![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 46. Go back in thread:
Posted by Cam W. on May 18, 2000, at 23:34:31
In reply to Re: Editorial Concern, Too, posted by bob on May 18, 2000, at 22:53:53
A fairly modern example out of physics is string theory, which was slammed as sham science for more than fifteen years because it proposed ideas contrary to the general model of the time (which in those fifteen years was poked through with experimental holes to the point of transparency). It also required an understanding of a branch of mathematics that most physicists knew nothing about, and did not care to learn in order to be better critics of the theory. Or, at least, so goes the story as I've heard it told....
bob - I have followed the superstring theory for the past 12 years, at least. Actually, I like the offshoot, "superrings" theory, but using elipses of the rings rather than circular rings (all these terms being relative, of course), believing (in my naivety) that this will clear up some of the mathematical conundrums. I try to avoid most of the math as much as possible, though. It gives me a pain in my M-branes. Want to share structure of universe theories via e-mail? - Cam
Posted by bob on May 19, 2000, at 0:29:07
In reply to Re: Editorial Concern, Too - off topic to bob, posted by Cam W. on May 18, 2000, at 23:34:31
> Want to share structure of universe theories via e-mail?
Well, I've been out of the loop (hah!) for a while, but I can give you my own theory on the structure of the universe. Back as an undergrad, I solved the "missing mass" problem you see. You know how a single sock out of a pair will disappear from the dryer with no explanation whatsoever? Or how you often see a single shoe lying along the side of the road, the other one no where in sight? Plus, I've heard from smokers that cheap plastic butane lighters have a tendency to disappear into thin air -- vanished without a trace! Well, the place that all this stuff goes to is where all the missing mass is ... one or more of those other 11 or 15 dimensions that are supposed to exist somewhere.
Anyway, there are some rather disturbing implications of this theory. While locally, here on earth, things like socks and butane are far more common than their cosmic distribution would suggest, we generally dismiss how rare free hydrogen is. Cosmically speaking, tho, hydrogen makes up 90% or so of the matter in the universe. So, logically, 90% or so of the missing mass should be hydrogen, right?
Well, what if some well-meaning but ignorant person should go in search of that sock or lighter? What if he or she actually FINDS it? I mean, besides all that hydrogen, there are all those other socks and probably a lot of dust bunnies.
Do you realize what would happen in the case of any static cling with those socks? Or what if someone flicks their newly-found Bic? Doesn't anybody remember the Hindenberg?
Yep ... we'd have ourselves another Big Bang.
So the moral of the story is that somethings that are lost should stay lost. Finding them just isn't worth the price.
cheers,
bobNow, wasn't there an item about ECT somewhere around here? ....
Posted by Cindy W on May 19, 2000, at 9:16:19
In reply to Re: Editorial Concern, Too - off topic to Cam, posted by bob on May 19, 2000, at 0:29:07
> > Want to share structure of universe theories via e-mail?
>
> Well, I've been out of the loop (hah!) for a while, but I can give you my own theory on the structure of the universe. Back as an undergrad, I solved the "missing mass" problem you see. You know how a single sock out of a pair will disappear from the dryer with no explanation whatsoever? Or how you often see a single shoe lying along the side of the road, the other one no where in sight? Plus, I've heard from smokers that cheap plastic butane lighters have a tendency to disappear into thin air -- vanished without a trace! Well, the place that all this stuff goes to is where all the missing mass is ... one or more of those other 11 or 15 dimensions that are supposed to exist somewhere.
>
> Anyway, there are some rather disturbing implications of this theory. While locally, here on earth, things like socks and butane are far more common than their cosmic distribution would suggest, we generally dismiss how rare free hydrogen is. Cosmically speaking, tho, hydrogen makes up 90% or so of the matter in the universe. So, logically, 90% or so of the missing mass should be hydrogen, right?
>
> Well, what if some well-meaning but ignorant person should go in search of that sock or lighter? What if he or she actually FINDS it? I mean, besides all that hydrogen, there are all those other socks and probably a lot of dust bunnies.
>
> Do you realize what would happen in the case of any static cling with those socks? Or what if someone flicks their newly-found Bic? Doesn't anybody remember the Hindenberg?
>
> Yep ... we'd have ourselves another Big Bang.
>
> So the moral of the story is that somethings that are lost should stay lost. Finding them just isn't worth the price.
>
> cheers,
> bob
>
> Now, wasn't there an item about ECT somewhere around here? ....
Bob, enjoyed your post. But there's one thing you need to consider...those lost socks are responsible for the superstring structure of the universe (they unravel when they leave the dryer).--Cindy W
Posted by Adam on May 19, 2000, at 23:49:32
In reply to Editorial Concern, Too, posted by boBB on May 18, 2000, at 18:33:42
I don't think there's anything contradictory about what I have said. I have merely stated
that when one peruses the literature on ECT, especially the publications from the last
decade or so, you see virtually no evidence in support of claims that ECT does permanent
harm to the brain. I have seen, rather rarely, and not much recently, articles in respected
journals suggesting (especially in the case of geriatric patients and some individuals who
may be at risk for siezures) that there can be prolonged, unwanted effects.I have just wondered, of those who have experienced persistant adverse effects due to ECT,
are these people just rare cases, indicating, at most, that perhaps better screening of
candidates for ECT should be developed, or are these people are a sort of "canary in a
coal mine," whose relative sensitivity gives the more tolerant the first sign of danger.
The danger may be subtle, and normally escapes detection.This is just speculation, of course. At any rate, it's not easy in science to always say
that two opposing views or claims are necessarily contradictory, even when they appear
to be on the surface. If alternate claims both appear credible, it probably just means
that more research needs to be done, and the differing conclusions result from the way the
investigators approached the subject. Often what one finds in science is that the question
is a lot more complicated than you first thought, and the answers may take a lot of hard
work to find.I'm not as cynical about science as bob is, though there are egos and idiocy to be had in
abundance in the field, just like any human endeavor. I do believe, though, that modern
psychiatry does need to find a balance between rather sweeping claims of safety and
efficacy (this goes for drugs, psychotherapy, you name it), and the rather alarmist claims
of a vocal minority, that many or our current psychiatric interventions are unacceptably
dangerous and are pushed on us by scheming capitalists. I think there may be real dangers
for some people, for any given treatment. Those who support psychiatry often minimize
the claims of adversity to the point that the victims and their concerned physicians are
accused of dissemblance. Those who don't give their support can sometimes blow isolated
cases out of all realistic proportion.I think the uncomfortable truth is likely to be that for treatment X, the odds are in your
favor that it will be safe for you. Unfortunately, if you are the one-in-large-number-N
who shouldn't use said therapy, not only is there no good way to screen for your
vulnerability, no one of any use to you may believe you when you complain of adverse effects.Statistics gives us a valuable set of tools, but I think maybe sometimes they are misapplied
in clinical research. Or maybe I should say, the tools we really need in addition to the
statistical analyses of heterogeneous populations are only just begining to show tangible
promise. When you think about it, the jump from the animal model of a drug trial, for
instance, to clinical studies doesn't involve any radical changes in analytical tools, even
though the expected polymorphisms in the group to be studied "in the real world" could be
orders of magnitude more frequent than what one finds in the lab. There's a big difference
between getting statistical data from a colony of Sprague-Dawley rats, which are highly
inbred and thus about as genetically alike as you can hope for without being total
Frankensteins, and, say, a group of 100 caucasian males, between the ages of 18 and 45,
non-smokers, with no known illnesses besides (your disease here).I imagine genomics, and the subsequent correlation between genetic differences and various
diseases will provide us with another piece of the puzzle. Hopefully with this information
we will be able to get a clearer picture of how these differences interact with environment
to yeild the observed syndrome. Then we'll do a better job of screening candidates for
various treatments. In defense of all that preceded such advances, that vital information
just wasn't available before, so we had to make do.What I find rather disturbing and unscientific about the attitudes taken by many practicing
or researching in the field of psychiatry (we'll call them the authorities on the subject, or
the credible ones), is that they seem to often react to the likes of Dr. Breggan and Dr.
McMullen with a response that is in polar opposition. No, ECT does not cause brain damage.
No, people don't commit suicide because they are taking an antidepressant. Why not respond
with something like "There may be many explanations for the symptoms described. We, as of
yet, have no statistically significant evidence to support contrary claims, but we must
remain open to the possibility that for some individuals, certain unacceptable risks may
exist, and as of yet, we do not know how to positively identify such rare individuals.
Given the cost-benefit analysis, we feel that (treatment) is safe for the vast majority
of the poulation, but that patients should still be closely monitored." It's wrong to go
around saying "Prozac KILLS! Lily is run by Nazis!" but it might be equally wrong to say
"Any such claim that (treatment) caused X is patently absurd." I don't see how we could
have enough information to make such a definitive statement.I suspect the lack of a moderate public stance on many of these issues has more to do with
politics and economics than science (which means we shouldn't impugn science, just those
who don't practice it with due dilligence or exaggerate pseudoscientifically). The trick
is figuring out how to approach various treatments safely and sanely without exposing
ourselves to unnecessary danger, or denying ourselves a useful treatment. I'd wonder, myself,
if the story with ECT is this: "For most people, it's quite safe. For some, it's not. We
have no idea if you fall into the former or the latter, just that the odds are in your
favor." I don't want to be in the latter catagory, and yet, I don't want to be suicidally
depressed either. ECT helped me in many ways. Did it hurt me? Can anyone say for certain
one way or the other? Are any of my fears and supicions valid? It's an uncomfortable and
unahppy position to be in, to not have any real answers, just "schools of thought." It's all
cost-benefit analysis at this point, just playing the numbers. And I don't like that. I also
know I have no real alternative approaches at this point. Nothing better to work with.> I have a question of purely editorial concern. It seemed your post offered two conflicting assessments of the available, peer reviewed literature regarding ECT.
>
> You wrote:
> > Nearly every major journal in psychiatry has published at least a couple of review articles on it, and ALL OF THEM (emphasis added), not for want of looking, claim unequivocably that there is no credible evidence in support of permanent harm from ECT.
>
> > I do find myself being afraid of THE FEW REPORTS, PUBLISHED (emphasis added) in peer-reviewed journals, that suggest ECT is not so benign.
>
> Maybe I damaged my memory some other way, like falling off my skateboard while improperly acting like a teenager, and comparing your two apparently contradictory assessments does require that I remember the one while I read the other. Are you saying that peer reviewed suggestions "that ECT is not so benign" do not undermine unequivocable claims that there is "no credible evidence in support of permanent harm from ECT"? If so, I guess your assessment is consistent, at least with itself.
>
> I understand that reports from people who awake from anesthetized ECT experiences with broken bones, or reports of long-lasting post-ECT memory loss do not carry water, scientifically, unless they are verified and published in peer reviewed literature. The question remains, however, whether informed consent implies only information published in peer reviewed publications, or whether it also implies access to case record of malpractic litigation, summaries of practitioners' records in adverse cases and access to reports compiled by public health agencies and other governmental bodies.
>
> The discussion of informed consent can also include discussion of the potentially prejudicial role of an authority figure who is supplying the information. If the clinical caregiver stands to gain from collection of Medicaid payments with little oversight concerning the efficacy of the treatment, which often seems to be the case, at least in the administration of ECT, we might want to consider whether the caregiver themself can be relied upon as a fair arbitrer of what information is sufficient to qualify the consent of the ECT subject. My perception of informed consent is that it refers to information provided to the subject of a therapy, who then consents, rather than information shared by scientists who then consent to allow or require a particular therapy.
>
> Anyway, I agree that waking from anesthesia ROCKs. (but that is a subjective, un-peer-reviewed assessment). AND, my sister had pretty good luck dressing up cats, but I have experienced ferocious resistance attempting to put pajamas on feline subjects.
Posted by bob on May 20, 2000, at 0:44:14
In reply to Re: Editorial Concern, Too, posted by Adam on May 19, 2000, at 23:49:32
> ... It's wrong to go
> around saying "Prozac KILLS! Lily is run by Nazis!" but it might be equally wrong to say
> "Any such claim that (treatment) caused X is patently absurd." I don't see how we could
> have enough information to make such a definitive statement.That's because you're not cynical enough about scientists. ;^)
Call it skepticism instead, and you'll wind up with a hallmark value of Science-as-we-know-it. My problem isn't with Science, but how it's practiced.
> I suspect the lack of a moderate public stance on many of these issues has more to do with
> politics and economics than science...It also has a lot to do with the difference between medicine and public health. Doctors deal with individuals. Good ones know that statistics do not apply to individuals (they apply to populations), and so statistical results are a guide and not a rule. On the other hand, public health DOES deal with populations. Well-documented and replicated stats are the law, not the rule. I've known smokers who lived out their long lives to succumb to something totally unrelated to their habit. I know long-time recreational drug users who haven't ruined their lives. I've known teens who've had unprotected sex and managed to avoid both pregnancy and disease. But if I was some public health official, do you think I'd publically admit to any of that?
Not on your life!
(well, on anyone's life for that matter, since that'd be a threat to, well, public health.)
cheers,
bob
Posted by Chris A. on May 20, 2000, at 0:53:56
In reply to Re: Editorial Concern, Too, posted by Adam on May 19, 2000, at 23:49:32
Adam,
It appears to me ECT didn't touch your intelligence. You may have lost a memory or two, but your input is rational, well informed and well written. I agree with you 100%. I'm a bit foggy, as I had a treatment this a.m. Fortunately I'm feeling pretty good. The memory difficulties are hard for me to deal with, but as you say, suicidal depression is not always easy to vanquish.Best,
Chris A.
Posted by Elizabeth on May 22, 2000, at 3:29:44
In reply to Re: ECT, bob, posted by Adam on May 17, 2000, at 23:07:19
> I hope they are correct. My memory difficulties are not my imagination,
> though. I've recently self-administerd some tests that would indicate
> some deficits, based on a high IQ combined with some specific difficulties
> with verbal and numerical memory. These deficits, however, have also been
> identified in persons with OCD, and it has been hypothesised that we OCD
> sufferers are a bit "constipated" when it comes to some mental tasks,
> essentially because we ruminate too much on the particulars, and thus
> score poorly on certain tests with time limits.Yeah, I doubt that can be attributed to ECT. I have the same sort of problems (I think you and I have even discussed this, though it could have been someone else), and I've never had ECT.
> I suppose it could even be that nearly a year of intense,
> sometimes mind-numbing depression terminating in a period of quivering
> frenzy did its own damage.Don't scoff so readily at this possibility! I've wondered about that myself.
Posted by Adam on May 23, 2000, at 19:19:10
In reply to Re: ECT, bob, posted by Elizabeth on May 22, 2000, at 3:29:44
> > I suppose it could even be that nearly a year of intense,
> > sometimes mind-numbing depression terminating in a period of quivering
> > frenzy did its own damage.
>
> Don't scoff so readily at this possibility! I've wondered about that myself.Actually, I was kind of serious about that. Cortisol, etc. Not a pleasant
thought.I think it's wrong to jump to too many conclusions about ECT, as tempting as
it is. However, I used to be rather convinced that nefazodone may have had
something to do with some of that "mind numbing frenzy", which, no matter how
bad my depression or obsessions got, was something quite beyond my experience.
The idea was repeatedly discounted by all my doctors.But I read, and read, and found some references, to mCPP, a major metabolite
of nefazodone. I first came across that chemical in my reading about OCD
and the serotonin receptors implicated in that disease, and mCPP is used quite
a lot to probe receptor binding, relieve OCD-like symptoms with chronic use
(at least, in animals), and acutely as an anxiogenic. The connnection to
nefazodone I stumbled on quite by accident.As it turns out, in some instances, prescribing nefazodone can be problematic
for some patients, because it can precipitate intense anxiety, as well as some
other distressing, almost hallucinogenic symptoms. Primarily this occurs when
those either genetically deficient in CYP450-2D6, or those who have recently or
are being prescribed a drug that inhibits 2D6, also take nefazodone, since 2D6
is the primary metabolizer of mCPP.As it turns out, I was also being prescribed clozapine, which is well known to
have a host of potential drug interactions, including and especially those drugs
which interact with 2D6. This may have been a particularly ill-concieved combo.,
since clozapine has never been convincingly shown to have any special benefits
for OCD sufferers (the reason I was told to take it). Meanwhile risperidone, which
has far lower potential for drug interactions, had been shown to be helpful for
some OCD patients at low doses, with statistical significance, in open-label
trials as early as 1995. What I describe above took place in late 1998, early
1999.
Anyway, I was at first suspicious, came to doubt myself after professional
reassurances, and now not only suspect nefazodone again, I have some real evidence
supporting that suspicion, with other cases of adverse reactions to such a combo.
documented, and a sound mechanistic explanation.My confidence has been shaken again and again by professional reassurances. I do
appreciate the fact that while the potential mCPP connection is well-documented,
any such claims about ECT and permanent damage are far less so. But when I have
doubts or suspicions, it's not so easy to brush them off as it used to be. I was
once dold Zoloft wasn't causing my weight gain, but when I took it I gained 30
pounds, and when I stopped taking it, I lost weight. What should one think under
such circumstances? I could only advise others to read. A lot.
Posted by Dave A on May 23, 2000, at 19:42:43
In reply to Re: ECT, bob, posted by Adam on May 23, 2000, at 19:19:10
Hi,
Not sure I'm doing this right, this is my
first time on this site.I have had bilateral treatments in the
past, but have trouble waking up all
confused and disoriented immediately
after a treatment. I was told unilateral
was easier.Has anyone had both? If so, can you describe
the differences in waking up? If anyone
has had just unilateral can you describe
what that is like. Confusion? Do you know
where you are? Delirium? For how long
after awaking?Thanks,
Dave A
Posted by Noa on May 24, 2000, at 16:53:50
In reply to Re: ECT, bob, posted by Adam on May 23, 2000, at 19:19:10
I think there is a discussion in Dr. Bob's Tips about this, and a suggestion that some people are genetically predisposed to experiencing bad effects from the metabolite. I think this could be an interesting avenue of research to pursue, not just for the question about who will respond favorably or unfavorably to this med or others, but perhaps identifying such genetic vulnerabilities can give more clues to the actual mechanisms causing the psychiatric symptoms in the first place.
Posted by Noa on May 24, 2000, at 16:55:47
In reply to ECT- Unilateral vs. Bilateral, Side effects ?, posted by Dave A on May 23, 2000, at 19:42:43
Welcome, and this is a great question to ask.. I am interested to learn more about this--it never occurred to me.
Posted by Adam on May 25, 2000, at 1:26:24
In reply to Re:nefazodone and mCPP, posted by Noa on May 24, 2000, at 16:53:50
> I think there is a discussion in Dr. Bob's Tips about this,
(Smack on forehead) But of course! I never think to look in Dr. Bob's Tips first, since I reflexively head for NCBI now, but it would probably save me a lot of time. Thanks for the pointer.
>and a suggestion that some people are genetically predisposed to experiencing bad effects from the metabolite.
Yes, and I believe this may be due largely to deficiencies in CYP450-2D6. I've considered this, though in some ways I lean toward the more mundane drug interaction theory because, well, it's more mundane. But, I should say that it is far more likely that something like clozapine would be elevated by a 2D6-inhibiting drug than the other way around, since it is not nearly as potent at inhibition as many common antidepressants. Actually, I was able to find only one reference describing clozapine's inhibitory potential for that enzyme, while risperidone, for instance, is just a substrate but not an inhibitor. What has fed my curiosity about the genetic theory is my previous experience with tricyclics, which was horrible. On about the lowest doses of imipramine, desipramine, and clomipramine (clomipramine was really, really bad) one can reasonably take, I was flat on my butt. As one can guess, due to the structural similarities clozapine has to the tricyclic antidepressants (it's a tricyclic benzodiazepine, basically, with some interesting similarities to lorazepam and clomipramine...I really love lorazepam, by the way, though this might implicate 3A3 and 3A4), all those drugs I took are targets for 2D6. My relative lack of tolerance to the TCAs might have something to do with that. Unfortunately, I never got a blood level taken, since the longest I could stand a TCA was about two weeks. I kind of wish I had now, since that could have provided clues. Unfortunately, the only real way to know is to measure 2D6 levels. I can't imagine how I could have that done without doing experiments on myself, which, though tempting, would probably get me in big trouble at work.
>I think this could be an interesting avenue of research to pursue, not just for the question about who will respond favorably or unfavorably to this med or others, but perhaps identifying such genetic vulnerabilities can give more clues to the actual mechanisms causing the psychiatric symptoms in the first place.
I'm sure learning about genetic polymorphisms and how they contribute to almost any illness you can think of will be of immense value. I am, I guess, a genetic determinist in my thinking (and try not to stumble unwittingly into Social Darwinist territory, though I'm sure I'm not 100% successful at that). If genes aren't a big part of psychiatric disorders, I'll be amazed. In the case of mCPP hypersensitivity, I'm not sure. It seems conceivable that if there were some kind of abnormality in 5-HT2 receptors, mCPP might exert a stronger effect than normal, and even the parent compound could act more like a partial agonist (it can even under "normal" circumstances to a limited extent). I think the metabolic explanation is easier conceptually, but how that would contribute to one's mental or emotional state I haven't a clue. Interesting to ponder, though.
You know, the more I think about it, the more likely the genetic link seems. That makes the clozapine-nefazadone combo. even more scary in some ways, since I also might have had to deal with problems related to relatively high levels of a neuroleptic.
I wonder if selegiline is metabolized by 2D6...
Posted by SLS on May 25, 2000, at 6:33:37
In reply to ECT- Unilateral vs. Bilateral, Side effects ?, posted by Dave A on May 23, 2000, at 19:42:43
> Hi,
Hi.
> Not sure I'm doing this right, this is my
> first time on this site.You hit the target! Not bad for a first shot.
> I have had bilateral treatments in the
> past, but have trouble waking up all
> confused and disoriented immediately
> after a treatment.Why was bilateral chosen over unilateral?
> I was told unilateral was easier.
Unilateral treatments do not usually produce as great a degree of disturbances of memory and cognition (the experience of thinking) as do bilateral.
> Has anyone had both? If so, can you describe
> the differences in waking up? If anyone
> has had just unilateral can you describe
> what that is like. Confusion? Do you know
> where you are? Delirium? For how long
> after awaking?I had both. I guess there may be a bit of a paradox here, but I don't remember experiencing any great degree of the type of confusion you describe. I truly don't recall that the bilateral treatments were different from the unilateral treatments in this regard. That's just me.
Perhaps the anesthesia contributed do your experience. What was used?
Is what you describe so severe as to discourage you from being treated again? I was more concerned as to how the treatments would affect me afterward.
How do treatments affect you overall? How did you feel after each treatment, and how did you feel after the full series was completed?
For me, bilateral treatments produced significantly more memory problems and disturbances of cognition than did unilateral. I felt pretty weird for about a month after the last treatment. I often felt disoriented any time I left the house, especially in shopping malls, department stores, unfamiliar places, and crowds of people. Sometimes, while I was driving, places that I knew like the back of my hand seemed unfamiliar. I think I may have had some difficulty remembering how to get places. Again, these things disappeared within a month. Had I responded to treatment, it would have been well worth it.
Bilateral treatments have a greater statistical rate of success. This does not necessarily mean that the quality of the response to unilateral treatments is any less than that of bilateral. It depends on the individual. Unilateral treatments are definitely more forgiving. I guess you and your doctor must evaluate the desirability of using a particular treatment based on your individual case. The reason my treatments were switched from unilateral to bilateral was because of how refractory my depression has been and the lack of improvement seen after the first six treatments.
I'm sure you'll get a great many replies here. I hope you receive more descriptions of personal experiences given by reasonable people.
> Thanks,
>
> Dave AMy (our) pleasure.
Sincerely,
Scott
Posted by SLS on May 25, 2000, at 7:19:51
In reply to Re:nefazodone and mCPP, posted by Adam on May 25, 2000, at 1:26:24
> Actually, I was able to find only one reference describing clozapine's inhibitory potential for that enzyme, while risperidone, for instance, is just a substrate but not an inhibitor.
Could the competition for enzyme sites by substrates with different binding affinities produce the same net effect?
> Unfortunately, the only real way to know is to measure 2D6 levels.
How does one go about this?
> >I think this could be an interesting avenue of research to pursue, not just for the question about who will respond favorably or unfavorably to this med or others, but perhaps identifying such genetic vulnerabilities can give more clues to the actual mechanisms causing the psychiatric symptoms in the first place.
Which? Metabolizing enzymes or synaptic structures?
> I'm sure learning about genetic polymorphisms and how they contribute to almost any illness you can think of will be of immense value. I am, I guess, a genetic determinist in my thinking (and try not to stumble unwittingly into Social Darwinist territory, though I'm sure I'm not 100% successful at that).
I'm too lazy to go look it up, but what is Social Darwinism (Cliff-Notes version)?
Of course, these types of investigations have been going on for a long time now. Many different polymorphisms of specific synaptic receptors and neurotransmitter transporters have been isolated.
> If genes aren't a big part of psychiatric disorders, I'll be amazed.
Big-time researchers are quite convinced of this. But they are having a hard time even isolating which chromosomes contain the genes that are involved in bipolar disorder, probably the most heritable of the affective disorders. It is most likely that there is an interplay among multiple genes. I recently spoke to Patrick J. McGrath of Columbia-Presbyterian / New York Presbyterian (or whatever they are calling themselves now). He told me that even the studies of bipolar disorder among Amish pedigrees have produced equivocal results. He said that it seemed difficult to reproduce results consistently. Psychosocial stressors are also involved in the precipitation of bipolar episodes, although not always. I suggested to him that perhaps the differences among the "heritability" of different pedigrees reflected a difference in psychosocial stresses within the different households (familial dysfunction is often passed along to subsequent generations). I was flattered by his unambiguous statement "Hmmm". Even so, concordant twins raised in the same household can be divergent in the presentation of bipolar disorder.
It seems to me that there must also be genetic variation involved in the other affective-spectrum disorders. I think the terms "genetic vulnerability" or "genetic predisposition" apply well.
> In the case of mCPP hypersensitivity, I'm not sure. It seems conceivable that if there were some kind of abnormality in 5-HT2 receptors, mCPP might exert a stronger effect than normal, and even the parent compound could act more like a partial agonist (it can even under "normal" circumstances to a limited extent).
What is a "partial" agonist. I asked this question before, but was disappointed by the replies because they lacked chemical or mechanical detail.
Adam, I enjoy your posts and the wealth of accurate information they contain. Thank-you.
- Scott
Posted by Noa on May 25, 2000, at 7:27:10
In reply to Re:nefazodone and mCPP, posted by Adam on May 25, 2000, at 1:26:24
>I think the metabolic explanation is easier conceptually, but how that would contribute to one's mental or emotional state I haven't a clue. Interesting to ponder, though.
Another area needing more research. Reading The Thyroid Solution has made me realize there is so much about how metabolic issues affect brain functioning that needs to be better understood and taken into account when treating psychiatric disorders. In medicine, western anyway, the thinking tends to be so specialized and localized, rather than systemic. In the future, I hope there will be more crossover specialties, like psychoendocrinologist or endopsychopharmocologist, for example.
Posted by Adam on May 25, 2000, at 15:45:14
In reply to Re:nefazodone and mCPP - Adam, posted by SLS on May 25, 2000, at 7:19:51
>
> Could the competition for enzyme sites by substrates with different binding affinities produce the same net effect?
>
If I understand correctly, this can happen with some drugs, and doesn't really happen with others at clinically relevant doses. You kind of have to watch this stuff on a drug-by-drug basis, it seems. In other words, a substrate isn't always a potent inhibitor.
>
> How does one go about this?
>
In regards to measureing a CYP450 family member directly, I was thinking of a number of possible ways to probe for it. One might be to actually look for the protein. You could use a technique called "Western blotting" to detect the actual protein. If it is found in the blood or excreted in some form in the urine (some proteins are), it would be quite easy to see if one did or did not express it.You could also give someone (or treat cells from that someone with) a drug that is metabolized by the enzyme of interest, and then look for the metabolites (probably excreted in the urine) using gas or liquid chromatography. The former might be preferable, since you get better resolution. You could check the values you get, under standardized conditions, with values gathered from other populations to see if they fall in a normal or abnormal range. You could also give them, after the requisite washing-out period, a known inhibitor of that enzyme, and then repeat dose with the substrate to see if there is much of a change in baseline levels, or if the change is of expected magnitude, using the same measurement techniques.
These are just a couple I can think of offhand.
>
> Which? Metabolizing enzymes or synaptic structures?Maybe both! I don't know, to be honest.
>
> I'm too lazy to go look it up, but what is Social Darwinism (Cliff-Notes version)?
>
That's a potentially long answer. The quick and dirty reply might be Social Darwinism is genetic determinism gone bad, sort of like combining the implications of genetic determinism with an unscientific social bias to justify racist or fascist policies. The "final solution" of the Third Reich is about the most horrifying example of Social Darwinism I can think of, though there are plenty of others. I think things like the African diaspora, driven by equally terrible bigotry, wouldn't fall under the heading of "Social Darwinism" due to a technicality: They flourished at a time that predated Darwin's theory of evolution.If I have been an S. D.-ist, it has perhaps been in instances where I condemn myself and others like me unfairly, perhaps by carrying genetic determinism too far in the context of the social responsibility of the depressed vs. their desire to have their own families, like everybody else. You address the complexities of such thinking well in your post.
>
> What is a "partial" agonist. I asked this question before, but was disappointed by the replies because they lacked chemical or mechanical detail.
>
I think "partial agonist" means just what it sounds like, something that has weak agonist activity, but may have other effects. I'm not very clear on the meaning beyond that, and I think what this moniker implies can depend on the drug, dose, etc. I take it to mean more than just "weak agonist", and I think in general it can mean that it might be a weak agonist of a receptor on a particular cell, and an antagonist of the same receptor on another cell. It may also mean the drug has some biphasic behavior in regards to drug action vs. dose, though the shape of the curve may look a little flat. I'm not so clear on the latter.> Adam, I enjoy your posts and the wealth of accurate information they contain. Thank-you.
>
I hope it's accurate! I do the best I can in a hurry, but I'm a layman, so I probably make some mistakes. Check that. I do make mistakes, but I don't know how often. I welcome corrections, by the way. Thank you, though.
Posted by Adam on May 25, 2000, at 15:46:31
In reply to Re:nefazodone and mCPP, posted by Noa on May 25, 2000, at 7:27:10
I agree!
> >I think the metabolic explanation is easier conceptually, but how that would contribute to one's mental or emotional state I haven't a clue. Interesting to ponder, though.
>
> Another area needing more research. Reading The Thyroid Solution has made me realize there is so much about how metabolic issues affect brain functioning that needs to be better understood and taken into account when treating psychiatric disorders. In medicine, western anyway, the thinking tends to be so specialized and localized, rather than systemic. In the future, I hope there will be more crossover specialties, like psychoendocrinologist or endopsychopharmocologist, for example.
Posted by Adam on May 25, 2000, at 15:49:44
In reply to Re:nefazodone and mCPP, posted by Noa on May 25, 2000, at 7:27:10
There is a thread right above this one where people are very intelligently discussing drug interactions, mCPP, etc. I missed this entirely. I apologize! I posted something up there, and if people want to continue discussing this, can we move to that thread (Risperidone and Serzone and Anger, Oh My!)?
Thanks, and sorry, again. It's just I'm interested in what y'all think, but I thought it would be more appropriate up there.
Posted by Dave A on May 26, 2000, at 12:57:15
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ?, posted by SLS on May 25, 2000, at 6:33:37
> > Hi,
>
> Hi.
>
> > Not sure I'm doing this right, this is my
> > first time on this site.
>
> You hit the target! Not bad for a first shot.
>
> > I have had bilateral treatments in the
> > past, but have trouble waking up all
> > confused and disoriented immediately
> > after a treatment.
>
> Why was bilateral chosen over unilateral?
>
> > I was told unilateral was easier.
>
> Unilateral treatments do not usually produce as great a degree of disturbances of memory and cognition (the experience of thinking) as do bilateral.
>
> > Has anyone had both? If so, can you describe
> > the differences in waking up? If anyone
> > has had just unilateral can you describe
> > what that is like. Confusion? Do you know
> > where you are? Delirium? For how long
> > after awaking?
>
> I had both. I guess there may be a bit of a paradox here, but I don't remember experiencing any great degree of the type of confusion you describe. I truly don't recall that the bilateral treatments were different from the unilateral treatments in this regard. That's just me.
>
> Perhaps the anesthesia contributed do your experience. What was used?
>
> Is what you describe so severe as to discourage you from being treated again? I was more concerned as to how the treatments would affect me afterward.
>
> How do treatments affect you overall? How did you feel after each treatment, and how did you feel after the full series was completed?
>
> For me, bilateral treatments produced significantly more memory problems and disturbances of cognition than did unilateral. I felt pretty weird for about a month after the last treatment. I often felt disoriented any time I left the house, especially in shopping malls, department stores, unfamiliar places, and crowds of people. Sometimes, while I was driving, places that I knew like the back of my hand seemed unfamiliar. I think I may have had some difficulty remembering how to get places. Again, these things disappeared within a month. Had I responded to treatment, it would have been well worth it.
>
> Bilateral treatments have a greater statistical rate of success. This does not necessarily mean that the quality of the response to unilateral treatments is any less than that of bilateral. It depends on the individual. Unilateral treatments are definitely more forgiving. I guess you and your doctor must evaluate the desirability of using a particular treatment based on your individual case. The reason my treatments were switched from unilateral to bilateral was because of how refractory my depression has been and the lack of improvement seen after the first six treatments.
>
> I'm sure you'll get a great many replies here. I hope you receive more descriptions of personal experiences given by reasonable people.
>
> > Thanks,
> >
> > Dave A
>
> My (our) pleasure.
>
>
> Sincerely,
> ScottThanks for responding,
Regarding your questions, I tried the
bilateral treatments several times and started to
feel better. I dropped out before finishing
a full course because the awaking part
bothered me so much. I also never did any
follow up treatments so the positive effects
I did get only lasted about a month. I was
hoping to find an easier way because I know
I need a full course and some follow ups.
Thus, I have been researching the unilateral
treatments.I used several different anesthesias, Diprivan
was the easiest. I also have OCD, so it makes
it harder for me do and deal with things.
(i.e. I'm having an abnormal amount of trouble
with the waking up process).Thanks,
Dave
Posted by medlib on May 27, 2000, at 2:02:24
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ?, posted by Dave A on May 26, 2000, at 12:57:15
Dave--
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.)
://archpsyc.ama-assn.org/issues/current/toc.html
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
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
> Dave--
>
> 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.)
>
> ://archpsyc.ama-assn.org/issues/current/toc.html
>
> 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
------------------------------------------------
Dear 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.
For Dave:
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.
Medlib:
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.
Another question:> 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.
Another question:> 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.
Thanks.
- Scott
----------------------------------------------
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!
Posted by medlib on May 27, 2000, at 16:17:32
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ?, posted by SLS on May 27, 2000, at 11:27:48
Scott--
I could not be a candidate for ECT were I so inclined--which I am not. I had a major stroke (right parietal hemorrhagic CVA); my left side was paralyzed for a while. One thing I learned from that experience is how hard it is to recover anything from any type of brain insult. If people spent a little time in a rehab hospital, they'd have more respect for that organ. Also, my son has epilepsy; so seizures, therapeutic or not, are pretty much anathema to me.
The bottom line for the blather above is that I have done little research on ECT, as it was not personally relevant; I found the articles I mentioned searching for something else. For me, the articles' results pretty much reified common sense; a 1:1:1 relationship between dosage levels, treatment efficacy, and cognitive deficits seems intutively obvious.
Since, for most people, communication centers, verbal cognition and memory are located in the left hemisphere, zapping that side will produce more readily apparent, more distressing deficits. The right hemisphere is thought to contain major affect centers, arithmetic, creative, and musical areas. However, these approximations have been modified by PET scan studies showing that multiple areas of the brain are activated by most "higher level" brain functions.
I found it distressing that the "therapeutic window was only 2 months for nearly half of the patients. That's just not an acceptable cost/benefit ratio, at least for me.
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?Translation: He can't remember the details. For me, the role of a medical book is to "lay out the bones" of a subject and review the research in a comprehensive, yet clear manner. Med books take too long to write and publish to do more than that. Journals are expected to "flesh out" those skeletons with the latest research results. Medical libraries consider a book dated if it's older than 5 years (unless it's a "classic"), so 1997 seems okay. ECT is an established therapy whose major treatment improvements were made some time ago. I believe that the author is more important than the absolutely newest date.
> 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.
>
>Translation: They zapped the "wrong" side with too little voltage.
> 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.
>
>Translation: ECT does some good for nearly everyone--for a while. Any given drug treatment usually work well longer for fewer people. "You pays your money; you takes your choice."
> Another question:
>
> > 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.Translation: They "do it" until it works. (I would think that the ECT dosage level might have some bearing on the number of treatments needed.)
>
>
> Another question:
>
> > 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.Translation: Every area of human endeavor that has been around long enough to evolve into an acronym has its own resident experts. (I would think that is especially true of ECT because it employs such a unique treatment modality.)
>
>
> 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.Scott, I would go with your gut on this one. It may be "new and improved," but I'd try everything else out there before revisiting what you didn't like the first time. In your shoes, I believe I'd give Dr. Jensen a try, and investigate vagal nerve stimulation first. Of course, you realize I really can't be objective on this one (or especially knowledgeable, either).
>
> I would really appreciate any input you can offer me.It feels great to be appreciated; sorry I couldn't be more helpful this time. I always read your posts (barring computer or medical disasters); you ask incisive questions and provide thorough, helpful information.
BTW, thought I'm flattered to be mistaken for one, I'm not really a psychopharm geek like Cam, Peter, JohnL, Andrew, et al. I just have an "ear" for the argot, a love of research, and some expertise in (and passion for) searching. I can understand, but I can't produce at that level. I'm grateful to have access to their and your knowledge.
I look to you as a role model for persistence and self education. Hope those good efforts pay off--soon; you have a lot to offer.
A life-long double dysthmic who's getting very tired of the struggle---medlib
Posted by SLS on May 28, 2000, at 9:06:41
In reply to Re: ECT---Scott, posted by medlib on May 27, 2000, at 16:17:32
> > 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.
> Scott, I would go with your gut on this one. It may be "new and improved," but I'd try everything else out there before revisiting what you didn't like the first time. In your shoes, I believe I'd give Dr. Jensen a try, and investigate vagal nerve stimulation first. Of course, you realize I really can't be objective on this one (or especially knowledgeable, either).
> > I would really appreciate any input you can offer me.
> It feels great to be appreciated; sorry I couldn't be more helpful this time. I always read your posts (barring computer or medical disasters); you ask incisive questions and provide thorough, helpful information.
> BTW, thought I'm flattered to be mistaken for one, I'm not really a psychopharm geek like Cam, Peter, JohnL, Andrew, et al. I just have an "ear" for the argot, a love of research, and some expertise in (and passion for) searching. I can understand, but I can't produce at that level. I'm grateful to have access to their and your knowledge.
> I look to you as a role model for persistence and self education. Hope those good efforts pay off--soon; you have a lot to offer.
> A life-long double dysthmic who's getting very tired of the struggle---medlib
Dear Medlib,Thanks for replying to my questions and offering such sound advice. I am grateful to you for reinforcing in words what my "gut" has been telling me.
I also appreciate your perspective on the replies given to me by Max Fink. I tend to be naive and trusting - especially of doctors operating at the forefront of a particular field. You have not converted me into a cynic, so don't worry. But I see that there may be such a thing as "healthy cynicism". No. On second thought, I still believe that this is an oxymoron. I deem what you display to be more like the wisdom of a balanced interpretation of things based upon experience and the knowledge gleaned from it. Thanks. I remain cynical of cynicism (it's really not healthy).
I also want to tearfully thank you for the recognition and acknowledgment of how excruciatingly difficult things are for me. There is no way that I was able to read more than a paragraph of the articles you directed Dave to. I have become adept at skimming through abstracts and focusing on summaries, along with salient details when I find it necessary. With some effort, I can read a few paragraphs of the posts here (all of the words), whereafter, I am drained of mental energy and must take some time off by staring into space. I am lucky to be able to do this, as the drug Lamictal gives me about a 10 percent improvement. Otherwise, I am limited to a few sentences. Actually, I wouldn't be here at Babble without it. This has been going on for about 20 years.
I wish this were an exaggeration produced by an individual in need of recognition by others of his troubles and a vidication of his failures.
I think what continues to drive me to research things is not so much to search for a cure for my illness, although that is a prime motivation, but a voracious hunger for knowledge and understanding. Another passion that drives me to research medical issues is my desire to cure everyone in the world of their illnesses. My greatest loss in life is that *my* illness has prevented me from doing so.
As far as what it is that keeps me alive - well, that's another story, albeit a short and simple one. I think I managed to summarize it in a previous post using four sentences.
Thanks for your kind and compassionate words.
I hope you are able to find an answer to your dysthymia. We both know how particularly stubborn this condition can be.
Was your use of the term "double dysthymia" an errant description of "double depression"? If so, are you currently suffering a major depressive episode?
Just to set things straight - It is much easier for me to regurgitate stuff I already know than it is to pound-in stuff I don't know through the limited access of a brick wall. For every paragraph I manage to read, I can write ten.
I do apologize for the babble, but I don't believe I have had (or made) the opportunity to relieve myself by venting this much. Of course, there is a tiny bit more. :-) :-(
Thanks again, Medlib. Please keep contributing. You make a difference.
Sincerly,
Scott
Posted by Chris A. on June 2, 2000, at 15:00:19
In reply to ECT- Unilateral vs. Bilateral, Side effects ?, posted by Dave A on May 23, 2000, at 19:42:43
Dave,
Having had multiple bilateral and unilateral treatments, please forgive me for not replying sooner. Procrastination is one of my gifts. I never had a problem with awakening. The bilateral treatments definitely leave me with much more confusion, short term and retrograde memory loss plus other cognitive difficulties for up to two months. The unilateral are definitely easier for me and research supports this. This a.m. was my twentieth unilateral treatment over a four month period. There is some associated memory loss and confusion. I expect it to clear up within a month or two of terminating treatment, as has been the case in the past. It must be really frightening to wake up with that degree of disorientation. The choice of anesthetic could possibly make a difference. It has been helpful to rehearse the events that occurred in the three or four months prior to initiating tratment that I particularly want to remember - such as my son's graduation and my parent's fiftieth wedding anniversary celebration. It does take more treatments, especially if one is treatment refractory. The stimulus intensity used does make a difference, too. It is nice to have some relief.Blessings,
Chris A.
Posted by SLS on June 2, 2000, at 18:50:39
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ?, posted by Chris A. on June 2, 2000, at 15:00:19
> Dave,
> Having had multiple bilateral and unilateral treatments, please forgive me for not replying sooner. Procrastination is one of my gifts. I never had a problem with awakening. The bilateral treatments definitely leave me with much more confusion, short term and retrograde memory loss plus other cognitive difficulties for up to two months. The unilateral are definitely easier for me and research supports this. This a.m. was my twentieth unilateral treatment over a four month period. There is some associated memory loss and confusion. I expect it to clear up within a month or two of terminating treatment, as has been the case in the past. It must be really frightening to wake up with that degree of disorientation. The choice of anesthetic could possibly make a difference. It has been helpful to rehearse the events that occurred in the three or four months prior to initiating tratment that I particularly want to remember - such as my son's graduation and my parent's fiftieth wedding anniversary celebration. It does take more treatments, especially if one is treatment refractory. The stimulus intensity used does make a difference, too. It is nice to have some relief.
>
> Blessings,
>
> Chris A.
Hi Chris.I haven't read you in a while. How are you doing? Are you satisfied with the way you are feeling?
Are you taking right-bilateral treatments. Are you using high-dosages?
What anesthetic and neuromuscular blocker do you use?
Do you have any plans to begin tricyclic or other antidepressants to help with prophylaxis?
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.
I am not in a position to exclude ECT.
Thanks.
- Scott
P.S. It was nice of you to reply to Dave, despite your confusion and "procrastination".
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