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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by pej on January 12, 1999, at 20:43:51
As I've mentioned, I have been on meds for a long time.
Off and on, mostly on since mid eighties. My mother, may she rest in peace, was given ect for a major bout with depression years ago and it was effective.
After re-reading a reply of yours in August to someone who was manic, you higly recommended ect. Of course, the inquirer was unsuccessful with meds and side effects.
My question is, do you think ect would be a safer option in the long run than staying on meds? I am not suicidal and get along as best I can but wonder if ect
would be a wiser, though maybe costlier, way to go?
Should ect in general be a more first line defense?
Thank you very much. Phil
Posted by Toby on January 13, 1999, at 12:00:16
In reply to Toby and Others...curious about ect, posted by pej on January 12, 1999, at 20:43:51
If I ever get depressed I will go straight to ECT. It is safe, quick, and highly effective for depression. The downside is expense since it has to be done in a hospital and anesthesia is required. However, the expense comes all at once rather than spread out over months, as with medications and repeat doctor visits and lost wages from work and loss of the joy of life. People still fear it because of movies and stories of relatives who had it many years ago that indicate it is painful and damages the brain. Indeed, the way it was administered in the 1940's and '50's was generally not very helpful. The amount of electricity was too high and it was given to control behaviors of severely mentally ill or retarded individuals, so it was given too often and for the wrong reasons. Now, only enough electricity is applied to create a seizure in the brain, the body is paralyzed so that bones aren't broken and generally not even any muscle aches are produced, and general anesthesia is given so that the patient is asleep during the whole thing. The memory loss that people get is usually just around the ECT itself, and the cause is as much due to the anesthesia as to the ECT. Depending on how many treatments are needed, usually 6-12 total, short term memory loss can occur for a few weeks or a month, but does return to baseline quickly (and when you think about how your memory is shot during an episode of depression anyway, it doesn't seem that much of a side effect). The few people who go on Geraldo with their notebooks and report having no memory of their entire lives and can't remember anything new seem to be fakers. They can certainly remember enough to get on Geraldo on time and remember that ECT caused them to, supposedly, lose their memory. Memory just doesn't work that way. Anyway, my point is that ECT probably should be used more than it is, and more as a first line treatment, and it is not something to be feared.
Posted by Elizabeth on January 18, 1999, at 8:50:51
In reply to Re: Toby and Others...curious about ect, posted by Toby on January 13, 1999, at 12:00:16
> If I ever get depressed I will go straight to ECT. It is safe, quick, and highly effective for depression. The downside is expense since it has to be done in a hospital and anesthesia is required. However, the expense comes all at once rather than spread out over months, as with medications and repeat doctor visits and lost wages from work and loss of the joy of life. People still fear it because of movies and stories of relatives who had it many years ago that indicate it is painful and damages the brain. Indeed, the way it was administered in the 1940's and '50's was generally not very helpful. The amount of electricity was too high and it was given to control behaviors of severely mentally ill or retarded individuals, so it was given too often and for the wrong reasons. Now, only enough electricity is applied to create a seizure in the brain, the body is paralyzed so that bones aren't broken and generally not even any muscle aches are produced, and general anesthesia is given so that the patient is asleep during the whole thing. The memory loss that people get is usually just around the ECT itself, and the cause is as much due to the anesthesia as to the ECT. Depending on how many treatments are needed, usually 6-12 total, short term memory loss can occur for a few weeks or a month, but does return to baseline quickly (and when you think about how your memory is shot during an episode of depression anyway, it doesn't seem that much of a side effect). The few people who go on Geraldo with their notebooks and report having no memory of their entire lives and can't remember anything new seem to be fakers. They can certainly remember enough to get on Geraldo on time and remember that ECT caused them to, supposedly, lose their memory. Memory just doesn't work that way. Anyway, my point is that ECT probably should be used more than it is, and more as a first line treatment, and it is not something to be feared.
Toby...a problem with ECT is unless you want to have maintenance treatments (pretty expensive, time-consuming (because of the general anaesthesia), a general PITA), maintenance meds might be required. However, your idea does have some merit - I think this might be a more common practice if people weren't so phobic about ECT (due to bad publicity and past problems more than anything else).
I will note that ECT hasn't been shown to work so well in most types of depression. For example, atypical depression (which is pretty common despite the name) seems to have a pretty low rate of response to ECT. It's best suited for typical melancholic depressions and psychotic depression.
Posted by alan on May 30, 1999, at 3:17:37
In reply to Re: Toby and Others...curious about ect, posted by Toby on January 13, 1999, at 12:00:16
I think there is reason to believe that the longer a depressive episode lasts, the higher the probability of (more frequent, more severe) recurrence. This is supposed to apply with special force to the first occurrences. If this is true, and if ECT is the fastest acting treatment, then it seems irresponsible to not use it as THE first line treatment, especially in initial occurences.
Moreover, it might be much less expensive in the long run. Comments?
Posted by David K. on July 3, 1999, at 8:11:02
In reply to Re: Toby and Others...curious about ect, posted by Elizabeth on January 18, 1999, at 8:50:51
>... only enough electricity is applied to create a seizure in the
brain, the body is paralyzed so that bones aren't
broken and generally not even any muscle aches are
produced, and general anesthesia is given so that
the patient is asleep during the whole thing.Why is general anesthesia given? Is it to allay the patient's fears of the operation? Or is there some medical reason for it? I can understand why muscle relaxants are used, but why general anesthesia?
>The memory loss that people get is usually just
>around the ECT itself, and the cause is as much
>due to the anesthesia as to the ECT.
>Depending on how many treatments are needed,
>usually 6-12 total, short term memory loss can
>occur for a few weeks or a month, but does return
>to baseline quickly (and when you think about how
>your memory is shot during an episode of depression
>anyway, it doesn't seem that much of a side effect).Exactly what are we talking about in regards to short-term memory?
>Anyway, my point is that ECT probably should be
>used more than it is, and more as a first line
>treatment, and it is not something to be feared.When I was young, my then-wife was diagnosed with multiple personalities and given ECT. Quick, boys and girls, what is the indicated treament for mulitple personalities. It sure ain't ECT. I knew that then as a young dumb kid, and I know that know when my psychologist, who has treated a couple of multiples, said so. Needless to say, my opinions of the mental health field were less then trusting for years afterward. It has taken me all of that time to even come to the decision that I need help for my depression. I've been on several meds, all with varying degrees of effectiveness and side effects. I've also been to a psychologist (which I found somewhat helpful). Why? It isn't because I've become more trusting of mental health care; its because I'm so god awful tired of feeling like this. There are days when the fear and loathing I've had for ECT and psychiatrists is drawfed by the mental pain I feel from depression. This has led me to consider ECT.
> Toby...a problem with ECT is unless you want to
>have maintenance treatments (pretty expensive,
>time-consuming (because of the general anaesthesia),
>a general PITA), maintenance meds might be
>required. However, your idea does have some
>merit - I think this might be a more common
>practice if people weren't so phobic about ECT
>(due to bad publicity and past problems more than
anything else).> I will note that ECT hasn't been shown to work
>so well in most types of depression. For example,
>atypical depression (which is pretty common
>despite the name) seems to have a pretty low rate
>of response to ECT. It's best suited for typical
>melancholic depressions and psychotic depression.What is the difference between atypical and melancholic depression?
Posted by Judy on July 3, 1999, at 11:11:42
In reply to Re: Toby and Others...curious about ect, posted by David K. on July 3, 1999, at 8:11:02
Correct me if I'm wrong, please, but I've been informed that the beneficial effects of ECT only last for 4 - 6 weeks. ECT has been recommended for me twice over the past 12 years by my psychiatrist when I was as low as I could posibly go and he wanted to buy me some time with the ECT so that I could start another AD and get it working before the ECT benefits wore off.
Both times I stamped my foot and absolutely refused because of the memory loss following ECT treatment. I do computer graphics for a living and use three very complicated software packages. On my best day, I have to stop and think about where, among the software's thousands of options, I last found a certain photo filter that I had used before. If the ECT tore holes in my memory for recently-learned (the past five years) skills, I would be out of the graphics business.
My question to anyone who has experienced ECT and the accompanying memory loss: Am I correct in assuming this treatment would be a disaster to my career, at least in the short term? Would I eventually fully recover the same knowledge of my graphics programs that I have now?
This is more a rhetorical question based on curiosity, because I don't think I'll ever have the courage to submit to ECT and risk my career should I ever find myself at the point where it would be recommended.
Thanks for any info you can provide.
Judy
> >... only enough electricity is applied to create a seizure in the
> brain, the body is paralyzed so that bones aren't
> broken and generally not even any muscle aches are
> produced, and general anesthesia is given so that
> the patient is asleep during the whole thing.
>
> Why is general anesthesia given? Is it to allay the patient's fears of the operation? Or is there some medical reason for it? I can understand why muscle relaxants are used, but why general anesthesia?
>
> >The memory loss that people get is usually just
> >around the ECT itself, and the cause is as much
> >due to the anesthesia as to the ECT.
> >Depending on how many treatments are needed,
> >usually 6-12 total, short term memory loss can
> >occur for a few weeks or a month, but does return
> >to baseline quickly (and when you think about how
> >your memory is shot during an episode of depression
> >anyway, it doesn't seem that much of a side effect).
>
> Exactly what are we talking about in regards to short-term memory?
>
> >Anyway, my point is that ECT probably should be
> >used more than it is, and more as a first line
> >treatment, and it is not something to be feared.
>
> When I was young, my then-wife was diagnosed with multiple personalities and given ECT. Quick, boys and girls, what is the indicated treament for mulitple personalities. It sure ain't ECT. I knew that then as a young dumb kid, and I know that know when my psychologist, who has treated a couple of multiples, said so. Needless to say, my opinions of the mental health field were less then trusting for years afterward. It has taken me all of that time to even come to the decision that I need help for my depression. I've been on several meds, all with varying degrees of effectiveness and side effects. I've also been to a psychologist (which I found somewhat helpful). Why? It isn't because I've become more trusting of mental health care; its because I'm so god awful tired of feeling like this. There are days when the fear and loathing I've had for ECT and psychiatrists is drawfed by the mental pain I feel from depression. This has led me to consider ECT.
>
> > Toby...a problem with ECT is unless you want to
> >have maintenance treatments (pretty expensive,
> >time-consuming (because of the general anaesthesia),
> >a general PITA), maintenance meds might be
> >required. However, your idea does have some
> >merit - I think this might be a more common
> >practice if people weren't so phobic about ECT
> >(due to bad publicity and past problems more than
> anything else).
>
> > I will note that ECT hasn't been shown to work
> >so well in most types of depression. For example,
> >atypical depression (which is pretty common
> >despite the name) seems to have a pretty low rate
> >of response to ECT. It's best suited for typical
> >melancholic depressions and psychotic depression.
>
> What is the difference between atypical and melancholic depression?
Posted by Joan D. on July 4, 1999, at 11:28:50
In reply to Re: Toby and Others...curious about ect, posted by alan on May 30, 1999, at 3:17:37
> I think there is reason to believe that the longer a depressive episode lasts, the higher the probability of (more frequent, more severe) recurrence. This is supposed to apply with special force to the first occurrences. If this is true, and if ECT is the fastest acting treatment, then it seems irresponsible to not use it as THE first line treatment, especially in initial occurences.
> Moreover, it might be much less expensive in the long run. Comments?I have had many rounds of ECT for bipolar depressions and manias. Yes they can be highly effective.
Don't kid yourself though..you many lose some memory especially retaining recent memories.
I have always had a day or two of muscle aches-nothing unbearable,and a big time headache on the day of the treatment.
I have not been on Geraldo and don't intend to go but I resent the implication that what i have experienced
is fake. ECT has made life possible for me but it should not be undertaken lighlty
or without full(and honest)consideration of the possible side effects.
Posted by David K. on July 4, 1999, at 15:54:54
In reply to Re: Toby and Others...curious about ect, posted by Joan D. on July 4, 1999, at 11:28:50
> I have had many rounds of ECT for bipolar depressions and manias. Yes they can be highly effective.
> Don't kid yourself though..you many lose some memory especially retaining recent memories.
> I have always had a day or two of muscle aches-nothing unbearable,and a big time headache on the day of the treatment.
> I have not been on Geraldo and don't intend to go but I resent the implication that what i have experienced
> is fake. ECT has made life possible for me but it should not be undertaken lighlty
> or without full(and honest)consideration of the possible side effects.Could you give me an idea what it is like to undergo ECT?
Also, could you read my previous post and possibly answer the questions that are in it?
Thanks!
Posted by Deb on July 4, 1999, at 17:08:31
In reply to Re: Toby and Others...curious about ect, posted by David K. on July 4, 1999, at 15:54:54
I've been following the posts on ect with much interest. I have suffered from depression much of my adult life. But...I had surgery in 1983 for a very large brain tumor, part of which is still in there. Is ect contraindicated for people with previous brain trauma? Been on meds for many years and always looking into new areas of treatment. Any info welcome.
Posted by Ruth on July 5, 1999, at 16:27:24
In reply to Re: Toby and Others...curious about ect, posted by David K. on July 3, 1999, at 8:11:02
David- I've had ECT twice (about a year apart). I'm not sure what the reason is for general anasthesia, though I think it is to reduce the likelihood of injury during the seizure. The net effect is that one minute you are talking to the doctor and the anasthesialogist as they put in an IV and the next you quickly lose contact and fall asleep. The next thing is waking up a bit disoriented and the nurse saying it's over, you've had your treatment.My experience with memory loss is that I remember little of the time during the treatments and of the time leading up to the treatments. For other memory I've called it swiss cheese, i.e. there are some things that I can remember and others that I have no recollection of. That applies to memories years before the treatment, although the years closer to the treatment seem to be most effected. I also find that absorbing new information is harder for me. I believe all of this to be a result of the ECT. My doctor feels that with the exception of the time around the treatments themselves the rest is residual of the depression and that it should resolve.
Post if you have more questions.- Ruth
> >... only enough electricity is applied to create a seizure in the
> brain, the body is paralyzed so that bones aren't
> broken and generally not even any muscle aches are
> produced, and general anesthesia is given so that
> the patient is asleep during the whole thing.
>
> Why is general anesthesia given? Is it to allay the patient's fears of the operation? Or is there some medical reason for it? I can understand why muscle relaxants are used, but why general anesthesia?
>
> >The memory loss that people get is usually just
> >around the ECT itself, and the cause is as much
> >due to the anesthesia as to the ECT.
> >Depending on how many treatments are needed,
> >usually 6-12 total, short term memory loss can
> >occur for a few weeks or a month, but does return
> >to baseline quickly (and when you think about how
> >your memory is shot during an episode of depression
> >anyway, it doesn't seem that much of a side effect).
>
> Exactly what are we talking about in regards to short-term memory?
>
> >Anyway, my point is that ECT probably should be
> >used more than it is, and more as a first line
> >treatment, and it is not something to be feared.
>
> When I was young, my then-wife was diagnosed with multiple personalities and given ECT. Quick, boys and girls, what is the indicated treament for mulitple personalities. It sure ain't ECT. I knew that then as a young dumb kid, and I know that know when my psychologist, who has treated a couple of multiples, said so. Needless to say, my opinions of the mental health field were less then trusting for years afterward. It has taken me all of that time to even come to the decision that I need help for my depression. I've been on several meds, all with varying degrees of effectiveness and side effects. I've also been to a psychologist (which I found somewhat helpful). Why? It isn't because I've become more trusting of mental health care; its because I'm so god awful tired of feeling like this. There are days when the fear and loathing I've had for ECT and psychiatrists is drawfed by the mental pain I feel from depression. This has led me to consider ECT.
>
> > Toby...a problem with ECT is unless you want to
> >have maintenance treatments (pretty expensive,
> >time-consuming (because of the general anaesthesia),
> >a general PITA), maintenance meds might be
> >required. However, your idea does have some
> >merit - I think this might be a more common
> >practice if people weren't so phobic about ECT
> >(due to bad publicity and past problems more than
> anything else).
>
> > I will note that ECT hasn't been shown to work
> >so well in most types of depression. For example,
> >atypical depression (which is pretty common
> >despite the name) seems to have a pretty low rate
> >of response to ECT. It's best suited for typical
> >melancholic depressions and psychotic depression.
>
> What is the difference between atypical and melancholic depression?
Posted by David K. on July 5, 1999, at 17:03:24
In reply to Re: Toby and Others...curious about ect, posted by Ruth on July 5, 1999, at 16:27:24
Hi, Ruth,
Thanks for taking the time to answer my questions. It's
greatly appreciated.> David- I've had ECT twice (about a year apart). I'm not sure what the reason is for general anasthesia, though I think it is to reduce the likelihood of injury during the seizure. The net effect is that one minute you are talking to the doctor and the anasthesialogist as they put in an IV and the next you quickly lose contact and fall asleep. The next thing is waking up a bit disoriented and the nurse saying it's over, you've had your treatment.
>
> My experience with memory loss is that I remember little of the time during the treatments and of the time leading up to the treatments. For other memory I've called it swiss cheese, i.e. there are some things that I can remember and others that I have no recollection of. That applies to memories years before the treatment, although the years closer to the treatment seem to be most effected. I also find that absorbing new information is harder for me. I believe all of this to be a result of the ECT. My doctor feels that with the exception of the time around the treatments themselves the rest is residual of the depression and that it should resolve.
> Post if you have more questions.- Ruth> > Why is general anesthesia given? Is it to allay the patient's fears of the operation? Or is there some medical reason for it? I can understand why muscle relaxants are used, but why general anesthesia?
There is no way I will do ECT on an inpatient
basis. There are too many practical and personal
considerations to allow that. I am concerned about
the anesthesia. If I do ECT, I wonder if it is
possible to do it without anesthesia? I'm not
talking about the muscle relaxant; just no anesthesia.
I understand quite clearly why muscle relaxants are
would be necessary. Any thoughts on this?> >
> > Exactly what are we talking about in regards to short-term memory?
> >Do these memory losses concern you? And where they
of significant events in your life or the
diminishment of work skills? There are a number of
memories I wouldn't mind loosing--namely my
marriage/divorce to a multiple personality. With
the exception of my daughter being born, there is
about a five year chunk of memories that I wish
would go away.
> > When I was young, my then-wife was diagnosed with multiple personalities and given ECT. Quick, boys and girls, what is the indicated treament for mulitple personalities. It sure ain't ECT. I knew that then as a young dumb kid, and I know that know when my psychologist, who has treated a couple of multiples, said so. Needless to say, my opinions of the mental health field were less then trusting for years afterward. It has taken me all of that time to even come to the decision that I need help for my depression. I've been on several meds, all with varying degrees of effectiveness and side effects. I've also been to a psychologist (which I found somewhat helpful). Why? It isn't because I've become more trusting of mental health care; its because I'm so god awful tired of feeling like this. There are days when the fear and loathing I've had for ECT and psychiatrists is drawfed by the mental pain I feel from depression. This has led me to consider ECT.What were you diagnosed with?
Overall, was your experience with ECT a positive
one?Was it effective in reducing your symptoms?
What type of electrod placement did you
have-bilateral or unilateral?Do you feel you gave true informed consent before
procedure?How long ago did you receive the treatments?
How many sessions did you have during each treatment?
Would you do it again?
> > What is the difference between atypical and melancholic depression?
Posted by s on July 5, 1999, at 19:44:50
In reply to Re: Toby and Others...curious about ect, posted by alan on May 30, 1999, at 3:17:37
> I think there is reason to believe that the longer a depressive episode lasts, the higher the probability of (more frequent, more severe) recurrence. This is supposed to apply with special force to the first occurrences. If this is true, and if ECT is the fastest acting treatment, then it seems irresponsible to not use it as THE first line treatment, especially in initial occurences.
> Moreover, it might be much less expensive in the long run. Comments?
Posted by Toby on July 6, 1999, at 11:26:45
In reply to Re: Toby and Others...curious about ect, posted by s on July 5, 1999, at 19:44:50
ECT can be done without anesthesia, but I would refer you to the horror stories of the 1950's for what that experience would be like. The muscle relaxant paralyzes ALL the voluntary muscles in the body including the lungs so that you have to have oxygen given and the lungs are inflated manually by the anestehsiologist. If you were to have the muscle relaxant without the anesthesia, you would be paralyzed yet awake, and experience the jolt of electricity before losing consciousness with the seizure. Very unappealing.
ECT is done on an inpatient basis for the initial round because there are so many treatments and the memory problems are strongest then. Once there has been a response, if the decision is made to continue maintenance treatments, those are generally done once a month or so and they are done on an outpatient basis.
Posted by alan on July 19, 1999, at 1:45:51
In reply to Re: Toby and Others./ect for me?, posted by Deb on July 4, 1999, at 17:08:31
> I've been following the posts on ect with much interest. I have suffered from depression much of my adult life. But...I had surgery in 1983 for a very large brain tumor, part of which is still in there. Is ect contraindicated for people with previous brain trauma? Been on meds for many years and always looking into new areas of treatment. Any info welcome.
My first and most important bit of advice--and for once, I can speak with authority--is not to take any advice from me: see your doctor, and maybe a neurologist! That said, I think that the fact that some of the tumour is still in there might be a contraindication, but also I think there can be no general answer here. The specifics of your particular case will need to be taken into account by someone who knows what he/she is doing.
This is directed to all considering ECT. Back in the early 50's my uncle-the-psychiatrist and some of his colleagues used to give ECT on an outpatient basis in their offices and without muscle relaxants or anesthesia. Most patients did not make all that big a deal of it, and quite a few who had had them before requested repeats when depresssed again. Maybe that will make it seem less scary. Not that I want it that way!
Posted by Kathy Martin on July 22, 1999, at 19:01:32
In reply to Re: Toby and Others./ect for me? Deb:, posted by alan on July 19, 1999, at 1:45:51
I am just started my 4rd series of ECT treatments. I had wonderful luck with 1 series back in 1976.
The other two were not very sucessful. I have
gotten so bad in this depression, I can hardly
function. I really don't know if the ECT will help
me, but I wasn't getting anywhere on all the different type of meds
I was taking. I feel so desperate and all I want
is to be normal and work like most of my friends
can. I just hope and pray that this series of ECT
will help me. I am so desperate. Any kind words
from anyone will be appreciated.
Sincerely, Kathy
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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