The Challenge of Informed Consent for Good Outcomes
Not every good outcome is benign.
The Frontier Psychiatrists is a daily-enough health-themed newsletter. Today is a meditation on a topic that's been bugging me.
What happens when we have outcomes of our treatments that can profoundly disrupt the lives of our patients, but not because they're bad? Not because they're adverse, per se, but because lives were built around living with an illness. An illness, after treatment, they no longer have to grapple with. What information do we have to include in our informed consent, then?
Do we have to have a process or special consideration to consent for treatment…that might work?
So here's the deal. With accelerated transcranial magnetic stimulation, particularly with SAINT neuromodulation (which targets the most anti-correlated region of the left dorsolateral prefrontal cortex with the subgenual cingulate cortex), the remission rate from depression is extremely high. In published studies, it's on the order of 79%.1 What those numbers don't tell you? They leave out what it…