Posted by Bob on July 5, 2008, at 20:04:17
In reply to Re: ECT response rate, posted by BGB on July 5, 2008, at 18:31:12
> > For some patients (Hemmingway is a prime example) the failure of ECT coupled with the the prospect of permanant brain damage is infact what prompts suicide.
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> I would have to respectably disagree with you, as far as using Hemingway as an example. Far too little is known about his physical condition at his time of death to make assumptions about his diagnosis of depression, OCD, or bipolar disorder. It has been documented that Hemingway's ECT may have failed because his depression was a result of hematomachrosis, a genetic disease which results in increased iron levels in the blood, which can cause severe and debilitating depression. Bloodletting is the only treatment for hematomachrosis, even to this day. ECT has never been advocated as a treatment for hematomachrosis. Hemingway was most likely treated for his symptom, depression, rather than his true illness as it was unknown to his physicians at the time. While no autopsy was done at his time of death due to his family's request, the disease is genetic and runs rampant in his family. It is extremely likely (although not confirmed) that he had the disease, which would explain why his ECT treatments failed. Hemingway's father, who also committed suicide, had the disease, and it is known to be passed down paternally.
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> Heart disease is also known to cause depressive symptoms, and it is documented that Hemingway had high blood pressure, extremely high cholesterol levels, and severe aortal inflammation.
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> Hemingway also survived not one but TWO plane crashes, causing trauma to his head and crushing his vertebrae, among other very serious injuries. His head injuries were so severe that he lost his vision and hearing on his left side for a period of time. Hemingway's injuries were so extensive that many American newspapers jumped the gun and actually published his obituary. Such severe trauma to the brain could not only explain his depression, it could also explain his memory loss during ECT. Patients with severe head trauma are known to experience greater memory loss with ECT than typical patients.
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> Additionally, it is known that Hemingway was a very heavy drinker his entire life, and became a raging alcoholic in his final years. Not only can alcoholism cause depression, but heavy drinking is contraindicated with ECT treatment. This could have played a HUGE role in his memory loss.
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> Furthermore, it is well accepted by physicians that memory loss often reverses itself in the days and weeks after ECT in many patients. Hemingway killed himself only a few days after his last ECT treatment. There is a possibility that his memory would have come back to him in time, at least partially.
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> Hemingway is used constantly as a reference by ECT critics, but we know far, far too little about him and his condition to judge ECT by his opinion. There are far too many extenuating circumstances to proclaim that ECT caused Hemingway's death, especially when you consider that his father, two of his siblings, and his granddaughter all took their own life.
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> While I acknowledge that Hemingway himself blamed his ECT on his suicide, he was far too sick at the time to be able to make clear and well-thought-out statements. I'm sure that he did feel as though ECT killed him, but that simply does not make it fact, especially when you consider the plethora of severe illnesses and injuries he had shortly before the time of his death.
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> Oh, and an interesting bit of Hemingway trivia for anyone who is interested--Hemingway purchased the shotgun that he used to kill himself at Abercrombie and Fitch!
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In my opinion, this is exactly why things like this are such a controversy. Ok, so maybe ECT didn't exacerbate Hemingway's condition. On the other hand, it definitely could have. Let's forget Hemingway for a second and use me as an example:I experienced the onset of major depression in the early nineties, and it crescendoed for the rest of that decade and into the 2000's. By the spring of '05 I had had enough of the endless drug trials and suffering. I felt I had exhausted possibilities with pharmacology and the a "last resort" (outside of the failure to get into a VNS trial) was ECT. Believe me, the 50%-80% figures were encouraging. The decision was not made lightly but I finally went forward with 21 sessions at an area hospital that has a good reputation with the treatments and their administration. The hospital was good, the treatments were not. The first few were ok, but I was expecting something would eventually kick in. As time went on, it turned more and more nasty until both my psychiatrist and the psychiatrist at the hospital decided that it not was producing good results any longer.
The procedure produced a litany of negative effects that is too long to list here with time as a consideration, but in a nutshell it was extremely destabilizing to my mood, and caused autonomic dysfunction, sleep problems, and eventually... suicidality. You might ask why I didn't stop after the first few, and the answer is because it happened slowly and kind of crept up on me. It's difficult to assess your situation when you're confused, have memory loss, and are walking around in a state of derealization. I guess I trusted that it would get better.
When the treatments where abruptly stopped, within 2-3 weeks I sank into the most intense depression of my life, but was still dealing with all the physical effects the ECT had left me with. There was much suicidality and emotional lability. It has taken 2.5 - 3 years to get to the incredibly bad baseline I had before the treatments. It's not the same though. One reason the depression was so bad immediately after the treatments was because they profoundly changed how I responded to meds. Post ECT, I can only tolerate miniscule doses of psych drugs, and some that I took previously I can no longer stand at all. Many cause suicidality instead of preventing it. This leaves very few options when one is in crisis - I can't go back to ECT, and I can't tolerate drugs well at all any longer.
Despite everything that happened to me, I concede that ECT is apparently a lifesave for many, and works better than anything else for some. However, for some it can be an unmitigated disaster. Looking back on my decision to undergo the procedure, I'd have to say that I made the best decision I could muster at the time with the info I had on hand. I was in a nasty situation with my response to meds and ECT was offering hope. You never know until you try it, right? Now, I'm in a bad way again but there really isn't out there to try any longer.
poster:Bob
thread:836941
URL: http://www.dr-bob.org/babble/20080626/msgs/838269.html