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
poster:Elizabeth
thread:97068
URL: http://www.dr-bob.org/babble/20020322/msgs/100067.html