Posted by Chris A. on May 18, 2000, at 12:58:53
In reply to Re: ECT, bob, posted by Adam on May 17, 2000, at 23:07:19
Adam,
Your account is similar to mine, except for the waiting in line part. Here, ECT is done in the PACU (recovery room) and there is a lot of privacy. Basically no one is around at 6:00 a.m.! Tomorrow I am having my nineteenth RUL treatment since the end of January. They've all been on an oupatient basis, except for two. My concerns over memory and cognition are similar to yours. The retrograde amnesia and temporary confusion go with the territory and are expected. Two months post treatment we are all supposed to test as well or better than we did prior to treatment. I realize the severity and length of my depression can interfere with memory and cognition. If one doesn't want to be alive, why would one care to think? My pDoc and I have discussed this repeatedly (how repeatedly, I wouldn't remember in my current fog). He does say there is evidence that some people lose random foci of memory permanently, which I have (over forty treatments total since 1977). Loss of specific memories is not equated with brain damage. When I had bilateral treatments in '92 with a high stimulus intensity, the confusion and immediate memory problems were severe, but the depression seemed to remit. When the confusion abated and my memory improved, I relapsed into depression, despite pharmacological treatment. My consultant's advice was to do the treatments farther apart over a longer period of time to avoid cognitive and memory problems. He also suggested using Aricept (donzepil) to minimize those problems. It may be helping some. The problem is that I am still extremely depressed 90% of the time and at points get really desperate. My pDoc and I are planning to make a decision whether or not to continue ECT or not on Tuesday. Do you by chance have the references to the peer reviewed articles you mentioned? It would be nice to review them prior to making a decision. There was an excellent article in the New England Journal in '93 that I was reviewing just a couple of days ago (again, as I didn't remember even having a copy of it until going through my papers). Following one treatment I had temporary aphasia (two - three hours). That was scary, but it is discussed in the literature. Word finding seems to be my most apparent cognitive difficulty otherwise. There is no doubt in my mind that my stints on Topomax and Tegretol were capable of producing real damage. One would have to come up with very solid evidence to convince me that there is any irreversible brain damage with ECT - no flawed studies allowed. People with complaints are usually still depressed. I understand being a bit scared of the memory loss and possible cognitive problems, but agree with you that the procedure itself is a piece of cake. There is probably no point in doing maintenance treatments if there are no results to maintain, though. That poses the question of what to do next. Today I am not currently down, but that is definitely due to sleep deprivation, the results of which are not sustainable. It's like playing with fire for those of us who are bipolar. One of my concerns about the portrayal of ECT on the net is that it is made to look extremely dangerous and misused. I don't believe that is the case at all in the US currently. The stigma surrounding it is probably costing lives that could have been saved (speaking from a public health standpoint). It is less risky than the vast majority of medical procedures and the reason it is used more for depression in the elderly and pregnant women is because there is less risk involved. Meds are not benign. In the back of my mind I wonder if I would have ever had a hypomanic/mixed epsisode if I hadn't taken Prozac. They say the bipolar is lurking...but, I still have always wondered if it would have been better to stick with the desipramine even though it didn't completely cause the depression to vanish. Of course my docs were concerned that I might ingest too much desipramine at some point and turn up dead, a reasonable concern. That is water under the bridge. Paxil and Effexor caused clear manic symptoms and Wellbutrin caused intense irritability (my poor Hubby). Subtle signs of TD started showing up with minimal use of neuroleptics and I certainly don't want to go there. I'll take the ECT any day - I just wish it worked for me. If you have those references available, I'd be grateful.Thanks for sharing and please forgive my rambling.
Chris A.
P.S. I completed my MA with a 3.5 after having had over twenty treatments total. Perhaps my subjective perception of cognitive impairment and the hard facts are not the same. Who knows. I don't. The procedure was not quite as refined when I started in '77.
poster:Chris A.
thread:33082
URL: http://www.dr-bob.org/babble/20000517/msgs/33901.html