![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by psychobot5000 on May 4, 2012, at 18:55:27
Hi all,
I'm seriously considering ECT for the first time in a 25+ year-long (I'm just over 30 now) major depressive episode. For years, I've put this off as a last resort, but have recently looked online (including in the archives here) to see what I could find out about the actual dangers vs. the benefits. I am fearful of brain damage and any loss of what cognitive function I still possess, because my mind already barely scrapes by, as is. However, I'm also hopeful that an improvement of my depression will improve my mental functioning--even assuming I continue 'maintenance ECT' for the long-term. I don't know what else to do.
This was an excellent resource concerning potential cognitive side-effects:
http://psychcentral.com/lib/2011/research-findings-on-memory-and-cognitive-impairment-in-ect/Here's what I've gleaned from this review and other sources concerning the risks of ECT and the differences between the types:
1) There seem to have been substantial advances in reducing the cognitive side-effects of ECT in recent years: right unilateral or nondominant unilateral ECT are better than bilateral; brief pulse, or--even better--ultra-brief pulse, are better than old sine-wave ECT; and, unsurprisingly, low to moderate doses/amplitudes are better than high-dose (though also probably less effective).
1a) Thus, for a first ECT experience, it's best to look for Right or nondominant unilateral ECT, done in ultra-brief pulses, preferably at a low to moderate dose. According to the numbers presented in the 68 studies referenced, after about two weeks, cognitive and memory functions generally return to normal or even slightly improve (presumably, because of the lifting of depression which can have nasty effects on cognitive function). This looks good!2) Cognitive areas studied include:
Reorientation time
Executive function
"Global cognitive function"
Global memory function
Anterograde memory
Retrograde memory
verbal memory
nonverbal memoryAs mentioned previously, unilateral and ultra-brief pulse ECT do quite well after two weeks have passed.
3) A concern: while the tentative judgments of this review aren't as bad as they could be, the paper acknowledges that measuring 'global cognitive function' is difficult. One of the measures used was evidently standard neuropsychological testing. This concerns me because I've taken those tests, and you'd have to have even more serious cognitive problems than I do to do poorly on any section of them. Thus, it bothers me that the standard may have been set so low that it didn't catch real degradation of cognitive function from ECT. Thoughts, anyone?
4) Another concern: according to 'The Death of ECT,' an intemperate document that takes for granted before it starts that ECT is evil, and presents no evidence bearing directly on the critical question of whether the potential dangers of the treatment outweigh the potential benefits (and which document makes an absurd statement indicating that psychiatry can take care of everything it needs to in affective disorders even without ECT), there is 'no evidence of efficacy after 30 days.' Thoughts? Any other sources I should read that might bear on that?
Finally, I'd like to ask those out there with ECT experience (or even those who've had friends or relatives who've gotten it) for their stories, including, if at all possible, what type of ECT was had. Are you still suffering any negative effects, or did they fade? Anyone out there want to put the lie to my hopes, and tell me you've had unilateral ultra-brief pulse ECT and that it wiped out your memory or otherwise damaged your mind? Though this is unscientific, I'd very much like to know from real people how it was, before I risk something like this with my own mind.Thanks so much,
Psychbot
Posted by lawgrindmeintoground on May 4, 2012, at 19:11:25
In reply to ECT: ultra-brief pulse cognitive side-effects, etc, posted by psychobot5000 on May 4, 2012, at 18:55:27
My mom went through ECT a couple of years ago. She was hospitalized (bipolar) because she was severely depressed and her neuropsych wanted to do a drastic switch of meds supervised. The meds didn't work, and a weekend stay turned into four weeks. So they went for a two week stretch of ECT 3x per week. She started getting better and was home a week after ECT stopped.
As for side effects, she was very constipated during the treatment time. She got confused and tired easily for a while. The saddest part is she had about four months of memory loss. She doesn't remember any of the hospitalization, a few months before and about a month afterwards. Of course, one may argue that it's better she forget. I haven't noticed any loss of cognitive function - other than normal midlife forgetfulness.
In summation, I wouldn't wish ECT on anyone, but that has more to do with the whole feeling of protectiveness towards my mom than anything else. I realize that it can be a viable therapeutic option that should not be ruled out if medication isn't working. I hope this helps.
Posted by emmanuel98 on May 4, 2012, at 20:00:47
In reply to ECT: ultra-brief pulse cognitive side-effects, etc, posted by psychobot5000 on May 4, 2012, at 18:55:27
I've had ECT twice. The first time unilateral, the second time bilateral. It is not for the faint of heart. Even unilateral -- which can be done out=patient as long as you have friends willing to drive you, wait, drive you home, come home with you and make sure you are okay -- left me feeling vague and tired. After the fifth or sixth session, I started getting this deja-vu like feeling that there was something I needed to remember, but I couldn't think of what it was. It completely dominated my mind and made it impossible to do anything else. I stopped after ten sessions.
I then did bilateral. This has to be done inpatient because the recovery period takes hours. I barely remember being in the hospital, though I was there for three weeks. People came to visit and I have no recollection. For a month afterwards, I could not remember the names of people I knew well, could not remember street names, had no idea where places were that I went to all the time. I had no real long-term memory loss -- I still knew what I needed to know to do my work -- but the short-term memory loss was bad. It did get better. After a month I was back to normal.
The problem with both these experiences is that they didn't relieve my depression. ECT eats up your life while it's happening. It takes hours to recover from the anethesia, you need lots of tolerant friends with time on their hands to take you to and fro. The process itself takes a couple of hours because of the anesthesia, the preparation, the waiting, the parking, etc.
I would regard it as a last resort. It didn't work for me, but I have a friend who wrote a book about it and she swears by it, does regular maintenance therapy, etc.
Posted by sigismund on May 4, 2012, at 20:01:26
In reply to Re: ECT: ultra-brief pulse cognitive side-effects, etc, posted by lawgrindmeintoground on May 4, 2012, at 19:11:25
My mother had agitated depression. Her medical treatment was incompetant. She was first started on Aurorix and Valium. She constantly complained about not sleeping. She was never taken seriously. Aurorix was new then. I suppose they wanted few side effects. I can't imagine they wanted to keep her sex drive up or make her more anxious. I forget what was next, but after that was ECT. Because it was ECT they assumed it was working. I was very struck by the contempt in which she was held. It didn't work so they assumed she needed more. They were going to put her on maintenance ECT. I don't know what sort she had. Then the syndrome wore itself out and she was relieved of that. Finally she got cancer and with that some useful morphine. The complete lack of respect was obvious. The doc would come when it suited him and if she was eating she would be taken from there to see him before she finished. I don't think anyone had a clue as to whether it worked and I don't think they were interested to find out, and if they had I don't think they would have cared. She complained for years about not sleeping. They just denied it. I was appalled. Anyway at least with the cancer she got something useful.
Posted by Christ_empowered on May 4, 2012, at 20:43:08
In reply to ECT: ultra-brief pulse cognitive side-effects, etc, posted by psychobot5000 on May 4, 2012, at 18:55:27
I've always heard that ECT has a huge relpase rate. Kind of like...someone hitting you on the head with a pipe might temporarily relieve depression, because of the head injury, but once that wears off...you've got a head injury plus depression.
I wouldn't do ECT, personally. Shrinks treat ECT patients like crap, which is ridiculous, considering how much money they make off the procedure.
Posted by Phillipa on May 5, 2012, at 10:31:11
In reply to Re: ECT: ultra-brief pulse cognitive side-effects, etc, posted by Christ_empowered on May 4, 2012, at 20:43:08
I witnessed it as a new grad and it made me sad as the poor guy was incontinent and remembered nothing and was so young. A slight convulsion. It didn't work for him. Phillipa
Posted by papillon2 on May 6, 2012, at 23:35:55
In reply to ECT: ultra-brief pulse cognitive side-effects, etc, posted by psychobot5000 on May 4, 2012, at 18:55:27
I was considering RUL ultra brief ECT (recommended by three separate doctors). Decided against it was wanted to try more medication options first.
Your notes are the same as mine. Other things to consider are:
(1) Your type of illness. ECT works best for melancholic depression and psychotic depression, over atypical depression.
(2) Your age. Cognitive/memory side effects are less in younger people over the elderly.
(3) The anti-depressant effect of ECT will last longer if you have a good medication regime with which to follow up. A study I read found that relapse rates after ECT were best for Nortriptyline + Lithium > Nortriptyline > Mirtazepine > an SSRI which I can't recall > Placebo. Unfortunately didn't bookmark the study so can't post a link for you.I know people who swear by ECT and say it was the best treatment decision they have ever made. Yes, they have a headache and memory problems for a short while after but these have been mild and reversible. I know other people who regret having it done and witnessed the massive anxiety and distress they experienced with having memory problems afterwards. I also know a lady who had it forced on her when she had psychotic depression which wasn't responding to anti-psychotics, she wasn't eating or drinking nor able to make treatment decisions for herself. She can't remember 6 months either side of the treatment but says it must have worked, she wouldn't have it again if given the choice but if it's the only option, so be it.
I wish there were some sort of way to know how your brain will respond to ECT. It's like jumping off a cliff not knowing how deep or shallow the water is. You could be fine (or better!), have temporary problems or be scarred for life.
Posted by papillon2 on May 6, 2012, at 23:41:59
In reply to Re: ECT: ultra-brief pulse cognitive side-effects, etc, posted by Phillipa on May 5, 2012, at 10:31:11
Another thing, research your hospitals carefully. Some use old machines and methods which cause more memory and other problems problems, e.g. going straight for bilateral or putting more current through the brain than is necessary.
Posted by psychobot5000 on May 8, 2012, at 22:20:25
In reply to Re: ECT: ultra-brief pulse cognitive side-effects, etc, posted by papillon2 on May 6, 2012, at 23:35:55
Thanks all for your experiences and notes so far. I'm still considering it (what else can I do?), but am a bit more wary than before. Fortunately, re: disorientation, I live in a city with an excellent public transportation system, so I shouldn't need rides. Hopefully. There also should be more than one clinic (and thus, type) available.
I am a bit disconcerted to find that most ECT in the US is still bilateral.
Papillon, do you happen to know anything of the types of ECT used on those acquaintances of yours for whom it worked? Was there a final reason you chose not to do ECT yourself?
Psychbot
Posted by papillon2 on May 9, 2012, at 19:14:23
In reply to Re: ECT: time to do it? Experiences? » papillon2, posted by psychobot5000 on May 8, 2012, at 22:20:25
> Fortunately, re: disorientation, I live in a city with an excellent public transportation system, so I shouldn't need rides. Hopefully.
The hospital is unlikely to let you leave by yourself. In fact they usually insist that someone looks after you for the rest of the day.
> Papillon, do you happen to know anything of the types of ECT used on those acquaintances of yours for whom it worked?
They all had right-unilateral ECT, including the people who reacted badly to it. Depending on whether or not they were involved in a study, the ECT may have been:
- brief pulse (standard form in this hospital and the control) or
- ultra-brief pulse; and
- the standard form of anesthesia (control) or
- the standard form of anesthesia combined with another agent such as ketamine.Here's one write-up:
http://m.taj.sagepub.com/content/3/2/69.abstract?sid=7094fe8c-33f4-4281-ac87-1e4ee9d88a1b> Was there a final reason you chose not to do ECT yourself?
I have always wanted to exhaust other more palatable options first, but it was never really my decision whether or not to have ECT. I had been in hospital for 4 months with a number of failed drug trials and although a voluntary patient they were considering having me sectioned for ECT for various reasons.
It was eventually decided that the risks of ECT outweighed the benefits, as I was re-experiencing trauma from previous involuntary, long-term hospitalizations as a teenager.
Posted by JohnLA on May 9, 2012, at 20:03:44
In reply to ECT: ultra-brief pulse cognitive side-effects, etc, posted by psychobot5000 on May 4, 2012, at 18:55:27
hi there-
i had 12 right uni-lateral ect's 2 years ago. not sure if it was brief or ultra-brief.
first, it unfortunately did not work. well, it worked for a few days and then i relapsed. by the 12th i was not getting any benefits like the first 2 or 3, so i stopped.
i had some memory problems from the time surrounding the treatments. 1 bizarre experience was going to see 'get him to the greek' and realizing a few weeks later i i didn't remember a single scene from the film. i watched the trailer and it scared me that not one scene looked familiar. i remember going to the theatre w/my friend, but absolutely no memory of seeing the film. by the way, my friend said i liked it and laughed quite a bit. wild.
the actual ect is not very scary. i have had several surgeries so going under is not a big deal for me. argh. i had it done at UCLA which is one of the best supposedly. the doc and staff were all very kind. i did lose it on the first one; i was crying like a baby. but, eventually i got used to the whole thing.
would i recommend it? maybe. i am a little bitter that i was only 2 months in to my first ever depressive episode and was 'talked in to' ect while i was voluntarily in-patient. looking back, even though i was claiming suicidal thoughts, i had only tried 3 or 4 ssri's and klonopin at that point. seems early for ect now with what i have learned since.
the idea of ect is very seductive for us suffering from depression. i have mentioned this quote before from my old high school football coach; 'i would give my left nut... (fill-in the blank; in this case) for relief from my depression.'
i am now at 26 months in to my depression. i find myself thinking about ect again sometimes even though it didn't work for me. i'm desperate.
as far as long-term issues i really believe i have none. my concentration and memory problems now are due to my severe depression and the bit of klonopin i use each day, not the ect. how can i say this? because there are times where my concentration is fine. if i had 'permanent damage' i believe this would not be the case.
it's a hard decision. like i said, i wish i hadn't done it now. but, i was scared and confused. i remember george harrison speaking about his lsd experience. he said there is life before lsd and life after lsd. meaning it was a very significant life experience. i feel the same about ect.
let me know if you have any more questions regarding my experience.
good luck in whatever you choose.
john
Posted by Jeroen on May 15, 2012, at 6:04:33
In reply to Re: ECT: time to do it? Experiences? » papillon2, posted by psychobot5000 on May 8, 2012, at 22:20:25
ECT = brain damage guaranteed! sorry to say but its true
and memory loss
Posted by Phil on May 15, 2012, at 7:00:39
In reply to ECT = brain damage guaranteed!, posted by Jeroen on May 15, 2012, at 6:04:33
Posted by psychobot5000 on May 15, 2012, at 14:07:32
In reply to ECT = brain damage guaranteed!, posted by Jeroen on May 15, 2012, at 6:04:33
> ECT = brain damage guaranteed! sorry to say but its true
>
> and memory lossJeroen, I agree that the evidence is pretty clear that cognitive side-effects occur, but do you have a source for the brain damage claim?
-P
Posted by Jeroen on May 15, 2012, at 14:16:21
In reply to Re: ECT = brain damage guaranteed! » Jeroen, posted by psychobot5000 on May 15, 2012, at 14:07:32
yes, i've seen cases who people cant talk normal anymore, memory loss, and eventually killed themselves, thank you for reading!
Posted by JohnLA on May 15, 2012, at 16:55:11
In reply to ECT = brain damage guaranteed!, posted by Jeroen on May 15, 2012, at 6:04:33
not my experience at all.
i can still speak, read and think clearly.
i just read a 500 page book...
my depression has effected me way more than the course of ect i did.
jeroen; many things come in to play with ect. the type, the # you have, the shock doc, etc.
*TRIGGER*
i had mine done at ucla. here is the team that did my ect. (yes, i know this is a 'promo' for ect @ ucla). listen what the doctor has to say at the 2:00 min mark about brain damage. i trusted dr espinoza. he made no promises about it working. but, he did tell me it would not cause any permanent harm. and, i didn't.
ttp://www.youtube.com/watch?v=ekzSnADL5kg
finally, each person's experience is unique. a blanket statement that ect causes permanent damage and memory loss guaranteed is simply not true. if it is, list some studies/etc. it is easy to find people/sites that say ect ruined there lives. i have to wonder how great somebody's life was before ect, if they chose to do it. i was way suicidal. i still am, but nowhere near as much as before i had ect.
i'm very sorry for the people you knew that had adverse reactions to ect.
john
Posted by Zyprexa on May 29, 2012, at 21:31:11
In reply to ECT = brain damage guaranteed!, posted by Jeroen on May 15, 2012, at 6:04:33
> ECT = brain damage guaranteed! sorry to say but its true
>
> and memory lossI belive that and I've had a lot of ECT. They should be baned.
Posted by Zyprexa on May 29, 2012, at 21:36:15
In reply to Re: ECT = brain damage guaranteed! YES, posted by Jeroen on May 15, 2012, at 14:16:21
> yes, i've seen cases who people cant talk normal anymore, memory loss, and eventually killed themselves, thank you for reading!
I belive that.
Jeroen have you tried ECT? Are you witnessing this in the hospital? Wish I could remember more of my visits, but they gave me so many ECTs.
Posted by psychobot5000 on May 29, 2012, at 23:28:52
In reply to Re: ECT = brain damage guaranteed! YES » Jeroen, posted by Zyprexa on May 29, 2012, at 21:36:15
> > yes, i've seen cases who people cant talk normal anymore, memory loss, and eventually killed themselves, thank you for reading!
>
> I belive that.
>
> Jeroen have you tried ECT? Are you witnessing this in the hospital? Wish I could remember more of my visits, but they gave me so many ECTs.Zyprexa, do you mind if I ask what type of ECT you've had? i.e. Unilateral or bilateral? Amplitude? Type of pulse? (i.e. brief, ultra-brief, sine-wave) Anything you could remember would be helpful.
Posted by Zyprexa on May 30, 2012, at 19:09:39
In reply to Re: ECT = brain damage guaranteed! YES » Zyprexa, posted by psychobot5000 on May 29, 2012, at 23:28:52
They never told me what kind of ECT they were giving me. In fact they didn't even ask if i wanted them. I was in mental hospital in Canada, even though I had signed my self into hospital, they never consulted with me on anything. Just take these pills and wisked me off on gurney in early morning. The only thing I know of it was that they gave me morphine. Also I don't remember much about that time when getting ECTs. Infact I didn't even know they were giving me ECTs in the first hospital stay, which was 3 months. I do remember at one time they put jell on head and this big helmit which was suposted to read brain waves or something. Not sure if it had anything to do with the ECTs.
Posted by Zyprexa on May 30, 2012, at 19:11:04
In reply to Re: ECT = brain damage guaranteed! YES » Zyprexa, posted by psychobot5000 on May 29, 2012, at 23:28:52
One thing I can tell you is it all happened in 1997. So what ever the practice was back then.
Posted by Phillipa on May 30, 2012, at 20:25:45
In reply to Re: ECT = brain damage guaranteed! YES, posted by Zyprexa on May 30, 2012, at 19:11:04
You've recovered now thought from the ECT? Phillipa
Posted by Zyprexa on May 30, 2012, at 22:17:26
In reply to Re: ECT = brain damage guaranteed! YES » Zyprexa, posted by Phillipa on May 30, 2012, at 20:25:45
I don't think I've fully recovered from the ECT. I've gotten better and recived some memory back, but I'm sure not all.
Posted by TiredofChemicals on May 30, 2012, at 22:36:12
In reply to respectfully disagree..., posted by JohnLA on May 15, 2012, at 16:55:11
I hope, not to sound harsh or negative but, for me, that was the final option that the doctors presented to me while I was in the psych ward.
I was really desperate and was considering going through with ECT. The timing didn't present the opportunity for me to go through with it. I was traveling often at the time and I wasn't in a position to go through with it.
Well....my travels landed me far from that particular hospital and I ended up in a different state with psychiatric treatment that differed greatly from where I was originally hospitalized.
So there I sat, slowly moving away from psychiatry with a great deal of time on my hands to ruminate and suffer with "depression".
I am in a better state now than I was then but I still struggle. The diagnosis's they gave me were 1) Psychotic depression and 2) bipolar.
I came to realize that I don't agree with the cookie cutter diagnosis's and have had what some may call a revelation. Others might just say "What a moron".Anyways, I'm glad I did not go through with it. I had already had a 95% failure rate while being treated by psychiatry over a ten year period.
Not sure I contributed anything here, just sharing my experience.Be gentle with me. eeeeeek!!!!
Kind regards
Posted by Phillipa on May 30, 2012, at 23:54:41
In reply to Re: ECT = brain damage guaranteed! YES » Phillipa, posted by Zyprexa on May 30, 2012, at 22:17:26
Zyprexa is it good or bad you think? Parents fill you in or try to? I'm sorry Phillipa
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.