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Re: maintenance, and also a question for SLS PhoenixGirl

Posted by SLS on November 23, 2001, at 17:57:15

In reply to maintenance, and also a question for SLS, posted by PhoenixGirl on November 23, 2001, at 15:18:06

Dear PG,

Thanks for responding.

> SLS, it sounds like the ECT helped, why didn't you keep getting it done on a maintenance basis?

In 1991, I received a series of 15 ECT treatments using a schedule of 3 treatments per week. My first 10 or so were unilateral left. The rest were bilateral. I experienced a mild improvement after the fifth treatment that lasted for a few hours. After that, nothing.

> That's when you get it done at first once a week for a month, then every 10 days for a month, then every 2 weeks for a month, and then once a month for who knows how long. I'm going to ask my doctor for this.

The great majority of people who respond well to ECT will relapse within a few months if no other treatment is used for prophylaxis. This isn't really so different from someone discontinuing a drug once they begin to feel better. They will most likely relapse too. Therefore, maintenance treatments are pretty much a given for people who have had a history of recurrent depressive episodes. It's great that the unilateral treatments are doing the trick. Unless a high dosage (current) is used, memory and cognitive disturbances are significantly less using unilateral versus bilateral.

> There's no way I'll accept going back to my pre-ECT days,

I can relate.

> I'll either keep getting ECT or I'll try Transcranial Magnetic Stimulation.

Where would you go for TMS? Is anyone using it outside an investigational setting? Can you be guarranteed indefinite access to treatment?

There are several different methods of rTMS being studied. The rate of success with the early trials were disappointing. I haven't kept up with it, but I believe there are differences in the intensity of the magnetic field, the frequency of the pulse, and the placement of the magnetic coil. Please let us know what you find out along the way. One person who has a lot of experience with rTMS is Dr. Mark S. George, who I believe is still working at the Medical University of South Carolina (MUSC). He also works with VNS (Vagus Nerve Stimulation).

> If those things fail, I may try some more meds, but I haven't had much luck with meds. Anyway, why didn't you do maintenance ECT? Oh, and as to right or left, I think it was the right side --- seems like that's where the jelly stuff was on my head when I woke up afterwards. I'm not sure though.

I didn't go for maintenance treatments because there was nothing to maintain. After my 15th treatment, I felt no better than I had before the first.

At the time of my treatments, it was standard to place the electrodes on the left side. Now, I think most practicioners choose to apply them to the right side. By contrast, I think rTMS is currently being applied to the left side.

> In the past couple of days, I've had some dark times and less of the wellbeing I described, but this could be from PMS. I'll know in a few days when my period starts, I'll see if I feel better then. I still feel a lot better than before the ECT, it's just that the last few days have been yuck.

That sounds yucky.

> If those things fail, I may try some more meds, but I haven't had much luck with meds.

I really don't know what the current practices are regarding the use of medication in conjunction with ECT. For instance, can someone respond to a drug after receiving ECT that they had failed to respond to previously? Can medication replace maintenance treatments? Is someone's chances of responding to ECT greater if they are taking medication at the same time?

One way or another, it sounds like you found an effective treatment for yourself. That's worth a smile! I'm so happy for you.

Take care.

- Scott




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