Jonathan Cole’s letter to Jay Amsterdam on Insulin Coma Treatment

Shridhar Sharma’s comments on Max Fink’s comment


        Thank you for asking me to comment on Max Fink’s comment on Jonathan Cole’s letter regarding Insulin Coma Treatment (ICT).

        I did not know Max Fink personally but on few occasions met him during American Psychiatric Association and World Psychiatric Association meetings. His views on the use of electro convulsive therapy (ECT) were more prominent and he was a supporter of ECT. His views on ICT, however, were mixed. He believed ICT acted similarly to Metrazol, but he believed ICT was a high-risk treatment, occasionally fatal. He had personal experience using ICT especially in catatonic schizophrenia but, like other researchers, was not clear about the potential mechanism of action. Dr. Fink earlier believed the ICT seizures improve the outlook in schizophrenic patients, similar to ECT.

        Seizure did occur during ICT, appearing in the second and third stage of coma, especially during periods of Dry Coma. Two schools of thought developed: 1) those who thought that seizure, like in ECT, was favorable for a better outcome; and 2) those who considered seizure as an unwanted side effect.

        I agree with Max Fink's view that although ICT was high risk and occasionally fatal in the mid-20th Century it was safe in hands of experts and effective when applied in good monitoring facilities.


August 1, 2019