Electroconvulsive therapy to combat the blues of age?
“Melancholy is a necessary and inescapable accompaniment of an old person,” observed Robert Burton in his famous 17 th-century treatise, The Anatomy of Melancholy. “After 70 years, all is trouble and sorrow.”
But no longer. The bus-pass generation is, if anything, more cheerful than their offspring — grateful, perhaps, that life has turned out so much better than might have been expected.
Still, it would be surprising if the inescapable realities of getting on and the losses associated with it did not dampen the spirit, and “after 70 years” around one in 10 are affected by the blues of sufficient intensity to warrant antidepressants.
These can be of value in about a third of those to whom they are prescribed, but it is not unusual to encounter those who have been taking them for several years to little effect, other than a medley of sideeffects.
It is thus of considerable interest that a modified version of the much frowned on electroconvulsive therapy (first introduced 80 years ago) should be found to “induce a rapid and robust improvement” in just over a fortnight in those who have not responded to medication.
This ultra-brief pulse ECT, as it is known, delivers half the previous electrical dose and is thus less likely to cause the confusion and shortterm memory loss associated with standard therapy.
This might sound almost too good to be true, but those who wish to know more will find a summary of recent studies by Googling “McKnight, Kellner, Pride, clinical psychiatry”.
The conundrum of the lady falsely accused of being drunk — on more than one occasion — because of her slurred speech when talking on the phone has prompted a bevvy of correspondence. The problem was most noticeable when she was fatigued but, as noted, her ENT specialist had found nothing amiss, such as nodules or swelling of the vocal cords.
The link with fatigue suggests that it could be the premonitory symptom of a neurological condition such as Parkinson’s — even in the absence of the usual, more prominent symptoms — which should respond to treatment with Levodopa.
It might also indicate myasthenia gravis, a rare neuromuscular disease that causes weakness in the skeletal muscles.
One reader offers another theory. “The vicar came to the altar one Easter morning, threw wide his arms and proclaimed ‘Chrisht ish rishen!’ I was horrified. Alas, it was not drink, but the first sign of motor neurone disease.”
The two other possibilities that should be considered are an underactive thyroid and rheumatoid arthritis, which can sometimes just affect the joints around the larynx.
Whatever it turns out to be, retired speech and language therapist Rita Twiston Davies urges that she contact the Royal College (rcslt.org) to find a practitioner in her area, who “should certainly be able to elucidate why she is having these communication problems at her age”.
I stopped drinking the ... grapefruit juice I have every morning ... and my wrist symptoms improved immediately.” Oxford lady troubled by arthritis in her right wrist
What the juice
Finally, it is always gratifying to hear from those who have benefited from recent items in this column.
“It was a light-bulb moment,” writes an Oxford lady troubled by arthritis in her right wrist when reading of the gardener on a private estate whose arthritic pains in his right hand (previously attributed to over-use of his secateurs) resolved when he gave up orange juice.
“I stopped drinking the glass of grapefruit juice I have every morning as the first of my five-a-day — and my wrist symptoms improved immediately.”
Email medical questions confidentially to Dr James Le Fanu at firstname.lastname@example.org
Antidepressants such as Prozac can be of value in about a third of people who take them.