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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jerseygal1 on October 13, 2011, at 17:00:51
My doctor has mentioned the possibility of ECT for me. I'm not sure how I feel about it. I've been on the following meds that haven't worked:
prozac (pooped out after 10 years)
lexapro
pristiq
zyprexa (with pristiq)
lithium
remeronLithium is the latest addition to see if it can get a response. So I'm currently taking pristiq, 100mg,lithium, 900 mg., remeron, 30 mg., and clonazepam, 2 mg.
I'm wondering if it is worth exploring all the meds out there before doing something as drastic as ECT. I've never tried zoloft or paxil, or any of the MAOI's.
Posted by SLS on October 13, 2011, at 17:17:33
In reply to ECT advice, posted by jerseygal1 on October 13, 2011, at 17:00:51
> My doctor has mentioned the possibility of ECT for me. I'm not sure how I feel about it. I've been on the following meds that haven't worked:
>
> prozac (pooped out after 10 years)
> lexapro
> pristiq
> zyprexa (with pristiq)
> lithium
> remeron
>
> Lithium is the latest addition to see if it can get a response. So I'm currently taking pristiq, 100mg,lithium, 900 mg., remeron, 30 mg., and clonazepam, 2 mg.
>
> I'm wondering if it is worth exploring all the meds out there before doing something as drastic as ECT. I've never tried zoloft or paxil, or any of the MAOI's.
Unless your doctor has a crystal ball, I don't think it makes sense to try ECT before investigating MAO inhibitors.
- Scott
Posted by Christ_empowered on October 13, 2011, at 17:19:43
In reply to Re: ECT advice, posted by SLS on October 13, 2011, at 17:17:33
It seems a little bit premature for ECT. However, ECT is highly profitable for doctors, so it kind of makes sense that your doctor would push it. Personally I think you should branch out and try other meds and/or psychotherapy.
Posted by Chairman_MAO on October 13, 2011, at 17:37:42
In reply to Re: ECT advice, posted by SLS on October 13, 2011, at 17:17:33
> Unless your doctor has a crystal ball, I don't think it makes sense to try ECT before investigating MAO inhibitors.It is a _violation of the hippocratic oath_ ("primum non nocere") to use ECT before trying MAO inhibitors and various other drugs and combinations, including but not limited to buprenorphine or oxycodone.
Posted by Phillipa on October 13, 2011, at 19:13:31
In reply to Re: ECT advice » SLS, posted by Chairman_MAO on October 13, 2011, at 17:37:42
I was told that ECT is a last resort in someone that is suicidal? Phillipa
Posted by hyperfocus on October 13, 2011, at 21:58:44
In reply to ECT advice, posted by jerseygal1 on October 13, 2011, at 17:00:51
What is your condition? There are a ton of meds and treatments you can try before resorting to that. ECT is sort of the Mutually Assured Destruction option.
Posted by jono_in_adelaide on October 13, 2011, at 22:07:26
In reply to Re: ECT advice, posted by SLS on October 13, 2011, at 17:17:33
I'd definatly try an MAOI and maybe clomipramine (150mg per day) before submitting to ECT
Posted by SLS on October 14, 2011, at 6:01:59
In reply to Re: ECT advice, posted by jono_in_adelaide on October 13, 2011, at 22:07:26
> I'd definatly try an MAOI and maybe clomipramine (150mg per day) before submitting to ECT
The clomipramine is a good idea, especially if one is not subject to intolerable side effects. Prior to its approval for marketing in the US, the more enlightened doctors would have their patients import clomipramine from other countries. I received mine from a small pharmacy in Canada. Clomipramine has had the reputation of being the most efficacous antidepressant available if one excludes the MAOIs.
- Scott
Posted by SLS on October 14, 2011, at 6:04:23
In reply to ECT advice, posted by jerseygal1 on October 13, 2011, at 17:00:51
Did your doctor discuss with you which protocol he would use to administer ECT? From what I have read, high-dosage unilateral right comes close to bilateral in efficacy, but without as much cognitive side effects.
I would be curious to know what the most recent thinking is on ECT methods.
- Scott
Posted by jerseygal1 on October 14, 2011, at 13:56:24
In reply to Re: ECT advice » jerseygal1, posted by SLS on October 14, 2011, at 6:04:23
Thanks for everyone's advice. I too am thinking that it's premature for ECT. My doctor would have to refer me to another doctor for it as he doesn't do the ECT himself. I never heard of clomipramine - I'll have to look into it. As far as MAOI's, which are supposed to be the most effective with the least amount of side effects?
Posted by Phillipa on October 14, 2011, at 19:12:07
In reply to Re: ECT advice, posted by jerseygal1 on October 14, 2011, at 13:56:24
Chlomipramine is a TCA used for OCD I am pretty sure. As for the Maois I would think all about equal in side effects. Nardil social phobia, Panate more energizing. Phillipa
Posted by emmanuel98 on October 14, 2011, at 19:18:34
In reply to Re: ECT advice, posted by jerseygal1 on October 14, 2011, at 13:56:24
I tried unilateral ECT which did nothing for me except leaving me with this constant sense that I was forgetting something important. I later tried bilateral ECT, which also did nothing for me except blow huge holes in my memory. I couldn't remember anything. My husband asked me to pick up something at the hardware store (that we go to all the time) and I asked him where it was located. When he told me the street it was on (a street I drive through every day) I asked him where that street was. It took a couple of months before my memory started to come back. My husband had to drive me places I used to go to all the time and show me how to get there. And the actual experience of bilateral ECT was nightmarish, waking up confused and sick from the anesthesia, remaining confused for the entire day.
I take parnate, which helps. But DBT has helped more than anything else.
Posted by bleauberry on October 15, 2011, at 7:15:32
In reply to ECT advice, posted by jerseygal1 on October 13, 2011, at 17:00:51
I had ECT several years ago. I did a lot of study on it and have direct experience with it. Here is a summary of what I know about ECT, most of which your doctor probably doesn't know or won't tell you.
ECT has an exaggerated success track record. In other words, it doesn't work as good as they would have you believe it does. There are not statistics to back up their claims.
ECT worked for about 2 days for me, right at the 12th and final round. After that I was in an ambulance to the psych ward worse than ever.
When ECT does work it usually doesn't for very long. Poop out is common and can happen in short time.
When ECT does work, drugs are commonly required in an attempt to keep it working. The med journey continues despite win or lose with ECT.
ECT is really expensive even with insurance. My insurance was awesome and paid most of it. But, the small amount of copay I had to pay was still in the multiple thousands of dollars.
ECT is a reasonable treatment for someone so sick they are institutionalized. ECT can at least allow them the possible opportunity to maybe leave the institution and live in a halfway home.
ECt can have serious memory loss issues that do not clear up with time. Mine were, and are, pretty serious. Entire random chunks of my life are completely gone. The part of the brain involved with name recall got totally fried during ECT.
ECT primary benefit in my opinion is that it closes an old chapter and opens a new one. Sometimes we just can't get out of the nightmare chapter we are in without doing something drastic, and ECT can do that. It doesn't necessarily mean ECT will create a better chapter, because I just never saw that happen, but it is a new chapter and that is a good thing because with new comes hope.
If there is memory loss surrounding the time of suffering leading up to ECT, that in my opinion is a good thing. Who would want to remember that crap?
Personally I would take a close look at the meds before thinking of ECT. For example, to revive a pooped out prozac it may have only needed a little bit of nortriptyline or ritalin or madafinil or adrafinil added to it.
I have never really seen remeron do anything really good for anyone. Ever. Except maybe as a sleep med at low doses. In my opinion it is an overglorified potent antihistamine but not an antidepressant except in marketing terms. I've never seen lithium work miracles either, except in cases of anxiety or mania. where it can calm things down pretty good.
If I were you I would be thinking in terms of hitting equally norepinephrine and serotonin. There are no single meds that do that except maybe adrafinil, savella, and parnate. A great combination to do that is Zoloft + Nortriptyline.
I can see where your doctor is going with this and it's pretty common. I don't happen to agree with it. I do not see any attempt here at balancing/supporting both NE and serotonin. I also don't see any attempts here at changing other things that need to be changed....choices of foods, supplements, herbs.
Some doctors don't mind, some doctors appreciate it and like it, but some don't like it.....when you come to their office with your own suggestions. That said, I would walk into the office with several suggestions:
1. Restart prozac but add nortriptyline to it.
2. Restart prozac but add ritalin to it.
3. Zoloft + Nortriptyline
4. Parnate
Pretty much everything else I can think of would, in my opinion, be a waste of time and suffering.I could mention a handfull of beneficial herbs, foods, and vitiamins. Among them, I'll just state the number one choice at the top of the list..... Rhodiola Rosea, with or without meds. Do some research on it, maybe read the book Rhodiola Revolution. I haven't read it but it was written by a psychiatrist who discovered by accident how well it worked with his own patients monotherapy or in med combinations, including his own treatment resistant wife. Every person I've suggested it to (sample size 3) went on to remission in just a couple weeks.
This is the end of the thread.
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