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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by SalArmy4me on August 23, 2001, at 8:04:38
Before you do it, talk to me. I can give you at least 5 very viable pharmacological alternatives to ECT. {But I am usually pro-ECT though in certain cases}. Actually, if you wanna talk to me about anything I'm always on AOL Instant Messenger. My screennname is of course, SalArmy4me.
Posted by Elizabeth on August 23, 2001, at 11:31:28
In reply to Think You Wanna Do ECT?, posted by SalArmy4me on August 23, 2001, at 8:04:38
> Before you do it, talk to me. I can give you at least 5 very viable pharmacological alternatives to ECT. {But I am usually pro-ECT though in certain cases}. Actually, if you wanna talk to me about anything I'm always on AOL Instant Messenger. My screennname is of course, SalArmy4me.
Sal, I agree with you that ECT is almost never necessary, and that there are usually safer alternatives that a person hasn't tried. But can I ask why you want people to speak to you off the message board rather than on it?
-elizabeth
Posted by SalArmy4me on August 23, 2001, at 12:01:22
In reply to Re: Think You Wanna Do ECT? » SalArmy4me, posted by Elizabeth on August 23, 2001, at 11:31:28
I prefer to talk in real-time.
Posted by Adam on August 23, 2001, at 13:23:14
In reply to Think You Wanna Do ECT?, posted by SalArmy4me on August 23, 2001, at 8:04:38
I'm not sure what this thread is about, but I'm giving maintainance ECT some serious thought, since I stopped taking selegiline about a week ago. I have, since then, felt unexpectedly wonderful. I liked selegiline a lot, and may go back to it, but I realise I am currently enjoying some residual antidepressant effects without having an antidepressant drug in my system. I have started to feel tired at midnight. I have had dreams (in one I was dreaming of my girlfriend...when I woke up, there she was...I wouldn't trade that moment for any amount of money), which I essentially stopped doing on selegiline without sedating myself with an antihistamine. I've lost the jitters, and the scattered thinking.
I've had this kind of feeling once before, about a week after having a standard course of ECT. If I hadn't been in such a weird place (literally and figuratively) at that time, I think I would have been nearly euphoric.
ECT has been around since the 1930s. It has evolved considerably since the days when people were held down by orderlies and the seizures broke bones. It's not perfect, but neither are drugs. Most of the risks are associated with the anesthesia, and are nearly always a manifestation of that in combination with an underlying physical problem (cardiovascular, usually). Not for want of looking, no one has been able to demonstrate convincingly that people who recieve ECT, either acutely or chronically, suffer ANY sequellae due to the seizures, and retrograde amnesia is the only significant side effect anyone has been able to report definitely, that usually being limited to the day/course of the procedure. Patient complaints of cognative deficits caused by ECT must be contrasted with controled studies where, following efficaceous ECT, every cognative function tested was unchanged or improved over placebo. Given the elaborate and highly-ritualized nature of the ECT procecdure, the placebo effect one ought to see in a controled study should be quite powerful. That it has been shown, then, to be a potent antidepressant, and safe in every thoroughly studied aspect, makes it tempting to regard much of the anti-ECT sentiment out there as specious and/or spurious.
(Disclaimer - Shortly after recieving ECT I had my own doubts too, despite my own success with it, because I felt so disoriented afterward, and because the effect didn't last. None of this should have been suprising, really, given the terrible shape I was in by the time I checked into the hospital. Since then the science, not the unsubstantiated suspicions, have swayed me. Hopefully someday people will pay more attention to real science than scientologists, and see ECT for what it is: A safe, efficacious, and nearly side-effect-free antidepressant therapy with a terribly unjustified reputation.)
Posted by SLS on August 23, 2001, at 18:33:25
In reply to Re: Think You Wanna Do ECT? » SalArmy4me, posted by Elizabeth on August 23, 2001, at 11:31:28
> Sal, I agree with you that ECT is almost never necessary,
Hi Elizabeth.I think it depends on the urgency of the situation and the history of response versus non-response to prior medical intervention.
What is it about ECT that makes it unsafe?
- Scott
Posted by SLS on August 23, 2001, at 19:10:33
In reply to Re: Think You Wanna Do ECT? » SalArmy4me, posted by Adam on August 23, 2001, at 13:23:14
> I'm not sure what this thread is about, but I'm giving maintainance ECT some serious thought, since I stopped taking selegiline about a week ago. I have, since then, felt unexpectedly wonderful. I liked selegiline a lot, and may go back to it, but I realise I am currently enjoying some residual antidepressant effects without having an antidepressant drug in my system.Adam, you might be experiencing a positive withdrawal rebound improvement. I have had similar brief improvements upon discontinuation of tricyclics and MAOIs. In fact, I have become seriously manic upon the discontinuation of Nardil. They generally last for a week or two.
I am sad to learn that your remission has not continued robustly. Perhaps the selegiline patch that you had so much success with will soon become available. I know nothing of its status.
In 1991, I received a course of 15 ECT treatments over the course of 5 weeks. The first six were unilateral left; the remaining were bilateral. I experienced a mild improvement after the fifth treatment that lasted for about half a day. In a recent communication with Max Fink, he deemed my treatments inadequate such that no conclusion could be made regarding its efficacy in my case. My doctor will bring it up from time to time just to remind me that ECT remains an option, but I doubt I am a good candidate for success. It is good that you remember how your prior treatments affected you with respect to its positive effects on mood and its negative effects on cognition to judge well its desirability for you at this time. I found that the bilateral treatments were much, much more disruptive to cognition and memory. There is some thought that high-dose right unilateral ECT is about as effective as bilateral, but with reduced cognitive side-effects. Low-dose unilateral provides for less cognitive disruption, but is significantly less effective.
Maintenance treatment is most often necessary as relapse usually occurs within a few months.
I think you might have participated in a thread last year involving this article:
http://archpsyc.ama-assn.org/issues/v57n5/ffull/ytm0500.html
If you do go back to selegiline, don't forget to include lithium in your list of augmentation strategies. One of my doctors had quite a bit of success with Parnate + lithium.
Good luck.
- Scott
Posted by Adam on August 23, 2001, at 20:13:13
In reply to Re: Think You Wanna Do ECT? » Adam, posted by SLS on August 23, 2001, at 19:10:33
Hi, SLS,
Actually, my remission remained quite robust. The problem is I have developed some odd physical symptoms, and my doctor thinks there is an outside chance that a pheochromocytoma is to blame. I need to get a plasma metanephrine test to determine if I have the tumor or not. Unfortunately, because of (especially oral) selegiline's effects on catecholamine levels in the body, it's impossible to get an accurate test result so long as it or some of its residual effects are present.
I have been hoping that I will stay in remission, but I do not expect to. I imagine at some point in the next couple of weeks or so I may relapse, but we'll see. In the mean time, I have an opportunity to revisit my treatment options. The only two things I have ever tried (and I've tried lots of things) that worked have been selegiline and ECT. So which should I go back to, once the test has been done and a hopefully negative result is returned? I will have time to ponder that over the next few weeks.
>
> I am sad to learn that your remission has not continued robustly. Perhaps the selegiline patch that you had so much success with will soon become available. I know nothing of its status.
>
Posted by SalArmy4me on August 23, 2001, at 20:42:25
In reply to Re: Think You Wanna Do ECT? » Adam, posted by SLS on August 23, 2001, at 19:10:33
That's good advice.
This is the end of the thread.
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