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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by cab on November 12, 2002, at 11:25:59
OK, I convinced my pdoc to let me do ECT (actually it didn't take much convincing) because I need relief as quickly as possible. I have my first consultation in a few days. Does anyone know whether one has to come off lithium before it starts? How about Paxil? And are there recommended drugs for maintenance, after the course is done? Any success stories with ECT, or just things I should know?
Thanks,
C
Posted by likelife on November 12, 2002, at 12:01:38
In reply to Starting ECT -- any advice?, posted by cab on November 12, 2002, at 11:26:25
cab,
I don't know about Paxil or lithium, but I took parnate while having ECT, and afterwards, and had no problems with it. I had about 20 treatments spaced out over four months or so, and it helped me tremendously to overcome a near catatonic depression. Six months later I had a relapse, but it wasn't nearly as bad as the original, and overall, ECT seems to have helped me a great deal.
I'm glad you were able to talk to your doctor about what you needed, and just that you know you need help right now. Good luck with everything,
likelife
Posted by Jumpy on November 12, 2002, at 14:36:50
In reply to Starting ECT -- any advice?, posted by cab on November 12, 2002, at 11:25:59
Hello,
Does anyone know whether one has to come off lithium before it starts? How about Paxil?
Well, having lithium in the blood stream during ECT may cause more memory problems, so most docs either stop it the day before a shock treatment or stop it altogether before ECT starts. Paxil maybe be used, but I assume if you are getting ECT, Paxil failed to help you. So you might as well taper off, unless your edoc and pdoc want to augment it with something else.
And are there recommended drugs for maintenance, after the course is done?
So far the only good study was with Sackeim at Columbia University. He looked at relapse rates for pamelor, pamelor + lithium and placebo. Pamelor/lithium was the best post ECT med. Sackeim mentioned in the paper that lithium post ECT didn't show any benefits in prior studies.
Max Fink states that you can't expect a medication that failed to help before treatment to help afterward. Finally, a harvard edoc told me he agrees with Fink, but usually he can find some combo (like effexor and remeron) that keep the patient in remission. If it doesn't, he will shock again and try another combo until he finds one that works. One women needed parnate, pamelor, ritalin combo post ECT to finally keep her in remission. Those drugs in combination are a big no no to convential psychiatry, but if you are treatment resistance ... you might need a heroic combo like that.
Any success stories with ECT, or just things I should know?
Sucess rate is 80 to 90% in general, but about 60 to 70 in treatment resistant folk. Although some ECT doctors claim they can get almost anyone out of a depression with ECT, the trick is keeping them out with the right meds or maintanance ECT. I think "Chloe" and "Geezer" are doing pretty well with ECT now.
> Thanks,
> CJumpy
Posted by cab on November 12, 2002, at 14:53:41
In reply to Re: Starting ECT -- any advice? » cab, posted by Jumpy on November 12, 2002, at 14:36:50
About the Paxil, I'm not sure yet if I'm resistant to it because I've only been on it 4 weeks. I'm doing ECT because every moment is torture and I need relief quickly. With the prospect of the paxil suddenly working seeming so dim, I feel as if I can't wait another 4 weeks, and then another 8 for a different drug, etc. And unlike the general population I'm not scared at all by ECT (except the possibility of it not working).
Thanks for your posts, Jumpy and Likelife.
Posted by nicole1011 on November 12, 2002, at 15:04:17
In reply to Starting ECT -- any advice?, posted by cab on November 12, 2002, at 11:25:59
are you sure you want to use ECT before the meds have a chance to kick in? it took about 6 weeks for paxil to start working for me, how about you wait a few more weeks? In my opinion ECT is a drastic measure and should be used as a last resort only. My mother had it done to her 7 or so times over the course of her life and she lost lots of memories, not to mention that she was a virtual zombie for awhile afterwards. However, it is your choice to make, i just think you need to think about it and do lots of research first
with kindness.... :)
Posted by Jumpy on November 12, 2002, at 19:10:49
In reply to Re: Starting ECT -- any advice?, posted by nicole1011 on November 12, 2002, at 15:04:17
> are you sure you want to use ECT before the meds have a chance to kick in? it took about 6 weeks for paxil to start working for me, how about you wait a few more weeks? In my opinion ECT is a drastic measure and should be used as a last resort only.
I agree, last resort. But if you can't wait for the paxil to kick in, ECT is the fastest method of getting one out of depression or mania. Otherwise, ECT is really just a temporary fix for a few months.
>My mother had it done to her 7 or so times over the course of her life and she lost lots of memories, not to mention that she was a virtual zombie for awhile afterwards. However, it is your choice to make, i just think you need to think about it and do lots of research first
Sorry to hear your mother has gone through so much. Forunately, it is now known that unilateral ECT is as effective as bilateral ECT without the memory loss/cognitive dysfunction. Also the anesthesia used today causes much less confusion after treatment.
So "Cab" you don't have to worry about those terrible side effects today. In a survey, most ECT patient stated that getting a treatment was less scary/painful than going to the dentist. But maybe they all have had lots of root canals and extraction though .. lol.
>
> with kindness.... :)Jumpy
Posted by Dave1 on November 14, 2002, at 20:33:00
In reply to Re: Starting ECT -- any advice? » cab, posted by Jumpy on November 12, 2002, at 14:36:50
HI,
My Pdoc took a course from Dr. Sackheim. He told me that the pamelar + LI was working so well that they stopped giving other maintainence drugs to their patients and now give only pamelar + LI. It would be interesting to see what Dr. Sackheim says about giving these drugs to treatment resistant patients. My Pdocs opinion was that It would work after even if not before.
Regarding the lithium before a treatment. I think you are supposed to hold it the day before. Thats what my pdoc said.
Dave
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