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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by inanimate peanut on November 30, 2009, at 11:44:37
I feel like this is the hardest decision ever. I'm waiting for EMSAM for work (9 days on 6 mg now day 2 on 9mg) and I'm doubtful it's going to work which will mean another 1-2 weeks washout period to try Parnate and then waiting for it to work (and if it doesn't then I don't know what because I've literally tried everything).
My option is to keep waiting or to go into the hospital and be cleared for ECT and start that Wednesday morning. I'm really scared of ECT because of the memory effects and because I'm really very smart and don't want it to make me stupid. I live alone and would be taking a taxi to treatments if I don't stay in the hospital, but I'm pretty sure I'll hate the hospital. I have no social support here where I live. I have family about 2 hours away. I want to die so bad but won't kill myself because of what it would do to my family but my family is so sick of me right now that they don't know what to do with me and aren't very supportive. I just spent the last hour on the internet figuring out that I could kill myself with an insulin overdose without making it look like suicide (and still donate my organs, which is important to me). Don't worry-- I haven't ordered the insulin so no imminent threat.
I just don't know what to do. I'm so sick of waiting and I really doubt the EMSAM is going to work so more waiting... Should I be scared of ECT? Could people who've been through it good and bad please let me know what you would do in my situation? I've read past threads but I need to hear more based on my situation. Please just say something. I need to talk to someone so badly.
Posted by Meltingpot on November 30, 2009, at 12:07:51
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
Hi,
I know very much how you are feeling as far as feeling suicidal goes. I hope you feel better soon, as I hope that one day I will feel better (I mean truly better). What makes you think that the Ensam isn't going to work? Is that the depression talking do you think?
I know that ECT does really help some people but not others.
I've not had a full course of it but I would suggest that if you are going to have it ask for pulse wave, high dose right unilateral to start with as that is supposed to have less impact on memory (not for everyone though). I don't think you can take MAOIs though whilst having ECT.
I was feeling very suicidal and very anxious yesterday, today I just feel very empty.
The one thing you need to do right now (and I should practice what I preach) is not give up hope that one day you will get out of this awful state of mind and enjoy life as you are supposed to enjoy it.
A friend of mine always tells me that nothing is constant (although this depression feels pretty constant to me) so try and tell yourself that the way you are feeling won't be forever. Things will change.
Also, Zyprexa has always given me some relief from suicidal thoughts, so you might want to try that every now and again.
Sorry, I wish I could write something a bit more inspiring and encouraging but not feeling that positive myself right now. I know that there are others on this board though who will pipe in with lots of useful suggestions.
Keep battling on.
Denise
Posted by Phillipa on November 30, 2009, at 12:09:32
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
You sound really desperate and suicidal to me I'd get to a hospital ASAP and let them help you. You don't appear to be in any condition to make decisions at the moment deep breath call pdoc. Please???? Love Phillipa
Posted by Maxime on November 30, 2009, at 12:34:29
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
Hi, as bad as hell is, I would wait. I would try the Parnate. Most people feel some effect of the Parnate at 40 mg and you can titrate Parnate every 3 days by 10 mg. I don't think the EMSAM is going to help you if you haven't felt something already.
In the meantime, you could try Zyprexa whilst you do your washout period. It really helps with depression and anxeity QUICKLY.
I am sorry that you are in such a bad place. I was there myself in October. Now I am on Parnate and happy!
You can do this! You are not alone.
Posted by bulldog2 on November 30, 2009, at 13:31:57
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
> I feel like this is the hardest decision ever. I'm waiting for EMSAM for work (9 days on 6 mg now day 2 on 9mg) and I'm doubtful it's going to work which will mean another 1-2 weeks washout period to try Parnate and then waiting for it to work (and if it doesn't then I don't know what because I've literally tried everything).
>
> My option is to keep waiting or to go into the hospital and be cleared for ECT and start that Wednesday morning. I'm really scared of ECT because of the memory effects and because I'm really very smart and don't want it to make me stupid. I live alone and would be taking a taxi to treatments if I don't stay in the hospital, but I'm pretty sure I'll hate the hospital. I have no social support here where I live. I have family about 2 hours away. I want to die so bad but won't kill myself because of what it would do to my family but my family is so sick of me right now that they don't know what to do with me and aren't very supportive. I just spent the last hour on the internet figuring out that I could kill myself with an insulin overdose without making it look like suicide (and still donate my organs, which is important to me). Don't worry-- I haven't ordered the insulin so no imminent threat.
>
> I just don't know what to do. I'm so sick of waiting and I really doubt the EMSAM is going to work so more waiting... Should I be scared of ECT? Could people who've been through it good and bad please let me know what you would do in my situation? I've read past threads but I need to hear more based on my situation. Please just say something. I need to talk to someone so badly.According to my p-doc he usually has to go to the 12 mg patch for depression. I guess the others just are not dosed high enough.
Posted by uncouth on November 30, 2009, at 16:10:12
In reply to Re: ECT or wait in hell? PLEASE HELP ME » inanimate peanut, posted by bulldog2 on November 30, 2009, at 13:31:57
inanimate,
I was exactly where you were just a few months ago (check my old posts if you don't believe me). In a horrible state of depression, deepest suicidal thoughts, feeling subhuman and braindead and alone.
With my doctor's suggestion, and due to the fact that I too was searching for ways to killmyself online, I went the ECT route and had 22 (or 23? can't remember...) bilateral treatments. That's a lot.
ECT was only of moderate benefit. The main thing it does is sorta zonk you out during the period your having it. However, it caused me some pretty serious cognitive problems, mostly in the memory realm. I lost about a year of memories, and it took about 6 months for some stuff to slowly come back. Other things are gone for good. The one thing it will feel like is post-ECT, you will feel some "distance" to your pre-ECT life, like it was a different lifetime.
I am not anti-ECT, but personally I don't think I would get it again due to the memory effects. In other cognitive realms, I saw improvement.
In terms of your treatment. I've been on Emsam and Parnate in the past (and may try them again in the future, but now im relatively stable) and with the MAOIs you can't be shy with the dose. There can be big differences once you push the dose higher. I would go to 12mg patch immediately.
Are you Bipolar2 at all? I am, and will say that the 12mg patch did give me lots of energy and improve my depression, but it ended in a horrible mixed-hypomanic depressive state, so I had to go off of it. But I do think it's a good medication nonetheless.
But the biggest advice I have here is: DO NOT undergo ECT before giving zyprexa a good try, at a reasonable dose. I don't care if you've been on other antipsychotics before, zyprexa is a completely different beast. Don't worry about the weight gain or other side effects -- if the decision is between zyprexa and ECT, a few pounds are worth your memory, trust me.
Zyprexa has brought me back from the dead. I wish I had tried it before ECT. You can eventually go off of it, or decrease the dose, or switch to another antipsychotic which might work, but right now, you sound like you're in a agitated, depressive pit with thoughts swirling all around...i've been there...i know, as many people on this board know, what it's like.
Please, ask your doctor to prescribe you 5mg of zyprexa and increase your Emsam to 12mg. Zyprexa can work within DAYS. If 5mg doesn't do it, try 10mg. As another poster mentioned, it may give you enough time ot let the Emsam work or go to Parnate (I personally prefer parnate to Emsam...but again...you can't be shy with the dose).
You may also want to consider lithium, as it has a strong anti-suicide effect. Though in my opinion lithium isn't as fast acting as zyprexa. However, I see no reason why any doctor wouldn't prescribe lithium as an adjunct to ANYONE expressing suicidal thoughts....Best to you. I know it doesn't feel like it, but you CAN and WILL get through this. All I can say is that I was there, exactly where you are, and if I can make it out, then so you can you.
Please keep us updated.
-uncouth
Posted by linkadge on November 30, 2009, at 16:49:19
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
Have you tried amitriptyline? I had literally tried every drug too (except amitriptyline) and it is remarkably effective.
Not to burst any hope, but theres not a lot of data behind emsam and treatment resistant depression. Although, amitripyline (or another TCA) may combine well with emsam.
I don't recomend ECT.
Linkadge
Posted by bleauberry on November 30, 2009, at 17:37:14
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
I would strongly urge to not do ECT.
I would strongly urge to do this instead:
Go ahead with the hospital if that's going to keep you alive. No question there.
Use the hospital time to wash out. Perfect environment for that. Then start Parnate. Honestly I don't even see the need to do much of a washout. I would think you could safely start Parnate at 5mg immediately after stopping Ensam. Ensam will take a week or so to be fairly cleared out, but during that time I really don't see risk with low dose Parnate. Then once the washout period is over, you are already ahead of the game and on your way.
Save ECT for the final straw if Parnate failed, Nardil failed, and a couple other exotic combinations failed. ECT does have the potential to pull you out of the hole...for a short temporary time...but it is by no means an end to the battle. On informal anecdotal polls at this forum the negative stories of ECT fairly well trounce the positive ones, and even the positive ones are not anything spectacular to write home about. I have never actually seen anyone claim remission. Nearly everyone post-ECT still needs meds. One's life is likely to be different post-ECT, almost like a different chapter, not necessarily better, not necessarily worse, but different. You'll never be the same.
If you haven't been clinically examined for Lyme disease by someone who treats that everyday, lab tested specifically through Igenex Labs, and had a thorough full spectrum thyroid panel done, there is no business even considering ECT in my opinion. If someone has not tried a potent antibiotic for a mere 4 days to see if a Herx reaction is provoked, or a potent antifungal in the same manner, or an Olive Leaf extract or St Johns Wort to pinpoint a viral component, there is absolutely no business thinking about ECT. We have to cover the basics.
Getting ECT without doing the above is kind of like jumping off a sailboat in the middle of a lake without every practicing swimming in a pool first.
Hospital, washout, Parnate, Nardil.
Posted by emmanuel98 on November 30, 2009, at 20:11:56
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
I tried ECT and it didn't help me, although others have found it helps a lot. But I would consider going in the hospital and suffering through the ten day washout in safety, then starting parnate. I tried Ensam this summer and it didn't help me. I ended up in McLean where they washed me out and put me on parnate. Parnate has worked wonders. I haven't been depressed in the least since I started it 4 months ago.
Posted by alchemy on November 30, 2009, at 23:00:29
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
ECT helped me and people still tell me I'm smart :) I was in the middle of a Masters of Information Systems during one round - which I completed.
It did not affect my intelligence, but it did wipe out some recent memories (which was worth it to me). The first time I tried it it only took 5-6 treatments. I felt awesome, although the "awesome" feeling did go away, I wasn't as depressed.
Yes, you are really not suppose to do ECT while on MAOIs, but my dr. did anyway. (Emsam didn't work for me, but it still might for you).
The farther you spread out the treatments the less memory loss you are likely to have, but the response time (if there is a response) may be slower.
I don't want to necessarily advise you to do it, but I did want you to hear my story.
I'm still depressed, and at this level I wouldn't do ECT, but if I ever went back to the lowest of the lows, I would do it again. I'm glad it worked for me.
Posted by rz on December 1, 2009, at 9:21:54
In reply to Re: ECT or wait in hell? PLEASE HELP ME, posted by alchemy on November 30, 2009, at 23:00:29
ECT was a nightmare for me. I had been in the hospital for my depression and the doctors pushed and pushed for me to have ECT. I finally gave in (although I don't think I should have been making such big decisions in my deep state of depression).They made it sound like it was going to be a "miracle" solution for me. Not the case. ECT made my depression worse. I would come out of each treatment sobbing and angry with a huge headache wondering where I was. They kept increasing the signals and went from uni-lateral to bi-lateral. I stopped after 5 or 6 treatments. It just made things worse. The memory loss was horrible even months after the treatment. I didn't really realize it until I saw pictures from a cousin's wedding I had been to a month or two after ECT. I was at that wedding but didn't remember any of it even seeing the pictures. It's been over a year now since ECT but I think it has permanently messed with my short term memory. I now have to constantly write stuff down or I will forget it (never used to be that way).
Posted by Meltingpot on December 1, 2009, at 12:28:48
In reply to Re: ECT or wait in hell? PLEASE HELP ME, posted by alchemy on November 30, 2009, at 23:00:29
Hi Alchemy,
It never ceases to amaze me how some people respond so well to ECT and others feel that it was the worse thing they ever did.
Can I ask you some questions about your experience of ECT and your diagnosis at the time?
What kind of illness were you suffering from prior to having ECT, unipolar depression, bipolar depression, Schitzophrenia?
What symptoms were you experiencing, were you catatonic? Did you have any anxiety? Were you still able to function?
What was your cognition like prior to having ECT, were you still able to express yourself articulately?
What kind of ECT did you have, unilateral or bilateral?
How many treatments of ECT did you have before responding to it?
What meds had you tried prior to having ECT and what meds were you on after it?
Hope you don't mind my asking.Regards.....Denise
Posted by Meltingpot on December 1, 2009, at 12:33:38
In reply to Re: ECT or wait in hell? PLEASE HELP ME, posted by rz on December 1, 2009, at 9:21:54
Hi rz,
Is it ok if I ask you the same questions that I asked alchemy? I no that everyone is different and that everyone responds differently to different treatments but just wondered if there could be any reason why you had such a bad response to it when alchemy didn't. Would you be ok in answering my questions below? Although I'm sure if there was any correlations with people who respond to ECT and those who don't they would have worked that one out by now but if you could just humour me.
I hope you are ok (depression wise).
What kind of illness were you suffering from prior to having ECT, unipolar depression, bipolar depression, Schitzophrenia?What symptoms were you experiencing, were you catatonic? Did you have any anxiety? Were you still able to function?
What was your cognition like prior to having ECT, were you still able to express yourself articulately?
What kind of ECT did you have, unilateral or bilateral?
How many treatments of ECT did you have before responding to it?
What meds had you tried prior to having ECT and what meds were you on after it?
Thanks.....Denise
Posted by floatingbridge on December 1, 2009, at 12:47:08
In reply to ECT or wait in hell? PLEASE HELP ME, posted by inanimate peanut on November 30, 2009, at 11:44:37
Peanut,
Have you gotten any helpful information? Let us know how you're doing. We're pulling for you.
fb
Posted by inanimate peanut on December 1, 2009, at 13:50:47
In reply to How are you today? » inanimate peanut, posted by floatingbridge on December 1, 2009, at 12:47:08
Well, the bottom looked like it was lifting a little yesterday and now it's back down a little today. I still just feel like every hour takes days to pass and I'm so miserable. I think I'm out of hospital danger atm, so that's good. I don't think the EMSAM will be my answer. I'm now clinging to the idea of Parnate like a life preserver (literally). I just wonder how soon I should wait before I get off the EMSAM, get the wash out over with, get on Parnate, and get on with my life. I don't know what I'll do if the Parnate doesn't work either... Part of me is so scared I'll be stuck like this forever. Thanks so much for your messages-- they are the highlight of my day. I wish I could talk to you since I think you understand what I'm going through. I am so lonely.
Posted by floatingbridge on December 1, 2009, at 17:07:18
In reply to Re: How are you today? » floatingbridge, posted by inanimate peanut on December 1, 2009, at 13:50:47
Peanut,
I'm glad you a smidge better--but sad to hear about your on-going distress. I read in MonicaL's post that the washout is ten days. Here's the link: (hope it's clickable)
http://www.dr-bob.org/babble/20091127/msgs/927379.htmlDo you know about babble mail? You can e-mail (through the site, not to personal email accounts) anyone whose name appears in blue in the upper left corner of their post like mine. I think in the registration page, you are able to go back and turn on your babblemail function. This will not give out you personal information or address to the reciever of your 'babblemail'.
You can babble me anytime. Sometimes I am away for periods of time, but I'll respond soon. That way, too, you could babble mail others who have experience or information you might need. They may not babblemail back (not everyone does) but I find many to be quite approachable.
Good luck to you--and keep hanging in there. Many others will know about the washout period and what you might take to get yourself into a comfort zone while you are waiting.
fb
Posted by alchemy on December 1, 2009, at 18:33:18
In reply to Re: ECT or wait in hell? to alchemy, posted by Meltingpot on December 1, 2009, at 12:28:48
Of course I don't mind.
I started my unipolar depression around puberty, but it was also kind of agitated depression. So that sort of puts me in the bipolar II category. Because I started on SSRIs at such a young age that probably induced a little cycling as I became older. I have never had a day I haven't wanted to die. But I have been able to struggle to maintain a job and have friends.
I went through two extreme every-minute-miserable black holes. They were both induced from med trials (one was a Adderall & Abilify, and the other was from Geodon).
These are some words I wrote:
- still freaked-out doom feeling, crazy/stuck. hard to do anything, but agitated to do something
- absolute mess- anxious/agitated/ mixed state w/ loneliness.
I'm not a fan of my mom, but I cried in her arms forever.I couldn't work and I went on disability for a few weeks. I initially went to the hospital & they tried me on lithim, which seemed to increase my agitation and anxiety. I left the hospital and then decided to try outpatient ECT shortly after.
I think I was so desperate that it didn't make me that nervous.I responded in only about 5-6 treatments.
After (only lasted a couple of weeks):
-want to do things
-want to interact w/ people & friends
-want to make other people feel good
-extra creative energyI think my cognition was ok prior to the ECT, but darkness definitely overshadowed everything.
I had unilateral. I don't think they usually do bilateral anymore. And for some reason my induced seizures are longer than normal.
There was a young man who was in a catatonic state and would shuffle in drooling with his mother. He also responded to getting back to normal.
What is strange for me is that ECT seems to only really benefit me when I am REALLY bad. I have tried maintenance, but that doesn't seem to be worth it. I will add that I know of a nurse that gets a monthly "zap" to keep her afloat.
I did have a few times that I would get my ECT treatment in the morning and then go to work. (of course I didn't drive though).
My med course? Before ECT: a lot of SSRIs, Effexor Wellbutrin, Zyprexa, Trileptal, Serzone, Seroquel, and maybe some others.
Currently I am on Lamictal, Xanax, Synthroid, and Celexa. I also just recently tried replacing Wellbutrin with some tricyclic that starts with a D.
My ECTs were a few years ago and I'm 38 right now. I have pretty much tried anything. I still have times that I think about suicide. At least I am not as bad as I would be without meds though.Feel free to ask any more questions. ~thx
Posted by Phillipa on December 1, 2009, at 19:12:12
In reply to Re: ECT or wait in hell? to alchemy » Meltingpot, posted by alchemy on December 1, 2009, at 18:33:18
Is that med desipramine? Phillipa
Posted by alchemy on December 1, 2009, at 19:34:47
In reply to Re: ECT or wait in hell? to alchemy » alchemy, posted by Phillipa on December 1, 2009, at 19:12:12
> Is that med desipramine? Phillipa
Yip, that's it. Have you tried it?
Posted by Phillipa on December 1, 2009, at 21:04:33
In reply to Re: ECT or wait in hell? to alchemy » Phillipa, posted by alchemy on December 1, 2009, at 19:34:47
No I think Scott has though. Love Phillipa
Posted by meltingpot on December 2, 2009, at 13:21:15
In reply to Re: ECT or wait in hell? to alchemy » Meltingpot, posted by alchemy on December 1, 2009, at 18:33:18
Hi Alchemy,
Thanks for answering my questions. In a way it's good that ECT only helps you when you are really bad because at least you know there is something that will work if you do get really bad.
I guess you must suffer from bipolar if you find that lamictal helps.
I'm still no wiser as far as whether a full course of ECT would help me but then I spose I will never know for sure unless I try it. I just sort of want to do it because it's one of the few things I haven't tried.
Denise
Posted by Zyprexa on December 3, 2009, at 21:35:01
In reply to Re: ECT or wait in hell? PLEASE HELP ME, posted by uncouth on November 30, 2009, at 16:10:12
I'm with everyone else, as my name suggests, try zyprexa before ECT. I had a lot of ECT before the zyprexa and after the ECT they put me on zyprexa. The zyprexa has kept me stable for the last 11 years with out needing ECT. I hate that I took the ECT, which I had no choice in. It did one thing, made me stupid. 12 years later and I'm still getting memories back. For a while after the ECT, I was thought blocking, at least that what they called. The truth was I could not think, mind was blank. My thoughts were all messed up, for years.
Try zyprexa first, it will start working in an hour. You will feel good fast.
Posted by morganator on December 4, 2009, at 0:11:02
In reply to Re: ECT or wait in hell? to alchemy » Meltingpot, posted by alchemy on December 1, 2009, at 18:33:18
Actually I believe it is that there only used to be unilateral and now they will try bilateral for people that cannot tolerate unilateral or are not suffering as bad. Bilateral is supposed to be less invasive. I've thought about trying it.
Posted by greywolf on December 4, 2009, at 3:00:43
In reply to Re: ECT or wait in hell? to alchemy » alchemy, posted by Phillipa on December 1, 2009, at 19:12:12
I wouldn't try ECT again if the docs told me it was my last chance. It actually worsened an already horrible condition, and more than six months later I still have only the vaguest memories of the hospital and the treatments.Maybe ECT works for some, but it was the worst treatment experience I have ever had (and I can confirm that I've taken every medication available in the United States (label or off-label) for treatment of BP I and II, and unipolar depression, as well as have had VNS surgery and implantation.
As a result of ECT, I still have short-term memory problems, cannot remember names of people I've known for years, and have lost most memories of last spring. All for no benefit at all (except scaring the hell out of my family).
In my view, you should save ECT as a treatment of absolute last resort.
Posted by uncouth on December 4, 2009, at 9:50:36
In reply to Re: ECT or wait in hell? to alchemy, posted by greywolf on December 4, 2009, at 3:00:43
grey, how did you respond to zyprexa vs. other atypical antispychotixs?
and how long ago did you have VNS implanted? is it working? side efx?
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