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

Max Fink’s comment 

            Thank you for the reminiscence of Jonathan Cole’s broad view of psychopharmacology that for him included insulin coma therapy.  He had personal experience with the procedure and was puzzled by the potential mechanisms.  The theories included Manfred Sakel’s Nazi concept that insulin selectively killed off the “bad” neurons of psychosis, the effects on memory (similar to ECT) and my thoughts that the limited efficacy was based on the induced seizures, that ICT was a weak form of Metrazole or ECT seizures.  He urged me and others (Haim Belmaker) to develop clinical studies.  By that time, I had published my RCT of ICT and CPZ, concluding that ICT was a high risk, occasionally fatal, riskful treatment that was no longer justified.  

            At a later date, I was consulted on the insulin coma applied to the Nobelist John Nash as described in the biography and film A Beautiful Mind. The filmmakers showed the induced seizure in the film. Alas, the benefits of the treatment were transient.  Attempts to sustain the benefits with CPZ devastated Nash physically and mentally.  As Sylvia Nasar wrote in the biography, Nash was offered ECT.  His Princeton colleagues dreaded the damage to "this beautiful mind" and convinced his wife to refuse consent.  (After reading the history and seeing a Nash interview, ECT as we were then learning to do, with C-ECT as an part of the treatment course, would have benefitted him much, since he met the criteria for catatonia, a treatable syndrome.)

            Jonathan Cole also was a supporter of the science of pharmaco-EEG, funding worldwide studies that identified many active entities (mianserin, 6-aza-mianserin), discarded as inactive (flutroline), reclassified more appropriately for marketing (doxepin).  When presented with a request for funding of a unproven methodology that required an IBM 1800 computer system (about $1,000,000) he did not flinch but organized funding across the NIH Institutes.  He had also funded (by a $10,000 supplement) an electronic frequency analyzer at Hillside Hospital in 1958 through the ECDEU system.  

February 28, 2019