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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by Amadeus on December 8, 2006, at 11:23:09
I wonder if someone could tell me about the pros and cons of ECT-therapy
How many treatments are needed to recover from depression?
How serious are memory problems?
What is the risk of a new depression?
Posted by blueberry on December 8, 2006, at 12:21:39
In reply to ECT experience, posted by Amadeus on December 8, 2006, at 11:23:09
ECT. Oh man. It brings back such terrifying memories. But I'll share. Keep in mind that I believe my bad experience was due to a doctor who mismanaged my case, not to ECT itself. But the memory loss...well, I'll get to that.
They say it takes 6 to 12 treatments, usually 12, at 3 per week.
My first 8 weren't doing anything except making me feel very weird and maybe even worse. I did not notice much memory loss, but I did notice some overall confusion and cognitive slowing. Somewhere between treatment 8 and 12 it kicked in. I felt very well. No depression. No anxiety. Perfectly comfortable in a crowd. Interested and motivated in life. It was nice.
The problem was that the doctor kept going at 3 times per week. I believe that was a mistake. As soon as a patient begins to respond I believe they should cut it back to twice a week and then once a week and then find whatever schedule it takes to maintain the goodness, which would probably vary from person to person. The only real side effect I noticed at treatment 12 was a completely dead sex life. It was gone. I was beginning to feel like something was too much. The goodness I felt didn't stop, it kept going higher, too high. I entered psychotic mania with significant agitation and restlessness. People said I had craziness in my eyes.
A mere 2 days after the last treatment I ended up with 6 police officers in my house and an ambulance ride to the hospital as I had crashed into such a deep dense depression I was crying hysterically and threatening suicide. It has been a slow crawl back, on my own, since then. My doctor refused to do anything else with me except ECT.
I asked where all the firewood in front of my house came from. I was told that I went and picked it up in my car. I have no recollection of that. I played guitar on stage for 3 church services. I have no recollection of that. I was pulled out of the congregation to play bass guitar when the regular bassist didn't show up. I have no recollection of that. Phone numbers. Forget it. They are all gone. My job. Forget it. I was like a new hire. No idea what to do. Even though I had been doing the job for 10 years. My new employer called me for my first day of work. I didn't even know I had applied for another job. And I could go on and on. Scary stuff. So now I find myself being trained in a new job where I have no idea how I ended up there.
ECT is supposedly very effective for both depression and mania. For me it brought out the worst of both, with only a 2 day wonderful normal period. Ever since then, the meds I have taken for a long time feel completely different, lots of side effects that never existed before, and they make my depression worse. They never did that before.
There is a 3 month period of my life that is completely utterly gone. No memory of it whatsoever.
The procedure itself wasn't too bad. Go to the hospital. They put several of us in our own draped cubicles, hooked up IVs to our arm veins, and when it was my turn they would wheel me to the work station. The doctor would look down at me and greet me and the next thing I knew I was at home.
I do not believe most cases go as bad as mine did. But it shows the potential is there for disaster.
Posted by Amadeus on December 8, 2006, at 14:01:42
In reply to Re: ECT experience » Amadeus, posted by blueberry on December 8, 2006, at 12:21:39
Wow, some experience. Thanx for sharing your story. I have heard that success rate is somewhere around 80%, but I guess your experience is part of the 20% failures.
I am really fed up with SSRI medication since it causes to many side effects and only provides partial recovery. I have recently seen a documentury about a depressed man who decided to use ECT. His medication only helped him partially and he claims that ECT was the only way to his recovery. After ECT he has continued his medication as a preventive measure.
As I understand it, ECT is used to make a quick recovery from depression, especially where suicide is at risk, but it does not prevent new depressions. It is kind of frustrating not knowing how you will respond to ECT. I guess that is why so many use it as a last resort.
Posted by blueberry on December 8, 2006, at 15:06:39
In reply to Re: ECT experience » blueberry, posted by Amadeus on December 8, 2006, at 14:01:42
When they say ECT is good for quick recovery, especially when suicide is a risk, I do not understand that, because for me it took 3 weeks to kick in. That is not quick as far as I'm concerned. Drugs can be just as quick. Heck, when I first started prozac many years ago, it had me feeling a lot better in 2 days.
When the ssris don't work, that just seems to me to be a decent clue that the underlying problem is not serotonin related. Maybe look at meds that work other neurotransmitters?
You never know, if you try ECT it might work out very well. But as my doctor said it, "ECT is a highly effective 'intervention' but is also highly intrusive"...referring to the memory loss, inability to drive a car during treatment, inability to work during treatment, and such.
Posted by Bob on December 8, 2006, at 15:17:40
In reply to Re: ECT experience » Amadeus, posted by blueberry on December 8, 2006, at 12:21:39
> ECT. Oh man. It brings back such terrifying memories. But I'll share. Keep in mind that I believe my bad experience was due to a doctor who mismanaged my case, not to ECT itself. But the memory loss...well, I'll get to that.
>
> They say it takes 6 to 12 treatments, usually 12, at 3 per week.
>
> My first 8 weren't doing anything except making me feel very weird and maybe even worse. I did not notice much memory loss, but I did notice some overall confusion and cognitive slowing. Somewhere between treatment 8 and 12 it kicked in. I felt very well. No depression. No anxiety. Perfectly comfortable in a crowd. Interested and motivated in life. It was nice.
>
> The problem was that the doctor kept going at 3 times per week. I believe that was a mistake. As soon as a patient begins to respond I believe they should cut it back to twice a week and then once a week and then find whatever schedule it takes to maintain the goodness, which would probably vary from person to person. The only real side effect I noticed at treatment 12 was a completely dead sex life. It was gone. I was beginning to feel like something was too much. The goodness I felt didn't stop, it kept going higher, too high. I entered psychotic mania with significant agitation and restlessness. People said I had craziness in my eyes.
>
> A mere 2 days after the last treatment I ended up with 6 police officers in my house and an ambulance ride to the hospital as I had crashed into such a deep dense depression I was crying hysterically and threatening suicide. It has been a slow crawl back, on my own, since then. My doctor refused to do anything else with me except ECT.
>
> I asked where all the firewood in front of my house came from. I was told that I went and picked it up in my car. I have no recollection of that. I played guitar on stage for 3 church services. I have no recollection of that. I was pulled out of the congregation to play bass guitar when the regular bassist didn't show up. I have no recollection of that. Phone numbers. Forget it. They are all gone. My job. Forget it. I was like a new hire. No idea what to do. Even though I had been doing the job for 10 years. My new employer called me for my first day of work. I didn't even know I had applied for another job. And I could go on and on. Scary stuff. So now I find myself being trained in a new job where I have no idea how I ended up there.
>
> ECT is supposedly very effective for both depression and mania. For me it brought out the worst of both, with only a 2 day wonderful normal period. Ever since then, the meds I have taken for a long time feel completely different, lots of side effects that never existed before, and they make my depression worse. They never did that before.
>
> There is a 3 month period of my life that is completely utterly gone. No memory of it whatsoever.
>
> The procedure itself wasn't too bad. Go to the hospital. They put several of us in our own draped cubicles, hooked up IVs to our arm veins, and when it was my turn they would wheel me to the work station. The doctor would look down at me and greet me and the next thing I knew I was at home.
>
> I do not believe most cases go as bad as mine did. But it shows the potential is there for disaster.
What an amazing post, Blueberry!!! I mean, it looks like something I wrote, and then forgot. I too had ECT - a total of 21 treatments, and I too had a very, very similar experience. I am now, like usual, left with a lot of questions, and no answers. The first few treatments were not terrible, but I did feel strange. I really didn't reach that middle point you described where I felt very good, but some problems did go away. I too feel that they can be too aggressive with the frequency and number of treatments. After about 5 or 6 treatments, things began to get worse, with anxiety, hypomania, emotional lability, morning depression, and some suicidality. Since I'm no expert, I was always waiting for some breakthrough, where everything would click. Like you, I feel that it was pushed too far. I often wonder what it would have been like to stop at a maximum of maybe 5 or 6 treatments, and then to have stepped back to see how things progress. The SOP is to achieve some plateau with the treatments and then keep it there with continuing treatment - the fear being the frequency won't be enough and the condition will relapse. But I feel there is a possiblity with people like you and me (and many others) that the brain must adapt and have time to reorganize. Continuing a barrage of treatments with the more is always better theory didn't turn out well in my case. One of my personal, crackpot theories is that people who have underlying anxiety disorders are more susceptible to responding in this manner, as ECT is an extremely stimulating treatment. It's beyond me how people who have mania are treated by this method but it apparently works for many. For me, it seems, hypomania, agitation, restlessness, panic, and anxiety were all caused by the treatments, and needed to be controlled with benzos. The benzos themselves have always been a problem for me, as even the most minute dosage changes (especially reductions) can cause depression and suicidality in me. It has happened time and time again. However, when I end up in a severely anxious and panicky state like that, I don't know that there's any other option.I still can't believe how well your case parallels mine. I too have had a very changed body, and my medicines all created effects, both intentional and unintentional, that were never present before. Mostly, I became extremely, and exquisitely senstive to meds that, before, didn't do much of anything. But, the sensitivity manifested itself in intolerance, not therapeutic results. My memory got rocked. It wasn't evident at first, but even now, 1.5 years later, there are events my friends and family relate that I have absolutely no recollection of. These events are usually form the time somewhat before, during and after the treatments: maybe +/- 1 to 2 years. Not everything, mind you, but enough to be discomforting.
I feel now, that my body is making its way back to pre-ECT days, but I dont' know if it will ever be 100%. Of course, that's hardly a goal to strive for, as I went it the treatments a desperate person. Sometimes on better days, I wonder what a single pop might do, where I can then wait and see if anything gets better, but I doubt I'd find any physician willing to engage in my experiments. That's one of the problems I see with the treatments, is that there is a stiff protocol in place, and no doctor is going to sit there and listen to what I have to say about it.
I'm sorry to hear about the crash you had into depression, as I had a similar experience after treatments stopped. I sank into a seriously scary place, and it wasn't like I could just go back and get more ECT at that point, as IMO, that was why I was where I was. Now, after a full year and a half, I'm "stabilized" somewhat with depression and anxiety, but have managed to keep the suicidal episodes at bay in recent times. I'm taking relatively low doses of Citalopram and Lithium, and don't really know what to do any longer.
Posted by Amadeus on December 8, 2006, at 15:29:52
In reply to Re: ECT experience » Amadeus, posted by blueberry on December 8, 2006, at 15:06:39
I guess it must be a horrifying experience if you do not know about the side effects in advance. It is really the risk of memory loss and the fact that you need anesthesia that scares me.
I have read some studies on ECT and what I have understood is that the ECT has to be "intrusive". It triggers release of growth factors (BDNF) and vascular regeneration improving blood circulation in the brain.
Hopefully this physiological process could be made by chemicals in the future.
Posted by blueberry on December 8, 2006, at 16:00:24
In reply to Re: ECT experience » blueberry, posted by Bob on December 8, 2006, at 15:17:40
That's a terrifying story Bob. I think you and I experienced something totally, umm, I don't think there any words in the English language, but something straight from hell or another galaxy or something. Usually we forget nightmares. But this nightmare will never go away. I wish that if there was any memory loss, it would be that I could forget ECT ever happened.
This doesn't add much to what I've already said. But it means a lot to me and I wanted to share...
"Amazing"...about a dozen times. "You opened the doors to heaven".
These are comments I received from people when I played my guitar in church. The only way I knew this is by reading my diary. Those are probably the most cherished words ever said to me, and the most meaningful experience, and I have zero, absolutely zero, memory of it. If not for my diary, they wouldn't exist at all.
Posted by linkadge on December 8, 2006, at 17:48:38
In reply to Re: ECT experience » blueberry, posted by Amadeus on December 8, 2006, at 15:29:52
>I have read some studies on ECT and what I have >understood is that the ECT has to >be "intrusive". It triggers release of growth >factors (BDNF) and vascular regeneration >improving blood circulation in the brain.
This may not be a good thing. I mean ECT does increase BDNF, but so does other traumatic brain injury. BDNF is not just a growth factor, but also a neuroprotective chemical. BDNF is greatly increased after certain neurological insult including epileptic seizures. It may just be a sign that the brain is trying to protect itself from what the hell is happening.
ECT also increases certain markers of cell injury such as GFAP, which is high after radiation and high in alzheimers.
I would not necesarily conclude ECT induced BDNF is a good thing.
Linkadge
Posted by Phillipa on December 8, 2006, at 19:58:03
In reply to Re: ECT experience » Bob, posted by blueberry on December 8, 2006, at 16:00:24
Blueberry I had no idea. That's so horrible. I always identified with your inability to handle regular doses of meds and minidoses. Do you remember me? And I'll never do ECT. Love Phillipa
Posted by Bob on December 9, 2006, at 14:20:36
In reply to Re: ECT experience » Bob, posted by blueberry on December 8, 2006, at 16:00:24
>
> "Amazing"...about a dozen times. "You opened the doors to heaven".
>
> These are comments I received from people when I played my guitar in church. The only way I knew this is by reading my diary. Those are probably the most cherished words ever said to me, and the most meaningful experience, and I have zero, absolutely zero, memory of it. If not for my diary, they wouldn't exist at all.It makes me realize how much a part of our lives our memory is. Truthfully, if your memory becomes significantly impaired, it causes me to reflect on how much life is worth living in that state. Just goes to show what a horrific tradgedy alzheimers is.
Posted by Bob on December 9, 2006, at 14:21:40
In reply to Re: ECT experience » Bob, posted by blueberry on December 8, 2006, at 16:00:24
>
> "Amazing"...about a dozen times. "You opened the doors to heaven".
>
> These are comments I received from people when I played my guitar in church. The only way I knew this is by reading my diary. Those are probably the most cherished words ever said to me, and the most meaningful experience, and I have zero, absolutely zero, memory of it. If not for my diary, they wouldn't exist at all.It makes me realize how much a part of our lives our memory is. Truthfully, if your memory becomes significantly impaired, it causes me to reflect on how much life is worth living in that state. Just goes to show what a horrific tradgedy alzheimers is.
Posted by Bob on December 9, 2006, at 14:23:09
In reply to Re: ECT experience, posted by linkadge on December 8, 2006, at 17:48:38
> >I have read some studies on ECT and what I have >understood is that the ECT has to >be "intrusive". It triggers release of growth >factors (BDNF) and vascular regeneration >improving blood circulation in the brain.
>
> This may not be a good thing. I mean ECT does increase BDNF, but so does other traumatic brain injury. BDNF is not just a growth factor, but also a neuroprotective chemical. BDNF is greatly increased after certain neurological insult including epileptic seizures. It may just be a sign that the brain is trying to protect itself from what the hell is happening.
>
> ECT also increases certain markers of cell injury such as GFAP, which is high after radiation and high in alzheimers.
>
> I would not necesarily conclude ECT induced BDNF is a good thing.
>
>
> Linkadge
>
>
Uh, I second that.
Posted by Karen44 on December 9, 2006, at 21:00:30
In reply to Re: ECT experience » Amadeus, posted by blueberry on December 8, 2006, at 12:21:39
It is your experience, blueberry, that scares the hell out of me with a recommendation for ECT. My pdoc thinks it would help me a lot as none of the antidepressants I have tried have worked for a variety of reasons. Some due to allergic reactions and some due to severe side-effects.
I am depressed but I continue to go to work everyday. I am a professional and need my memory to do my job. I do not want to lose verbal or nonverbal memory. I depend on both being intact. My pdoc says he has had other professionals who have been okay with ECT and even went to work after the treatments. He said I could even drive, though the hospital would not want me to due to liability issues. He said he has had around 70 patients that have gotten ECT, and he said only one had problems, that this was someone who had dementia to begin with. He said she ended up somewhat worse. I just don't know what to think.
In the past Parnate worked very well for me, and then I was off all antidepressnat medication for around 11 or 12 years and was fine until I developed all at once lots of physical problems such as COPD, sleep apnear, GERD, had to have cervical spine surgery, and surgery for a deviated septum--all this in 2005. This year, less, but I am going in for surgery on my hand/thumb on Tuesday. I have way thought why not just stay at U of chicago and let them zap my brain too. But then I decided that I will get a second opinion before I do anything of the sort.
Karen44
Posted by invisiblemanpa on December 10, 2006, at 4:07:43
In reply to Re: ECT experience, posted by Karen44 on December 9, 2006, at 21:00:30
Don't do it! I had been struggling with major depression for 10 years, social anxiety my whole adult life, it has cost me my family,successful career, you know the story....I have been on every major 2nd generation anti depressant combo....none work......only the benzos provide some temp. relief....so I agreed to ECT in late summer...I hate hospitals, needles, so that part was bad enough....but..the end after I think 12 treatments.....my mind is scrambled eggs..I have no memory of this fall and not of most of 2006, depression worse, anxiety worse, concentration shot, thoughts start and vanish.....I can't even follow the instructions on how to use my new cell phone....I have a masters degree, blah blah blah...it's all gone...before the ECT.... I could do a little bit, still had hope of maybe pulling life, career, back together.......now it's all gone....
ECT should be outlawed....it is experimental torture..in 50 years it will be looked upon as we do now when docs used to bleed people and use leeches....DON'T DO IT.........
I SAY THROW ALL THE MEDS AWAY AND KEEP SOME COLD ONES ON ICE..........JUST DON'T DRIVE.....
Posted by Karen44 on December 10, 2006, at 8:01:47
In reply to Re: ECT experience/Dr. Frankenstein Lives!, posted by invisiblemanpa on December 10, 2006, at 4:07:43
I think this is not such a wonderful idea myself. I have a doctorate, and I don't want to forget anything; I just hate that I developed so many physical issues, and just when something seems resolved and in remission, a new thing pops up like now I have psoriasis of the scalp and need surgery on my thumb. A joint is eroded and caused the two upper joints to dislocate so that I have a zig zag thumb and am in lots of pain. The other hurts too and will need surgery before the end of 2007. This is what gets me down.
I don't see how ECT would help this except that my pdoc seems to think it will allow the antidepresant medication to work better. So, I am at least curious as to which one he thinks he would try after ECT. I am also planning to make an appointment with another psychiatrist who is more analytically trained; this is my training as well.
I currently work as a forensic psychologist. Can't you see me going to court and saying I don't remember the person; or can't you see me not being able to recognize subtle nuances during the interview; or can't you see me being unable to remember how to do psy testing. I think I must be totally nuts to have considered it.
My pdoc says he does therapy, psychodynamic, and so I stayed with him after referring myself to him. He deals with people who have co-occuring medical and psychiatric issues. Later, however, I challenged him on this approach he said he uses as I felt I could do what he was doing on my own. I have advanced training in psychoanalytically informed approaches to therapy and from a hospital that was ranked number one in the country for psychiatry when I was there.
Anyway, you see my point about not wanting to lose what I learned, etc. My pdoc decided I was too hostile for him to work with me last summer when I challenged him on his expertise in "pychodynamic" therapy. Asked him first just how would he describe his approach, and it went down hill from there. I tried to patch things up when he said go find someone else and by giving him a b*llshit reason why I was getting angry, that I was trying to push him away because we were dealing with issues I found too sensitive. I think I just need to go see a therapist who is more knowledgeable. Hard to do as I have seen my current pdoc for over one year now.
Karen44
Posted by linkadge on December 10, 2006, at 8:28:15
In reply to Re: ECT experience/Dr. Frankenstein Lives! » invisiblemanpa, posted by Karen44 on December 10, 2006, at 8:01:47
I would agree. With any decision like this you would need second, third, fourth, and fifth opinions.
Doctor's opinion of ECT varies dramatically from what I have heard. Some doctors refuse to do it.
Some doctors say it never causes memory problems, but these are usually the ones who say SSRI's never cause sexual dysfunction.
Linkadge
Posted by Bob on December 10, 2006, at 10:55:00
In reply to Re: ECT experience/Dr. Frankenstein Lives!, posted by linkadge on December 10, 2006, at 8:28:15
> I would agree. With any decision like this you would need second, third, fourth, and fifth opinions.
>
> Doctor's opinion of ECT varies dramatically from what I have heard. Some doctors refuse to do it.
>
> Some doctors say it never causes memory problems, but these are usually the ones who say SSRI's never cause sexual dysfunction.
>
> Linkadge
>
>... or weight gain, or apathy, or have discontinuation syndromes.
Posted by gardenergirl on December 10, 2006, at 12:32:10
In reply to Re: ECT experience/Dr. Frankenstein Lives!, posted by invisiblemanpa on December 10, 2006, at 4:07:43
>
> ECT should be outlawed....it is experimental torture..in 50 years it will be looked upon as we do now when docs used to bleed people and use leeches....DON'T DO IT.........I'm sorry you had such a difficult experience with ECT. Different points of view are welcome here, but I need to ask you to not exaggerate or overgeneralize, please.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions. Thus, you can always appeal this decision to him, and he may choose a different action.Thanks,
deputy gg
Posted by invisiblemanpa on December 10, 2006, at 15:22:45
In reply to Please be civil » invisiblemanpa, posted by gardenergirl on December 10, 2006, at 12:32:10
Over generalize or exegerate......I was being nice...It is a gross invasive destructive process...brain salad surgery without the blood....No my friend, be afraid, very afraid....
Posted by chiron on December 10, 2006, at 19:10:48
In reply to ECT experience, posted by Amadeus on December 8, 2006, at 11:23:24
ECT has made a huge positive difference in my life. It got me out of a dark hole (created by the wrong meds) after only 6. Unfortunately, it wasn't a one-time cure. I have gone back & am currently on maintenance- but I have never felt this good in my life (of 34 years).
The main con is the memory loss. You don't lose everything, but it has definitely been a set-back (but worth it). Plus it is a little scary.
I just read "Shock" by Kitty Dukakis. I would recommend reading it.
Posted by gardenergirl on December 10, 2006, at 20:06:25
In reply to Re: Please be civil, posted by invisiblemanpa on December 10, 2006, at 15:22:45
>It is a gross invasive destructive process...brain salad surgery without the blood.
Please don't exaggerate or overgeneralize about a treatment intervention that others have had or are considering. I asked you to be civil, so now I am blocking you from posting for a week.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civilFollow-ups regarding these issues should of course be civil. Dr. Bob has oversight over deputy decisions. Thus, you can always appeal this decision to him, and he may choose a different action.
Regards,
deputy gg
Posted by Karen44 on December 10, 2006, at 22:23:01
In reply to Re: ECT experience, posted by chiron on December 10, 2006, at 19:10:48
> ECT has made a huge positive difference in my life. It got me out of a dark hole (created by the wrong meds) after only 6. Unfortunately, it wasn't a one-time cure. I have gone back & am currently on maintenance- but I have never felt this good in my life (of 34 years).
> The main con is the memory loss. You don't lose everything, but it has definitely been a set-back (but worth it). Plus it is a little scary.
> I just read "Shock" by Kitty Dukakis. I would recommend reading it.In what way has it impacted on your work, if any, and is it very important that your memory remain more than just "good."
Karen44
Posted by Dr. Bob on December 10, 2006, at 23:53:36
In reply to Please be civil » invisiblemanpa, posted by gardenergirl on December 10, 2006, at 12:32:10
> Follow-ups regarding these issues should be directed to Admin
Here's a link:
http://www.dr-bob.org/babble/admin/20061202/msgs/712406.html
Thanks,
Bob
Posted by chiron on December 11, 2006, at 7:48:35
Regarding the question about ECT affecting work:
A few times I would actually have ECT at around 6 am, recover, and then get to work around 10 (which is not suggested). I work as a business analyst on projects. Most of my memory remained, or it would come back to me with cues.
I also saw a guy recover with ECT from being catatonic - he became catatonic from the stress of his computer science program. This program is known to be extremely intense. I am also working on my Masters in Information Systems. So maybe ECT is effective for "computer brains" ...? :)
Posted by dessbee on December 11, 2006, at 13:19:44
In reply to Re: ECT experience, posted by linkadge on December 8, 2006, at 17:48:38
Most neurobiologists consider BDNF a good thing.
SSRI also triggers increased BDNF levels.I have read there is company working on producing BDNF. It could be a efficient medicine in many neurodegenerative diseases.
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