Posted by psychobot5000 on May 4, 2012, at 18:55:27
Hi all,
I'm seriously considering ECT for the first time in a 25+ year-long (I'm just over 30 now) major depressive episode. For years, I've put this off as a last resort, but have recently looked online (including in the archives here) to see what I could find out about the actual dangers vs. the benefits. I am fearful of brain damage and any loss of what cognitive function I still possess, because my mind already barely scrapes by, as is. However, I'm also hopeful that an improvement of my depression will improve my mental functioning--even assuming I continue 'maintenance ECT' for the long-term. I don't know what else to do.
This was an excellent resource concerning potential cognitive side-effects:
http://psychcentral.com/lib/2011/research-findings-on-memory-and-cognitive-impairment-in-ect/Here's what I've gleaned from this review and other sources concerning the risks of ECT and the differences between the types:
1) There seem to have been substantial advances in reducing the cognitive side-effects of ECT in recent years: right unilateral or nondominant unilateral ECT are better than bilateral; brief pulse, or--even better--ultra-brief pulse, are better than old sine-wave ECT; and, unsurprisingly, low to moderate doses/amplitudes are better than high-dose (though also probably less effective).
1a) Thus, for a first ECT experience, it's best to look for Right or nondominant unilateral ECT, done in ultra-brief pulses, preferably at a low to moderate dose. According to the numbers presented in the 68 studies referenced, after about two weeks, cognitive and memory functions generally return to normal or even slightly improve (presumably, because of the lifting of depression which can have nasty effects on cognitive function). This looks good!2) Cognitive areas studied include:
Reorientation time
Executive function
"Global cognitive function"
Global memory function
Anterograde memory
Retrograde memory
verbal memory
nonverbal memoryAs mentioned previously, unilateral and ultra-brief pulse ECT do quite well after two weeks have passed.
3) A concern: while the tentative judgments of this review aren't as bad as they could be, the paper acknowledges that measuring 'global cognitive function' is difficult. One of the measures used was evidently standard neuropsychological testing. This concerns me because I've taken those tests, and you'd have to have even more serious cognitive problems than I do to do poorly on any section of them. Thus, it bothers me that the standard may have been set so low that it didn't catch real degradation of cognitive function from ECT. Thoughts, anyone?
4) Another concern: according to 'The Death of ECT,' an intemperate document that takes for granted before it starts that ECT is evil, and presents no evidence bearing directly on the critical question of whether the potential dangers of the treatment outweigh the potential benefits (and which document makes an absurd statement indicating that psychiatry can take care of everything it needs to in affective disorders even without ECT), there is 'no evidence of efficacy after 30 days.' Thoughts? Any other sources I should read that might bear on that?
Finally, I'd like to ask those out there with ECT experience (or even those who've had friends or relatives who've gotten it) for their stories, including, if at all possible, what type of ECT was had. Are you still suffering any negative effects, or did they fade? Anyone out there want to put the lie to my hopes, and tell me you've had unilateral ultra-brief pulse ECT and that it wiped out your memory or otherwise damaged your mind? Though this is unscientific, I'd very much like to know from real people how it was, before I risk something like this with my own mind.Thanks so much,
Psychbot
poster:psychobot5000
thread:1017140
URL: http://www.dr-bob.org/babble/20120425/msgs/1017140.html