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Doctor posting, not a psychiatrist but an anesthesiologist who has done several ECT's. The procedure itself is akin to any other surgery, you are asleep for it, but will reap the benefits (and sometimes side effects) once you awake. I am a big proponent of ECT. I have also seen some patients who had bad experiences. One guy had such memory loss that he ended up with like 3 new phones because he had no recollection of ever getting one, and happened into Sprint, Verizon, and some other store and walked out of each thinking he had a brand new phone and plan! But that is the extreme and rare. If anyone else wants some other perspective on ECT, this was/is/should be required reading on any psych rotation during training. It is Kitty Dukakis's story about ECT for depression. (For the young people Kitty Dukakis was the wife of one time Presidential candidate Michael Dukakis). http://abcnews.go.com/GMA/story?id=2458124&page=1 Its an interesting piece and quick read. Not to hijack the thread but I am happy to answer some of the technical questions about ECT as they appear.
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May 2, 2016 05:48
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| # ? Apr 25, 2024 16:08 |
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Your avatar is wrong: you DO have something of value to contribute. Seriously, though, I enjoy it when you pop into threads like this.
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May 5, 2016 21:23
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I keep telling myself I want to propose this to my PCP but then i never do As bad as depressive phases get for me I can never rank it as worse than moderate, and even suggesting ECT seems like overkill for that
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May 6, 2016 05:33
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Fellow ECT patient popping in to say that ECT is probably the main reason I am still alive right now. I went into a serious depression about three years ago now that wouldn't let up. I was in and out of inpatient, self-harming, attempted suicide and had constant ideation, and no medication they tried me on seemed to have much of an effect. I have only vague memories of this period, also partly because of the ECT, and I'm mostly happy to not remember it. It was horrible. My psychiatrist suggested ECT initially as a means of getting me out of the suicidal, self-harming stuff long enough to find an effective medication, which according to my (limited) research is one of the major situations in which ECT is used. It might not make you immediately great again, but it will help a hell of a lot. I think it's underused really, probably because of a mixture of the whole One Flew Over the Cuckoo's Nest image it has and the cost, because it can be very effective. I don't remember exactly how many treatments I ended up having, but it was a fair few. I spent about half of last year in inpatient, receiving ECT 3 times a week, and then receiving maintenance treatments weekly until early February when I stopped because I was going back to studying and needed my brain to be able to remember things that happened more than a day ago. I have no idea how much all of this cost as I'm in Australia and was covered by my parents' insurance, but it must have been a lot. As for the procedure itself, I had pretty much the same experience as OP. I went in in the morning, laid down on a bed and got various pieces of monitoring equipment stuck to me while the anaesthetist put a cannula in, then they gave me oxygen to breathe while I was given the anaesthetic and off to sleep I went. From there you got moved into a recovery room and then transferred into another room with big recliners that you sat in while they gave you something to eat and drink and monitored your blood pressure. Usually I would end up fading back in while sitting in the chairs. I don't recall any major soreness, although I did find that I didn't remember a lot of things I had done in the months preceding the treatment until someone told me about them, and then only very vaguely. For what it's worth re: medications, I went through most of the more 'modern' antidepressants of various kinds and several antipsychotics before ending with nortriptyline, an old banger drug that knocked me around a little bit when I was starting on it but has ended up working far more than any other drugs I've tried. I don't think that says anything in particular about newer drugs, since different drugs work for different people, but I will say that it may be worth trying a MAOI or TCA if other things haven't worked. They are also fairly cheap, by virtue of being old. Just make sure you start on a very low dose (I'm on 150mg and started at 12.5mg - my psychiatrist initially said to start at 25mg, but it made me pretty sick) because they can have some pretty strong side effects.
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May 9, 2016 14:33
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I'll just come straight out and ask. How severe do you think clinical depression, anxieties, or whatever else have to be before ECT can be considered a realistic option?
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May 11, 2016 22:05
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Ciaphas posted:I'll just come straight out and ask. How severe do you think clinical depression, anxieties, or whatever else have to be before ECT can be considered a realistic option? I'd say ECT gets a big spot on the table of options as soon as two different types of anti-depressants or what have you saw no worthwhile effect. The number of treatments and the intensity of each one is flexible, so if you think you only have moderate problems, you could receive very moderate ECT. If it didn't cost thousands of dollars each then one or two zaps would be a better first venture into treatment than any pill we have.
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May 11, 2016 23:38
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By "types" do you mean categories like SSRI, SNRI, MAOI, TCAs? Or specific formulations? I've been through probably eight SSRIs of varying doses in the last decade, one or two SNRIs, and none of the others 'cos my PCP's spooked about making my weight problem worse (and because MAOIs appear to mean no cheese, and gently caress that, though I realize that's a bit silly  )
Ciaphas fucked around with this message at 01:52 on May 12, 2016 |
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May 12, 2016 01:49
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ECT is a realistic option to look into. Party down. and yes, I meant categories. Really as soon as it looks like genuinely different medicines aren't making any new headway, it should be on the board. Talk to the doc about it, and if they can't help you look for places that perform it and talk to them.
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May 12, 2016 02:12
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What I learned in school (and have seen in practice) is that you try meds + therapy first. If one med doesn't work, try another. A third may even be tried depending on if the other 2 did anything. After that, ECT is definitely an option. ECT in of itself is pretty safe, the anesthesia is the bigger concern. Its generally for whats called "refractory depression" which doesn't respond to first line treatment.
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May 12, 2016 03:37
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I suppose the least I can do is ask my PCP what she thinks, but I don't have a psychiatrist at all. Bloody hard to find one that takes appointments for new patients and takes my insurance, and I'm not rich enough to skip insurance. Wonder how much of a barrier that will be. My PCP is, for all the things I like about her, vulnerable to suggestion about the latest and greatest from the pharmaceutical companies, though, so I'm not getting my hopes up on getting a way forward from her.
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May 12, 2016 21:07
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You may want to talk to a doctor or clinic that actually does the treatment if you want to have the conversation but you feel like your PCP will dodge it. You're gonna have to get all your insurance's ducks in a row and then some if you choose to actually do it, so you'd have to find one that takes yours at some point.
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May 12, 2016 23:43
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Do you continue to take medication while doing ECT? For people with bipolar, does it increase manic/depressive behaviour, or does it help with thst too?
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May 12, 2016 23:54
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Wulfolme posted:You may want to talk to a doctor or clinic that actually does the treatment if you want to have the conversation but you feel like your PCP will dodge it. You're gonna have to get all your insurance's ducks in a row and then some if you choose to actually do it, so you'd have to find one that takes yours at some point. You're right but finding a psychiatrist here in Las Vegas / Henderson, NV who takes BC/BS and new patients is like asking Sisyphus to push two of those goddamn boulders at the same time, so I might as well start somewhere Probably never gonna happen anyway because I'm 99% sure I would not get any kind of salary or disability for the month+ off work that ECT would seem to require so this is a bit pointless, really Ciaphas fucked around with this message at 00:49 on May 13, 2016 |
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May 13, 2016 00:46
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Wulfolme I am so happy for you, you don't even know. Have a friend who went through somewhat of the same thing, but ECT was "last resort" before he'd be carted into the looney bin to prevent him from suicide. It's awful that ECT is a last resort option. For severe depression it should be second resort. The ECT helped him greatly.
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May 13, 2016 03:00
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DicktheCat posted:Do you continue to take medication while doing ECT? For people with bipolar, does it increase manic/depressive behaviour, or does it help with thst too? I think whether or not you stay on medication depends on the meds and on you as a patient, I was kept on my medication while having it but wasn't allowed any benzos as prn since they can interfere with the seizures. I've read both that it can trigger mania in bipolar patients and that it can be effectively used in treating mania and bipolar disorder, so I guess that means 'talk to your doctor? 
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May 13, 2016 13:14
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I'd like to comment from the opposite side of the coin. I had ECT about four years ago for treatment resistant depression, which included a month spent inpatient getting treatments 3x a week and then a tapering number for the next few months. Honestly the worst part of treatments was getting constant IVs. Now, with a big warning that this might not be someone else's experience and is certainly not typical; I experienced some relief of symptoms around the time I had them, but it didn't persist. (I am going off my husband's word here, since I don't remember most of that time.) Unlike others in this thread, I've also had some permanent memory loss issues in addition to the heavier temporary memory loss surrounding the treatment itself, including things like getting lost on the way home from my best friend's house in the other side of my own neighbourhood- a path I took at least a dozen times a week. I am hopeless now at lists more than a few items long, and am forever writing things down for myself when I didn't have an issue with it before. A good chunk of my childhood/teenage years are pretty blank as well. I have little snatches of it, but major things like who my friends were, what we did, who my teachers were, are pretty much gone, and we haven't even come up on 10 years yet. I was very active in theatre all throughout school but memorizing a script of more than a handful of lines now is nigh on impossible. If this wasn't the age of instant maps and stuff, I'd be pretty much screwed, and side effects have affected my day to day life to the point my psychiatrist and therapist both suggested I look into going on disability for it. Anyway, side effects like these aren't common, but they are definitely within the realm of possibility. The possibility of permanent side effects was NOT mentioned to me going in- only the temporary ones. I've known other people whose lives it far changed for the better, but also a few like myself or my friend who keeps throwing herself back into ECT in an effort to forget how much she hates her life and herself (this hasn't worked yet, after dozens and dozens of treatments, for obvious reasons). It's definitely not something that should be viewed as a magic solution to anyone and everyone that hasn't responded well to medication and/or therapy. uranium grass fucked around with this message at 17:44 on May 13, 2016 |
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May 13, 2016 17:38
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I was hospitalized for bipolar depression and investigating ECT when the head of the ECT practice at my hospital recommended transcranial magnetic stimulation. Long story phone-short, a few months of 10 minute outpatient treatments later, I was better than I had been for 25 years. We don't know what the long term management model will look like (intervention-only, refresher treatments, etc), but it's been a good year since then. My doctor was involved in some of the TMS trials, so he's perhaps biased, but he also does a half-dozen ECT treatments a week and thinks that TMS could help a lot of people who would otherwise "resort to" ECT. It's certainly less invasive, so if that's the case it would be great.
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May 25, 2016 02:51
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I'm sure it's not, really, but TMS reads like those bracelet things that do nothing but emit lights but somehow cure knee pain that you see on TV sometimes
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May 25, 2016 05:49
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Ciaphas posted:I'm sure it's not, really, but TMS reads like those bracelet things that do nothing but emit lights but somehow cure knee pain that you see on TV sometimes TMS has many well studied and documented uses in both diagnosis and treatment. That's like saying MRI does nothing because its just magnets!
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May 25, 2016 06:10
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TMS may have real potential, but the problem right now is finding a place that does it. I looked into that first, and I don't even know if we ever found a place in the state that performed it.
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May 25, 2016 06:23
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Wulfolme posted:TMS may have real potential, but the problem right now is finding a place that does it. I looked into that first, and I don't even know if we ever found a place in the state that performed it. In terms of treatment for depression, bipolar, etc. it is still very new and experimental. The only real way to is find an ongoing study and enroll. Its definitely no where near being the standard of care.
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May 25, 2016 06:25
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Interestingly, there appears to be a place that does it near me. Suppose it couldn't hurt to ask for information. Though I've still had like zero luck securing an appointment with a psychiatrist in this loving city argh Ciaphas fucked around with this message at 06:44 on May 25, 2016 |
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May 25, 2016 06:35
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swickles posted:In terms of treatment for depression, bipolar, etc. it is still very new and experimental. The only real way to is find an ongoing study and enroll. Its definitely no where near being the standard of care. There are private clinics in both the Bay Area and Toronto that offer it (the only places I've bothered to check), and Medicare covers it in some regions along with several private insurance plans (I know of Anthem and Cigna). The FDA has approved it for certain classes of MDD since 2008, so I don't think it's really considered experimental any longer for the uses being described here. You certainly don't have to find a study to participate in. http://tmsyou.com/directory/ is one way to find a possible provider, https://neurostar.com/neurostar-physician-locator/ is another; certainly not all of these private clinics are running trials. Neither list is comprehensive, but the psych dept at your local hospital should be able to tell you of some in your area if they exist, as should your psychiatrist.
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May 26, 2016 14:21
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I wonder if, because of how noninvasive it appears to be, you can do TMS without a psychiatrist's orders or with just that from a family doc That's still all I've got, and I haven't had a chance to call and ask all week Been in a bad way, especially the last few days, so I kind of hope so
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May 27, 2016 05:48
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If your family doc can attest in a convincing way that your depression is treatment-resistant, that might well be enough. I suspect it varies a bit between hospitals and private clinics. Hope you're feeling better soon. (Sorry to derail the thread with magnet chat.)
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May 27, 2016 06:17
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Turns out my doctor knows nothing about TMS and the place in town that did it closed several weeks ago anyway. Yet another loving dead end 
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May 27, 2016 17:31
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