|
A lot of goons have the sadbrains. A lot of goons have tried drugs, and been disappointed. I want more sad goons to know about ECT because it was the answer for me, and the whole stigma around it delayed me from considering it for years. It was a half-joke when I did finally look into it, but it helped me. I can't tell you everything, but I can tell you what a firsthand experience will probably be like. I can't imagine the procedure varies too much across different facilities. I have refractory major depression. It is now considered to be in remission. We tried all the drugs. They didn't work. I went n' got zapped a dozen times and that did what the drugs were supposed to. The treatments took a month, and I remember about 45 seconds and a handful worth of snapshots from that month. This kind of memory loss around the treatment period is the primary side effect. It doesn't make your memory worse in the future, you just lose that month. It is extremely loving expensive. Thousands, easily. You get put under for every treatment and the anesthesiologist is half the bill. The front of your body will be incredibly sore for a few days after your first treatment because all the tiny muscles twitch like crazy for those few seconds, and then they hurt for a while. The spot where they put the electrode may hurt on the inside of your head, too, but I only noticed that on the first treatment. You have to have someone that can drive you home from the facility because you will be zonked out, even if you are awake and capable of walking to the car. You won't have any instance of snapping awake like normal anesthesia; you fade back in at a later time, or even a later date. You don't act strangely and you don't do anything wild or unimpeded that will embarrass you later, you just don't remember anything for very long. I had 4 more treatments a year later to finish the job. It always felt like 12 helped, but that more was needed. All the effects that are supposed to be alleviated by antidepressants are now at a manageable level, and this made it possible for me and my crack team of overworked psychiatrists to identify major anxiety disorder problems as well, which I am now taking effective medication for. Things are looking up, and that upswing could have begun years earlier if ECT had been presented to me as a legitimate option sooner. Side note: I had a great-grandmother who regularly received ECT treatments for years and they were a godsend for her, decades ago, when the methodology was still shaky. Even though I was cycling through anti-depressants and having bad reactions to some of them, no one in my family thought to mention this. Thanks, family. Thamily. That's the high and low of it. If you have any other questions I'll answer them as best I can.
|
#
?
Apr 17, 2016 04:13
|
|
|
|
| # ? Apr 20, 2024 05:19 |
|
|
Are you in the USA? If so, did you get, or try for, insurance coverage for the procedures? Are we talking thousands per go, or thousands for all 12+ sessions? (edit) How long was it after each session before you were able to return to work?
|
|
#
?
Apr 18, 2016 20:04
|
|
|
In general psychiatrists are very unwilling to try anything other than SSRIs/SNRIs as far as non-therapy treatment goes. I chalk this up to a combination of ignorance (caused at least partially by what they're told by drug reps) and being extremely (and overly, in my opinion) risk averse. In general, you should be very suspicious of an psychiatrist whose first pharmacological attempt at treating depression is anything other than a generic SSRI. There is almost never any reason for the first medication a depression patient tries to be a more recent (and expensive) brand-name antidepressant. As far as "treatments that are statistically far more effective than SSRI/SNRIs", there's not just ECT. MAOIs are also significantly more effective than SSRIs (in the treatment of moderate to severe depression), but most psychiatrists won't prescribe them unless you're literally about to commit suicide or something. This is largely due to their potentially dangerous side effect profile (you can't eat certain foods), but there are later MAOIs that minimize this problem. In general I find ignorance among psychiatrists to be a pretty major issue. Many have extremely dumb/unscientific views (like thinking one SSRI is randomly better for "energy" than others) and don't seem to understand that moderate/severe depression is a serious enough issue that it's worth dealing with some potential side effects or having to avoid cheese. It is a sad truth that a reasonably intelligent layperson who has read some wikipedia articles might be more informed than many psychiatrists. Strangely, the best psychiatrist I've ever had was this young guy who was still in med school.
|
|
#
?
Apr 18, 2016 21:21
|
|
|
I know someone who had this done and like you she loved the results. But she said she forgot a number of things that happened before her treatment, not just the time during it. Some of those things would come back if someone reminded her about them, but some did not and were new to her. The worst one was that she forgot her grandmother died and had to be told about it again. Did anything like that happen to you?
|
|
#
?
Apr 18, 2016 21:50
|
|
|
Ciaphas posted:Are you in the USA? If so, did you get, or try for, insurance coverage for the procedures? Are we talking thousands per go, or thousands for all 12+ sessions? Yes, and insurance helped for 12 sessions per year , which was why I stopped at 12 in 2014. It was several thousand dollars altogether for those 12 treatments, and I believe insurance paid for a little over half. As far as work went, I'd say that after a week you would be fine even after any number of treatments. The memory fuzz didn't bother anything beyond that. There was one woman who came and got zapped every single Friday morning, every single week. I assume she had been doing this for years and intended to keep doing it for life. Hell if I know how she paid for it, but she must have been cool to work at least 4 weekdays. Choose Deth posted:I know someone who had this done and like you she loved the results. But she said she forgot a number of things that happened before her treatment, not just the time during it. Some of those things would come back if someone reminded her about them, but some did not and were new to her. The worst one was that she forgot her grandmother died and had to be told about it again. Did anything like that happen to you? My grandparents took me to the clinic for the treatments for one week and I had no idea they were ever involved. I also got to watch How To Train Your Dragon 2 for the first time twice, which was neat. I knew I had seen the movie, but I remembered nothing of it. All the big reveals and major plot points were totally new to me, even though I had definitely seen them before. I also had to ask my mother if we saw Edge of Tomorrow or if I was just remembering a trailer. We had seen it. This I only remember because I wrote it down, but one day I walked 4 miles to a big store, back to our extended stay hotel, then ~3 miles to some other store and back, just to kill the day. 15 mile walk in the height of summer because I couldn't remember that my feet should hurt by now. The memory effects may be different for every person, but I can tell you that I didn't lose anything that wasn't within 48 hours of a jolt. Ytlaya posted:In general psychiatrists are very unwilling to try anything other than SSRIs/SNRIs as far as non-therapy treatment goes. The doctor running the facility would say that one or two treatments of ECT should be the very first thing people try when facing depression, not the 20th. Twinty Zuleps fucked around with this message at 02:44 on Apr 19, 2016 |
|
#
?
Apr 19, 2016 02:40
|
|
|
Sounds dangerous and painful.
|
|
#
?
Apr 19, 2016 10:06
|
|
|
lllllllllllllllllll posted:Sounds dangerous and painful. No. Single needle stick for a little IV for the anesthesiologist to put you under. They usually did mine in a vein on the back of my hand. Muscle soreness at the outset, oh gravy gracious. The treatment itself doesn't hurt because you will not be awake for it, and the anesthesia has a higher risk of dangerous side effects than the ECT.
|
|
#
?
Apr 19, 2016 12:10
|
|
|
Do you mind going into more detail about how you felt different after the procedure? Like, in what ways did you feel better? How long after the procedure did you notice that you were feeling better?
|
|
#
?
Apr 19, 2016 19:43
|
|
|
I'll add more to this later, but one big thing that changed immediately was that I would have a physical response to an emotional state again. You know the sad part of a movie, where everyone gets a little jerked up and half the people watching cry a bit? Well, for years things like that would just wash right over me with no effect. I don't remember what movie it was, but it got to the big emotional crescendo and I felt a pressure in my chest and the threat of tears in my eyes. It was weird, for me. The sad part of the movie was making me feel sad. I had forgotten that things could do that. While it was never so intense with moments of happiness, those got to the point of a warm fuzzy feeling instead of just a robot THIS IS GOOD. I AM HAPPY ABOUT THE OCCURRENCE OF THIS THING THAT IS GOOD. HOORAY. I noticed that effect in less than a week. Part 2: While it was more subtle, and drove the feeling that 12 wasn't enough, I started caring about doing things. I wanted to do things, instead of just killing time and seeking distraction. I could complete some humdrum task and have a sense of accomplishment from it. It made sticking to it on some project or actually getting out of bed and leaving the house for work without contemplating believable excuses for calling in sick for 45 minutes happen much more often. The thing depression kills is your emotional, neurochemical connection to everything you do, and you just stop caring about anything. Every action you take is supposed to have a feeling of value to it, however incremental. The ECT brought that back for me. Mostly. Twinty Zuleps fucked around with this message at 21:03 on Apr 19, 2016 |
|
#
?
Apr 19, 2016 20:54
|
|
|
Did you actively seek out ECT treatment on your own, or was it recommended to you by a psychiatrist? Generally, what was the lead-up to / history behind deciding to go for it? If a psych twigged you to it, was it considered quickly, or as an option of last resort? ECT is something I'm at least interested in researching for myself, but I have to say I don't know if my severity level of depression merits it. I'm what you'd call the 'worried well', I suppose--somewhere between mild and heavy-moderate, no suicidal ideation or whatever and I'm (usually) functional--just that meds and talk don't work as a rule, or if they do, it's not for very long. I also ask because I have had zero luck finding a psychiatrist who wasn't effectively a medicine dispenser--my PCP does that just fine, thank you--so if it's something I can think about pursuing on my own, that'd be nice. (ed) Wulfolme posted:Part 2: While it was more subtle, and drove the feeling that 12 wasn't enough, I started caring about doing things. I wanted to do things, instead of just killing time and seeking distraction. I could complete some humdrum task and have a sense of accomplishment from it. It made sticking to it on some project or actually getting out of bed and leaving the house for work without contemplating believable excuses for calling in sick for 45 minutes happen much more often. The thing depression kills is your emotional, neurochemical connection to everything you do, and you just stop caring about anything. Every action you take is supposed to have a feeling of value to it, however incremental. The ECT brought that back for me. Mostly. Basically I'd like this result Ciaphas fucked around with this message at 22:09 on Apr 19, 2016 |
|
#
?
Apr 19, 2016 22:06
|
|
|
Did it cure you of being a brony
|
|
#
?
Apr 19, 2016 22:32
|
|
|
Ciaphas posted:Did you actively seek out ECT treatment on your own, or was it recommended to you by a psychiatrist? Generally, what was the lead-up to / history behind deciding to go for it? If a psych twigged you to it, was it considered quickly, or as an option of last resort? The first mention of ECT as a treatment option was floated by a therapist in an effort to briefly alarm me. He likes to do things like that and it's usually a good idea when he does. Therapy should be uncomfortable at times. I cannot tell you when I started considering getting it myself, but I think I asked that therapist if he had any patients that had experienced it. He had, and told me that the response ranged from great to neutral, with almost everyone seeing some positive benefit. Everything for getting the treatment was arranged through the same psychiatrist I had run the gamut of medications with; she found the nearest (400 miles away, gently caress yeah texasss) clinic with an experienced staff, and set up the preliminary tests I had to receive as well. I needed a chest x-ray, an EKG, and some blood work. It's probably the same story for most of the US. If you're looking into it, you should find the nearest place that does ECT, call them and ask them what they need you to get done first. Telling a psychiatrist you've been seeing that you want to try ECT won't be a bad way to start, though. They may already know some reason that you can't do it, and the worst thing they can do is fail to help you get it. They might be able to make the whole thing happen themselves. As for worrying about the severity, 3 treatments isn't going to have a catastrophic effect on anything, and if a minor change is what you're really itching for, it may be perfect. E: Oh, one more major thought: Talking abut effects being temporary? I still definitely have my highs and lows, but it's like the ECT has taken the whole wave and hiked it up a few notches. That change has never wavered. I worry about it decaying over the course of years, and I do worry that I may always need more rounds in the future, but I can say that the lows never get as low as they used to and my fears of decaying effects may all be in my head. Twinty Zuleps fucked around with this message at 23:52 on Apr 19, 2016 |
|
#
?
Apr 19, 2016 23:41
|
|
|
Wulfolme posted:I have refractory major depression. It is now considered to be in remission. We tried all the drugs. They didn't work. I went n' got zapped a dozen times and that did what the drugs were supposed to. The treatments took a month, and I remember about 45 seconds and a handful worth of snapshots from that month. This kind of memory loss around the treatment period is the primary side effect. I believe that the memory loss IS the treatment. Depression is a thought disorder. A continuing cycle of negative thoughts leads to depressed feelings which leads to more negative thoughts. ECT completely fucks your memory during the time the treatments are going on, to the point where you forget you are supposed to be depressed. The cycle of thoughts is broken.
|
|
#
?
Apr 20, 2016 09:21
|
|
|
Uhh... No. No, not at all. I'm not sure how you arrived at this idea but it's completely wrong.
|
|
#
?
Apr 20, 2016 11:07
|
|
|
Wulfolme posted:Uhh... Considering that doctors haven't the slightest idea why it works, my idea is no worse than anyone else's. Also, mine makes sense, as it explains why it works, and why it often doesn't work in the long run. It could be tested, by looking at the (temporary) memory loss in different people who have had ECT done and seeing how it correlates with depression relief.
|
|
#
?
Apr 21, 2016 06:00
|
|
|
Orange Sunshine posted:I believe that the memory loss IS the treatment. Noooot really. Neurotransmitters, hormones, chemicals and a bunch of other things can be the difference between depression and not. People who only get severely depressed during hormone changes, people with SAD, etc. While I personally haven't needed ECT for mine, my godmother's bipolar only reacts to ECT treatment. Although she's lost memories of the month which she has it in (and some others), her physical health was fine during it, and it made a huge difference to her depression. So I'll also vouch for it working for severe cases otherwise unresponsive to meds.
|
|
#
?
Apr 21, 2016 06:43
|
|
|
Orange Sunshine posted:I believe that the memory loss IS the treatment. This is very wrong, it also sounds like something a "doctor" that is a guest of Oprah would say. The neural etiology of depression is very complex, and not well understood, but certain patterns pop up time and time again. Depression overwhelmingly appears to have a physical basis though, especially when considering how heritable it is.
|
|
#
?
Apr 21, 2016 07:27
|
|
|
OK. First of all, I would genuinely like to know how you arrived at these conclusions. I'm not trying to call you stupid. I think you got some bad information presented in a way that made sense, and you've put some thought of your own on top of that flawed foundation. None of your conjecture matches up with the real experience.Orange Sunshine posted:...Depression is a thought disorder... Orange Sunshine posted:I believe that the memory loss IS the treatment... ...A continuing cycle of negative thoughts leads to depressed feelings which leads to more negative thoughts. ECT completely fucks your memory during the time the treatments are going on, to the point where you forget you are supposed to be depressed. The cycle of thoughts is broken. Let me elaborate on the memory effects. You keep no long-term memories from around the time of the treatments. That's it. This feels like none of it ever happened, like the last month of your life was a dream that you only remember a few major points of. To say that it 'fucks with your memory' doesn't mean anything substantial, and you talk about it like it has a constant, moment-to-moment effect. From moment to moment, day to day, nothing changes. You don't forget any part of your personality or anything that happened recently. It's just that after the fact, you'll have no memory of any of it. I can tell you that you do not forget the feelings and negative thoughts that make you depressed. You do not forget to be sad. Everything, every feeling, every memory, every negative thought is all still there during that patch that's going to fade away. They way you think and the way you respond to things starts to change, and the way you feel about the negative thoughts starts to alter. Orange Sunshine posted:Considering that doctors haven't the slightest idea why it works... Orange Sunshine posted:...my idea is no worse than anyone else's.
|
|
#
?
Apr 21, 2016 07:34
|
|
|
Orange Sunshine posted:Considering that doctors haven't the slightest idea why it works, my idea is no worse than anyone else's. Also, mine makes sense, as it explains why it works, and why it often doesn't work in the long run. Except lots of experts know a shitload more than you do. Just because they don't know exactly what's going on in there doesn't mean that the layman knows any better. As for your idea making more sense as to why it works and why it doesn't in the long run...if it breaks cycle of depressive thoughts, why do the depressive thoughts come back? It's almost like there's an underlying neurochemical reason, and that's why breaking the cycle of negative thoughts doesn't completely solve the problem. It's almost like your idea of what causes depression is entirely wrong.
|
|
#
?
Apr 21, 2016 10:56
|
|
|
As a response to the above: First of all, psychiatry and psychology are roughly where medical science was in general around the year 1800 or so. Before DNA and viruses had been discovered, before bacteria were known to cause disease. Doctors knew many things, but there was far more they had no understanding of at all, and a lot of what they thought they knew was complete nonsense. We don't know how the brain works. Oh, we know a bunch of stuff about it, but we lack an overall understanding. We don't know how memory works, how emotion works, why people have different personalities, why psychological disorders happen or don't happen, and we don't understand the mechanics of any of the above. We've observed that certain psychological symptoms tend to cluster together, and we call one cluster of symptoms bipolar disorder, and another schizophrenia, and so on. We find a drug that alleviates certain symptoms, some of the time, or we find that shooting electricity into people's heads to cause a seizure alleviates certain symptoms, and we have no idea why. Vague ideas of "chemical imbalances" are put forth, which are almost certainly the modern version of keeping bodily humors in balance. I bring this up because you can't understand anything until you start by admitting what you do know and what you don't. In this area, there are no experts. Now, as to my ideas on this, looking at depression as a thought disorder would actually be the essence of the cognitive half of Cognitive Behavioral Therapy, so I don't believe this is a fringe concept. I believe depression is a vicious circle of negative thoughts leading to miserable emotions leading to negative thoughts. The thoughts become habitual, they are viewed as being true, they cycle endlessly unless something breaks the cycle. Like a bunch of seizures leading to severe short term memory loss over a period of a month or so. I came to this conclusion on ECT based on my experience with a friend who had it a number of years ago. She was severely depressed and suicidal. The first few treatments didn't seem to be doing anything. Then, with repeated treatments, her memory was fried, and that's when she came around and changed. In her case, it didn't last, though. Eventually the treatments stopped, and she remembered to be depressed again. I'd like to point out that there's a well-discussed theory now that, for antidepressants, the side effects ARE the treatment. That is to say that antidepressants are merely extremely effective placebos. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ My view is that, rather than supposing some mysterious effect ECT might be having, we look at the obvious effect it most definitely does have, which is memory loss, and look at that as being the actual treatment. It's certainly possible that I'm wrong about ECT. It would be easy to test, although I'm not sure if anyone has done so. The fact that unilateral ect leads to less memory loss than bilateral, and doesn't work as well as bilateral, is evidence in favor of my view.
|
|
#
?
Apr 21, 2016 11:07
|
|
|
Slime posted:Except lots of experts know a shitload more than you do. Just because they don't know exactly what's going on in there doesn't mean that the layman knows any better. As for your idea making more sense as to why it works and why it doesn't in the long run...if it breaks cycle of depressive thoughts, why do the depressive thoughts come back? It's almost like there's an underlying neurochemical reason, and that's why breaking the cycle of negative thoughts doesn't completely solve the problem. It's almost like your idea of what causes depression is entirely wrong. I wrote my above message before I read yours. The answer to this is that depression is a habitual pattern of thoughts, and habitual behaviour once stopped can easily come back. As an alcoholic can quit drinking for years, and then start right back up again as a bottomed out alcoholic as if the period of sobriety had never happened. As to the experts knowing more than me - imagine you've traveled back in time to the year 1800, and have been injured. There's the esteemed doctor, explaining to you that you must rub "sugar of lead" on your wound and have your blood let in order to cure you. You're searching for some nice way to say, "I know you don't know this, but you have NO IDEA WHAT YOU'RE DOING", and decide instead to say nothing, pretend you will follow his treatment plan, and sneak out when he's not looking. The year 1800 had experts in many fields, but medicine was not one of them.
|
|
#
?
Apr 21, 2016 11:31
|
|
|
You're doing that thing where you have a narrative about something that you really enjoy and you go out looking for reasons to back it up instead of paying attention to things that might shake it. Have you talked to this friend about how she felt and what changed, or did you come up with this explanation for her symptoms without consulting her?
|
|
#
?
Apr 21, 2016 12:59
|
|
|
Orange Sunshine posted:looking at depression as a thought disorder If only I had thought to think positive thoughts, I could have avoided years of bi-polar! Orange Sunshine posted:imagine you've traveled back in time to the year 1800 Oh poo poo, so that's why my therapists all recommend phrenology
|
|
#
?
Apr 21, 2016 14:33
|
|
|
@OP: Pretty much my only awareness of ECT came from One Flew Over the Cuckoos Nest. I thought ECT was a dangerous, outdated treatment; in modern applications reserved for only the most serious patients. Kinda like lithium being a last resort for treatment where others failed. Neat to see I was wrong, or at least there are different opinions on it.
|
|
#
?
Apr 21, 2016 14:36
|
|
|
Orange Sunshine posted:I'd like to point out that there's a well-discussed theory now that, for antidepressants, the side effects ARE the treatment. That is to say that antidepressants are merely extremely effective placebos. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ It doesn't take much effort to find a study that disagree & state that SSRIs are more effective than placebos. And this covers just SSRIs. If you change SSRI & simply look for MAOIs, tetracyclic antidepressants, tricyclic anti depressants, SNRIs, & the other varieties of antidepressants available. Simply saying "antidepressants are effective placebos" is a meaningless statement without clarification. I also think that prescribing a placebo with side effects like "increased risk of suicidal ideation" would be horrifically irresponsible, & it also doesn't cover the fact that that risk increases if you just stop taking them rather than go through a gradual tapering down of your meds. The side effects of SSRIs are lovely. Erectile dysfunction, nausea, loving with your appetite, etc
|
|
#
?
Apr 21, 2016 14:50
|
|
|
McPhock posted:@OP: That's common. To many doctors, it is infuriating. I'm glad I could help.
|
|
#
?
Apr 21, 2016 14:58
|
|
|
I think the core of your misunderstanding is the fact that depression is not a single condition. Like, two people with depression do not necessarily have the same condition; depression is just a symptomatic diagnosis. A good analogy is to compare it with diagnosing someone with "fever". So what you're saying is sort of like saying "Fever is always caused by the flu" and then basing all your other conclusions off of that, when in reality the symptom of depression can be caused by a variety of things, both completely physical and mental/psychological. As a result, you have some instances of depression that may be caused mostly or completely by bad thought patterns or bad life experiences. Others may be mostly or even entirely physical (brain not producing enough of a particular neurotransmitter or something). While you're right that psychiatry isn't anywhere near most other areas of medicine, we do know certain things. For example, we know that the neurotransmitters seratonin, norepinephrine, and dopamine have an impact on some forms of depression. We don't fully understand how, and there are likely other things that *also* influence depression, but we know they do. Orange Sunshine posted:As to the experts knowing more than me - imagine you've traveled back in time to the year 1800, and have been injured. There's the esteemed doctor, explaining to you that you must rub "sugar of lead" on your wound and have your blood let in order to cure you. You're searching for some nice way to say, "I know you don't know this, but you have NO IDEA WHAT YOU'RE DOING", and decide instead to say nothing, pretend you will follow his treatment plan, and sneak out when he's not looking. The year 1800 had experts in many fields, but medicine was not one of them. Your comparison here is also wrong (see a trend here?). There is a lot we don't know about psychiatry, but unlike the 1800's we know what we don't know (or at least the people who actually do the research do, if not individual psychiatrists). Like I mentioned above, we know for a fact that certain neurotransmitters affect depression, and we also know that we don't fully understand how. If your analogy were accurate, then the situation would be one where researchers strongly believe some random thing causes depression that actually doesn't cause it at all, but that isn't the case. Unlike back then, we understand the limitations of our knowledge and what we can safely be confident about. Ytlaya fucked around with this message at 17:53 on Apr 21, 2016 |
|
#
?
Apr 21, 2016 17:48
|
|
|
Ytlaya posted:I think the core of your misunderstanding is the fact that depression is not a single condition. Like, two people with depression do not necessarily have the same condition; depression is just a symptomatic diagnosis. A good analogy is to compare it with diagnosing someone with "fever". So what you're saying is sort of like saying "Fever is always caused by the flu" and then basing all your other conclusions off of that, when in reality the symptom of depression can be caused by a variety of things, both completely physical and mental/psychological. True dat. I've got atypical depression and for the longest time, I denied having depression partially since a good portion of the symptoms didn't match at all. I never really wanted to kill myself and could react to things positively but in exchange, I didn't really care to make any effort at all and I just wanted to sleep all the time. Even now, sometimes I just want to crawl under a rock and sleep forever. If I somehow got timestopping powers, that would be the first thing I would do. Just SSRIs weren't really cutting it either, I tried a lot of different ones. I finally got on bupropion and Cymbalta and I'm doing okay though my hands shake, I am heat intolerant and I gained a lot of weight due to increased appetite. I would go from fine to starving very quickly. Therapy has helped some but a lot of this isn't mental. I just didn't have the energy for daily life before. It had gently caress all to do with my thoughts because a lot of the time I wasn't even actively thinking.
|
|
#
?
Apr 21, 2016 22:36
|
|
|
Ytlaya posted:I think the core of your misunderstanding is the fact that depression is not a single condition. Like, two people with depression do not necessarily have the same condition; depression is just a symptomatic diagnosis. A good analogy is to compare it with diagnosing someone with "fever". So what you're saying is sort of like saying "Fever is always caused by the flu" and then basing all your other conclusions off of that, when in reality the symptom of depression can be caused by a variety of things, both completely physical and mental/psychological. I agree with your statement that depression is not a single condition, and it's part of what I was saying earlier, that nobody really understands what's going on in human psychology. The word depression is being used to mean a number of different things, some very different from others. Atypical depression, mentioned above, seems nothing like other forms of depression in many cases, since all a person has to do to qualify for atypical depression is to be fat and sleep a lot, or to be socially sensitive and hungry a lot. When nobody really knows what depression or bipolar disorder or schizophrenia are, other than "a bunch of symptoms that tend to cluster together", understanding these various disorders will be difficult. I'm referring to the classic idea of depression, someone who feels hopeless, despondent, and has constant negative thoughts running through their mind.
|
|
#
?
Apr 22, 2016 06:32
|
|
|
forkboy84 posted:The side effects of SSRIs are lovely. Erectile dysfunction, nausea, loving with your appetite, etc You fool, don't you get it?! The erectile dysfunction IS the treatment! Who can focus on their regular lovely thoughts once their dick stops working? 
|
|
#
?
Apr 25, 2016 13:38
|
|
|
Orange Sunshine posted:I'm referring to the classic idea of depression, someone who feels hopeless, despondent, and has constant negative thoughts running through their mind. The "hopeless, despondent" and "constant negative thoughts" aspects are not necessarily related, though. The former can be the result of a purely "physical" problem, while the latter can likely be at least somewhat alleviated with psychotherapy. I think another thing you're mistaken about is that there's a difference between "nobody really understands what's going on" and "we have limited understanding." You seem to imply that we just have no idea what the gently caress is going on (based upon your comparison with 19th century bloodletting IIRC), but that isn't the case here at all. We are far from understanding the big picture, but there are some things we know and can be confident about regarding depression treatment. For example, there are certain treatments that we know perform better than placebo when generally applied to people with the cluster of symptoms we call "depression." It may not be ideal, but it is absolutely better than nothing. This does not mean they will necessarily have any effect for any specific person, but they definitely treat at least some instances of depression and are superior to doing nothing at all (or placebo treatment). If you had to come up with an analogy to some other area of medicine, I would probably compare current psychiatry with the state of medicine relatively soon after something like germ theory became well accepted. That is, we understand that depression is the result of an individual's neurochemistry and/or stuff like thought patterns, environmental factors, etc. But we don't know enough to look at many given instances of depression and accurately determine their specific cause. It's sort of like knowing that a sickness is caused by a virus/bacteria but having no way to determine which virus/bacteria it is. You can throw penicillin at the problem and it'll do better than placebo when applied to large populations (since it will be the correct cure for some instances of sickness), but you can't actually look at a microscope and say "ah, this is bacteria X which requires antibiotic Y to be cured."
|
|
#
?
Apr 26, 2016 22:46
|
|
|
I've been depressed since I've been 17 (I'm 28 now) and . I've had about 28ish ECT treatments and suffered no memory loss. I still take zyprexa and prozac for my mental illness but I feel completely cured. ECTs treatments and meds have been a real life saver for me. Ask if you have any questions.
|
|
#
?
Apr 27, 2016 04:19
|
|
|
No memory loss, even around the time of the treatments? Were they spread out to something like once every 2 weeks or something similar?
|
|
#
?
Apr 27, 2016 05:41
|
|
|
I'd like to talk about my perspective with ECT treatments. I started them nearly two years ago, after trying many medications. While I personally, would not make ECTs one of the first things you do, my therapist is of the opinion that my RN should have referred me to the psychiatrist in charge of my ECTs sooner, because I started going on some really obscure medications. In case it's not obvious, I have severe depression, and serious anxiety. Those are the main things they try to treat me for (they may just be trying to treat me for the depression, but they continue to ask me about my anxiety, so I assume they're trying to treat me for that). When I was referred, I got a pamphlet, that's pretty much all I remember, other than this key fact: you have to arrange a ride, because for obvious reasons you cannot drive home, and they will not let you take the bus or a taxi home either, even with someone else. For a long time, I would have treatments three times a week, unless my doctor was out of town or something. This period was hell. I could not remember anything, and frankly, I became more depressed when I realized that I couldn't remember the contents of the book I had been reading when I started treatment. The days just blurred together. Eventually I got to a point where I was seeing them two times a week, then once, then every two weeks, then three. I was at once a month until about January of this year, when I had to increase it due to some circumstances. But while I am grateful to my ECT treatments for getting my depression under control, I sort of resent them at the same time because I feel like they run my life. For example: I'm going to school while doing my treatment, and I have to schedule them for Fridays, because they don't do weekends (it's not like I don't understand, but it honestly sucks). No matter what, I miss a weekday, but considering that I need time to recover afterwards, Fridays are best. That means I need to pick classes keeping in mind that if they meet on Fridays I'll be missing them at least once a month. So it dictates my class selection. I get accommodations for the absences, but I'm not sure they'd provide a notetaker for those days, you know? I have to decide when to schedule appointments for things like my RN and therapist (since I make them in advance) and I can't make them Fridays. So that blocks out other days. I'd like to study abroad if I could afford it (though with medical bills I sort of wonder), but I'd have to find a short program so I can get a treatment, get on a plane within a couple days, and then get a treatment when I get back. But enough of my whining, here's the details. Of course no food or drink after midnight the day before. I also cannot take any anxiety meds after 5 PM as well. When I wake up (usually an hour - 30 minutes before I have to go) I can't have any coffee of course, so I mostly lounge. When I get there, it's a game of luck. If I got the lovely 6:30 time, I'll enter right away. If not, I may get to, or I may have to wait. If I have to wait, there's always this jackass who has fox news cranked up really loud so you can't help but hear it unless you have ear plugs. Really, no wonder everyone here is depressed.  When I enter, I have to remove my any sweatshirt or coat, my shoes and such. They'll want to put in the IV of course, and give you meds. There are three as far as I know, though I don't know their names: an anti-nausea, one for headaches (I'm not sure how much it helps) and one to dry up saliva that lasts pretty much all day so you're constantly thirsty. If it's the lovely 6:30 time, you have to wait around an hour for the doctor to get there and it's really boring since it's a featureless room and you're stuck with your thoughts and the blood-pressure cuff. I finally just requested to stop having them then, but last time I did the nurse let me keep my phone until it was time, so since the hospital has wifi I got to surf. At some point the nurse will interview you a bit, might make you do this depression test, that sort of thing. The anesthesiologist will come in to talk to me at some point to make sure I don't have problems with the anesthesia. I also need to point out to them that I bite my tongue a lot. I'm not sure if it's my fault or theirs. Eventually the doctor comes in. I don't dislike him or anything, but I never get a chance to talk to him. He's the one I need to talk to if I think I'm ready to reduce my appointments to less frequently or something, but you simply do not get an opportunity since he comes in 10 seconds before you go under. I figured out a solution though: I leave notes. But then they put me under. Eventually I wake up or a nurse wakes me up, and they call my ride, disengage me from the IV, the electrodes and such. This is also when they inform me of my appointments, when I'm too groggy to tell them "no I told you I can't come at 6:30" or "can we do next week, I have a test that day" so I usually have to call the next day they're open to reschedule. So yeah, while ECTs have certainly improved my life, they're a big step, which is why, at least from my perspective, I would not make them one of the first things you try. Like I said, they dictate my life, and my memory is not very good these days. Of course, I'm aware a lot of people may not have my problems and may more be like the OP and not have to have ECTs for 2 years and presumably more.
|
|
#
?
Apr 27, 2016 13:36
|
|
|
Wulfolme posted:No memory loss, even around the time of the treatments? Were they spread out to something like once every 2 weeks or something similar? I had mine three times a week and then two times a week. I was a little groggy from the anesthesia after waking up but I remembered everything. I just don't want people to not receive ECTs because they are afraid of memory loss.
|
|
#
?
Apr 27, 2016 20:57
|
|
|
Lot of misinformation in this thread... quote:I'd like to point out that there's a well-discussed theory now that, for antidepressants, the side effects ARE the treatment. That is to say that antidepressants are merely extremely effective placebos. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ This is a pairing of a pretty broad and rather extraordinary statement with an insufficient amount of evidence. But I'd like to point out that the proposed mechanism of action for ECT is very similar to the proposed mechanism of action for most anti-depressants so it speaks to an ignorance of the most current scientific literature to suggest that one is an "extremely effective placebo" and another is effective. I can cite studies if you want but the most current research points to a spontaneous and protracted release of monoamines (in particular dopamine, serotonin, and noradrenialine) in the cortico limbic circuits of the brain. We believe that this is the proposed mechanism because we've observed releases of these monoamines in animal studies and have also found that, among people with impaired release of these neurotransmitters, ECT has less clinical efficacy. The best clinical picture we have is that this spontaneous and sudden NT release precipitates the creation of monoamine receptors that make your brain more reactive to normal and typical release of these neurotransmitters. Put another way, a sudden release of dopamine makes your brain think, "hey, I have more dopamine available" and create more receptors to align with that concentration. Well, post treatment, you don't have as much dopamine but you still have the receptors so that, when your brain releases its normal-but-low amount of dopamine from then on, you have more receptors and are now more reactive to smaller quantities of dopamine (substitute serotonin and noradrenaline in place of dopamine; the mechanism is the same for all three and all three are released in massive quantities with ECT). So now, even though your depressed brain is releasing less neurotransmitter per reaction, your receptors are now more sensitive leading to an increased level of effect. Obviously it's much more hideously complex than this and there are other proposed and concurrent mechanisms of action but this is it. When I say the mechanism is similar to antidepressants, I mean in the creation of monoamine receptors within the synaptic cleft. The most current model of most anti depressants maintain that by blocking the reuptake of serotonin +/- noradrenaline, you leave more of these chemicals within the synaptic cleft to exert an effect. It's a common belief that more neurotransmitter is the reason why these medications work but that's not the full story... having more neurotransmitter makes the synapse think, "hey, I have more dopamine/noradrenaline/serotonin" and just like with ECT create more receptors for these monoamines such that less neurotransmitter in the synaptic cleft will still exert an effect. It takes 2-4 weeks for the transcription factors to start to encode for additional receptors and up-regulate the creation of more receptors in the presence of more neurotransmitter which is why you don't typically see full clinical efficacy reached until you've been taking the medication for a number of weeks. But in either case, the proposed mechanism is premised on the upregulation of these monoamine receptors... While other causitive mechanisms have been proposed for ECT (e.g., depletion of GABA stores leading to increased excitability, prolactin and oxytocin surges), it's a really difficult thing to study. ECT does a LOT of things all at once, some things you wouldn't expect (for example, ECT treatment has been shown to increase serum cholesterol and decrease ghrelin, a hunger-regulating hormone). Because so many things change at once, it's virtually impossible to isolate any one thing and study it independently in order to say that <this> change is what is involved in the therapeutic effect. If we could isolate which change was effective, I would imagine ECT would rapidly fall out of favour as we perfect and patent a drug or delivery system that can create that effect independent of the other effects. ECT has been shown to change glucose metabolism in the brain at different rates in different areas. Does this create the therapeutic effect? Does it contribute to the therapeutic effect? impossible to say because we lack the technology to induce this same effect independent of an electric current that also causes spontaneous release of these monoamines, deregulates the HPA axis, changes hippocampal metabolism etc etc quote:First of all, psychiatry and psychology are roughly where medical science was in general around the year 1800 or so This is also a really dumb statement. In the 1800s, the scientific method and current research methodology wasn't developed enough to test medical principals with the sort of rigor you have now. Yes, psychiatry/psychology is underdeveloped when compared to other medical specialties but we have a research infrastructure and principals sufficiently developed that, as new theories are developed or new procedures to measure psychological phenomenon is developed, research to a high and contemporary standard soon follows. There's no real time period comparison you can make, anything you can say along the lines of "current psychiatry is equivalent to 19XX medicine" doesn't pay sufficient homage to research protocols that have developed in this time. The way research findings are disseminated in 2016 alone represents an incredible advancement in medical research; imagine how quickly medical science would have grown from 1800 to 1900 if the internet had been around to inform Dr Smith from New York that Dr von Lichenstan from Austria found his lead-based panacea was ineffective for the treatment of gout among his cohort of 45 patients.
|
|
#
?
Apr 29, 2016 09:40
|
|
|
Serrath posted:Lot of misinformation in this thread... That's a lot of great stuff about the science behind all this, but come ooon, one stubborn idiot that everyone else is calling out too hardly counts as misinformation. E: Had a chance to read all of this more closely, and I want to thank you for putting that together. That's really helpful to know the hard details like that. Twinty Zuleps fucked around with this message at 16:19 on Apr 29, 2016 |
|
#
?
Apr 29, 2016 11:32
|
|
|
Serrath posted:Lot of misinformation in this thread... I've been trying to find a book academic book on ects like this. Any recommendations?
|
|
#
?
Apr 29, 2016 19:35
|
|
|
I see lots of people with bad depression who don't respond to meds respond well to ECT. Just make sure its being combined with lots of other stuff--psychotherapy, a perscriber who you feel good about, lifestyle changes-maybe a rehab worker to help out with building a healthy routine every day.
|
|
#
?
May 1, 2016 17:21
|
|
|
|
| # ? Apr 20, 2024 05:19 |
|
|
Orange Sunshine posted:I wrote my above message before I read yours. The answer to this is that depression is a habitual pattern of thoughts, and habitual behaviour once stopped can easily come back. As an alcoholic can quit drinking for years, and then start right back up again as a bottomed out alcoholic as if the period of sobriety had never happened. Even leaving aside the massive overstatement here, are you under the impression that the medical theories of a random guy on the street back then were better? You're not a time traveler from the year 2232, you're someone on the internet who doesn't even know what science *does* know about the brain
|
|
#
?
May 1, 2016 19:00
|
|
