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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Thrud on March 31, 2001, at 16:50:43
Hi everyone.
After suffering depression for over ten years with poor response to medication, I am considering ECT. I have read many postings by people who have had bad memory problems as a result of ECT. Has anyone out there had only minor, transient memory difficulties like the literature says you should expect? Or is the reality grim?
I really appreciate your experiences.Thrud
Posted by Adam on April 1, 2001, at 14:56:27
In reply to Any POSITIVE experiences with ECT?, posted by Thrud on March 31, 2001, at 16:50:43
Thrud, (interesting handle...)
I had one course of ECT a couple years ago. It worked very well, though the effects were temporary, as expected.
I had what you might say were "bad" problems with memory. They were transient, though, and really were only pronounced when it came to events the day of or shortly after the treatment. I probably had a month, give or take, of marked improvement, and less than a week of that was lost to amnesia. However, what was lost was truly lost. One remarkable example was an evening out with my parents (the hospital allowed time to leave the ward for voluntary admittees) at what was, I hear, an excellent Italian restaurant, that I have absolutely no recollection of whatsoever. It never happened, as far as I can tell (with the possible exception of a creepy experience I had strolling the North End of Boston, but that's another story...). These lapses were spotty...some things I remember very well, others are complete blanks. I kept a diary at the time, and that helped a great deal, though I find it painful to read now. For whatever reason, I didn't write down that I had gone out to dinner with my parents that night. This actually led to a small argument, because the three of us DID in fact go to an Italian restarant a few months earlier, and I thought THEY had the dates mixed up. "How could you mess up THAT with the time I was in the HOSPITAL, fercryinoutloud", etc. But I know they didn't mix things up now, and it was just one very stark example of how weird the experience of ECT-induced retrograde and anti-retrograde amnesia can be.
I tell you this for one reason: I'd do it again in a hearbeat if faced with the same dilemma I had at that time. I'm pretty sure I would have opted for it even under less dire circumstances. As one doctor once said to me, "it's the cat's pajamas." It works most of the time for most of the people who try it, the results can be fast, and often quite dramatic. It's disturbing as hell (at least for me) to think about, and I'll readily concede the memory lapses were both unnerving and disorienting. But given the alternative, there's no question: I'd do it again.
I had an intesive course of bilateral ECT. For some, especially those who get it chronically (because no other AD works for them, most likely), the deleterious effects on memory can be mitigated to some degree (perhaps even a great degree) by limited consecutive sessions and unilateral, instead of bilateral, seizures. You might, for instance, get a one to two week long course of bilateral ECT, maybe upwards of ten or more sessions in a row, after which I would be willing to bet you would have memory difficulties. If you responded well, your doctors then might perform a monthly maintainance treatment, perhaps unilateral. It is conceivable that this could be enough to relieve you of depression to a satisfactory degree with minimal associated memory loss.
ECT is scary, and I fear some of my apprehensions about it, both before and after, could have contributed to an overly pessimistic view of the procedure. Pessimism is an easy thing to succumb to when depressed, so I would like to stress two points: Yes, it can be weird, and frightening, whatever doctors may say. Yes, it's also worth it. When doing the cost-benefit analysis, I'd say the scales tip heavily in favor of the benefits. For me, it worked that well, and I think the only reason I did not continue with it was because I had some other ideas about what I might try, having never opted for an MAOI (namely, I had it in the back of my mind that, when I was able to qualify, I might try a clinical trial, which turned out to be a very good decision for me). If the MAOI door was somehow closed to me, doubtless ECT would have been in my future. Who knows, maybe someday it will be again. Time can only tell.
> Hi everyone.
> After suffering depression for over ten years with poor response to medication, I am considering ECT. I have read many postings by people who have had bad memory problems as a result of ECT. Has anyone out there had only minor, transient memory difficulties like the literature says you should expect? Or is the reality grim?
> I really appreciate your experiences.
>
> Thrud
>
Posted by SalArmy4me on April 1, 2001, at 18:42:16
In reply to Any POSITIVE experiences with ECT?, posted by Thrud on March 31, 2001, at 16:50:43
Like I mentioned in another reply to your post: name what you have tried and I will find you _50_ other good things that you haven't tried.
> Hi everyone.
> After suffering depression for over ten years with poor response to medication, I am considering ECT. I have read many postings by people who have had bad memory problems as a result of ECT. Has anyone out there had only minor, transient memory difficulties like the literature says you should expect? Or is the reality grim?
> I really appreciate your experiences.
>
> Thrud
>
Posted by Thrud on April 1, 2001, at 23:04:36
In reply to Re: Any POSITIVE experiences with ECT?, posted by Adam on April 1, 2001, at 14:56:27
Many, many thanks for your posting, Adam.
I have a further question for you though: did it affect your ability to work (if you worked back when you were treated)?
Thanks again.Thrud
Posted by Thrud on April 1, 2001, at 23:07:46
In reply to Re: Any POSITIVE experiences with ECT?, posted by SalArmy4me on April 1, 2001, at 18:42:16
> Like I mentioned in another reply to your post: name what you have tried and I will find you _50_ other good things that you haven't tried.
Yes, I saw your posting and I am now looking them all up on the net to get a feel for them. Thanks for that. BTW, have you ever tried ECT?
Thrud
Posted by kazoo on April 2, 2001, at 0:49:48
In reply to Any POSITIVE experiences with ECT?, posted by Thrud on March 31, 2001, at 16:50:43
> Hi everyone.
> After suffering depression for over ten years with poor response to medication, I am considering ECT. I have read many postings by people who have had bad memory problems as a result of ECT. Has anyone out there had only minor, transient memory difficulties like the literature says you should expect? Or is the reality grim?
> I really appreciate your experiences.
>
> Thrud
>
^^^^^^^^^I have read your previous posting re. the problem(s) with medication. What disturbs me the most is this recent fanatical interest in ECT, which has been a common topic of discussion here lately. From what I know of ECT, it is not a walk in the park, nor like a trip to the dentist. This is a serious undertaking, not to be taken lightly or accepted as a panacea for any kind of depression. By virtue of the fact that you're able to analyze your situation and post intelligently about it indicates to me that you are probably not the "ideal" candidate for this procedure. Remember: ECT is a serious, end-of-the-line, last-resort procedure indicated for only a small percentage of those who are totally unable, and incapable, to help themselves out of depression so profound that hospitalization is usually indicated. Despite a recent revival of interest in ECT, the jury is still out as to its longitudinal efficacy, not to mention damage.
A word to the wise is sufficient.
kazoo
Posted by Adam on April 2, 2001, at 1:58:41
In reply to Re: Any POSITIVE experiences with ECT? » Thrud, posted by kazoo on April 2, 2001, at 0:49:48
> ^^^^^^^^^
>
> I have read your previous posting re. the problem(s) with medication. What disturbs me the most is this recent fanatical interest in ECT, which has been a common topic of discussion here lately. From what I know of ECT, it is not a walk in the park, nor like a trip to the dentist.I'm in total agreement here. But neither is long-term, refractory depression. Cost-benefit, that's the key.
>This is a serious undertaking, not to be taken lightly or accepted as a panacea for any kind of depression.
Nothing is, unfortunately.
>By virtue of the fact that you're able to analyze your situation and post intelligently about it indicates to me that you are probably not the "ideal" candidate for this procedure.
During my most serious episode, I had experiences that, in retrospect, seem borderline psychotic, and I think that may have something to do with a particularly bad drug combination (for me), and, probably, a particularly bad doctor. Anyway, I certainly never lost my ability to think with intelligence, and it was during a frank time of self-analysis and assessment of my life that I agreed to try ECT, which I did not have to do. I believe this has a great deal to do with the fact that I am still alive now, because if I had lost these abilities, which, according to you or your source, would have made me an "ideal" candidate, I'd be dead by my own hand. I felt considerably better even after admitting myself to the hospital, and thought much more clearly after A) I had had some time to rest, and B) I was taken off the idiot drug regimen I was on. I do not know what the basis is for this statement (though I am quite curious), and I'm inclined to strongly disagree with it.
>Remember: ECT is a serious, end-of-the-line, last-resort procedure indicated for only a small percentage of those who are totally unable, and incapable, to help themselves out of depression so profound that hospitalization is usually indicated. Despite a recent revival of interest in ECT, the jury is still out as to its longitudinal efficacy, not to mention damage.
>
> A word to the wise is sufficient.
>
The procedure is reasonably safe, according to the AMA. It carries with it all the usual risks associated with medical procedures involving anaesthesia, etc. There have been some reports of brain damage, but most reports indicate that there are no lasting sequelae, and strongly refute the former. Is the jury still out? Depends on who you ask. The same could be said for medications. There are bright people who consider antidepressant drugs to be absolute last-resort interventions, so, in the minds of some, all the tools of psychiatry are to be used only in the direst need. I do not know for certain who is right, but the preponderance of evidence states that ECT carries acceptable risks.You may note that several studies have demonstrated that the stress that accompanies depression is itself harmful to the brain. One very interesting study has noted the normalization of neuro-stem-cell growth in those treated with ADs (including ECT), which has directly measureable affects on the hippocampus, a vital portion of the brain for memory. I am, myself, of two minds about this phenomenon, but, in the absence of evidence that it is harmful (and there is none), what we see is what appears to be a return to a normal rate of repair of brain tissue, and hence an avoidance of the very thing those who fear ECT most worry about: damage to the brain.
In the most pessimistic assessment of ECT, the worst I can say, then, is choose your poison. At least one has the potential to relieve the symptoms of a dibilitating disease.
Posted by Adam on April 2, 2001, at 2:09:01
In reply to Re: Any POSITIVE experiences with ECT? Adam, posted by Thrud on April 1, 2001, at 23:04:36
I did not return to work for more than two weeks after I had been treated. By that time, the obvious memory problems had ceased. If I had gone to work the next day? I'm sure there would have been some problems, but it's not like I lost my mind for a week. I had daily (sometimes hourly) group sessions to attend, both as an in-patient and an out-patient. I read a couple books, wrote in my diary, went for walks when I was bored, etc. If I had kept diligent notes of tasks I needed to perform, etc., I can't see any serious reason why work would have been a problem, except that, at that time in my life, I needed some time to rest and focus on getting better, which did not include going to work, ECT or no.
I really can't reassure you on this subject as best as you probably would hope, because I simply don't know what the effects would have been, if I were suffering from periods of amnesia while working. My guess is that, if I noticed some particular problems, they could be dealt with using a notebook and/or a tape recorder during important meetings, etc. At most, a few days after treatment, the problem would have gone away.
> Many, many thanks for your posting, Adam.
> I have a further question for you though: did it affect your ability to work (if you worked back when you were treated)?
> Thanks again.
>
> Thrud
Posted by SalArmy4me on April 3, 2001, at 2:30:51
In reply to Re: Any POSITIVE experiences with ECT? SalArmy4me, posted by Thrud on April 1, 2001, at 23:07:46
I have never tried ECT and most likely never will because I am willing to try all experimental stuff and take chances on medications that might have little or no chance of working. But I have succeeded: Pindolol is the semi-antidepressant that I have found, and it will keep me from ECT.
Ask me about all alternative medications and I will give an educated answer about their possible efficacy for you.
This is the end of the thread.
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