on the other hand, there are many patients who claim that treatment has saved their lives.

"Some also say that the cognitive damage done to them is significant, but lucrative. For example, actress Kerry Fisher, star of Star Wars, became addicted to treatment and also wrote a book about it. She became the presenter of the treatment but admitted that one of the reasons for writing the book was the significant impairment of her memory and desire Document her life. "

What else did you discover during your field activities?

"As an activist, I am exposed to countless stories, personal conversations and support groups of former patients. Almost everyone, like my story, did not have a psychiatrist who was serious about their side effects. They experienced a painful door slam, no rehabilitative response. Be warned about the side effects to the fullest, and most have experienced the horrible feeling in which the therapist becomes blind to their reports and bears the blame for the disease itself. 

"Although psychiatrists try to shatter the stigma surrounding the treatment, claiming it is done under anesthesia and muscle relaxation - precisely because of these substances, which raise the threshold of convulsions, electrical tension is often needed, almost three times as much as it used to be. In addition, because the procedure involves So many are changing and changing from one medical center to the next, psychiatrists have a very hard time conducting a reliable study to evaluate it.

P. (48), a Northern resident, remarried and father of three, is a successful hospitality and hotel business. In the past he suffered from severe depression, was treated with medication and became resistant to drug treatment. "The first seizure was in 1997. I got Effexor for six months, I got back and was fine," he says. "In the second seizure, in 2006, I had a very strong seizure, got me off Effexor and tried a variety of treatments. At one point, they stopped having an effect and I felt terrible. ". 

The power to fight is over
Twelve years ago he was treated with electricity, and at the end of a series of 12 treatments he decided to stop. "I ran away like a fire," he says. "If I could go back in time, I wouldn't sign the consent form. I felt worse. My condition got worse, I started having crazy nausea that was driving my body crazy. As time went on, the more my personality structure felt Variable, I become indifferent and slow. At one point, I saw that I had to deal with lists to be able to remember or understand what I was doing. Customers were very hurt by my behavior. My wife left me. Depression is a devastating disease, you lose everything. I couldn't function as a father, as a husband, The financial situation was bad, the burden on the divorced was unbearable. " 

Today you are back to Effexor. Is it possible that the treatment of electric shocks helped?

"Reverse. The treatment did not make any difference, a fact that we tried more drugs. It was a long time before I came to the same professor who made the decision to return me to the first treatment, at a higher dose. That's what helped me. Beyond that, 12 years later, I have to register immediately "Anything that happens, otherwise I forget. Alongside that, I have a severe impairment of concentration and attention, and every learning process is accompanied by tremendous effort."

Were you aware of the possible side effects of treatment?

"Anyone who is in severe depression is ready to do anything, and will easily sign anything to get him out of this unbearable nightmare. Only the cost of the treatment can be devastating. Luckily, I went out cheap. I rehabilitated myself, and I'm in good functional condition. Faith to get out of the situation. I believed there had to be a way to get back to myself, and I learned to admit what I have in life. "

My father, too, (47), tells of a severe memory impairment following one treatment with electric shocks. At age 30, he was defined as depressed, due to borderline personality disorder. According to him, in 2013 he took drug treatment that was successful, but not for long. "I thought I was on the wave, I had a bakery business, I thought I was going out of the crisis, but after a few months the depression returned. I fell asleep and stopped functioning." 

Who recommended you for the treatment of electric shocks?

"I asked for my initiative to go through it. I heard it helped a lot of people, and I wanted to find a quick solution. I read that it could hurt my memory, but I couldn't believe it. In 2014, I went to a day hospital in the north, where I went through treatment. About two weeks later, while I was at a friend in Tel Aviv, my brother asked me to bounce something to Holon, I remember being shocked because I couldn't remember what the general direction was. The least I knew was simply erased. If, in the future, I am allowed to go abroad, there is no way I can communicate. " 

Did all this happen from just one treatment? 

"Definitely yes. In the past I was one of those who roamed the whole country, I knew all the roads and routes, I was a weasel, the sense of orientation in the space was very high. I mostly had a sense of independence. Today I am a dependent person. "I need a physical escort of another person. I can't get anywhere new alone. In the past, I used to go every week to my mother's house, from Netanya to Rishon Lezion.

Did you report these side effects?

"Yes. Doctors do not think it is about electricity, but my illness. What is upsetting is that if I had managed my business in the past even when I was depressed - very hard, but I did - today I do not even remember how to do all these things. To fight for a solution to the situation. I have no choice but to accept that there is no turning back and that the damage has already been done. "

"The family saved me"
For Maya (Maika) Ferrer, 39, Shefit and a successful caterer, painter, and sculptor, the power stunt is a real trauma. "I was a nature child, and all I wanted to do was run in the fields and create," she says, "When I went to first grade, the frame, board and notebooks turned me off. I felt trapped, stopped communicating with the environment. "I came to psychiatry very much. I tried every possible drug treatment that could kill me, and I had side effects that impaired my function. Beyond being obscure, I had muscle weakness and lost appetite, which contributed even more to weight loss." 

"It's important that people suffering from mental health problems are not ashamed." -Maya Ferrer

She is a native of Crane Seat in the Western Galilee, a daughter of a textile engineer and artist who immigrated from South Africa. "It is important to me that people who suffer from mental health problems are not ashamed. They are not guilty of their condition and they deserve dedicated and sensitive therapists who will listen to them. It is important to me that they know that they are not alone in the campaign.

"Four years ago, I had an episode of depression and I was hospitalized. I was offered the treatment of electric shocks. I don't know if it helped me get out of the depression, but I can say for sure that the physical trauma was terrible. They say the treatment doesn't cause suffering, but it's just not true. When you wake up feeling the physical trauma, I remember lying on a wheelchair with a headache that is an inordinate pain. You feel your body is just electrified, it's a terrible feeling. To this day I have cognitive impairment, I have lost entire parts of my life. People who knew me, and they were disappointed to find out that I just didn't know who they were, couldn't remember them.

Are you sure that memory impairment is related to therapy?

"Yes. This is an ongoing injury that started after the treatment, and I suffer from it to this day. I did not complain, when you come out of the hospital after such an experience, the last thing you have the energy to do is fight, and frankly, I didn't think anyone would listen to me.

"I don't want to imply that I'm against the field of psychiatry. I personally found the psychiatrist who helped me get out of the condition I was and almost completely dropped me off the drug treatment. Only she was one of the dozens I met during my life. And realizing myself. Without my family, I wouldn't be sitting here with you today. I couldn't have gone through this journey without their support. I can't imagine what it means for others to go through it without support. "

Escape from the question marks
Veteran psychiatrist, Dr. Peter Breggin, a resident of New York State, is one of the leading opponents in the treatment of electrical disorders. Breggin has established a site that concentrates and updates more than 150 scientific studies and documents dealing with the procedure and its implications, arguing that treatment must be prohibited because it inevitably causes brain damage. The cases are irreversible. 

"The process causes epileptic seizures, sometimes more powerful than the Grand Mal (Tony Clooney's attack, attributed to epilepsy patients and sudden loss of consciousness), to temporary coma and often to flushing of the brainwave - a precursor to brain death," he says. Reversible, and there are also persistent impairments in cognitive function, such as difficulties in concentration and difficulties in learning new material. "

In a 2012 research article reviewing brain imaging in patients with electrical disorders, he testified to "a change in brain functional architecture," Dr. Breggin explained that this is evidence of a reduction in the activity of that neural region that connects the frontal lobes to the rest of the brain - "the same part The thinker, pondering, creative, who deals with insights and love. " Or removed from each other).

Dr. Ruhama Merton, a veteran psychiatrist who worked for many years in the public service and later founded the Human Rights Physicians Organization and headed it for 30 years, emphasized the significance of the effect of the treatment of electric shock. "Electric shock is not much different from lobotomy," she says. The goal is the same: to isolate the person from his or her personality. Modern medicine has found a sophisticated way of shackling the injured person. Instead of tying it up in chains and between walls, the treatment of electric shocks insulates it from its individuality. He walks away from himself, for better or worse, incarcerated outside the problem, but also outside the solution itself. " 

Merton also emphasizes that psychiatry has no alternative to electrical therapy: "Psychiatrists simply do not have to be in the position of asking questions about electrical therapy, a treatment that psychiatry is dependent on. If the drugs do not help, they have no other solutions. They will want to protect her insanely. "

US neurologist Dr. John Friedberg insisted that memory impairment was not a side effect of the treatment of electrical disorders, but its main effect. In 2001, when he testified at a New York Mental Health Committee meeting about the end of the procedure, A way to get around the damage done to electric power. The intensity of the energy transferred to the brain is equal to the energy needed to light a 100-volt light bulb for one second, or to throw a 30-pound object from a 30-cm distance on the head."

English psychologist Professor John Read, who has been in the UK and US mental health administration for nearly 20 years, argued: "In the 1940s, the brain impaired memory in order to relieve the patient, but later stopped talking about it. In these terms. "Another of his claims is that at the research level," there is no single controlled study that has shown that the treatment of electric shocks is more effective than placebo (anesthesia only) beyond the first few weeks after treatment. Statistics show that a third of patients experience temporary relief, which will pass after a few weeks. " 

At the same time, Professor Read claims that "close to a third will experience continuous memory loss as a result of brain damage." He adds that while the psychiatric establishment has argued that treatment prevents suicide risk - "this claim relies on anecdotal evidence that is not one-sided."

"The benefit is higher than the price"
Alongside the hard evidence, most psychiatric establishments seem to recognize the effectiveness, safety, and importance of veteran care. Those who witnessed their medical experience being critical in serious mental health conditions include Dr. Moshe Isserles, director of the Depressive Depression Treatment (chronic, severe depression, whose patients are unresponsive to drug therapy) and brain stimulation in the psychiatric ward of Hadassah Medical Center, 2003 He said he had seen quite a few cases over the years in which the treatment saved from suicide, relieved depression and prevented severe psychotic seizures.

"There are a lot of people who suffer from depression and schizophrenia that drug treatment just doesn't help them, and sometimes it is harmful," he says. "When I realize that the source of the problem is biological and that drug-resistant treatment is often the best option, treatment is done under full anesthesia, accompanied by Murphy. Muscles, and only about ten minutes long, so that the patient does not experience any suffering during the course.

"I have quite a few success stories. For example, a patient who suffered from bipolar disorder and his manic attacks were very extreme. He received all the possible drugs, including lithium, which is a very powerful drug given during manic attacks as a mood stabilizer, just that nothing He also had to undergo a kidney transplant because of the side effects of the drugs, and finally he received one course of electric medicine, namely a series of 12 treatments, and entered a remission of nearly two decades, and to my knowledge also stopped receiving drug treatment. Another manic attack, he got electric shocks again, and entered again for a continuous respite. " 

Dr. Islerles tells of another, very difficult, case of a 50-year-old patient receiving a schizophrenia drug. "Due to extremely severe side effects that included a significant injury to white blood cells and severe obesity, he was hospitalized intensive care," he says. It goes into catatonic mode (motor deadlock with no response to the environment). We already thought he wouldn't come out alive from the hospital. As a last resort, it was decided to perform electric braces in intensive care, and to our delight, he left the hospital on his feet. 

"For cost-benefit considerations, the benefit is much higher than the cost. This treatment draws people out of depression, returns them to function, and can release patients from high doses of medication. Between 60 and 70 percent of patients will go out of depression and return to function.

How many patients receive maintenance treatment?

"Nearly half of them require maintenance treatments, because there is no complete cure. Maintenance can be done twice a week or once a month." [Important to note that there is no regulation at this time as to how frequently maintenance ECT is given].

Some patients claim that treatment has significantly damaged their memory.

"I have encountered memory impairment, but not the vulnerability that I have experienced that is significant or irreversible. According to professional literature, damage that persists over time and significantly impairs functioning or quality of life is rare. Significantly, through the positive effect on the symptoms of depression, there may be remnants of a cognitive problem, but the patient will still be in a better cognitive state after a power outage because the depression has been treated.

"If it was possible to do research that takes people who have a first wave of moderate to severe biological depression and have not been given medication, and some give medicine and others some electric power, I would not be surprised if electric power is more effective, even in the long term. Chronic illness that tends to recur. We get people whose brains have changed from drugs, and some may become drug resistant. The chance that one course of electricity will last them forever is low. So there are two options: either pursue drugs in different combinations, or perform electricity and continue maintenance therapy."  

Ministry of Health Response: 
"The Ministry of Health does not have accurate data on the number of recipients of electricity treatment [because it's not regulated or audited]. Generally speaking, electricity treatment is one of the most effective and safe treatments, which for historical and cultural reasons carries a negative image and suffers from poor public relations without proper justification. As a result, access to care for those who need it is impaired. Contraindications for the treatment of electrical disorders are varied and include mood disorders (depression and mania), catatonic and other psychotic conditions, resistant to drug therapy, and electrical therapy can also be effective in conditions of Parkinson's disease and epilepsy resistant to treatment. 

"Regarding one of the side effects - the Ministry of Health procedure recommends pre-treatment cognitive evaluation. During the treatment and afterwards it is possible to make repeated assessments according to the clinical need. 

"Informed consent form does not exhaust the informed consent process, which takes place between the therapist and the patient as a condition of treatment. As with any treatment, the cautious position that manufacturer's warnings (especially in the US) aimed at legal protection of the company should be distinguished from the clinical position, which is intended to allow For a patient suffering from a disease, it is difficult to consider informed consent for treatment. The role of the physician is to explain to the patient the potential for harm versus the benefit potential, with reference to the side effects. 

"In the past, the treatment involved significant memory impairment, but in recent decades there have been technological improvements that have reduced the potential for harm. Today, the incidence of memory impairment is often temporary and reversible. Sometimes, depending on the severity of the mental state, the patient chooses to continue treatment despite the minor memory loss that is expected to occur. - While exercising an informed and relevant system of therapeutic benefits against the side effects, it should be borne in mind that the drug alternatives also have quite a few side effects, which may be more severe than those of the treatment of electrical fever. 

"Research has shown that electrocution does not cause any damage to brain tissue (including microscopic damage), even in people who have received hundreds of treatments throughout their lives. ****Please see peer-reviewed citations below**** 

 Response of the Psychiatric Association in Israel:
"First of all, because of the stigma against the treatment of electricity, some sufferers of severe depression and loss who refuse to receive this life-saving treatment. Sometimes the results of tragic avoidance. Treatment of electric power is very important, and is made according to the procedures of the Ministry of Health and in accordance with the Western world. Pre-treatment cognitive function testing is performed at the discretion of the attending physician, the patient's condition and ability to cooperate in this complex examination, and the preparation and approval process for conducting the treatment is complex, including laboratory tests, neurological examination, examination by a physician, and physician. Anesthesia, a preliminary conversation with the patient himself And / or his or her family members, as well as the involvement of the department manager, the hospital or his / her deputy in making the decision to perform and approve the treatment, and according to a clear and orderly standardization. Furthermore, the treatment is performed in Israel and the world solely through the demonstration of its efficacy by reliable clinical studies.

Regarding regulation - FDA treatment is approved by the FDA and the labeling in Israel is the same as in the US. " 

Citations for microscropic damages related to ECT's electrical injury 

1. American Psychiatric Association. (1978). Electroconvulsive therapy: Task Force report. Washington D.C. Retrieved from https://www.psychiatry.org/File Library/Psychiatrists/Directories/Library-and-Archive/task-force-reports/tfr1978_ECT.pdf

2. Breggin, P. R. (1986). Neuropathology and Cognitive Dysfunction From ECT. Psychopharmacology Bulletin, 22(2), 476–479. Retrieved from http://breggin.com/wp-content/uploads/2008/01/neuropathologyand.pbreggin.1986.pdf

3. Calloway, S. P., Dolan, R. J., Jacoby, R. J., & Levy, R. (1981). ECT and cerebral atrophy. Acta Psychiatrica Scandinavica, 64(5), 442–445. https://doi.org/10.1111/j.1600-0447.1981.tb00803.x

4. Ferraro, A., Roizin, L., & Helfand, M. (1946). Morphologic changes in the brain of monkeys following convulsions electrically induced. Journal of Neuropathology & Experimental Neurology, 5, 285–308. https://doi.org/10.1097/00005072-194610000-00002

5. Ferraro, A., & Roizin, L. (1949). Cerebral Morphologic changes in monkeys subjected to a large number of electrically induced convulsions (32-100). The American Journal of Psychiatry, 106(October), 278–284. https://doi.org/10.1176/ajp.106.4.278

6. Friedberg, J. (1977). Shock treatment, brain damage, and memory loss: a neurological perspective. American Journal of Psychiatry, 134(9), 1010–1014. https://doi.org/10.1176/ajp.134.9.1010

7. Hartelius, H. (1952). Cerebral Changes Following Electrically Induced Convulsions: An experimental study on cats. Acta Psychiatrica et Neuroligica Scandinavica (Vol. Supplement). Copenhagen. Retrieved from http://www.ectresources.org/ECTscience/Hartelius_1952___Animals___Brain_damage__Definitive_.pdf

8. Kragh, J., Bolwig, T. G., Woldbye, D. P. D., & Jørgensen, O. S. (1993). Electroconvulsive shock and lidocaine-induced seizures in the rat activate astrocytes as measured by glial fibrillary acidic protein. Biological Psychiatry, 33(11–12), 794–800. https://doi.org/10.1016/0006-3223(93)90020-E

9. Orzi, F., Zoli, M., Passarelli, F., Ferraguti, F., Fieschi, C., & Agnati, L. F. (1990). Repeated electroconvulsive shock increases glial fibril- lary acidic protein, ornithine decarboxylasc, somatostatin and cholecystokinin immunoreactivities in the hippocampal formation of the rat. Brain Research, 533, 223–231. https://doi.org/https://doi.org/10.1016/0006-8993(90)91343-F

10. Mclaren, N. (2017). Electroconvulsive Therapy: A Critical Perspective. Ethical Human Psychology and Psychiatry, 19(2), 91–104.

Citations for ECT's electrical injury causing acquired channelopathies

11. Chen, R., Li, Y. J., Li, J. Q., Lv, X. X., Chen, S. Z., Li, W. Z., … Li, X. Y. (2011). Electrical injury alters ion channel expression levels and electrophysiological properties in rabbit dorsal root ganglia neurons. Burns, 37(2), 304–311. https://doi.org/10.1016/j.burns.2010.08.006

12. CHEN, W., & LEE, R. C. (1994). Evidence for Electrical Shock–induced Conformational Damage of Voltage‐gated Ionic Channels. Annals of the New York Academy of Sciences, 720(1), 124–135. https://doi.org/10.1111/j.1749-6632.1994.tb30440.x

13. Chen, W., Zhongsheng, Z., & Lee, R. C. (2006). Supramembrane potential-induced electroconformational changes in sodium channel proteins: A potential mechanism involved in electric injury. Burns, 32(1), 52–59. https://doi.org/10.1016/j.burns.2005.08.008

14. Kragh, J., Bolwig, T. G., Woldbye, D. P. D., & Jørgensen, O. S. (1993). Electroconvulsive shock and lidocaine-induced seizures in the rat activate astrocytes as measured by glial fibrillary acidic protein. Biological Psychiatry, 33(11–12), 794–800. https://doi.org/10.1016/0006-3223(93)90020-E

15. Lee, R. C. (2005). Cell Injury by Electric Forces. Annals of the New York Academy of Sciences, 1066, 85–91. https://doi.org/10.1196/annals.1363.007

16. Lee, R. C. (2011). Injury by Electrical forces: Pathophysiology, manifestations, and therapy. Current Problems in PTCA, 34(9), 680–764. https://doi.org/10.1007/978-3-642-72407-7

***In 2004, Dr. Harold Sackheim testified under oath that more than two million people receive ECT internationally each year.  That number has likely grown with the redution of "stigma" regarding it's practice and the reclassification of the ECT device for use on children ages 13 and older as a "class II" device.