[Bill S (OP)]

https://www.usnews.com/news/health-news/articles/2020-04-07/magnetic-brain-zap-shows-promise-against-severe-depression

Some time ago I posted about a friend who was seriously suicidal.  He’s still with us, and is now considering trying the “Brain-Zap”.  Better than suicide, I guess.
 
It’s 20 years since I left MH work, and I believe this sort of treatment has progressed considerably in that time, but in the back of my mind there is still the lurking image of the post ECT “zombies” I’ve worked with.
 
Does anyone have any information about this?

[evan_au]

By "Brain Zap", do you mean this:
https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation

This causes much less sensory pain than this:
https://en.wikipedia.org/wiki/Electroconvulsive_therapy

[alancalverd]

I worked on the certification of ECT machines about 20 years ago, with considerable trepidation. At one point the Medical Devices Agency refused to consider it a medical device because nobody could explain why it worked, but there is no doubt that it does, and the empirical calibration of dose is at least based on a vast number of ethically dubious but scientifically valid experiments (I didn't do the experiments - they date back to the 1930s).

If pushed, I'd prefer ECT to medication, but only in a center with a training program, equipment and clinical procedures approved by the Royal College of Psychiatrists. But the prior requirement should be to determine the cause of suicidal intention - I can imagine problems for which it is the most rational solution.

[Bill S (OP)]

If pushed, I'd prefer ECT to medication,

 

My comment should not be taken to suggest that I do not accept that ECT has its successes, or that I consider it “better” or “worse” than other forms of treatment.  Providing psychiatric liaison in a busy A & E Dept. I was much more likely to be in contact with the failures of treatment, of all types, than with the successes.  The successes being less likely to attempt suicide.     
 
The “Psychotropic Revolution” produced its plethora of mumble-worded, shuffle-footed victims; but these tended to be kept out of sight until “Care In The Community” liberated them; often to squats and shop doorways.  When I transferred to working in the “grey area” between the Criminal Justice System an MH provision, it was, again, the failures of the care provision who were most commonly referred in our direction.  Perhaps this leads to a jaundiced view. 

However, it was information/opinions about a specific device I was looking for, rather than any sort of critique of NHS provision, fascinating as that might be

[Bill S (OP)]

By "Brain Zap", do you mean this:
https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation

More specifically; this device.

 https://www.newscientist.com/article/2221743-europes-first-home-brain-zap-device-for-depression-launched-in-uk/

[alancalverd]

Said device is an electrical, not a magnetic stimulator, but as it works at about 1% or less of the ECT current it is much less likely to do any acute harm.

Wikipedia summarises NICE findings - somewhat more effective than sham treatment, but as there are distinct acute sensations with active tDCS I'm not sure how good a sham procedure really can be.

[evan_au]

I wonder how long do the batteries last? Or are you tethered to a wall socket?

[alancalverd]

I worked on the certification of TENS machines before ECT. The specified skin impedance was around 500 ohm, so a constant current of 4 mA for tDCS requires about 2V. Assuming the gadget uses a conventional PP3 battery and allowing for 50% efficiency in the system, it should run for at least 100 hours.