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Re: rTMS sucess

Posted by Psychquackery on August 25, 2003, at 14:32:03

In reply to Re: rTMS sucess, posted by mattdds on August 25, 2003, at 13:58:16

> Hello Igor,
>
> I'm a bit put off by what I see as a condescending tone to a lot of your posts.

Just telling the truth

> It is pretty apparent that you are a big proponent of ECT, and that is perfectly fine.

Only because its the only thing that actually works well for a specific type of severe depression


>
> As you have mentioned, ECT is a valid choice for severe depression. But I find it offensive when you imply that nothing else besides ECT is worthwhile. I had severe, drug resistant depression as measured by every type of scale currently used in research (HAM-D, the Beck Depression Inventory, etc.), which responded very nicely to Cognitive Therapy and moderate-dose clonazepam (panic attacks were a large part of the problem).
>

Panic attacks are an anxiety disorder, not a mood disorder. ECT is not effective for panic attacks Matt.

> Now you could argue that my depression wasn't severe, because it didn't necessitate ECT.

It didnt necessitate ECT because it sounds like the core of your problem was more anxiety disorder, rather than major depression.

>But that sets up a very arbitrary definition of "severe depression", saying that severe depression only responds to ECT. In my opinion, that would sound a little silly (the statement, not you).

There are certain subtypes of major depression such as severe melancholia and psychotic depression which studies have shown respond poorly to drugs alone. Both severe melancholia and psychotic depression have been shown in many studies to REMIT best with bilateral ECT. Many have trouble accepting this basic fact, probably because of an inherent deepseated fear of ECT and electricity. However, its still the basic fact regarding severe depression.

>
> I take it that you had good success with ECT. I am very happy for that. But just because someone does not go straight to ECT when they get depressed does not mean they are "cowards" or "pathetic", as you put it. Even the biggest proponents of ECT will concede that other strategies should be tried first. And sometimes, ECT is just not indicated (panic, social anxiety, dysthymia, schizophrenia). Also, what about the folks with moderate or even mild depression? Let's not minimize their suffering, just because it's not an indication for ECT.

People who avoid ECT because they are scared and continue on endless medication augmentation trials ARE cowards. Medication augmentation trials are poorly studied and have not been proven to be very effective. ECT on the other hand has been proven to work effectively. rTMS as well has not been proven to be clinically of value after all these years of serious research. In the end, when all the dust and hype clears, ECT still reigns supreme.

>
> Remember, we're trying to support each other here, not tell them the treatment they're using (and having success with) is worthless.

I call a spade a spade. If you call that not being supportive, then youre not an honest person. If you want to get better, get ECT (providing your main problem is a mood disorder). If you want to keep playing games and hanging out on psychobabble, continue avoiding ECT and trying silly medication augmentation trials that dont work and seeking out "experimental" treatments for depression. Which dont work either.


BTW my definition of severe depression is the following:

"Also treat those with melancholia, inanition, severe weight loss and insomnia, concentration and memory difficulty, stupor, or suicidal ideation as if they had psychotic depression. These symptoms and signs are evidence that the patient’s neuroendocrine system is disturbed, an indication of severe depression that responds poorly to antidepressant drugs alone."

The above was taken from the Max Fink article I posted below and it jibes exactly with my personal experiences.

Igor


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poster:Psychquackery thread:253579
URL: http://www.dr-bob.org/babble/20030823/msgs/253923.html