Skip to main content
SpringerLink
Log in

Last Resort Interventions?: A Qualitative Study of Psychiatrists’ Experience with and Views on Psychiatric Electroceutical Interventions

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Psychiatrists play an important role in providing access to psychiatric electrical interventions (PEIs) such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). As such, their views on these procedures likely influence whether they refer or provide these types of treatments for their clinically depressed patients. Despite this, scholars have too infrequently examined psychiatrists’ views about specific PEIs and have not yet examined their views across different PEIs. To gain insight into psychiatrists’ views about PEIs, we conducted a qualitative study based on semi-structured interviews with 16 psychiatrists in Michigan. The majority of psychiatrists had a positive attitude towards PEIs in general. One-third reported cautionary attitudes towards PEIs; they did not reject the interventions but were skeptical of their effectiveness or felt they needed further development. The majority of psychiatrists consider ECT and TMS to be viable therapies that they would discuss with their patients after several failed medication trials. There was a lack of knowledge about surgical PEIs, such as deep brain stimulation. This study provides insights into how psychiatrists perceive PEIs. While broadly positive attitudes exist, this research highlights certain challenges, particularly lack of knowledge and ambiguity about the use of PEIs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Famm K, Litt B, Tracey KJ, Boyden ES, Slaoui M. Drug discovery: a jump-start for electroceuticals. Nature. 2013;496:159–61.

    Article  CAS  Google Scholar 

  2. McKhann G. Stimulating the brain: electroceuticals. The Dana Foundation 1–3, 2015.Available from: http://www.dana.org/Brain_in_the_News/Stimulating_the_Brain__Electroceuticals/

  3. Reardon S. Electroceuticals spark interest. Nature news. 2014;511:1–1.

    Google Scholar 

  4. Strickland E. Latest From SXSW: Big Pharma’s big bet on Electroceuticals. IEEE Spectr 1–3, 2016.Available from: http://spectrum.ieee.org/the-human-os/biomedical/devices/latest-from-sxsw-big-pharmas-big-bet-on-electroceuticals

  5. Aaronson ST, Carpenter LL, Conway CR, Reimherr FW, Lisanby SH, Schwartz TL, et al. Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects. Brain Stimul. 2013;6:631–40.

    Article  Google Scholar 

  6. Conway CR, Cristancho P, Schlaepfer TE Neurostimulation Treatments in Psychiatry: An Overview and Recent Advances Psychiatry Times 1–4, 2013.

  7. Dell’Osso B, Oldani L, Camuri G, et al. Augmentative repetitive transcranial magnetic stimulation (rTMS) in the acute treatment of poor responder depressed patients: a comparison study between high and low frequency stimulation. Eur Psychiatry 1–6, 2015.

  8. Solvason HB, Husain M, Fitzgerald PB, Rosenquist P, McCall WV, Kimball J, et al. Improvement in quality of life with left prefrontal transcranial magnetic stimulation in patients with pharmacoresistant major depression: acute and six month outcomes. Brain Stimul. 2014;7:219–25.

    Article  CAS  Google Scholar 

  9. Weiner RD, Reti IM. Key updates in the clinical application of electroconvulsive therapy. Int Rev Psychiatry. 2017;29:54–62.

    Article  Google Scholar 

  10. Bergfeld IO, Mantione M, Hoogendoorn MLC, Ruhé HG, Notten P, van Laarhoven J, et al. Deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression. JAMA Psychiat. 2016;73:456.

    Article  Google Scholar 

  11. Choi KS, Riva-Posse P, Gross RE, Mayberg HS. Mapping the “depression switch” during intraoperative testing of subcallosal cingulate deep brain stimulation. JAMA Neurol. 2015;72:1252–60.

  12. Ilse G, Martijn F, Damiaan D. The application of deep brain stimulation in the treatment of psychiatric disorders. International Review of Psychiatry 0: −000, 2017.

  13. Lipsman N, Sankar T, Downar J, Kennedy SH, Lozano AM, Giacobbe P. Neuromodulation for treatment-refractory major depressive disorder. Can Med Assoc J. 2014;186:33–9.

    Article  Google Scholar 

  14. Pierce RC, Vassoler FM. Deep brain stimulation for the treatment of addiction: basic and clinical studies and potential mechanisms of action. Psychopharmacology. 2013;229:487–91.

    Article  CAS  Google Scholar 

  15. Fins JJ, Mayberg HS, Nuttin BJ, Kubu CS, Galert T, Sturm V, et al. Misuse of the FDA's humanitarian device exemption in deep brain stimulation for obsessive-compulsive disorder. Health Aff. 2011;30:302–11.

    Article  Google Scholar 

  16. Shen H. Tuning the brain. Nature. 2014;507:290–2.

    Article  CAS  Google Scholar 

  17. Yue Z, Moulton SE, Cook M, O'Leary S, Wallace GG. Controlled delivery for neuro-bionic devices. Adv Drug Deliv Rev. 2013;65:559–69.

    Article  CAS  Google Scholar 

  18. Dauenhauer LE, Chauhan P, Cohen BJ. Factors that influence electroconvulsive therapy referrals. J ECT. 2011;27:232–5.

    Article  Google Scholar 

  19. Finch JM, Sobin PB, Carmody TJ, et al. A survey of psychiatrists’ attitudes toward electroconvulsive therapy. Psychiatr Serv. 1999;1–2.

  20. Lutchman RD, Stevens T, Bashir A, et al. Mental health professionals' attitudes towards and knowledge of electroconvulsive therapy. J Ment Health. 2009;10:141–50.

    Google Scholar 

  21. Schweder LJ-V, Lydersen S, Wahlund B, Bergsholm P, Linaker OM. Electroconvulsive therapy in Norway. J ECT. 2011;27:292–5.

    Article  Google Scholar 

  22. Stern AP, Boes AD, Haller CS, Bloomingdale K, Pascual-Leone A, Press DZ. Psychiatrists' attitudes toward transcranial magnetic stimulation. Biol Psychiatry. 2016;80:e55–6.

  23. Ali R, DiFrancesco MF, Ho AL, et al. Attitudes toward treating addiction with deep brain stimulation. Brain Stimulation. 2016;9:1–3.

    Article  Google Scholar 

  24. Cormier J, Iorio-Morin C, Mathieu D, Ducharme S. Psychiatric neurosurgery: a survey on the perceptions of psychiatrists and residents. Can J Neurol Sci. 2019;46:303–10.

    Article  Google Scholar 

  25. Naesstr M, Blomstedt P, Hariz M, Bodlund O. Deep brain stimulation for obsessive-compulsive disorder: knowledge and concerns among psychiatrists, psychotherapists and patients. Surg Neurol Int. 2017;8:298–6.

    Article  Google Scholar 

  26. Cabrera LY, Courchesne C, Kiss ZHT, et al. Clinical perspectives on psychiatric neurosurgery. Stereotact Funct Neurosurg. 2020;97:391–8.

    Article  Google Scholar 

  27. Sadowsky J. Electroconvulsive therapy in America. Routledge, 2017.

  28. Frank L. The pleasure shock. Penguin, 2018.

  29. Marshall C, Rossman GB. Designing Qualitative Research, 6th ed. SAGE, 2016.

  30. Miles MB, Huberman AM, Saldaña J. Qualitative Data Analysis. SAGE, 2013.

  31. Hsieh HF. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.

    Article  Google Scholar 

  32. Sandelowski M. Focus on research methods whatever happened to qualitative description? Res Nursing Health. 2000;23:334–40.

    Article  CAS  Google Scholar 

  33. Bhriain SN, Malone K. ECT: a controversial but effective treatment. Ir J Psychol Med. 2003;20:74–6.

    Article  Google Scholar 

  34. Ross EL, Zivin K, Maixner DF. Cost-effectiveness of electroconvulsive therapy vs pharmacotherapy/psychotherapy for treatment-resistant depression in the United States. JAMA Psychiat. 2018;75:713–0.

    Article  Google Scholar 

  35. Donahue AB. Electroconvulsive therapy and memory loss. J ECT. 2000;16:133–43.

    Article  CAS  Google Scholar 

  36. Beale MD, Kellner CH. ECT in treatment algorithms: no need to save the best for last. J ECT. 2000;16:1–2.

    Article  CAS  Google Scholar 

  37. Hariz M, Blomstedt P, Zrinzo L. Future of brain stimulation: new targets, new indications, new technology. Mov Disord. 2013;28:1784–92.

    Article  Google Scholar 

  38. Klein E, Goering S, Gagne J, et al. Brain-computer interface-based control of closed- loop brain stimulation: attitudes and ethical considerations. Brain-Computer Interfaces 1–9, 2016.

  39. Kalayam B, Steinhart MJ. A survey on the use of electroconvulsive. Hosp Community Psychiatry. 1981;32:1–4.

    Google Scholar 

  40. Kerr RA, McGrath JJ, O'kearney RT, et al. ECT: misconceptions and attitudes. Australian & New Zealand J Psychiat. 2009;16:43–9.

    Article  Google Scholar 

  41. McDonald A, Walter G. The portrayal of ECT in American movies. J ECT. 2001;17:264–74.

    Article  CAS  Google Scholar 

  42. Walter G. About to have ECT? Fine, but don't watch it in the movies: the sorry portrayal of ECT in film. Psychiatr Times. 2004;21:65–5.

Download references

Acknowledgments

We further thank our participants for their time and insightful responses. We also thank Marissa Cortright and Emily Castillo for their support in coding the interviews.

Availability of Data and Material

Access to interview data is available upon request.

Code Availability

NA

Funding

This work was supported by the NIH BRAIN-NIMH under Grant number: 1RF1MH117802–01, PI: LC.

Author information

Authors and Affiliations

  1. Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Fee Hall, 965 Wilson Road, Rm C211, East Lansing, MI, 48824, USA

    L. Y. Cabrera & G. R. Nowak III

  2. Department of Translational Neuroscience, Michigan State University, East Lansing, MI, USA

    L. Y. Cabrera

  3. Department of Sociology, Michigan State University, East Lansing, MI, USA

    G. R. Nowak III & A. M. McCright

  4. Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, USA

    E. Achtyes

  5. Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA

    E. Achtyes

  6. Lyman Briggs College and Dept. of Philosophy, Michigan State University, East Lansing, MI, USA

    R. Bluhm

Authors
  1. L. Y. Cabrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. R. Nowak III
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. M. McCright
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Achtyes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Bluhm
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Laura Y. Cabrera, Robyn Bluhm, Aaron McCright; Methodology: Laura Y. Cabrera, Robyn Bluhm; Formal analysis and investigation: Laura Y. Cabrera, Robyn Bluhm; Writing - original draft preparation: Laura Y. Cabrera, Gerald R. Nowak III (discussion); Writing - review and editing: Robyn Bluhm, Gerald R. Nowak III, Aaron McCright, Eric Achtyes; Funding acquisition: Laura Y. Cabrera; Resources: Eric Achtyes; Supervision: Laura Y. Cabrera, Robyn Bluhm, Aaron McCright.

Corresponding author

Correspondence to L. Y. Cabrera.

Ethics declarations

Conflict of Interest

LC, RB, and AM have no conflicts of interest to declare. EA has received research support from the following entities in the preceding 12 months: Alkermes, Astellas, Biogen, Boehringer-Ingelheim, InnateVR, Janssen, National Network of Depression Centers, Neurocrine Biosciences, Novartis, Otsuka, Pear Therapeutics, Takeda, and the Vanguard Research Group. He has also served on advisory boards or consulted with: Alkermes, F. Hoffman-La Roche, Janssen, Otsuka/Lundbeck, and Sunovion.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 31 kb)

ESM 2

(DOCX 21 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cabrera, L.Y., Nowak, G.R., McCright, A.M. et al. Last Resort Interventions?: A Qualitative Study of Psychiatrists’ Experience with and Views on Psychiatric Electroceutical Interventions. Psychiatr Q 92, 419–430 (2021). https://doi.org/10.1007/s11126-020-09819-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-020-09819-1

Keywords

Search

Navigation