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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by TooDeadForDreamin on November 5, 2003, at 13:08:51
My doctor and I are considering maintenance ECT in combination with an AD to treat my major recurring depression. I have never met anyone who actually received maintenance ECT, so I'm somewhat skeptical. Does anyone have experience with maintenance ECT, with or without antidepressants?
Background: Tried about every AD on market, with no positive results. About five years ago I had a dozen ECT treatments (half unilateral, half bilateral). The most notable effect was significant memory loss for several months. Shortly after these treatments, I learned that a close relative was successfully treating their depression with Paxil combined with another AD.
I had tried Paxil previously, but within days I was sleeping around the clock. This time (about 6 weeks post-ECT) I chopped up pills to get a dose of around 2-3 mg daily. Within 48 hours, I noticed a significant improvement in my mood, energy, social engagement, etc. And there was no somnolence. But it happened so quickly, and reminded me so much of what I had heard about manic episodes, that I got scared. It was a weekend and I was unable to reach my doctor. I stopped the Paxil and my mood returned to normal (which is to say deep depression). A few weeks later I re-started Paxil, and this time all it did was make me sleepy.
Our conclusion: somehow ECT had changed my chemistry such that small doses of Paxil provided antidepressant effect. We are now interested in the idea of combining Paxil with a few ECT treatments to see if we can fashion a useful treatment schedule.
I am still troubled by the lack of information from people who have actually tried maintenance ECT. Any relevant experience or information would be appreciated.
Too Dead For Dreamin,
But still not plugged in
Posted by DanielJ on November 5, 2003, at 13:59:18
In reply to Maintenance ECT Anyone?, posted by TooDeadForDreamin on November 5, 2003, at 13:08:51
I don't want to talk you out of ECT in case it would work but as far as meds like Paxil, Zoloft, Lexapro etc. as with any semi permanent medication, I believe the secret is finding the most effective dosage and adding enough daily to maintain the proper level for yourself. Chopping up the pills is a good idea and experimentation by varying dosage can help you find that level. This may take some time though. Remember ADs like Paxil etc. often cause drowsiness for the first few days or even a couple of weeks before they kick in. When you restarted the Paxil, perhaps the level of it in your system was near zero. Starting it again may have caused drowsiness till it kicked in again. Sometimes drowsiness is a sign of over-medication too. Till it kicks in you may be drowsy/sleepy, when it reaches the point that there is too much in your system you may start to be sleepy again. Taking small amounts (chopped up pills) as you did back then helped to lower the medication level to the most effective point. It sounds like you were almost there, but that is just my opinion. Good Luck!
Posted by TooDeadForDreamin on November 5, 2003, at 14:17:13
In reply to Re: Maintenance ECT Anyone? , posted by DanielJ on November 5, 2003, at 13:59:18
I have already tried 20+ ADs, several mood stabilizers, various augmentation and combination strategies: all without benefit. I'm no fan of ECT, but at this point the odds of finding the right combination to provide any benefits is a real longshot. So is the ECT + AD option, but at least it holds the promise that for a few days it did work.
> I don't want to talk you out of ECT in case it would work but as far as meds like Paxil, Zoloft, Lexapro etc. as with any semi permanent medication, I believe the secret is finding the most effective dosage and adding enough daily to maintain the proper level for yourself. Chopping up the pills is a good idea and experimentation by varying dosage can help you find that level. This may take some time though. Remember ADs like Paxil etc. often cause drowsiness for the first few days or even a couple of weeks before they kick in. When you restarted the Paxil, perhaps the level of it in your system was near zero. Starting it again may have caused drowsiness till it kicked in again. Sometimes drowsiness is a sign of over-medication too. Till it kicks in you may be drowsy/sleepy, when it reaches the point that there is too much in your system you may start to be sleepy again. Taking small amounts (chopped up pills) as you did back then helped to lower the medication level to the most effective point. It sounds like you were almost there, but that is just my opinion. Good Luck!
Posted by Robert Fairburn on November 5, 2003, at 16:24:24
In reply to Re: Maintenance ECT Anyone? , posted by TooDeadForDreamin on November 5, 2003, at 14:17:13
Have you given parnate a try
Regards Robert
Posted by TooDeadForDreamin on November 5, 2003, at 17:02:17
In reply to Re: Maintenance ECT Anyone? , posted by Robert Fairburn on November 5, 2003, at 16:24:24
> Have you given parnate a try
Yes. It increased my depression, particularly suicidal thoughts. This grew stronger as I increased the dosage. It also made it almost impossible to sleep, which gave me nearly 24 hours a day of suicidal ideation. It took us about ten days to catch on to the relationship: when I stopped the Parnate, the other stuff went away.
Also tried Nardil and Selegiline (capsule, not the patch) with no help, although without that kind of side effect.
Posted by Bob on November 6, 2003, at 3:37:41
In reply to Maintenance ECT Anyone?, posted by TooDeadForDreamin on November 5, 2003, at 13:08:51
You mentioned that the ECT caused memory loss, but never said whether it helped you at all. Did it alleviate any symptoms of your illness in any respect whatsoever, or was it totally ineffectual from that standpoint?
Posted by TooDeadForDreamin on November 6, 2003, at 8:43:21
In reply to Re: Maintenance ECT Anyone? » TooDeadForDreamin, posted by Bob on November 6, 2003, at 3:37:41
> You mentioned that the ECT caused memory loss, but never said whether it helped you at all. Did it alleviate any symptoms of your illness in any respect whatsoever, or was it totally ineffectual from that standpoint?
The ECT doctor said it helped (don't they always?), but I obviously have no recollection.
By the time my basic memory functions returned (a couple of weeks), I was more depressed than before. So the ECT itself was of no value to me, unless there was a brief period when I was a happy zombie.
But whatever neurochemistry changes it created did seem to effect my subsequent experience with the Paxil.
Posted by Bob on November 6, 2003, at 13:27:15
In reply to Re: Maintenance ECT Anyone?, posted by TooDeadForDreamin on November 6, 2003, at 8:43:21
> > You mentioned that the ECT caused memory loss, but never said whether it helped you at all. Did it alleviate any symptoms of your illness in any respect whatsoever, or was it totally ineffectual from that standpoint?
>
> The ECT doctor said it helped (don't they always?), but I obviously have no recollection.
>
> By the time my basic memory functions returned (a couple of weeks), I was more depressed than before. So the ECT itself was of no value to me, unless there was a brief period when I was a happy zombie.
>
> But whatever neurochemistry changes it created did seem to effect my subsequent experience with the Paxil.
>
>
Whoa. That is not very encouraging for ECT.
Posted by almondjoy on November 8, 2003, at 11:13:00
In reply to Re: Maintenance ECT Anyone?, posted by TooDeadForDreamin on November 6, 2003, at 8:43:21
"By the time my basic memory functions returned (a couple of weeks), I was more depressed than before. So the ECT itself was of no value to me, unless there was a brief period when I was a happy zombie."
This seems like your answer.
I got treatments (not maintenance though) almost four years ago, and my brain is still a bit fried. i doubt i'll ever return to the same level of functioning. Your statement mentions that it didn't help with your depression the first time so why would it now. The same reaction is likely to repeat, your depression returning by the time you remember up from down unless you continue treatments so you never remember up from down and never remember your depressed, until such a time that you stop and want to remember up from down and hope that your brain will still function enough to let you.
i understand wanting all this junk to stop and go away and the desperation that makes you feel like anything that has the possibility of helping might be worth it BUT step back and look at the whole picture first. you're not on a deadline make sure you understand your past experiences and future expectations.
also, your doctor, myself, and other posters on this board can't make up your mind for you though...doing some research from unbiased sources niether for or against ECTs might help you find whether maintenance ECTs are beneficial LONG TERM.
good luck, and i usually don't pray, but youre in my prayersDove
This is the end of the thread.
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