Posted by SLS on June 5, 2000, at 10:21:25
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ? » SLS, posted by Chris A. on June 4, 2000, at 19:51:52
Hi Chris.
I needed something to do, so...> > I haven't read you in a while. How are you doing? Are you satisfied with the way you are feeling?
> Thanks for asking. At the momment - lousy - low. For ten days following the May 19th treatment I felt good. Then I went into a mixed state - probably due to sleep deprivation. Since my tx the 2nd my mood has been low, but my sleep is back on track.
Was sleep-deprivation used intentially for its antidepressant effects?
> The treatments are right unilateral. The stimulus intensity was just increased by 10%, so I'm not exactly sure how high the dose is now.
I reviewed the ECT articles located at the URL Medline posted to be able to offer you some comments regarding ECT dosage:
archpsyc.ama-assn.org/issues/current/toc.html
I understood all but the statistical stuff, and decided that there are too many clinical perspectives to be considered. Your doctor is the person who is in the best position to make a judgment. That he continues to titrate the dosage higher is encouraging.
> > What anesthetic and neuromuscular blocker do you use?
> Brevital and succinylcholine
> > Do you have any plans to begin tricyclic or other antidepressants to help with prophylaxis?
> ADs historically have caused me to cycle.
I use 5 or 10 mgs. of Eldepryl during the consistently low times and sometimes a light box.I hope you've tried Nardil and Parnate.
> We are using Aricept to try to offset some of the cognitive side effects. Right now I'm hoping the omega 3's in mega doses work. My Omega-Brite arrived less than a week ago. They do smell less fishy than the other brands I've been using.
It seems that St. John's Wort (hypericum) has produced sustained mild to moderate improvements in some people. Perhaps this could fill the role that you currently use Eldepryl for. I would think it would be prudent to use Eldepryl continuously rather than use it as "when needed". Is there a specific reason why you have not?. St. Johns Wort has been studied for use in SAD. The few studies I found on Medline reported success rates similar to light-therapy. I would be cautious when interpreting such a small number of investigations. The NIH has funded research into its use in depression. I don't know when if or when the results are available.
> > I guess you have been treatment resistant. If you wouldn't mind, could you please summarize your diagnosis, characteristics of your depression, the drugs you have tried, and those that have been partially effective.
> Definitely tx refractory. I am dx mixed bipolar with Hashimoto's thyroiditis and hypothyroidism, which was diagnosed postpartum when the depression returned full force.
I am currently trying find an optimum mood stabilizer "base" upon which to add antidepressants for my treatment-resistant bipolar depression. Lamictal 300mg helps a little. I have added Neurontin to see if that produces any further improvement. I am also looking at Gabitril. I consider ANY little nudge to be significant, and worth continuing a drug for.
> The depression started at puberty, if not before. The suicidal obsession started at age 15 or 16 and remits when the depression does.
Does depression remit spontaneously? Is it consistently seasonal? Mania? What seasonal pattern do you exhibit? How long do your depressive episodes last?
I came across an abstract describing a *seasonal* schedule of ECT maintenance. I included it below, along with an interesting "girly" abstract.
> There is virtually nothing I haven't tried in the way of meds. Prozac induced hypomania, tricyclics weren't real effective and Wellbutrin caused hyper-irritability.
With which antidepressants have you combined with lithium? Is lithium absolutely contraindicated for those with Hashimoto's?
> I have a touch of TD from neuroleptics (a touch is too much). Mood stabilizers, with the exception of Lamictal, didn't do anything other than cause side effects.
That sucks. Something like Zyprexa would have been something nice to try in combination with one of the antidepressants that were partially helpful or even one of those that precipitated mania.
Estrogen? The incidence of SAD is higher in women than in men. There is some speculation that estrogens might be implicated (the obvious choice), perhaps through hypothalamic mechanisms. Estrogen therapy. Estrogen is sometimes used as therapy for treatment-resistant as an adjunct depression. It has also been known to induce mania and rapid-cycling. Estrogen-receptor blockade is hypothesized to have antimanic and mood stabilizer potential. I believe tamoxifen is being looked at.
Isn't it great how motivated to help each other here on Psycho-Babble. I end up learning more trying to fix other people than I do trying to fix myself!
> > I am not in a position to exclude ECT.
>
> For some it is a miracle treatment. For me it has been better than meds, although not perfect.
>
> Hope you find a treatment that works for you.> Blessings,
>
> Chris A.
Thanks and Ditto.
- Scott
-----------------------------------------------------1 : J ECT 1999 Sep;15(3):226-31 Related Articles, Books, LinkOut
A seasonal schedule for maintenance ECT.Kramer BA
Department of Psychiatry and the Behavioral Sciences, University of Southern California School of Medicine, Los Angeles, USA.
The case of a patient with bipolar disorder is presented to illustrate that past clinical course may suggest flexible scheduling strategies for maintenance ECT (MECT), which will allow some patients to be successfully treated with the fewest number of ECT. For 7 years prior to MECT, manic episodes regularly occurred during early summer and late autumn/early winter. ECT rapidly aborted the mania in the two episodes prior to referral for MECT. Given the rhythmicity of his manic episodes, MECT was begun by giving four outpatient ECT during the two at-risk periods each year to both abort and prevent affective episodes and to stop cycling. No breakthrough hypomania occurred by the third such period, and the ECT was reduced to three ECT for the following period and two for the next. The patient had no significant affective episodes or hospitalizations during the 3 years of MECT. He continued maintenance lithium carbonate between ECT. This treatment strategy has allowed the patient to maintain stability in his employment and personal life.
PMID: 10492862, UI: 99422530
----------------------------------------------------
6 : Am J Psychiatry 1996 Feb;153(2):163-73 Related Articles, Books, LinkOut
Women with bipolar illness: clinical and research issues.Leibenluft E
Clinical Psychobiology Branch, NIMH, Bethesda, MD 20892-1390, USA.
OBJECTIVE: The purpose of this article is to review the literature concerning gender differences in the course of bipolar illness and discuss issues relevant to the treatment of women with the illness. METHOD: The literature concerning the following topics is reviewed: gender differences in the course of bipolar illness; effects of the female reproductive cycle on the course of bipolar illness; special considerations in the treatment of bipolar women (focusing on the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroid axes); and hypotheses to explain the greater prevalence of rapid cycling among bipolar women than among bipolar men. RESULTS: Data clearly indicate that rapid cycling is more common among bipolar women. Data also suggest that bipolar women may have more depressive episodes (and fewer manic episodes) and may be more likely to suffer from mixed (as opposed to pure) mania than bipolar men. While it is clear that bipolar women are at high risk for postpartum episodes, the effects of other reproductive system events (i.e., puberty, menstrual cycle, pregnancy, menopause, use of oral contraceptives or hormone replacement therapy) on the course or treatment of bipolar illness have received little systematic study. It is unclear whether women are at higher risk than men for developing lithium-induced hypothyroidism. Higher rates of hypothyroidism, greater use of antidepressants, and gonadal steroid effects are possible explanations for the greater prevalence of rapid cycling among bipolar women. CONCLUSIONS: Gender differences in bipolar illness and the effects of the female reproductive system on the course and treatment of the illness deserve more study. The importance of a longitudinal approach to these questions is emphasized.
Publication Types:
Review
Review, tutorialComments:
Comment in: Am J Psychiatry 1997 Mar;154(3):441PMID: 8561195, UI: 96155926
poster:SLS
thread:33082
URL: http://www.dr-bob.org/babble/20000603/msgs/36114.html