![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 46. Go back in thread:
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".
Posted by Dave A on June 3, 2000, at 6:09:23
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ? » Chris A., posted by SLS on June 2, 2000, at 18:50:39
> > 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".
Hi Chris and Scott,Thank you so much for your response.
I have read what you said in articles,
but it is much more reassuring to hear
that unilaterals are easier from an
actual participant. Hopefully, now
I will be able to try them. I have done
some incomplete bilateral sessions and
was starting to see results. I have
used several different anesthesias, and
DIPRIVAN (PROPOFOL) is definetly the
easiest to wake up from. If you aren't
using it now, you should ask for it.
Other research: (Might help Scott too.)My P-DOC gave me the MAY 2000 issue
of Archives of General Psychiatry, and it
gives a good, current article on Unilateral
vs. Bilateral, as well as some stuff on
continuation therapy to prevent relapse.
This is something I might have a problem
with. In each of my previous treatment sets, though incomplete, the positive effects only
lasted about a month.Bye,
Dave
Posted by SLS on June 3, 2000, at 7:36:40
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ?, posted by Dave A on June 3, 2000, at 6:09:23
Dear Dave,
Thanks for citing the article. I don't know if I will be able to read it, but perhaps I can get to it in the future.e
> Other research: (Might help Scott too.)
>
> My P-DOC gave me the MAY 2000 issue
> of Archives of General Psychiatry, and it
> gives a good, current article on Unilateral
> vs. Bilateral, as well as some stuff on
> continuation therapy to prevent relapse.
> This is something I might have a problem
> with. In each of my previous treatment sets, though incomplete, the positive effects only
> lasted about a month.Have you decided to continue with bilateral or unilateral?
Are the bilateral treatments you are currently receiving considered to be high-dosage?
I would be interested to know if your doctor would consider using an antidepressant to help with prophylaxis.
- Scott
Posted by Dave A on June 3, 2000, at 17:04:39
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ? » Dave A, posted by SLS on June 3, 2000, at 7:36:40
> Dear Dave,
>
> Thanks for citing the article. I don't know if I will be able to read it, but perhaps I can get to it in the future.e
>
> > Other research: (Might help Scott too.)
> >
> > My P-DOC gave me the MAY 2000 issue
> > of Archives of General Psychiatry, and it
> > gives a good, current article on Unilateral
> > vs. Bilateral, as well as some stuff on
> > continuation therapy to prevent relapse.
> > This is something I might have a problem
> > with. In each of my previous treatment sets, though incomplete, the positive effects only
> > lasted about a month.
>
> Have you decided to continue with bilateral or unilateral?
>
> Are the bilateral treatments you are currently receiving considered to be high-dosage?
>
> I would be interested to know if your doctor would consider using an antidepressant to help with prophylaxis.
>
>
> - Scott
Scott,I'm not sure whether they were high or low
voltage. I did it several times a while ago.
I believe the best results I had were when
I did high voltage. Each time I was also on
a moderate dose of Prozac (if this is what you
mean by prophylaxis). Also, the article
said that a TCA with lithium was the best to
prevent relapse. Maybe you could try that or
Prozac during the initial treatments. Also,
I think that augmenting with caffeine can help.
If I'm correct about my previous sessions,
High voltage bilaterals might be your answer.P.S. I think if I do it again I will try
high dose unilateral.Luck,
Dave
Posted by Chris A. on June 4, 2000, at 19:51:52
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ? » Chris A., posted by SLS on June 2, 2000, at 18:50:39
Scott,
> I haven't read you in a while. How are you doing? Are you satisfied with the way you are feeling?Thanks for asking. At the momment - lousy - low. For ten days following the May 19th treatment I felt good. Then I went into a mixed state - probably due to sleep deprivation. Since my tx the 2nd my mood has been low, but my sleep is back on track.
The treatments are right unilateral. The stimulus intensity was just increased by 10%, so I'm not exactly sure how high the dose is now.> What anesthetic and neuromuscular blocker do you use?
Brevital and succinylcholine
> Do you have any plans to begin tricyclic or other antidepressants to help with prophylaxis?
ADs historically have caused me to cycle. I use 5 or 10 mgs. of Eldepryl during the consistently low times and sometimes a light box. We are using Aricept to try to offset some of the cognitive side effects. Right now I'm hoping the omega 3's in mega doses work. My Omega-Brite arrived less than a week ago. They do smell less fishy than the other brands I've been using.
> I guess you have been treatment resistant. If you wouldn't mind, could you please summarize your diagnosis, characteristics of your depression, the drugs you have tried, and those that have been partially effective.Definitely tx refractory. I am dx mixed bipolar with Hashimoto's thyroiditis and hypothyroidism, which was diagnosed postpartum when the depression returned full force. The depression started at puberty, if not before. The suicidal obsession started at age 15 or 16 and remits when the depression does. There is virtually nothing I haven't tried in the way of meds. Prozac induced hypomania, tricyclics weren't real effective and Wellbutrin caused hyper-irritability. I have a touch of TD from neuroleptics (a touch is too much). Mood stabilizers, with the exception of Lamictal, didn't do anything other than cause side effects.
> I am not in a position to exclude ECT.
For some it is a miracle treatment. For me it has been better than meds, although not perfect.
Hope you find a treatment that works for you.
Blessings,
Chris A.
Posted by SLS on June 5, 2000, at 10:21:25
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ? » SLS, posted by Chris A. on June 4, 2000, at 19:51:52
Hi Chris.
I needed something to do, so...> > I haven't read you in a while. How are you doing? Are you satisfied with the way you are feeling?
> Thanks for asking. At the momment - lousy - low. For ten days following the May 19th treatment I felt good. Then I went into a mixed state - probably due to sleep deprivation. Since my tx the 2nd my mood has been low, but my sleep is back on track.
Was sleep-deprivation used intentially for its antidepressant effects?
> The treatments are right unilateral. The stimulus intensity was just increased by 10%, so I'm not exactly sure how high the dose is now.
I reviewed the ECT articles located at the URL Medline posted to be able to offer you some comments regarding ECT dosage:
archpsyc.ama-assn.org/issues/current/toc.html
I understood all but the statistical stuff, and decided that there are too many clinical perspectives to be considered. Your doctor is the person who is in the best position to make a judgment. That he continues to titrate the dosage higher is encouraging.
> > What anesthetic and neuromuscular blocker do you use?
> Brevital and succinylcholine
> > Do you have any plans to begin tricyclic or other antidepressants to help with prophylaxis?
> ADs historically have caused me to cycle.
I use 5 or 10 mgs. of Eldepryl during the consistently low times and sometimes a light box.I hope you've tried Nardil and Parnate.
> We are using Aricept to try to offset some of the cognitive side effects. Right now I'm hoping the omega 3's in mega doses work. My Omega-Brite arrived less than a week ago. They do smell less fishy than the other brands I've been using.
It seems that St. John's Wort (hypericum) has produced sustained mild to moderate improvements in some people. Perhaps this could fill the role that you currently use Eldepryl for. I would think it would be prudent to use Eldepryl continuously rather than use it as "when needed". Is there a specific reason why you have not?. St. Johns Wort has been studied for use in SAD. The few studies I found on Medline reported success rates similar to light-therapy. I would be cautious when interpreting such a small number of investigations. The NIH has funded research into its use in depression. I don't know when if or when the results are available.
> > I guess you have been treatment resistant. If you wouldn't mind, could you please summarize your diagnosis, characteristics of your depression, the drugs you have tried, and those that have been partially effective.
> Definitely tx refractory. I am dx mixed bipolar with Hashimoto's thyroiditis and hypothyroidism, which was diagnosed postpartum when the depression returned full force.
I am currently trying find an optimum mood stabilizer "base" upon which to add antidepressants for my treatment-resistant bipolar depression. Lamictal 300mg helps a little. I have added Neurontin to see if that produces any further improvement. I am also looking at Gabitril. I consider ANY little nudge to be significant, and worth continuing a drug for.
> The depression started at puberty, if not before. The suicidal obsession started at age 15 or 16 and remits when the depression does.
Does depression remit spontaneously? Is it consistently seasonal? Mania? What seasonal pattern do you exhibit? How long do your depressive episodes last?
I came across an abstract describing a *seasonal* schedule of ECT maintenance. I included it below, along with an interesting "girly" abstract.
> There is virtually nothing I haven't tried in the way of meds. Prozac induced hypomania, tricyclics weren't real effective and Wellbutrin caused hyper-irritability.
With which antidepressants have you combined with lithium? Is lithium absolutely contraindicated for those with Hashimoto's?
> I have a touch of TD from neuroleptics (a touch is too much). Mood stabilizers, with the exception of Lamictal, didn't do anything other than cause side effects.
That sucks. Something like Zyprexa would have been something nice to try in combination with one of the antidepressants that were partially helpful or even one of those that precipitated mania.
Estrogen? The incidence of SAD is higher in women than in men. There is some speculation that estrogens might be implicated (the obvious choice), perhaps through hypothalamic mechanisms. Estrogen therapy. Estrogen is sometimes used as therapy for treatment-resistant as an adjunct depression. It has also been known to induce mania and rapid-cycling. Estrogen-receptor blockade is hypothesized to have antimanic and mood stabilizer potential. I believe tamoxifen is being looked at.
Isn't it great how motivated to help each other here on Psycho-Babble. I end up learning more trying to fix other people than I do trying to fix myself!
> > I am not in a position to exclude ECT.
>
> For some it is a miracle treatment. For me it has been better than meds, although not perfect.
>
> Hope you find a treatment that works for you.> Blessings,
>
> Chris A.
Thanks and Ditto.
- Scott
-----------------------------------------------------1 : J ECT 1999 Sep;15(3):226-31 Related Articles, Books, LinkOut
A seasonal schedule for maintenance ECT.Kramer BA
Department of Psychiatry and the Behavioral Sciences, University of Southern California School of Medicine, Los Angeles, USA.
The case of a patient with bipolar disorder is presented to illustrate that past clinical course may suggest flexible scheduling strategies for maintenance ECT (MECT), which will allow some patients to be successfully treated with the fewest number of ECT. For 7 years prior to MECT, manic episodes regularly occurred during early summer and late autumn/early winter. ECT rapidly aborted the mania in the two episodes prior to referral for MECT. Given the rhythmicity of his manic episodes, MECT was begun by giving four outpatient ECT during the two at-risk periods each year to both abort and prevent affective episodes and to stop cycling. No breakthrough hypomania occurred by the third such period, and the ECT was reduced to three ECT for the following period and two for the next. The patient had no significant affective episodes or hospitalizations during the 3 years of MECT. He continued maintenance lithium carbonate between ECT. This treatment strategy has allowed the patient to maintain stability in his employment and personal life.
PMID: 10492862, UI: 99422530
----------------------------------------------------
6 : Am J Psychiatry 1996 Feb;153(2):163-73 Related Articles, Books, LinkOut
Women with bipolar illness: clinical and research issues.Leibenluft E
Clinical Psychobiology Branch, NIMH, Bethesda, MD 20892-1390, USA.
OBJECTIVE: The purpose of this article is to review the literature concerning gender differences in the course of bipolar illness and discuss issues relevant to the treatment of women with the illness. METHOD: The literature concerning the following topics is reviewed: gender differences in the course of bipolar illness; effects of the female reproductive cycle on the course of bipolar illness; special considerations in the treatment of bipolar women (focusing on the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroid axes); and hypotheses to explain the greater prevalence of rapid cycling among bipolar women than among bipolar men. RESULTS: Data clearly indicate that rapid cycling is more common among bipolar women. Data also suggest that bipolar women may have more depressive episodes (and fewer manic episodes) and may be more likely to suffer from mixed (as opposed to pure) mania than bipolar men. While it is clear that bipolar women are at high risk for postpartum episodes, the effects of other reproductive system events (i.e., puberty, menstrual cycle, pregnancy, menopause, use of oral contraceptives or hormone replacement therapy) on the course or treatment of bipolar illness have received little systematic study. It is unclear whether women are at higher risk than men for developing lithium-induced hypothyroidism. Higher rates of hypothyroidism, greater use of antidepressants, and gonadal steroid effects are possible explanations for the greater prevalence of rapid cycling among bipolar women. CONCLUSIONS: Gender differences in bipolar illness and the effects of the female reproductive system on the course and treatment of the illness deserve more study. The importance of a longitudinal approach to these questions is emphasized.
Publication Types:
Review
Review, tutorialComments:
Comment in: Am J Psychiatry 1997 Mar;154(3):441PMID: 8561195, UI: 96155926
Posted by Chris A. on June 6, 2000, at 23:59:17
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ? » Chris A., posted by SLS on June 5, 2000, at 10:21:25
Dear Scott,
How are you doing today? Thanks for sharing those references. The challenge in ECT is to obtain maximum antidepressant effect while trying to minimize cognitive side effects. We have to a certain extent accomplished the latter by spreading the treatments out four or five days apart at the start. In the beginning I was informed that this approach would require more treatments to achieve an AD effect. I'm sure my insurance company doesn't like this. Wish I knew all of the answers.Best,
Chris A.
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