![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 46. Go back in thread:
Posted by Adam on May 17, 2000, at 23:07:19
In reply to Re: ECT, posted by bob on May 16, 2000, at 21:40:40
You're welcome. I honestly do feel it's a useful means of treating the
illness, and the actual procedure is a breeze. I've had more unpleasant
dentist's appointments. I must confess I actually like the feeling of
succumbing to the effects of anaesthesia. Of course, at the time, being
unconscious was as close a thing to true bliss as I could imagine.But, as I said, the after-effects were both wonderful and frightening.
If I were back where I was then, I'd do it in a heartbeat. Brain dammage
seemed worth it. I even asked the attending and the head resident how
much damage I could expect, and their answer was an emphatic "none!" I
do remember posting here before that the principle investigator of the
transdermal selegiline study I was in called ECT "the cat's pajamas."ECT has a lot of supporters. I've combed the literature for clear
evidence of ECT-related damage to the brain, and could find nothing that
seemed incontrovertable. Nearly every major journal in psychiatry has
published at least a couple of review articles on it, and all of them,
not for want of looking, claim unequivocably that there is no credible
evidence in support of permanent harm from ECT. Some papers I have
encountered even have claimed ECT protects the brain from the negative
effects of stress hormones, etc.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. I am thinking of seeing
a specialist (I met her at a party, actually), who is both a diagnostician
and a counselor for cognative disorders.I'm hoping I can get some answers. It could be age. It could be
selegiline (though the suggestion has been met with incredulity by my
doctors). 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.I don't know. I do know that, well, I don't remember having such a hard
time remembering some things. It seems to be a fairly recent problem. I
do find myself being afraid of the few reports, published in peer-reviewed
journals, that suggest ECT is not so benign. It may not be a reasonable
fear, but I have it all the same.
>
> Thanks for the detailed and even-handed account. I found it quite informative. It's still a bit disquieting for me, since your experiences confirm both the "good" and the "bad" of modern ECT.
>
> But I guess we never get any clear, unequivocable answers in our field anyway.
>
> cheers,
> bob
Posted by Chris A. on May 18, 2000, at 12:58:53
In reply to Re: ECT, bob, posted by Adam on May 17, 2000, at 23:07:19
Adam,
Your account is similar to mine, except for the waiting in line part. Here, ECT is done in the PACU (recovery room) and there is a lot of privacy. Basically no one is around at 6:00 a.m.! Tomorrow I am having my nineteenth RUL treatment since the end of January. They've all been on an oupatient basis, except for two. My concerns over memory and cognition are similar to yours. The retrograde amnesia and temporary confusion go with the territory and are expected. Two months post treatment we are all supposed to test as well or better than we did prior to treatment. I realize the severity and length of my depression can interfere with memory and cognition. If one doesn't want to be alive, why would one care to think? My pDoc and I have discussed this repeatedly (how repeatedly, I wouldn't remember in my current fog). He does say there is evidence that some people lose random foci of memory permanently, which I have (over forty treatments total since 1977). Loss of specific memories is not equated with brain damage. When I had bilateral treatments in '92 with a high stimulus intensity, the confusion and immediate memory problems were severe, but the depression seemed to remit. When the confusion abated and my memory improved, I relapsed into depression, despite pharmacological treatment. My consultant's advice was to do the treatments farther apart over a longer period of time to avoid cognitive and memory problems. He also suggested using Aricept (donzepil) to minimize those problems. It may be helping some. The problem is that I am still extremely depressed 90% of the time and at points get really desperate. My pDoc and I are planning to make a decision whether or not to continue ECT or not on Tuesday. Do you by chance have the references to the peer reviewed articles you mentioned? It would be nice to review them prior to making a decision. There was an excellent article in the New England Journal in '93 that I was reviewing just a couple of days ago (again, as I didn't remember even having a copy of it until going through my papers). Following one treatment I had temporary aphasia (two - three hours). That was scary, but it is discussed in the literature. Word finding seems to be my most apparent cognitive difficulty otherwise. There is no doubt in my mind that my stints on Topomax and Tegretol were capable of producing real damage. One would have to come up with very solid evidence to convince me that there is any irreversible brain damage with ECT - no flawed studies allowed. People with complaints are usually still depressed. I understand being a bit scared of the memory loss and possible cognitive problems, but agree with you that the procedure itself is a piece of cake. There is probably no point in doing maintenance treatments if there are no results to maintain, though. That poses the question of what to do next. Today I am not currently down, but that is definitely due to sleep deprivation, the results of which are not sustainable. It's like playing with fire for those of us who are bipolar. One of my concerns about the portrayal of ECT on the net is that it is made to look extremely dangerous and misused. I don't believe that is the case at all in the US currently. The stigma surrounding it is probably costing lives that could have been saved (speaking from a public health standpoint). It is less risky than the vast majority of medical procedures and the reason it is used more for depression in the elderly and pregnant women is because there is less risk involved. Meds are not benign. In the back of my mind I wonder if I would have ever had a hypomanic/mixed epsisode if I hadn't taken Prozac. They say the bipolar is lurking...but, I still have always wondered if it would have been better to stick with the desipramine even though it didn't completely cause the depression to vanish. Of course my docs were concerned that I might ingest too much desipramine at some point and turn up dead, a reasonable concern. That is water under the bridge. Paxil and Effexor caused clear manic symptoms and Wellbutrin caused intense irritability (my poor Hubby). Subtle signs of TD started showing up with minimal use of neuroleptics and I certainly don't want to go there. I'll take the ECT any day - I just wish it worked for me. If you have those references available, I'd be grateful.Thanks for sharing and please forgive my rambling.
Chris A.
P.S. I completed my MA with a 3.5 after having had over twenty treatments total. Perhaps my subjective perception of cognitive impairment and the hard facts are not the same. Who knows. I don't. The procedure was not quite as refined when I started in '77.
Posted by boBB on May 18, 2000, at 18:33:42
In reply to Re: ECT, bob, posted by Adam on May 17, 2000, at 23:07:19
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 18, 2000, at 22:53:53
In reply to Editorial Concern, Too, posted by boBB on May 18, 2000, at 18:33:42
boBB, I share your concerns over the objectivity not just of ECT research reports but, in the academic climate these days, ANY research reports from studies that uncovered data contrary to what either a source of funding or the professional body of that field of study might want to hear. 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....
That being said, there is a great deal of difference in a scientific research report between what can be supported by statistical inferences based on hard evidence and what researchers will speculate upon in the conclusions section of their papers. Adam's statements are not necessarily self-contradictory. Findings of no permanent harm from ECT due to a lack of credile evidence sounds like a statistical argument that any data demonstrating some permanent damage is not common enough in controlled studies to rule out random chance or any other number of factors as the cause of that damage. "Suggestions" in journal articles are often speculations on anomalous data or trends (i.e., non-statistically significant results that the researchers want to discuss anyway -- more an indication of researcher bias than of good scientific practice) that can often either appease editorial board members with an agenda or make the article a little "sexier" and atractive as a publication.
It's not how all science is done, but it certainly is how a lot of science gets reported.
Consider also the source for such publications -- usually large university-based research and teaching hospitals. Within those sites, not everyone who receives treatment will be included in any study. And not everyone who receives treatment will get it at a place where research on ECT is being done. Combine that with the fact that over the thousands of people who receive ECT each day/week/month/whatever, very few will respond really well to it, most will have some good results and some side effects, and another few will have extremely horrible responses to it. That this only happens to a few people does nothing to mitigate the damage done, but portraying their stories as what potentially awaits every individual undergoing ECT is IMO more scientifically irresponsible than relying on statitistical models to fill a gap in our understanding of brain function.
Not being scientists, we don't necessarily have to base our own decisions on what science finds support for -- you may not value their standards of "truth". But doctors don't ethically or professionally have that option of disregarding scientific evidence out of hand.
[well, unless they're up for tenure somewhere and they REALLY NEED those pubs on their vitas]
cheers,
bob
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!
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.