In the deepest despair, electroconvulsive therapy offers hope(psyche.co)
psyche.co
In the deepest despair, electroconvulsive therapy offers hope
https://psyche.co/ideas/in-the-deepest-despair-electroconvulsive-therapy-offers-hope
65 comments
Psychedelics are still grinding their way through the testing and licensing processes. One of the reasons ketamine had so much buzz was because it was initially going to be used for this group of patients.
In England (where the author works) ECT really is used for people who are very severely ill. They will have been through several different types of medications first. When psychedelics get approval those will go into the roster of things to try before ECT.
It's possible for someone to write an advance directive that says they want ECT to be used, so I guess there's some people for whom it's not used as a last resort.
In England (where the author works) ECT really is used for people who are very severely ill. They will have been through several different types of medications first. When psychedelics get approval those will go into the roster of things to try before ECT.
It's possible for someone to write an advance directive that says they want ECT to be used, so I guess there's some people for whom it's not used as a last resort.
This is not true in the US. Ketamine is FDA-approved for treatment-resistant depression now, and it's thought that ketamine's effectiveness is because it is a psychedelic.
[deleted]
"At least a third of patients experience memory loss after ECT."
That's a sizable proportion.
"But there are other patients who claim that the long-term side-effects have been severe enough to stop them from working, and have had a catastrophic effect on their lives."
How many patients report such catastrophic symptoms? The author doesn't say.
That's a sizable proportion.
"But there are other patients who claim that the long-term side-effects have been severe enough to stop them from working, and have had a catastrophic effect on their lives."
How many patients report such catastrophic symptoms? The author doesn't say.
This is why ECT is not a first-line treatment. It's where you turn when you've pretty much exhausted the alternatives.
However it's important to keep in mind that
1) Memory loss is often very short term, or temporary.
2) losing the ability to hold down a job is a non-issue for patients who may end up out of work on disability
3) Many antipsychotics and mood stabilizers come with their own memory issues and other side effects... There's always a trade off.
4) We need better treatment methods. To say ECT is a shotgun approach is an understatement. It's a scorched-earth approach where you hope the ashes end up fertilizing a new crop.
5) It's a tragedy that many of our best and brightest STEM minds pursue an education that leads them to jobs optimizing ad-tech or hustling for an exit plan to get rich. Theranos duped so many people in part because everyone wanted to believe big tech could be more than this. Which at least means that if you're in it for the big payoff then you should find something with the same potential for human impact only, you know, not a massive fraud. If you do that, you'll bank a lot more money than in finding the next SaaS that provides an incremental improvement on an existing product category.
However it's important to keep in mind that
1) Memory loss is often very short term, or temporary.
2) losing the ability to hold down a job is a non-issue for patients who may end up out of work on disability
3) Many antipsychotics and mood stabilizers come with their own memory issues and other side effects... There's always a trade off.
4) We need better treatment methods. To say ECT is a shotgun approach is an understatement. It's a scorched-earth approach where you hope the ashes end up fertilizing a new crop.
5) It's a tragedy that many of our best and brightest STEM minds pursue an education that leads them to jobs optimizing ad-tech or hustling for an exit plan to get rich. Theranos duped so many people in part because everyone wanted to believe big tech could be more than this. Which at least means that if you're in it for the big payoff then you should find something with the same potential for human impact only, you know, not a massive fraud. If you do that, you'll bank a lot more money than in finding the next SaaS that provides an incremental improvement on an existing product category.
are we sure it's a scorched earth approach? I thought we don't exactly know WHY ect works. its possible calibrating neuronal stimulation is good for the brain and helps calibrate neuronal connections that otherwise were not as excercised as much as the ones very depressed people have.
In general, deeply depressed people interpret and perceive even language and visuals differently, in more negative and cynical lights, its hard to consciously teach yourself to constantly perceive the opposite or think in a more positive way, perhaps just stimulating ALL nuerons helps calibrate paths that otherwise were not favored other neuronal pathways highly utilized by depressed people.
To be honest, I've seen more people in my life die from going from antidepressents to street heroine than I have people from ect. I am not ready to say ect is safer than antidepressants. It's also to be noted antidpressants its a multibillion dollar industry of which a very few very rich families make a ton of money and also sell the same drugs for heroine overdoses, many heroine addicts of which came from being cut off from abusing antidepressants, 1/3rd of all heroine addicts actually so...
when you compare ect therapy to a massive opioid epidemic that makes a few people rich, and all of the violence that has encompassed the heroine drug dealing industry, I would say ect is potentially a safer option.
It has a stigma because of how it was originally used.
I would still though be interested in psychadelics over ect but shrooms can cause permanent damage and impacts everyone differently as well so both are hard to streamline I imagine.
In general, deeply depressed people interpret and perceive even language and visuals differently, in more negative and cynical lights, its hard to consciously teach yourself to constantly perceive the opposite or think in a more positive way, perhaps just stimulating ALL nuerons helps calibrate paths that otherwise were not favored other neuronal pathways highly utilized by depressed people.
To be honest, I've seen more people in my life die from going from antidepressents to street heroine than I have people from ect. I am not ready to say ect is safer than antidepressants. It's also to be noted antidpressants its a multibillion dollar industry of which a very few very rich families make a ton of money and also sell the same drugs for heroine overdoses, many heroine addicts of which came from being cut off from abusing antidepressants, 1/3rd of all heroine addicts actually so...
when you compare ect therapy to a massive opioid epidemic that makes a few people rich, and all of the violence that has encompassed the heroine drug dealing industry, I would say ect is potentially a safer option.
It has a stigma because of how it was originally used.
I would still though be interested in psychadelics over ect but shrooms can cause permanent damage and impacts everyone differently as well so both are hard to streamline I imagine.
A literal scorched earth strategy in war is often used while retreating from an enemy & deliberately damaging your own lands to help stop an enemy with the hope that if you ultimately won, you'll be able to rebuild.
This is why I label ECT scorched earth. It risks significant self-damage in what is often a last resort. I'm not dismissing it as a useful treatment, I'm saying it is broad and unfocussed as a result of our inability to do any better, to come up with a better tactic that doesn't risk wholesale destruction of the person. If it was a real war, perfect knowledge of the enemy might allow a less destructive strategy: the same applies here. But there are no medical treatments that don't carry significant risks. It's all a balance, with escalating risks taken when less risky options don't work.
This is why I label ECT scorched earth. It risks significant self-damage in what is often a last resort. I'm not dismissing it as a useful treatment, I'm saying it is broad and unfocussed as a result of our inability to do any better, to come up with a better tactic that doesn't risk wholesale destruction of the person. If it was a real war, perfect knowledge of the enemy might allow a less destructive strategy: the same applies here. But there are no medical treatments that don't carry significant risks. It's all a balance, with escalating risks taken when less risky options don't work.
> 5) It's a tragedy that many of our best and brightest STEM minds pursue an education that leads them to jobs optimizing ad-tech or hustling for an exit plan to get rich.
Many smart people choose ICT because of freedom it offers. Although biological/medical research looks interesting, i would not want to do it because things like this:
https://slatestarcodex.com/2017/08/29/my-irb-nightmare/
(even trivial questionnaire research is plagued by impossible board reviews)
Many smart people choose ICT because of freedom it offers. Although biological/medical research looks interesting, i would not want to do it because things like this:
https://slatestarcodex.com/2017/08/29/my-irb-nightmare/
(even trivial questionnaire research is plagued by impossible board reviews)
IRB boards view the inability to adhere to their submission protocols as an extreme red flag because research itself is much more stringent and demanding in the protocols to be followed than simply following IRB submission guidelines.
The story you linked to is exactly this situation. They showed up on the doorstep with nothing but a vague idea and no clue on how a project like this was supposed to be organized-- details they could have learned in an hour or two.
Research with human subjects is not something you can approach with an MVP, move fast and break things approach. (Also a resident doctor is still literally in training. Needing someone above that level to oversee the process is by no means unreasonable, and a PI is not the same as giving that person credit for the research: The person that wrote this blog could still have received first author placement.)
I've had to work with IRBs and I've heard the same committeee described as a nightmare to work with, or a breeze. The difference I've notice is that people who are organized about it do fine. The rest get basic things wrong, raise those red flags, and have a hard time as a result. If you do not, for example, fully describe the data you will use and how it will be used in your initial submission then an IRB must be conservative and assume a general lack of care for such things.
Stakes are much higher. There are no "build it in a weekend" projects with human research subjects. You need to be willing to put in at least a few weeks of lit review, proposal organization before you get ready to submit something for review. If a person doesn't have the discipline for that then no serious project they undertake in any profession should be trusted, even when that isn't required.
Do you think closing a VC deal would be any less stringent? Would you show up on their doorstep without even knowing how their pitch process worked and expect to be welcomed with open arms? Of course not.
The story you linked to is exactly this situation. They showed up on the doorstep with nothing but a vague idea and no clue on how a project like this was supposed to be organized-- details they could have learned in an hour or two.
Research with human subjects is not something you can approach with an MVP, move fast and break things approach. (Also a resident doctor is still literally in training. Needing someone above that level to oversee the process is by no means unreasonable, and a PI is not the same as giving that person credit for the research: The person that wrote this blog could still have received first author placement.)
I've had to work with IRBs and I've heard the same committeee described as a nightmare to work with, or a breeze. The difference I've notice is that people who are organized about it do fine. The rest get basic things wrong, raise those red flags, and have a hard time as a result. If you do not, for example, fully describe the data you will use and how it will be used in your initial submission then an IRB must be conservative and assume a general lack of care for such things.
Stakes are much higher. There are no "build it in a weekend" projects with human research subjects. You need to be willing to put in at least a few weeks of lit review, proposal organization before you get ready to submit something for review. If a person doesn't have the discipline for that then no serious project they undertake in any profession should be trusted, even when that isn't required.
Do you think closing a VC deal would be any less stringent? Would you show up on their doorstep without even knowing how their pitch process worked and expect to be welcomed with open arms? Of course not.
My father had this for suicidal depression. After each ECT he would expect my mother to be taking him home, but he had to be reminded that they were divorced. He forgot. It was not a pleasant experience and didn't seem to help him with his depression.
Did he remember his being divorced, eventually? Not the fact of being divorced, but the memories and feelings around it.
ect helps about half of patients. that is known from the get go
I thought this was pretty interesting and goes into a hypothesis of why ECT might be effective (in the context of sleep deprivation being effective) https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d...
It's also possible the memory loss is partly a treatment effect and not a side effect. It might be weakening some of these learned patterns is what helps shake loose the depression.
"Put these two lines of research together and you get something like: synapse density increases over the course of the day, then sleep prunes it down again. Depression is associated with low synapse density. So it would make sense that depression gets better over the course of the day (including the extra-long artificial days of sleep deprivation) and then gets worse again after sleep."
It's also possible the memory loss is partly a treatment effect and not a side effect. It might be weakening some of these learned patterns is what helps shake loose the depression.
"Put these two lines of research together and you get something like: synapse density increases over the course of the day, then sleep prunes it down again. Depression is associated with low synapse density. So it would make sense that depression gets better over the course of the day (including the extra-long artificial days of sleep deprivation) and then gets worse again after sleep."
> I thought this was pretty interesting and goes into a hypothesis of why ECT might be effective (in the context of sleep deprivation being effective) https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d...
This is entirely subjective but I suspect there might be something else at play than anything mentioned in that blog post. (edit: that is, when it comes to sleep deprivation vs depression.)
I've had to go through depression myself, and also noticed that my mood is different when I'm sleep-deprived. The mood when sleep-deprived would often be elevated, assuming I didn't have to force myself to do something that required concentration. I'm not sure that state is so much an absence of depression as it might be a slightly hyper mood. (I once read someone's comment on the topic somewhere that it seems like the depression gets replaced by some kind of a hypomania-like state rather than a normal, non-depressed mood. I don't even remember where that comment was and it was also just speculation, but it rang a bell.)
I've noticed that kind of slightly hyper mood has also happened when sleep deprived outside of a depressive episode. (Perhaps it is in compensation for feeling tired when you for some reason psych yourself to still staying active, or something.)
It might feel preferable to a depressed state but I'm slightly sceptical of the idea that something with a similar mechanism could be used directly to return to a normal non-depressive state.
I don't know about ECT though.
This is entirely subjective but I suspect there might be something else at play than anything mentioned in that blog post. (edit: that is, when it comes to sleep deprivation vs depression.)
I've had to go through depression myself, and also noticed that my mood is different when I'm sleep-deprived. The mood when sleep-deprived would often be elevated, assuming I didn't have to force myself to do something that required concentration. I'm not sure that state is so much an absence of depression as it might be a slightly hyper mood. (I once read someone's comment on the topic somewhere that it seems like the depression gets replaced by some kind of a hypomania-like state rather than a normal, non-depressed mood. I don't even remember where that comment was and it was also just speculation, but it rang a bell.)
I've noticed that kind of slightly hyper mood has also happened when sleep deprived outside of a depressive episode. (Perhaps it is in compensation for feeling tired when you for some reason psych yourself to still staying active, or something.)
It might feel preferable to a depressed state but I'm slightly sceptical of the idea that something with a similar mechanism could be used directly to return to a normal non-depressive state.
I don't know about ECT though.
> It's also possible the memory loss is partly a treatment effect and not a side effect.
Very plausible but imo very dangerous, a lot of your emotions are rooted in your memories and weakening the network could very much lead to loss of self or incoherence.
Very plausible but imo very dangerous, a lot of your emotions are rooted in your memories and weakening the network could very much lead to loss of self or incoherence.
David Foster Wallace resorted to ECT, sounds like it didn't do him any favors. https://www.tandfonline.com/doi/full/10.1080/00111619.2017.1...
ECT: permanent mental impairment for temporary change in behavior.
Saying depression is a “temporary change in behavior” is like saying pneumonia is a “temporary change in respiration.” It’s insulting and dismissive and indicates you don’t really care very much about this issue.
Depression kills people. ECT has serious side effects but it is also has proven efficacy and, if administered properly, is never fatal. All medicine involves this sort of cost-benefit analysis and in cases of severe drug-resistant depression, where there is a high risk of the patient dying in the short term, ECT is the only alternative.
Depression kills people. ECT has serious side effects but it is also has proven efficacy and, if administered properly, is never fatal. All medicine involves this sort of cost-benefit analysis and in cases of severe drug-resistant depression, where there is a high risk of the patient dying in the short term, ECT is the only alternative.
While the parent comment isn't all that helpful, I suspect they meant "...in exchange for a temporary change..."; in other words, not that that depression is temporary, but beneficial effects of ECT are.
> Saying depression is a “temporary change in behavior"
That ain't how I interpreted the above comment.
> but it is also has proven efficacy
Right, but at what cost? It seems very much like something that just replaces one problem with another, at best (and at worst, introduces more problems while the existing ones don't go away).
But hey, as long as it's voluntary, who am I to judge?
That ain't how I interpreted the above comment.
> but it is also has proven efficacy
Right, but at what cost? It seems very much like something that just replaces one problem with another, at best (and at worst, introduces more problems while the existing ones don't go away).
But hey, as long as it's voluntary, who am I to judge?
> But hey, as long as it's voluntary, who am I to judge?
If we are talking about very severely depressed you can't trust them to weight the risks and benefits in their own favor, so the physicians have so big overwhelming influence on their decision that it can't be argued otherwise.
If we are talking about very severely depressed you can't trust them to weight the risks and benefits in their own favor, so the physicians have so big overwhelming influence on their decision that it can't be argued otherwise.
That's kind of what I was underhandedly getting at, yeah.
And when applied to more debilitating conditions like schizophrenia, "consent" is even more wibbly-wobbly.
And when applied to more debilitating conditions like schizophrenia, "consent" is even more wibbly-wobbly.
[deleted]
You're lucky to never have been at a place in your life where that sounds like it's worth trying.
Maybe it's just me but I think I'd actually prefer suicide over the "possible" (but quite common) mental handicap that ECT will cause.
And please note that psychiatrists lie. Technically it may be the truth what they say, but it is a disgusting lie through deception. Yes it is quite rare for a single ECT treatment to cause permanent memory loss or "severe" loss of function. What they "forget" to tell you is that an ECT regimen is not one treatment, but 7 to 20 individual sessions. Mathematically you can say that (1-(1-p)^20) is a hell of a lot larger than p. Intuitively you can say that it only works BECAUSE it does damage. So without at least some loss of function there is no benefit to it at all). It is also not so rare for the treatment to be abandoned, by the way, because the particular loss of function has medical consequences.
They also say it doesn't hurt, except that is patently false. When you have a medical operation doctors will use 3 sedatives, not just one. They use something akin to GHB that prevents the formation of memories, a muscle relaxant (prevents you from moving) and something to actually sedate (depress neural activity). For ECT they use a muscle relaxant and GHB. So ECT doesn't hurt in the sense that afterwards you don't remember. They would use a sedative, except with those it doesn't work. The working principle of ECT seems to be extreme pain and trauma, and they merely prevent you from remembering that. They explicitly don't prevent extreme pain. We know it's extreme because it used to be done without any sedation at all, so there's no shortage of patient testimonies on the subject.
Psychiatrists still want to use it because it is effectively the only medical treatment that can result in permanent change in behaviour. Nearly everything else (or let's say everything legal/moral) only results in change while the treatment continues, like antidepressants. If the treatment is stopped (voluntarily or not, say because of money issues) all effects stop in a matter of hours to weeks.
And yes, I think it should be outlawed. Also the modern forms. That psychiatry has no answers for problems is not new.
And please note that psychiatrists lie. Technically it may be the truth what they say, but it is a disgusting lie through deception. Yes it is quite rare for a single ECT treatment to cause permanent memory loss or "severe" loss of function. What they "forget" to tell you is that an ECT regimen is not one treatment, but 7 to 20 individual sessions. Mathematically you can say that (1-(1-p)^20) is a hell of a lot larger than p. Intuitively you can say that it only works BECAUSE it does damage. So without at least some loss of function there is no benefit to it at all). It is also not so rare for the treatment to be abandoned, by the way, because the particular loss of function has medical consequences.
They also say it doesn't hurt, except that is patently false. When you have a medical operation doctors will use 3 sedatives, not just one. They use something akin to GHB that prevents the formation of memories, a muscle relaxant (prevents you from moving) and something to actually sedate (depress neural activity). For ECT they use a muscle relaxant and GHB. So ECT doesn't hurt in the sense that afterwards you don't remember. They would use a sedative, except with those it doesn't work. The working principle of ECT seems to be extreme pain and trauma, and they merely prevent you from remembering that. They explicitly don't prevent extreme pain. We know it's extreme because it used to be done without any sedation at all, so there's no shortage of patient testimonies on the subject.
Psychiatrists still want to use it because it is effectively the only medical treatment that can result in permanent change in behaviour. Nearly everything else (or let's say everything legal/moral) only results in change while the treatment continues, like antidepressants. If the treatment is stopped (voluntarily or not, say because of money issues) all effects stop in a matter of hours to weeks.
And yes, I think it should be outlawed. Also the modern forms. That psychiatry has no answers for problems is not new.
Suicide is a temporary change in behavior.
I'm in the middle of a course of ECT's newer, kinder, gentler cousin: trans-cranial magnetic stimulation (TMS). The idea is similar. The brain is stimulated by magnetic pulses in place of electrodes, and there are no seizures. Every weekday morning, I go to a place where they strap on a helmet that hits me with a 2-second pulse every 20 seconds for about 20 minutes. They calibrate the power by testing your motor threshold. Mine was low, so I get relatively gentle pulses. Having declined the required offer of earplugs, I sit and chat with the tech and barely notice the knocking on my head. With chances for in-person socializing being hard to come by, I find my treatments to be rather pleasant.
The only side effects are mostly headaches and nausea, which are usually managed by just ramping up to full strength at the beginning. If you needed stronger pulses, I could imagine it being fairly uncomfortable. But no seizures means no anesthesia and no memory loss. Really, the main drawback is that it's time-consuming, and it's still not quite as effective as ECT. A typical course is 36 treatments administered 5-6 times per week. And insurance won't cover it unless you've tried a bunch of other stuff. Out of pocket, it costs a few grand.
I've started to feel it helping me, but the real test will be when I try to go off my antidepressants.
The only side effects are mostly headaches and nausea, which are usually managed by just ramping up to full strength at the beginning. If you needed stronger pulses, I could imagine it being fairly uncomfortable. But no seizures means no anesthesia and no memory loss. Really, the main drawback is that it's time-consuming, and it's still not quite as effective as ECT. A typical course is 36 treatments administered 5-6 times per week. And insurance won't cover it unless you've tried a bunch of other stuff. Out of pocket, it costs a few grand.
I've started to feel it helping me, but the real test will be when I try to go off my antidepressants.
I'd be curious to test whether it works better or the same when attempting to concentrate or meditate during the stimulation vs. distracting yourself with conversation.
Who knows... maybe there's some difference?
Who knows... maybe there's some difference?
Thank you for sharing and good luck with your treatment, I hope it is successful.
For anyone interested. NICE - the UK's 'National Institute for Health and Care Excellence' has published its guidance on the use of ECT here: https://www.nice.org.uk/guidance/ta59/resources/the-use-of-e...
"NICE has looked carefully at the evidence and has recommended that ECT should only be used for the treatment of severe depressive illness, a prolonged or severe episode of mania, or catatonia if the conditions described in the following paragraphs are applied. ECT should be used to gain fast and short-term improvement of severe symptoms after all other treatment options have failed, or when the situation is thought to be life-threatening. A risk–benefit assessment for the individual should be made and documented. It should include the risks associated with the anaesthetic, whether the person has other illnesses, the possible adverse effects of ECT (particularly problems with memory), and the risks of not having treatment."
"NICE has looked carefully at the evidence and has recommended that ECT should only be used for the treatment of severe depressive illness, a prolonged or severe episode of mania, or catatonia if the conditions described in the following paragraphs are applied. ECT should be used to gain fast and short-term improvement of severe symptoms after all other treatment options have failed, or when the situation is thought to be life-threatening. A risk–benefit assessment for the individual should be made and documented. It should include the risks associated with the anaesthetic, whether the person has other illnesses, the possible adverse effects of ECT (particularly problems with memory), and the risks of not having treatment."
This treatment scares me to no end. I would never ever do it. Also I get sick to my stomach when movies speculate on its use.
I had the same advice, then I saw someone in my family transformed from a frightening robot like state, to a warm nice person again.
Truly astonishing!
There's a lot of myths associated with ECT, especially the procedure and equipment. I've seen the procedures carried out on people with schizophrenia and depression in documentaries and it's not the least bit scary to watch.
I read this title as "In the deepest despair, electroconvulsive therapy offers hype" and tend to agree with my misreading of it, is it the memory loss that makes patients to forget about their depression? Psychedelics can sometimes cause you to forget who you are and reset some brain circuits but at least it's temporary and could be done in a more controlled and comfortable settings. I would argue that the long term memory loss caused by ECT is often more debilitating than any side effects that psychedelics could produce.
FYI/PSA: treatment-resistant depression can be caused by sleep apnea, metabolic, or endocrine issues that psychiatric meds can only partially mask.
Psychiatrists are medical doctors and will typically attempt to exclude these diagnoses. I've had all sorts of tests issued by psychiatrists.
In the US, mine is an MD too. Must be a different kind of psychiatrist because mine sent me to my PCP to narrow down health issues.
Perhaps I can rephrase it. Psychiatrists are aware of multiple organic causes for depressive symptoms and would prefer to treat the causes, not just the symptoms. It's not accurate to say that a psychiatrist would be expected to simply prescribe an antidepressant without some additional investigation.
The evidence of efficacy is very weak and the risks are very high. This article goes into much better detail about that:
https://theconversation.com/no-evidence-that-ect-works-for-d...
https://theconversation.com/no-evidence-that-ect-works-for-d...
I was casually considering ECT until I discovered a ketamine clinic near me. Ketamine is really a wonder drug, at least for me.
The whole point of ECT is to spur neurogenesis.
This can also be accomplished with magnesium (l-threonate) and l-theanine before bed.
This can also be accomplished with magnesium (l-threonate) and l-theanine before bed.
Consider the value of your comment:
To someone with no knowledge about your claim (me included), it seems like an extraordinary claim with no extraordinary evidence, or really any information at all, to back it up.
To someone with knowledge of your claim, assuming it is a true one, it adds nothing to what they already know. So maybe it's obvious to an expert, but then they don't need to be told.
To someone with no knowledge about your claim (me included), it seems like an extraordinary claim with no extraordinary evidence, or really any information at all, to back it up.
To someone with knowledge of your claim, assuming it is a true one, it adds nothing to what they already know. So maybe it's obvious to an expert, but then they don't need to be told.
I disagree. I think statements like that can capture people's interest and spur them on to look into it further on their own. It's kind of a reminder that X exists.
got any sources for that? I would think that any credible, conclusive evidence of nootropics actually doing anything would spur a great deal of fanfare
They do do something. Caffeine is a nootropic that has well studied positive effects.
The thing with most nootropics though is that the effects aren't big, the side effects of chronic usage aren't well known, and the basics such as exercise/sleep have a bigger effect.
Out of the two mentioned above (magnesium and l-theanine) - many people are deficient in magnesium due to modern diet, and there's some evidence that l-theanine works well with caffeine to aid concentration (it's found in green tea but not coffee). I have no idea about the neurogenesis claims though.
The thing with most nootropics though is that the effects aren't big, the side effects of chronic usage aren't well known, and the basics such as exercise/sleep have a bigger effect.
Out of the two mentioned above (magnesium and l-theanine) - many people are deficient in magnesium due to modern diet, and there's some evidence that l-theanine works well with caffeine to aid concentration (it's found in green tea but not coffee). I have no idea about the neurogenesis claims though.
Does lithium count as a nootropic?
https://pubmed.ncbi.nlm.nih.gov/15581403/
https://www.neuroscience.cam.ac.uk/publications/download.php...
https://pubmed.ncbi.nlm.nih.gov/15581403/
https://www.neuroscience.cam.ac.uk/publications/download.php...
linuxftw(5)
Nicotinic Acid is as safe as it gets, but does not get much discussion. It's worth trying.
Disclaimer: Not for everyone. I am not a doctor. Do not eat fungi you find in the wild unless you are a trained mycologist.