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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 26 to 50 of 69. Go back in thread:
Posted by OldSchool on March 21, 2002, at 21:19:28
In reply to Re: Anyone had success with ECT? Dave » Denise528, posted by Dave1 on March 21, 2002, at 20:35:02
> Hi Denise,
>
> I have had chronic, unremmitting unipolar depresssion for about 20 years. Some doctors say I have minor delusions (I think I'm going
> insane, even though they tell me I'm not). But
> no major delusions (I think the T.V. is telling me something).
>
> Regarding the doctors, you should call the psych wards of some major hospitals, and ask if ECT is done at them. If so ask for the names of the doctors that do them. I went to pdocs for 15 years, and even though I never responded to anything, none told me about ECT. I had to research it, and initiate it myself.
>
> Regarding the efficacy, I was shocked, after 2 or 3 treatments, I started getting memories of my old emotions, and then I actually felt the emotions for the first time in 15 years.
>
> Most ECT doctors tell me they get a 90% success rate. So I would be pretty surprised if you don't get atleast some relief.
>
> Note: Not to scare you, but when I did it they used several different types of anesthesia. Waking up from Diprivan (Propofol) is easiest so I would insist they use it instead of one of the others such as Brevital or Pentothol. Waking up from these can be rougher, and Diprivan works just as well.
>
> Go for it. I'm trying to get myself to do it again also.
>
> Bye,
>
> Dave
Dave, you are the man!!Old School
Posted by IsoM on March 22, 2002, at 1:02:56
In reply to Re: Anyone had success with ECT? Dave, posted by Denise528 on March 21, 2002, at 12:53:36
Denise, don't be scared of it not working. My ex-husband was the only case the doctors had ever heard of. I don't know if it made medical journals. They had thought that because his diabetes wasn't controlled, that it may have been a major factor for the stange reaction the last time. I don't think you should be scared or it - not enough to not give it a try.
Posted by Dave1 on March 22, 2002, at 12:24:47
In reply to ECT reset your brain chemistry » Dave1, posted by GB on March 21, 2002, at 21:12:42
Hi,
That is one theory. One doctor told me he can give the same after ECT and it works, even though it didn't before. Another doctor told me that this possible, but nobody is really sure if the theory is true.
Bye,
Dave
Posted by Dave1 on March 22, 2002, at 12:34:14
In reply to Re: Anyone had success with ECT? Dave, posted by OldSchool on March 21, 2002, at 21:19:28
>
>
> Dave, you are the man!!
>
> Old SchoolTHANKS, even though lately I've been avoiding getting ECT because I'm afraid of them.
Posted by OldSchool on March 22, 2002, at 22:54:05
In reply to Re: Anyone had success with ECT? Dave » OldSchool, posted by Dave1 on March 22, 2002, at 12:34:14
>
> >
> >
> > Dave, you are the man!!
> >
> > Old School
>
>
>
> THANKS, even though lately I've been avoiding getting ECT because I'm afraid of them.You demonstrate that you are a courageous person by having ECT. And by coming on here and describing your ECT experiences that means a lot. Usually all you read on the Internet is the usual anti-ECT spiel on the anti-psychiatry websites.
take care,
Old School
Posted by Elizabeth on March 23, 2002, at 13:00:10
In reply to Re: Anyone had success with ECT?ISO M Shelli R, posted by OldSchool on March 18, 2002, at 20:26:15
Hi everyone. I was just looking through this thread concerning indications for ECT.
It's true that ECT is mainly reserved for situations when medications don't work. ECT is very effective for major depression *in general*. However, it's more effective for some types of depression than others.
The main types of depression for which ECT is known to be especially effective are severe depressions with melancholic and/or psychotic features. These types of depression usually (not always) respond well to medications, though (in the case of psychotic depression, an antipsychotic drug is almost always necessary in addition to an antidepressant). ECT is sometimes used when the risk of suicide and/or starvation (or serious malnutrition) is immediate enough that it would be too dangerous to wait for an antidepressant to start working. (There are also some rapid-acting medications, such as antipsychotics, benzodiazepines, stimulants, and opioids, that may be used temporarily to keep the depression under control while waiting for an antidepressant to work.) In the past ECT has been used when medications were contraindicated for safety reasons; because of the discovery of safer ADs, I don't think that this situation comes up much anymore. (In the past, MAOIs were sometimes used as an alternative when TCAs were contraindicated, since MAOIs do not cause the potentially dangerous cardiovascular side effects that are seen with TCAs. If antidepressant medication in general was contraindicated -- for example, in pregnancy -- or if MAOIs didn't work, ECT was often used.)
Atypical depressions and depressions associated with personality disorders are frequently resistant to usual medication treatments; such depressions can be very severe, as well. But ECT is generally *not* an effective treatment for these types of depression. ECT is similarly ineffective for dysthymia (which, although not severe, can cause quite a bit of impairment and is sometimes refractory to medication treatments).
Many depressions don't meet the criteria for "melancholic" or for "atypical" features. It's not clear how well ECT works in these cases; because they are so heterogeneous, it's probably impossible to make any prediction. My guess is that it would be worth trying ECT in severe refractory cases of "undifferentiated" depression [not a technical term, just my word for it], particularly if the depression has features that somewhat resemble melancholia (e.g., melancholic-like neurovegetative signs with reactive mood).
In addition to depression, ECT is used to treat bipolar disorder (including mania) and schizophrenia. In bipolar disorders, ECT can be used to quiet down an acute manic or mixed episode (something that often can't wait; mixed states, in particular, are associated with a high degree of suicidality), as well as relieving depression (although, interestingly, ECT can trigger mania or hypomania when used to treat bipolar depression -- I think it's less likely to than antidepressants are, tho'). We don't have much information on the use of ECT for rapid-cycling bipolar disorder. Using ECT to treat episodes in bipolar disorder can be awkward since you can't take anticonvulsants while having ECTs!
ECT is effective for catatonic states, which occur in both mood disorders and schizophrenia and which aren't always treatable with medications.
In schizophrenia, ECT works best if the illness has been of brief duration, rather than chronic. ECT is used sometimes as an adjunct to antipsychotic medication in partial responders; by itself, it's less effective than antipsychotic drugs.
It's not clear when, if ever, bilateral ECT should be tried before unilateral.
Posted by Mags on March 23, 2002, at 13:31:37
In reply to Re: Anyone had success with ECT?, posted by Elizabeth on March 23, 2002, at 13:00:10
Thanks for great info Elizabeth. I am scheduled for ECT but have to first figure out how to get Lamictal out of my system and how long it should be out. I am presently on 100 mg which took forever to get there plus Remeron and Wellbutrin.
My doc is supposed to get back to me but it has been a week with no response. I don't feel like taking these drugs for no reason. I am BP11 and still in a DEEP atypical type depression. just got out of hospital after four weeks. Am very sensitive to drugs.
Any info is greatly apprecited!
Mags
Posted by OldSchool on March 23, 2002, at 15:04:53
In reply to Re: Anyone had success with ECT?, posted by Elizabeth on March 23, 2002, at 13:00:10
> Hi everyone. I was just looking through this thread concerning indications for ECT.
>
> It's true that ECT is mainly reserved for situations when medications don't work. ECT is very effective for major depression *in general*. However, it's more effective for some types of depression than others.
>
> The main types of depression for which ECT is known to be especially effective are severe depressions with melancholic and/or psychotic features. These types of depression usually (not always) respond well to medications, though (in the case of psychotic depression, an antipsychotic drug is almost always necessary in addition to an antidepressant). ECT is sometimes used when the risk of suicide and/or starvation (or serious malnutrition) is immediate enough that it would be too dangerous to wait for an antidepressant to start working. (There are also some rapid-acting medications, such as antipsychotics, benzodiazepines, stimulants, and opioids, that may be used temporarily to keep the depression under control while waiting for an antidepressant to work.) In the past ECT has been used when medications were contraindicated for safety reasons; because of the discovery of safer ADs, I don't think that this situation comes up much anymore. (In the past, MAOIs were sometimes used as an alternative when TCAs were contraindicated, since MAOIs do not cause the potentially dangerous cardiovascular side effects that are seen with TCAs. If antidepressant medication in general was contraindicated -- for example, in pregnancy -- or if MAOIs didn't work, ECT was often used.)
>
> Atypical depressions and depressions associated with personality disorders are frequently resistant to usual medication treatments; such depressions can be very severe, as well. But ECT is generally *not* an effective treatment for these types of depression. ECT is similarly ineffective for dysthymia (which, although not severe, can cause quite a bit of impairment and is sometimes refractory to medication treatments).
>
> Many depressions don't meet the criteria for "melancholic" or for "atypical" features. It's not clear how well ECT works in these cases; because they are so heterogeneous, it's probably impossible to make any prediction. My guess is that it would be worth trying ECT in severe refractory cases of "undifferentiated" depression [not a technical term, just my word for it], particularly if the depression has features that somewhat resemble melancholia (e.g., melancholic-like neurovegetative signs with reactive mood).
>
> In addition to depression, ECT is used to treat bipolar disorder (including mania) and schizophrenia. In bipolar disorders, ECT can be used to quiet down an acute manic or mixed episode (something that often can't wait; mixed states, in particular, are associated with a high degree of suicidality), as well as relieving depression (although, interestingly, ECT can trigger mania or hypomania when used to treat bipolar depression -- I think it's less likely to than antidepressants are, tho'). We don't have much information on the use of ECT for rapid-cycling bipolar disorder. Using ECT to treat episodes in bipolar disorder can be awkward since you can't take anticonvulsants while having ECTs!
>
> ECT is effective for catatonic states, which occur in both mood disorders and schizophrenia and which aren't always treatable with medications.
>
> In schizophrenia, ECT works best if the illness has been of brief duration, rather than chronic. ECT is used sometimes as an adjunct to antipsychotic medication in partial responders; by itself, it's less effective than antipsychotic drugs.
>
> It's not clear when, if ever, bilateral ECT should be tried before unilateral.
It might be true that atypical depression doesnt respond as well to ECT. I agree the kind of depression ECT works best for is mood disorders with psychotic features. Or classic severe melancholia depression (endogenous depression). But in the real world, if you dont respond well to meds and get a referral for ECT, I dont think most shock docs differentiate that much between atypical depression and the other more conventional depression types. They just wanna shock you...period.I doubt most shock consultations the docs go thru a big long list of things like you just posted. You might know more about this than the docs do in some cases because of your readings. You know how it is in the real world, if you dont respond to meds you just get shocked, period.
As far as bilateral, its definitely better to start off with if you have psychotic features with your mood disorder. Also remember bilateral doesnt require an initial titration the first time like unilateral requires. Thus with unilateral, your first treatment is wasted. Bilateral is more effective, but has more memory side effects. Bifrontal ECT is supposed to be the best of both worlds, having effectiveness comparable to bilateral, but without the severe memory loss side effects of bilateral.
Old School
Posted by BarbaraCat on March 24, 2002, at 15:43:06
In reply to Re: Anyone had success with ECT?ISO M Shelli R » Denise528, posted by shelliR on March 13, 2002, at 23:03:30
Hi Shelli,
I just read your prior post:
> And I hurt all the time horribly. So ect was a last resort <well, actually a partial opiate is my last last resort.>I don't know if we've discussed this before or not, but have you considered that you have fibromyalgia? I do along with severe episodes of depression. I've been through all the newer ADs (with some old TCA's thrown in) and am very treatment resistant. When either the fibro flares up, or I'm having a bout with depression (honestly, I don't think they're separate anymore) I get horrible pain throughout my body. Flu-like aches that move around my body, extreme fatigue and a bleak dark despondent hopelessness. Feels like every cell in my body is sick and poisoned. If you do have fibro it's very important to attend to that metabolic dysfunction along with your antidepressant regimen. YET ANOTHER cause of body pain is hypothyroidism. I (lucky me) also have that. I believe for me all these diseases are interweaved so I know that if I don't take care of one aspect, the others fail as well. - Barbara
Posted by shelliR on March 24, 2002, at 20:51:33
In reply to Hurting all the time? » shelliR, posted by BarbaraCat on March 24, 2002, at 15:43:06
Hi Barbara,
I didn't know that hypothyroidism causes pain. Actually I do take a combination natural thyroid, but I should look at my records and make sure that my thyroid is the highest it can be in the normal range. At least that's where I was told, by a pdoc, it should be if I'm depressed.
Re pain. Mostly my pain is inseparable from my depression, also. But it is mainly in my chest. I have costochondritis (inflammation of the cartilage where ribs attach to the breast bone.) It hurts to the touch and my pain/depression was there 100% of the time before I started buprenorphine. I've also started taking advil or other anti-inflammatories round the clock and I've set up an appointment with a pain specialist to see if a cortisone shot will help.
As far as fibromyalgia, Lorraine recently suggested that. I'm sure my immune system is affected, but as I told her: I don't see much point in persuing it since my worst pain is in my chest, and also I can't see spending the time and money to see new doctors when there is really no cure for fms. Basically I'll just stay on bupe as long as I can get it. I feel pretty much like a normal person, although I do wish a doctor would prescribe it, instead of me getting it off the internet. But considering I was huddled up in bed a month ago, and not able to eat anything, I shouldn't complain.
Thanks for the suggestion, though.
Take care,
Shelli
Posted by BarbaraCat on March 25, 2002, at 0:58:52
In reply to Re: Hurting all the time? » BarbaraCat, posted by shelliR on March 24, 2002, at 20:51:33
Shelli,
Regarding fms and no cure, I agree with you. I've spent alot of money on specialists who try one thing after the other and then finally admit that there's no cure at this time. I mainly control it by diet and stress reduction. I'm familiar with costocondritis, having had it myself about 5 years ago. It eventually went away. I remember it being very painful and not being able to raise my arms at all or take a deep breath.
Yes, low thyroid causes a deep muscular aching pain, muscle weakness and tingling. In fact there are some schools of thought that suggest improper functioning of the thyroid causes fms. I know that when I upped my dose (also taking natural brand) my fms pains diminished considerably. I'd urge you to get it checked since even a slightly low function can mean depression. AT the risk of repeating what you already know: Your TSH values should be around 1.0 - 1.5. Many doctors will let it go at 2 and above, but that is not good enough to get a good therapeutic antidepressant effect. Good luck to you. - Barbara
Posted by Elizabeth on March 25, 2002, at 14:43:45
In reply to Re: Anyone had success with ECT?, posted by OldSchool on March 23, 2002, at 15:04:53
> It might be true that atypical depression doesnt respond as well to ECT.
From what I've read, it's not totally clear to me whether there's solid evidence of this, or whether it's just a reputation. Interestingly, there doesn't seem to be any recent research on the subject at all. But anyway, these subtypes don't predict anything *absolutely*, so in some cases it's probably worthwhile to try ECT even if you seem to have "atypical" depression.
My pdoc and I did talk about ECT once (when I was in Boston), and he took the particular features of the illness (neurovegetative signs/symptoms, etc.) into consideration. This was when I'd tried a lot of things to augment Nardil (which had pooped out) and they didn't help. In the end we decided to keep trying with the medications. This ended up paying off, although it took a long time.
I think that doctors in a place like Boston, where there's a major medical center (three, in fact) and lots of research going on, would probably be more likely to take subtypes of depression into account than the average community doctor. Boston doctors also seem to be into trying experimental medication approaches, rather than just trying you on an SSRI, TCA, MAOI, and lithium and then referring you for ECT. :-)
> You might know more about this than the docs do in some cases because of your readings.
That's pretty scary, because I really don't know much about ECT. I definitely would not be willing to have ECT on the advice of a doctor who knew even less about it than I do.
> You know how it is in the real world, if you dont respond to meds you just get shocked, period.
Heh, my experience has that they just throw more meds at me!
> As far as bilateral, its definitely better to start off with if you have psychotic features with your mood disorder.
Hmm. It's been a long time since I seriously considered ECT, so I'm not sure that my information is up to date. My recollection is that it's a judgment call, though: you might want to start out using bilateral ECT for the most urgent cases, whereas if there isn't so much of a hurry you can afford to titrate so as to minimize the risk of cognitive side effects. Is there some other issue, or is that what you were thinking of?
> Bifrontal ECT is supposed to be the best of both worlds, having effectiveness comparable to bilateral, but without the severe memory loss side effects of bilateral.
I'm not very familiar with bifrontal ECT, but I'll keep this in mind (although I hope I never have to use the information myself!).
-elizabeth
Posted by Elizabeth on March 25, 2002, at 14:59:27
In reply to Re: Anyone had success with ECT? » Elizabeth, posted by Mags on March 23, 2002, at 13:31:37
> I am scheduled for ECT but have to first figure out how to get Lamictal out of my system and how long it should be out.
I'm not sure if there's any washout required beyond the time it takes to get the Lamictal out of your system, which is itself hard to predict because the elimination half-life is so variable. (Two weeks should probably cover it, I'd think. I'll be interested to hear what your doctor has to say.)
> I am BP11 and still in a DEEP atypical type depression. just got out of hospital after four weeks. Am very sensitive to drugs.
Is that one of the reasons you're trying ECT, because you have trouble with medication side effects? I hope that it works for you. Are you going to remain outpatient while having ECT?
It'd be great if you'd post here about the treatments; I think it's important for people here to get real stories from people about what ECT is like from people who've actually had it.
> Any info is greatly apprecited!
Sure. What would you like to know?
-e
Posted by Mags on March 25, 2002, at 18:06:03
In reply to Re: Anyone had success with ECT? » Mags, posted by Elizabeth on March 25, 2002, at 14:59:27
> > I am scheduled for ECT but have to first figure out how to get Lamictal out of my system and how long it should be out.
>
> I'm not sure if there's any washout required beyond the time it takes to get the Lamictal out of your system, which is itself hard to predict because the elimination half-life is so variable. (Two weeks should probably cover it, I'd think. I'll be interested to hear what your doctor has to say.)
>
> > I am BP11 and still in a DEEP atypical type depression. just got out of hospital after four weeks. Am very sensitive to drugs.
>
> Is that one of the reasons you're trying ECT, because you have trouble with medication side effects? I hope that it works for you. Are you going to remain outpatient while having ECT?
>
> It'd be great if you'd post here about the treatments; I think it's important for people here to get real stories from people about what ECT is like from people who've actually had it.
>
> > Any info is greatly apprecited!
>
> Sure. What would you like to know?
>
> -e
Thanks for response Elizabeth,
You have so much information to share. I am not so much looking for info now as I have researched it myself (I think) and have definately decided to go ahead with it.I am really hoping to hear from others who have had ECT.
Re meds: I am very sensitive as in headaches or GI symptoms, or unusual responses(couldn't stay awake on Wellbutrin!)
..if I survive S/E's then I haven't had anything work except as follows:
"four days of major on top of the world happiness" When Lithium was added to Effexor while in hospital due to suicidal ideation...then a MAJOR crash. Then I couldn't take Li anymore (dopey, staggering, shakes,throwing up)Then I got onto Lamictal...25 mg and I was on top of the world for about 6 weeks then an insidious backslide until my next hospital stay due to an OD. Increases in Lamictal didn't help. I am only at 100Mg now and it took four months to get there.
Also tried Prozac and felt very, very good for about a week, then crashed.
Other meds tried with either no response or couldn't take side effects:
Desipramine
Celexa
Zoloft
Remeron
WellbutrinThis has been in the last two years.
So now doc thinks ECT. He is a very young, progressive doc.His idol is Stephen M. Stahl.
He doesn't like labelling patients too soon but he thinks I MAY be BPll due to my responses to meds, my previous history of sexual promiscuity and spending WAY too much (bankruptcy)plus my Mom ,who committed suicide, was diagnosed as BPII. But none of my super happy times seemed manic and did not involve lack of sleep,but my sleep has always been affected by my depression
( can't get to sleep for hours then the 4:00 AM wakeup call)Other than times mentioned above I have been depressed (exhausted, no energy,sleep and eat too much, weepy, withdrawn, anti-social, apathetic, irritable.)But I can respond to events and/or people favourably for a short time and do smile, even laugh sometimes.
My doc is confering with a neurologist to make sure re washout of Lamictal. He will be doing Bilateral ECT twice a week in hospital at first and then as an outpatient.(He wants to keep his eye on me and space out the treatments as apart as we can and watch for memory loss, but doesn't want to "waste" a treatment by trying unilateral)...he calls me one of his challenges due to my S/E's and weird responses.I actually tried Speed as a teenager and slept for three days!I am very lucky to live in Canada where this will not cost me anything, plus I am on Disability through my employer. I am hoping I will respond more favourably to meds after treatments but if not I am prepared to get maintenance ECT.
Sheesh, I guess I really rambled , didn't I? Anyway, I welcome any words of wisdom you may have.
Thanks!
Mags
Posted by BarbaraCat on March 25, 2002, at 19:21:36
In reply to Re: Anyone had success with ECT? » Elizabeth, posted by Mags on March 25, 2002, at 18:06:03
Mags,
I'd also like to second that it would be a great favor to all of us here if you kept us informed of your ECT experiences. You probably won't be feeling too peppy during the treatments, but it might be good therapy and a contribution to your 'memoirs' to keep a record of your days during this time. Who knows, there may even be a book in it for you down the line!I'd also like to let you know how much your meds and 'wanton' history jibes with mine. I've gone through every single one of the newer ADs and some of the older ones. I'll get a honeymoon rush for a few weeks or months and then - splaaat!
My garage resembles a stuffed to the gills warehouse. I can easily open a Michael's Craft Store with all the fallout from my brilliant craft and project ideas that never came to fruition (you have no idea how serious I am about this!). Bankruptcy has not happened yet, but looms and leers around every corner every month of the year. Billpaying time is either a matter of intense overwhelm and stress or 'I'll think about it tomorrow' and tomorrow never comes.
I'm currently stabilized and relatively serene on a brew of Remeron, lithium, Klonopin and thyroid (plus handfulls of vitamins and amino acids). I'm counting the days until another splaaat.
I've recently been upgraded from unipolar to Bipolar II mainly because of my med history and the fact that members of my family fit into the BPII category.
So, I think we have much in common, and I'd like you to know that you're not alone by any means. Please keep in touch. - BCat
Posted by Mags on March 25, 2002, at 21:00:20
In reply to Re: Anyone had success with ECT? » Mags, posted by BarbaraCat on March 25, 2002, at 19:21:36
Hi BCat,
WOW...we DO sound alike....I just about fell off my chair when you mentioned crafts and Michael's!! I too have got all hepped up about something, flower arranging, ceramics, computer crafts, sewing etc. I buy all the stuff, do it for awhile, get bored and give it up or I just lose interest. I have often wondered if I could have ADD. Sometimes I can concentrate and sometimes I can't even read this board!I also SOOO relate to bill paying....I actually call myself Scarlett.....I find even when I have the money I put it off....sometimes the simplest chore seems so overwhelming..it took me an hour today just to convince myself I could do the dishes!
I will definately keep everyone informed about my ECT experience. I do sporadically keep a journal so I will try to make notes. The nurses on the Pyschiatric unit (where I have spent TOO much time) are very helpful and will remind me to do it. Someone else on this board said to keep notes BEFORE the ECT to jog my memory and I plan to do that also.
I am sure it won't be a Bestseller (I wish) but I will do my best!
Thanks for your well wishes. That's what makes this board so great...it is nice to know we are not alone....that is one thing I have really learned when in hospital...I have made some good friends from my incarcerations ;o)
Mags
Posted by OldSchool on March 25, 2002, at 22:12:17
In reply to Re: Anyone had success with ECT? » OldSchool, posted by Elizabeth on March 25, 2002, at 14:43:45
> > It might be true that atypical depression doesnt respond as well to ECT.
>
> From what I've read, it's not totally clear to me whether there's solid evidence of this, or whether it's just a reputation. Interestingly, there doesn't seem to be any recent research on the subject at all. But anyway, these subtypes don't predict anything *absolutely*, so in some cases it's probably worthwhile to try ECT even if you seem to have "atypical" depression.thats my plan. I dont know what type of depression I have at this stage anyway. I dont think any of my doctors do either. Its changed probably ten times thru the years. I personally think I have melancholic depression with some psychotic depression mixed in with it. So Im just gonna do the bilateral ECT thing. Ive also been told I have a retarded depression but with "mood reactivity" and a "rigid" personality. whatever that means.And Ive had atypical depression dx a few times. I also have the EPS symptoms now, mild parkinsons type symptoms, mild rigid right arm and stuff. Not noticeable to the naked eyeball unless I get examined though.
Frankly, I think the only thing anybody knows is Ihave some sortof mood disorder and thats about all. And some kind of mild movement disorder thats not severe.
>
> My pdoc and I did talk about ECT once (when I was in Boston), and he took the particular features of the illness (neurovegetative signs/symptoms, etc.) into consideration. This was when I'd tried a lot of things to augment Nardil (which had pooped out) and they didn't help. In the end we decided to keep trying with the medications. This ended up paying off, although it took a long time.
>
> I think that doctors in a place like Boston, where there's a major medical center (three, in fact) and lots of research going on, would probably be more likely to take subtypes of depression into account than the average community doctor. Boston doctors also seem to be into trying experimental medication approaches, rather than just trying you on an SSRI, TCA, MAOI, and lithium and then referring you for ECT. :-)
>Is it really that much different in Boston? I realize its an elite academic town and all. But when it comes to psychiatry, which is so primitive about wherever you go, I find it hard to believe the psychiatric services there would be much different than in Winston, or Charlotte...or NYC..or wherever. Are there really experimental drugs there available for the taking? I realize people up there are probably more open minded than down here. But are there really more treatments up there?
> > You might know more about this than the docs do in some cases because of your readings.
>
> That's pretty scary, because I really don't know much about ECT. I definitely would not be willing to have ECT on the advice of a doctor who knew even less about it than I do.
>
> > You know how it is in the real world, if you dont respond to meds you just get shocked, period.
>
> Heh, my experience has that they just throw more meds at me!
>
> > As far as bilateral, its definitely better to start off with if you have psychotic features with your mood disorder.
>
> Hmm. It's been a long time since I seriously considered ECT, so I'm not sure that my information is up to date. My recollection is that it's a judgment call, though: you might want to start out using bilateral ECT for the most urgent cases, whereas if there isn't so much of a hurry you can afford to titrate so as to minimize the risk of cognitive side effects. Is there some other issue, or is that what you were thinking of?
Bilateral is just plain stronger and it doesnt require a titration procedure so the first treatment is not wasted like in unilateral. I figure I should just go for the gusto and go for bilateral and expect memory loss. At least Iknow it will be powerful.
>
> > Bifrontal ECT is supposed to be the best of both worlds, having effectiveness comparable to bilateral, but without the severe memory loss side effects of bilateral.
>
> I'm not very familiar with bifrontal ECT, but I'll keep this in mind (although I hope I never have to use the information myself!).Bifrontal is supposed to have the effectiveness of bilateral, but without the memory loss side effects. Its the best of both worlds. The electrodes are placed above the eyes, on the forehead instead of the temples. Its making a comeback from what Ive read.
later,
Old School
Posted by shelliR on March 25, 2002, at 22:43:19
In reply to Re: Anyone had success with ECT?, posted by OldSchool on March 25, 2002, at 22:12:17
>
> Bilateral is just plain stronger and it doesnt require a titration procedure so the first treatment is not wasted like in unilateral. I figure I should just go for the gusto and go for bilateral and expect memory loss. At least Iknow it will be powerful.> Bifrontal is supposed to have the effectiveness of bilateral, but without the memory loss side effects. Its the best of both worlds. The electrodes are placed above the eyes, on the forehead instead of the temples. Its making a comeback from what Ive read.
This past February I went through a series of bifrontal ECT treatments. The bad news is that the treatments didn't turn out to be helpful in treating my depression. (I don't know what specific kind I have--diagnosis is major depression.) The good news is that my memory loss was pretty minimal; there is a lot gone from the period that I was getting the treatments, and some minor memory blocks of things before the treatments, like directions, names of things, etc. Within about ten days of the last treatment, I was pretty much able to jump right back into life and work. I got eight all together: Mondays, Wednesdays, and Fridays. I think it made it easier for me to be in the hospital (it was a pretty nice hospital with a nice staff). I don't regret trying it
shelli
Posted by IsoM on March 25, 2002, at 22:43:40
In reply to Re: Anyone had success with ECT? » Elizabeth, posted by Mags on March 25, 2002, at 18:06:03
Excuse me for jumping in but I read in your post that "I actually tried Speed as a teenager and slept for three days!" That sort of reaction sounds very much like you've got ADD traits, no matter what else you may have. Have you been checked by a "QUALIFIED" psychologist who specialises in ADD for it? Most doctors & pdocs will brush it off & refuse to believe that adults really have it. Please post your answer back about this, Mags.
Posted by Mags on March 25, 2002, at 23:25:58
In reply to About Possible ADD » Mags, posted by IsoM on March 25, 2002, at 22:43:40
> Excuse me for jumping in but I read in your post that "I actually tried Speed as a teenager and slept for three days!" That sort of reaction sounds very much like you've got ADD traits, no matter what else you may have. Have you been checked by a "QUALIFIED" psychologist who specialises in ADD for it? Most doctors & pdocs will brush it off & refuse to believe that adults really have it. Please post your answer back about this, Mags.
Thanks for jumping in IsoM!
I have never been diagnosed for ADD...I just kinda wondered because of things I read here plus I took one of those self diagnostic tests on the web, and it said I could possibly be ADD.
Why would my weird reaction to speed be a clue?
Would this make a difference in how I would be treated?
Thanks,
Mags
Posted by IsoM on March 25, 2002, at 23:51:19
In reply to Re: About Possible ADD » IsoM, posted by Mags on March 25, 2002, at 23:25:58
Depending on how I'm feeling Dexedrine will either wake me up & help me focus, or if I'm worn out, it'll calm me down & let me sleep. To a certain extent, it depends on the time of day for the reaction I get.
People with ADD will often have so many things going on in their mind at one time that don't necessarily lead anywhere except to another thought. I compare my thoughts to popcorn being popped & richocheting around in my head. Dexedrine will stop thoughts from bouncing about & calm my focus allowing me to slow my thoughts down to fall asleep. It seems to be fairly common in ADD people but it's not a reaction found in ordinary persons.
I know you're home for now from the hospital but I don't recall reading what your diagnoses is supposed to be. Could you explain first before I suggest anything? Have you taken various ADs before & what was your responses to them? A bit of background info would be helpful.
I have ADHD & narcolepsy. I think depression developed not as a separate issue but related to the ADHD, narcolepsy, & absolutely crappy, stress-filled marriage I had. The depression was secondary.
Posted by BarbaraCat on March 26, 2002, at 0:28:51
In reply to Re: Anyone had success with ECT? » BarbaraCat, posted by Mags on March 25, 2002, at 21:00:20
Mags,
You have no idea how relieved I am to know that I'm not the only one who has these 'irresponsible' habits. I can get so down on myself and frustrated because I know better. I'm beginning to see the light that these behaviors are a product of some weird syndrome we suffer from and not due to some horrible shortcoming. The thing is that I am very talented and could probably put these artsy crafty things to very good use - another Georgia O'Keefe - if only I could concentrate long enough. Or slog through the piles of boxes and stuff to find the darn items I need when I'm wildly inspired. I also wonder about ADD, but what's in a name? It's all just degrees of the same malfunction. Well good. Connect those circuits in our brains and watch out World!The reason I'm so interested in ECT is that I'm coming to believe that medication has the unfortunate effect of lag time. By the time the receptors are duly affected, our chemistry has moved on to new things. I think that resetting our brain's circuits via electric or magnetic means is the key and I hope they figure out how to do it right in our lifetimes. We're rooting for you - what an adventure. Also, if you could let us know when you'll be going in, there's a few of us here who wouldn't mind putting in a good word for you in our daily good thoughts. - Barbara
Posted by BarbaraCat on March 26, 2002, at 0:51:19
In reply to About Possible ADD » Mags, posted by IsoM on March 25, 2002, at 22:43:40
Anyone who has a clue,
My drug of choice when I was in my late teens and early twenties (back in the early '70's) was methadrine. It was the only substance I recall where I would feel sooooo mellow, focused and centered. It was a Zen-like no-thoughts space that I sought forever after. I know now that I was self-medicating via the street scene. Even so, speed in abusive amounts is a killer, no doubt about it. I also stayed up for days, crashed and burned, and fried my delicate system.
A question I'd like to put out there is: this suggests to me that I have ADD in addition to depression. However I also have a tendency towards severe anxiety and panic disorder. I'd hesitate at this stage to take a stim because I do not want to elicit a strung-out spin into hypomania or compromise my fledgling health and immune system. I have an appt with my pdoc this week. He's very wary of prescribing a stim because he knows I had a bit of a Jones in the past. The bottom line of my question is, how do speed-type drugs affect those with serious affective/anxiety disorders? - BCat
Posted by Zo on March 26, 2002, at 3:56:56
In reply to Re: About Possible ADD - Speed anyone?, posted by BarbaraCat on March 26, 2002, at 0:51:19
Hi BCat, I have a friend in same situation, and she survives on Adderall. . .got to THIRTY mgs a grain at a time. I've been on Dex for four years, and some Adderall, am BPII. .. and neither ever rocketed me to any kind of interesting high. Anyway, the Adderall has not triggered any old addiction in her, nor have I gotten manic. On other meds, yes, but not stims! You control the anxiety by ramping up sloooowly, and by using benzos PRN.
Zo
Posted by Mags on March 26, 2002, at 7:47:04
In reply to Re: About Possible ADD » Mags, posted by IsoM on March 25, 2002, at 23:51:19
Pls see this and let ne know what else I can add...
Mags
http://www.dr-bob.org/babble/20020322/msgs/100101.html
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