Reply #78: Insulin Coma Therapy:

[polly7]

"In the sadly now departed spirit of have-a-go experimentalism, the newly discovered insulin was then tried out on patients suffering with illnesses for which no treatment was known. In Berlin , between 1928 and 1931, Dr. Manfred Sakel used insulin to reduce the unpleasant symptoms of patients undergoing opiate withdrawal. With insulin, they became calm, gained weight, and were much more cooperative. When the dose of insulin was high, the patient went into stupor; after such events, the patients were less argumentative, less hostile, and less aggressive.

Noting these results, Sakel moved to Vienna , and was assigned to treat patients with schizophrenia. He further investigated the benefits of insulin, and reported that when the patients developed stupor or coma, they lost their psychotic thoughts. His experience was reported to the Vienna Medical Society in January 1933, and by May 1936, favorable reports of the benefits of insulin coma therapy in schizophrenia from 22 countries were presented at a major meeting of the Swiss Psychiatric Society....."


"...Essentially the treatment involved a large dose of insulin which lowered the patient’s blood glucose enough to produce a coma. This would be maintained for one to three hours and terminated by either tube feeding or intravenous glucose. A course of treatment could include up to 60 comas. Serious side effects were common, and a mortality of at 1-10% could be expected depending on the standard of the clinic and physical state of the patient. Epileptic seizures could occur during the beginning stages of treatment, roughly 45–100 minutes into the procedure, but before the onset of the comatose state. Seizures occurring during the coma were more dangerous, requiring immediate interruption of the procedure and coma termination, and were often followed by delayed recovery or severe hypotension. Complications would also occur from the unconsciousness reaching excessive depths and that the coma would not end despite the administration of feeding or glucose. Administrators would monitor the patient’s vital signs, to determine the level of danger."...

..."There were always some doctors who doubted the efficacy of insulin coma treatment. Their doubts were reinforced by a controlled trial by Acker and Oldham (1962) who found that, in patients with schizophrenia, insulin coma was no more effective than a similar period of unconsciousness induced by barbituates. It may be that the treatment had a tranquillising effect on patients by inducing brain damage through the prolonged deprivation of the brain cells of glucose, as suggested in a journalist Robert Whitaker’s book Mad in America*. It was also a very dramatic procedure, with patients being put into a long coma, and then re-awoken quite suddenly by the injection of glucose. This raises the possibility that coma therapy may have owed its perceived effect to a placebo effect, and a result of the drama of the whole procedure."

http://frontierpsychiatrist.co.uk/things-that-have-given-psychiatry-a-bad-name-2-insulin-coma-therapy/