Posted by SLS on May 27, 2000, at 11:27:48
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ?, posted by medlib on May 27, 2000, at 2:02:24
> Welcome to Babbleland! There are a couple of articles on right unilateral vs. bilateral ECT in the current issue of "Archives of General Psychiatry," a publication of the American Medical Association. If you haven't run across these already, you might be interested. (Note that the URL has no "www" in it.)
> You can select full text or abstract. BTW, if you're into research, sometimes the reference list at the end of a good, relevant article is better than the best search. The subject of ECT continues to produce unlimited quantities of published research, differing opinions, and heated emotions. I deal with the first category here because the latter two have been covered quite thoroughly by others in earlier posts.
> Well wishes---medlib
On behalf of Dave, myself, and others - Thanks.
It is funny that you should provide an answer to the questions I just yesterday posed to Dr. Max Fink.
According to the article referred to by Medlib -
Right-unilateral treatments (RUL) are as effective as bilateral treatments, but only at high dosages. High-dosage RUL does not disturb memory and cognition as much as bilateral treatments, and does not produce the same degree of post-treatment disorientation that you experienced. Although not as effective as high-dosage RUL, low and moderate dosages of RUL cause less side effects. I'm not sure if this summary was necessary. I hope you are not insulted that I wrote it.
It was great to read that high-dosage right-unilateral ECT is as effective as bilateral ECT. That RUL treatments exhibit less severe cognitive side effects than BL seems to allow for an easy decision in favor of RUL. Would you like to comment on this? Are the findings of these studies consistent with others you have read?
Max Fink suggested that I get a hold of a book:
TEXTBOOK BY RICHARD ABRAMS: ELECTROCONVULSIVE THERAPY (OXFORD U
PRESS, 3RD EDITION, 1997)
I would think this a bit out of date. I had asked him to compare left, right, and bilateral treatments with regard to efficacy and side effects. He replied that there was a wealth of study in this area, and that it would be better if I were to read the book.
What do you think?
In 1991, I received a series of 6 left-unilateral treatments. When it didn't seem that much was happening, I asked for the remaining 6 to be bilateral. No success, except for a small improvement I experienced after the fifth unilateral.
I described to Dr. Fink my non-response to this course of treatments. He replied:
THE UNILATERAL TREATMENTS WERE PROBABLY INEFFECTIVE... CONSIDERING WHAT WE HAVE LEARNED SINCE 1991, I WOULD NOT USE THAT EXPERIENCE AS A GUIDE TO WHAT CAN BE DONE TODAY.
I don't think he was deterred by the description of my history of treatment-resistance to pharmacological treatment:
ALL DEPRESSIVE CASES SEEM TO RESPOND THE SAME TO ECT. IT IS THE MOST BROADLY EFFECTIVE TREATMENT, WHEN PROPERLY APPLIED. NOT LIKE DRUGS -- EACH HAS A LIMITED RANGE OF ACTIONS.
> What is the recommended number of treatments given before one
is considered a non-responder?
DEPENDS ON THE DIAGNOSIS. FOR PSYCHOTIC PATIENTS, WE OFFER 15-20 TREATMENTS. BUT MANY TREATMENTS ARE INEFFECTIVE, SO COUNTING TREATMENTS IS NOT USEFUL. ANY MORE THAN COUNTING PILLS.
> Can you recommend anyone in the NYC area who might be well
suited to treat me pharmacologically?
NO. YOU SEEM TO HAVE SEEN THE DRUG EXPERTS. PERHAPS YOU SHOULD SEE AN ECT EXPERT. ASK YOUR PRESENT THERAPIST TO SUGGEST ONE.
I had never considered that there might be experts in ECT as there are in pharmacology. This offers me a fresh perspective on an old idea. This morning, I tried to imagine myself going through another course of treatments. I cringed.
Because treatment-resistance to medication still seems to indicate a reduced chance of responding to ECT, I am reluctant to look into it again.
I would really appreciate any input you can offer me.
One last response by Dr. Fink:
> I am partially responsive to MAO inhibitors, tricyclics, amphetamine, dopamine receptor agonists. I experience a significant responce to these drugs lasting for about 3 days before depression returns abruptly. This phenomenon occurs consistently.
PARTIAL RESPONSE GETS NO CIGAR!