Author | Max Fink, MD


ECT for Self-Injurious Behavior in Autism: A New Indication

February 15, 2018


ECT has been found effective in mitigating the deleterious consequences of SIB.

ECT for Catatonia and Melancholia: No Need for Ambivalence

September 28, 2017


For ethical and economic reasons, when patients are acutely ill with catatonia and melancholia, ECT is best considered sooner rather than later.

Revive Flurothyl Inhalation Therapy

March 19, 2014


A reexamination of flurothyl infusions holds promise for improved resolution of severe mood disorders, as well as for a greater understanding of the mechanism of their pathophysiology.

The Race to Patent Bio-tests for Schizophrenia and Depression

November 18, 2011


The articles by Arline Kaplan and Hagop Akiskal, MD, in the November 2011 issue of Psychiatric Times highlight the race to patent bio-tests for schizophrenia and depression.

Alfred M. Freedman, MD, 1917-2011

June 28, 2011


Alfred Freedman was an eminent psychiatric educator, a leader of his profession, and a man willing to challenge public prejudice. He was also one of my closest friends.

The Perplexing History of ECT in Three Books

August 12, 2010


Despite these divergent books, it is important to avoid characterizing ECT as controversial. The Shorter-Healy and Dukakis books should dampen the controversy, because they characterize ECT as a safe, effective, and important treatment that psychiatry almost forgot. With its emotion-laden accusations and name-calling, the Andre book will inflame opinions.

DSM-V: Applying the Medical Model

June 09, 2009


In “Changes in Psychiatric Diagnosis” (Psychiatric Times, November 2008, page 14) Michael First relates the sad fact that the reorganization of DSM is still without formal guidelines and continues to be subject to the vicissitudes of groupthink and vocal constituencies. He relates that he and Allen Frances envisioned the application of biologically based diagnostic criteria when summarizing the work of DSM-IV, but complains that no criteria are forthcoming as yet.

Why Evidence-Based Medicine Cannot Be Applied to Psychiatry

April 01, 2008


Evidence-based medicine (EBM) is rapidly becoming the norm. It is taught in medical schools and is encouraged by both government agencies and insurance plan providers. Yet, there is little proof that this model can be adapted to fit psychiatry.

Major Studies on ECT for Depression: What Have We Learned?

October 01, 2007


Early relapse is a limiting defect in electroconvulsive therapy (ECT). Although more than 80% of patients with a severe depressive illness who complete an acute course of ECT are relieved within three weeks, up to 60% relapse within six months, despite continuation treatments with antidepressant medications.1,2 In a large, government-supported, collaborative study led by the Columbia University Consortium (CUC), patients with unipolar major depression that had failed to respond to multiple trials of medications were treated with ECT to clinical remission and then randomly assigned to one of three continuation treatments--placebo, nortriptyline (Aventyl, Pamelor) alone, or the combination of nortriptyline and lithium (Eskalith, Lithobid). The patients were monitored for adequacy of blood levels.1 Within the six-month follow-up period, 84% of patients treated with placebo, 60% of patients treated with nortriptyline, and 39% of patients treated with the combination medications had relapsed.

Electroshock Works. Why?

June 01, 2007


Grand mal convulsive seizures are characterized by the sudden loss of consciousness and motor inhibition, followed by tonic flexion and extension, repetitive clonic movements, and motor relaxation and lassitude. Seizures are elicited in all vertebrates that have been tested. The loss of both vigilance and the defenses of fight or flight incur life-threatening risks to the individual. In evolutionary history, we would expect this behavior to be extinguished. Its persistence prompts the query: What are the benefits of seizures?