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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by dave1 on May 28, 2003, at 20:24:16
Hi,
Has anyone had ECT and not relapsed?
Thanks,
Dave
Posted by Jack Smith on May 28, 2003, at 20:59:02
In reply to Has anyone had ECT and not relapsed?, posted by dave1 on May 28, 2003, at 20:24:16
I think this is a question for a doctor. Most people who are in remission do not post here, with notable exceptions of course. I found that when my depression remitted for about two years, due to a standard ssri therapy, I completely stopped posting on several boards where I had been posting. Just didn't need the reminder of bad times.
I saw a whole special on PBS about this guy who was in the NY philharmonic who had ECT and had a complete remission. Later, he relapsed but had a few more treatments and then back to "normal."
You might want to contact this guy:
http://www.barrykramermd.com/ect.html
JACK
Posted by SLS on May 29, 2003, at 7:34:06
In reply to Has anyone had ECT and not relapsed?, posted by dave1 on May 28, 2003, at 20:24:16
> Hi,
>
> Has anyone had ECT and not relapsed?
>
> Thanks,
> Dave
Hi Dave.The rate of relapse within a few months after a course of ECT is very high. However, I don't think ECT should be looked at as a one-time treatment, especially in recurrent depression. It should either be considered an ongoing treatment with maintenance sessions or a way to kick-start medication therapy. That's just my opinion, of course. For some people, it is the only thing that works. ECT might also be considered during an acute episode when someone is psychotic or persistently suicidal.
ECT works, but is not without compromise in terms of side-effects and convenience. Hopefully, rTMS (repetitive transcranial magnetic stimulation) will offer an alternative that is equally efficaceous, but without the side effects and the necessity for general anesthesia of ECT. I have gone through a course of ECT (6 unilateral followed by 8 bilateral). Despite the fact that it was generally without effect, I would not hesitate to try rTMS.
- Scott
Posted by Mimi on May 29, 2003, at 16:43:19
In reply to Has anyone had ECT and not relapsed?, posted by dave1 on May 28, 2003, at 20:24:16
> Hi,
>
> Has anyone had ECT and not relapsed?
>
> Thanks,
> DaveDave,
I had 9 sessions of ECT 1 and 1/2 years ago. I was hopelessly suicidal because of my life circumstances and history of double depression.
I have NOT relapsed. Meds worked after that and I've sinced changed my life significantly, including getting a job just 2 weeks post ECT and becoming engaged for the first time at 43 years of age. I never intend to relapse and I would not have ECT again, because it destroyed my memory function for months. Also, I lost some memory which has never returned.
But ECT did snap me out of it and I did meet folks who undergo maintenance ECT. Strange concept but it's a done thing!
I am happy for the first time ever in my life, but I believe it is due to med changes post ECT and an overhaul of my life circumstances. I take 5 psych meds every day and know that my well-being depends upon them. I will always have to take meds, but hopefully will be able to get by with fewer.
Sincerely,
Mimi
Posted by denise528 on June 1, 2003, at 8:41:34
In reply to Re: Has anyone had ECT and not relapsed? Yes!!! » dave1, posted by Mimi on May 29, 2003, at 16:43:19
Hi Mimi,
Can I ask you what medication you're taking now?
Denise
Posted by Mimi on June 1, 2003, at 17:03:00
In reply to Re: Mimi!!!, posted by denise528 on June 1, 2003, at 8:41:34
> Hi Mimi,
>
> Can I ask you what medication you're taking now?
>
>
> Denise
Denise,I'm taking Seroquel-50mg, Pamelor-50mg, Celexa-20mg, Buspar-15mgX2, and Ambien-10mg for sleep. I take all my meds at night with the exception of Buspar at night and at p.m. (30mg. total).
I was on a low dose of lithium for one year post-ECT but it turned out I didn't need it as I never have manias. Maybe it augmented the others. There's no way to tell. Was very glad to drop lithium as it lowered my functional IQ and sedated me quite a bit.
Does this help?
Mimi
Posted by denise528 on June 2, 2003, at 15:54:32
In reply to Re: Mimi!!! » denise528, posted by Mimi on June 1, 2003, at 17:03:00
Yes thanks Mimi, I was just wondering what does each drug that you take do for you, can you tell me the benefits of each one?
Also, did you find the ECT helpful, if you had been put on that combination of drugs without having had the ECT do you think you would have recovered as well?
Denise
Posted by dave1 on June 3, 2003, at 11:59:24
In reply to Re: Mimi!!! » denise528, posted by Mimi on June 1, 2003, at 17:03:00
Hi Mimi,
It's good to hear a success story. Were these the meds they were giving right after the ECT's?
If not which ones did they give you? I've heard alot about pamelar + li to prevent relapse. It sounds good that they would give several different classes to prevent relapse just to make sure they covered everything. When I had my treatments they didn't do much to prevent relapse. Now, I'm considering it again armed with much more knowledge.Thanks,
Dave
Posted by dave1 on June 3, 2003, at 12:05:11
In reply to Re: Has anyone had ECT and not relapsed?, posted by SLS on May 29, 2003, at 7:34:06
Hi Scott,
Thanks for the response. What happened with your ECT's? Do you get a good response? Did they give you anything for maintenance? Also, did the unilaterals help at all? Did they get you partially out of the depression so you didn't need as many unilaterals. One more thing.
Did you have less confusion when awakening from unilaterals vs. bilaterals. I had a terrible time waking up from the bilaterals. Sorry for all the questions. Only answer the ones you can.Curious,
Dave
Posted by Mimi on June 3, 2003, at 18:39:34
In reply to Re: Mimi!!!, posted by denise528 on June 2, 2003, at 15:54:32
> Yes thanks Mimi, I was just wondering what does each drug that you take do for you, can you tell me the benefits of each one?
>
> Also, did you find the ECT helpful, if you had been put on that combination of drugs without having had the ECT do you think you would have recovered as well?
>
>
> DeniseYes, Denise. Thanks for asking such specifics. It is a useful exercise for me to try to articulate the differences in med effects.
Let me preface by saying I've been on meds just five years and had ECT just 1 and 1/2 years ago.
I would say that Seroquel is by far the most important med to me. 50mg of Seroquel per diem provides me with an unprecedented sense of well-being and ease with life. (Risperdal was my intro to antipsychotic meds and I loved it, but I had to also take Bromocryptine to counteract ensuing lactation. Risperdal was the first med to ever work for me and I felt the wonderful effects as I swallowed it for the first time!!!)My second favorite med is Buspar--which in my case causes the least side effects (drowsiness for 1 hour). Buspar allowed me to excell at my paying job as it freed me from lifelong social anxiety. I used to fear greatly talking on the phone in a workplace setting. Once I began taking Buspar all social situations were a cinch for me. I would say it allows my base personality to shine.
I acquired Ambien fairly recently for sleep. Wonderful med. Few side effects. I take it and I sleep through the night vs. waking up screaming at the top of my lungs from night terrors. Before that I took Periactin which caused me to gain weight rapidly. And before Periactin I took Klonopin which sedated me 24 hours a day and was highly addictive--not at all satisfactory for me.
Celexa elevates my mood, although I'm having a hard time differentiating the effects of Celexa from those of Nortriptyline. Celexa does reduce my sex drive as do some of the others. More than 20mg. is intolerable to me because of the sedating side effects.
As of yesterday, I have begun weening myself off of Nortriptyline. Upon rereading the PDR Family Guide to Prescription Drugs I determined that Nortriptyline has the most and the worst side effects (although that is debatable) and that it was the med I could most afford to lose. My pdoc has wanted me to get off it for some time as it has an overdose potential.
I am tired of being on so many meds and only being functional half the day (the afternoon). I know there is a danger of relapse so I am self-monitoring carefully.
To answer your question about whether I could have gotten by without ECT I will provide a short background story. Even though it sounds weird and archaic, my family or origin had forced me into an arranged marriage with a very nice but boring young man. After trying to get out of it for some years, I felt hopelessly trapped. Mind you I had suffered for years from double depression & PTSD. In fact, I did not wish to live due to the hopelessness of my social situation.
After 9 rounds of ECT I felt hope, was able to secure a new job, and swap my arranged marriage for a man I truly love. The side effects of ECT were tremendous. I have no memory of that fall nor did I have any functional memory at all for about six months after. My life and my memories began again when I met my fiancee in May 2002 (I had ECT in Nov. 2001). There is no way to answer your question. I wish I knew. I never intend to have ECT again--but it did seem to work or else the change in my life was coincidental. I know that I had risked my life with ECT (the MD told me I could die) and that after that there was NO risk I could not take. Does that make any sense to you? There also was a certain clarity of self that resulted from ECT: you lose your mind due to the injury to the brain but you regain your essence and your spiritual being. Strange, huh.
Are you contemplating ECT? I certainly did my research first, while I was in the hospital. I had many many friends. I was still a gamble. I don't know how it would have turned out otherwise. I truly had NO will to live at that time.
Yours,
Mimi
Posted by Mimi on June 3, 2003, at 19:01:58
In reply to Re: Mimi!!! » Mimi, posted by dave1 on June 3, 2003, at 11:59:24
> Hi Mimi,
>
> It's good to hear a success story. Were these the meds they were giving right after the ECT's?
> If not which ones did they give you? I've heard alot about pamelar + li to prevent relapse. It sounds good that they would give several different classes to prevent relapse just to make sure they covered everything. When I had my treatments they didn't do much to prevent relapse. Now, I'm considering it again armed with much more knowledge.
>
> Thanks,
>
> DaveDave,
Although I studied current research on ECT while I was in the psych hospital 1 and 1/2 years ago, I did not think far enough ahead to study relapse prevention. I never heard of Lithium +Pamelor to prevent relapse, but this could be what the pdocs had in mind. Thanks for informing me!!! Something certainly worked. Mind you I had never taken Lithium before my ECTs and currently do not take it. It stupified me quite a bit. (I'm med sensitive.) I haven't taken Lithium for one year and I have been free from relapse.
I would say STAY VIGILENT concerning pdocs and treatment. My latest fiasco with a Geodon trial served to remind me of that all-important survival lesson.
What else do you know about relapse prevention? I am concerned about relapse now that I am wanting to go off at least one of my meds?!
See my post entitled "From Mimi to DENISE and others."
I was reading an article about ECT today and they have a new kind called bifrontal. Be sure to research that, although it may be too new to gather much meaningful info.
Yes, I was given Lithium, Pamelor and Nortriptyline post ECT. I can't remember clearly anything else. I do know I initiated treatment with Celexa, Buspar, and Ambien. Also, it was almost ridiculous that I went to work at a job within two weeks of my last ECT treatment. I was severely memory-impaired. Were you memory-impaired after your first set of ECT treatments?
How long was it before you relapsed? And what meds were you given post ECT?
Best of luck to you, and remember information is POWER. Be sure to post back if you have any more questions. ECT is a serious procedure.
Mimi
Posted by dave1 on June 4, 2003, at 8:58:30
In reply to Re: Mimi!!! » dave1, posted by Mimi on June 3, 2003, at 19:01:58
Hi Mimi,
Thanks for your response. I had some treatments in in 1995 and was taking Prozac. I continued on it afterwards but relapsed in a couple of weeks. Regarding the relapse thing, Columbia University put a paper out in 2001 which you can find on PUBMED. Dr. Sackheim is the main author. They studied all the meds for relapse and found nortriptyline + LI to be superior to all others. Now when I looked up CLINICALTRIALS.COM, I found that they are doing a major study at several hospitals testing the combo. for relapse and also testing maintenance ECTs. The results aren't in yet so I always ask ECT people what they are taking for relapse.
I had a "follow up" question for you. Were you treatment resistant before your treatments? Also, was you depression acute and short term, or long term and chronic?
Thanks,
Dave
Posted by dave1 on June 4, 2003, at 9:08:51
In reply to Re: Mimi!!! » dave1, posted by Mimi on June 3, 2003, at 19:01:58
Mimi,
Its Dave again. I don't think there is much risk in dying from ECT. I guess the only thing would be the anesthesia, which is very low in risk. My stepmother is an anethestist where they do ECT. I'll ask her if anyone has ever died from ECT where she works. Also, when I read about the brain damage thing, I found that when they did MRIs before and after treatments they found no differences.
Bye,
Dave
Posted by Mimi on June 4, 2003, at 19:10:15
In reply to Re: Mimi!!! » Mimi, posted by dave1 on June 4, 2003, at 8:58:30
> Hi Mimi,
>
> Thanks for your response. I had some treatments in in 1995 and was taking Prozac. I continued on it afterwards but relapsed in a couple of weeks. Regarding the relapse thing, Columbia University put a paper out in 2001 which you can find on PUBMED. Dr. Sackheim is the main author. They studied all the meds for relapse and found nortriptyline + LI to be superior to all others. Now when I looked up CLINICALTRIALS.COM, I found that they are doing a major study at several hospitals testing the combo. for relapse and also testing maintenance ECTs. The results aren't in yet so I always ask ECT people what they are taking for relapse.
>
> I had a "follow up" question for you. Were you treatment resistant before your treatments? Also, was you depression acute and short term, or long term and chronic?
>
> Thanks,
>
> DaveDave,
Thanks for the great info. Perhaps I should withdraw from the Celexa and not the Nortriptyline? Good question for my pdoc next appt.
Yes, I was treatment resistant before my treatments, though Risperdal had gotten me through in the recent past. None of the antiD's had ever worked for me.
My depression was long-term and chronic. Double depression is the most accurate diagnosis(as you know: dysthymia w/ recurrent major depression).
The shock doc told me repeatedly that, although it was rare, I could die during ECT. I'm sure it's in the consent form.
I asked about the detection of brain abnormalities in MRI's. The shock doc told me that MRI's can only detect gross structural abnormalities in the brain. My MRI's were completely normal. I was told a PET scan would answer more of my questions about brain function. Apparently, PET scans are more expensive and harder to get.
Do you know anything about PET scans or other brain imaging tests?
Thanks,
Mimi
Posted by dave1 on June 5, 2003, at 13:30:06
In reply to Re: Mimi!!! » dave1, posted by Mimi on June 4, 2003, at 19:10:15
Hi Mimi,
When I was younger I was in an OCD study at NIH. They did a PET scan on me there. They injected a dye into me and then took pictures of my brain to see what part of my brain was being used by picking up the radiactive dye in my brain.
By the way, what indication do you have that ECT causes brain damage? I interviewed for a study at Columbia last year for a magnetic study and they said they had tested it on animals and found no brain damage. I guess they autopsied the animals after the magnetic stimulation, I'm not sure. Maybe there is some literature an animal studies for ECT brain damage. I guess I'll look into it. Also, they were going to give me neuropsych tests before and after the study to see if there were any brain changes.
Bye,
Dave
Posted by SLS on June 6, 2003, at 9:59:30
In reply to Re: Has anyone had ECT and not relapsed? » SLS, posted by dave1 on June 3, 2003, at 12:05:11
Hi Dave.
Sorry to get to this post so late (the usual excuses).
> What happened with your ECT's? Do you get a good response? Did they give you anything for maintenance? Also, did the unilaterals help at all? Did they get you partially out of the depression so you didn't need as many unilaterals.
I had 6 unilateral left followed by 9 bilaterals. I actually felt a transient mood lift after the fifth treatment. It lasted for half a day or so, but I figured I was home free. Unfortunately, that was the only response I had.
> One more thing. Did you have less confusion when awakening from unilaterals vs. bilaterals. I had a terrible time waking up from the bilaterals. Sorry for all the questions. Only answer the ones you can.
I had more trouble getting reoriented upon awakening after the bilaterals than the unilaterals. After the first 6 unilaterals, I experienced no change in cognition or the way I felt in general. However, beginning with the first bilateral treatment, I felt strange all day long. This cognitive disturbance lasted for at least a month after my last treatment. I remember driving down roads that I had travelled all my life, and having them seem unfamiliar to me. I would say that there were no long lasting negative effects. For unilateral treatments, I believe the placement of the electrodes over the right hemisphere is now preferred.
I'd be happy to answer more question for you.
- Scott
Posted by Mimi on June 6, 2003, at 12:03:16
In reply to Re: Mimi!!! » Mimi, posted by dave1 on June 5, 2003, at 13:30:06
> Hi Mimi,
>
> When I was younger I was in an OCD study at NIH. They did a PET scan on me there. They injected a dye into me and then took pictures of my brain to see what part of my brain was being used by picking up the radiactive dye in my brain.
>
> By the way, what indication do you have that ECT causes brain damage? I interviewed for a study at Columbia last year for a magnetic study and they said they had tested it on animals and found no brain damage. I guess they autopsied the animals after the magnetic stimulation, I'm not sure. Maybe there is some literature an animal studies for ECT brain damage. I guess I'll look into it. Also, they were going to give me neuropsych tests before and after the study to see if there were any brain changes.
>
> Bye,
Dave
********************************Dave,
Transcranial Magnetic Stimulation is an entirely different procedure from ECT. It is considered safer, although it is still being tested.The brain damage from my ECT's was evident. As you know ECT's amount to seizures induced by an electrical current. Months of stored memory was entirely wiped out in my case. So either those brain cells were wiped out or the brain cells that had allowed me to access that info were wiped out.
Also, for many months following ECT, I no longer had the ability to form new memories. How can that be explained except by death of brain cells? I understand my recovery of brain function is due to my brain's ability to rewire itself with new or remaining cells.
What types of things can PET scans detect? Was it useful?
Mimi
>
>
Posted by dave1 on June 6, 2003, at 13:41:16
In reply to Re: Mimi!!! » dave1, posted by Mimi on June 6, 2003, at 12:03:16
Hi Mimi,
I looked up the brain damage thing on PUBMED and most of the research I read said no brain damage from animal autopsies, human autopsies, blood tests and brain scans. One article said the ECTS enhanced some neuronal growth. There were some articles that said that there was brain
damage but I couldn't read those because there were no abstracts. I used to think my depression was caused by brain damage, but my doctor insisted it was biochemical changes. I guess that could also cause the memory loss in ECT. I guess no one knows for sure. But I no longer think my depression is from brain damage.Regarding PET, I think the main thing it shows is what parts of your brain are being used. In my case they were trying to see if OCD patients were using different parts of your brain than non-OCD patients.
The magnetic study I'm looking into is a new thing where they use magnets to stimulate seizures with less side effect than ECT. It is more potent than TMS which gives no seizure and lasts about two weeks.
Keep up the maintenance You are a great ECT success story and I would hate to see you relapse. I would stay on the meds and get a maintenance treatment if you start to feel bad.
Bye,
Dave
Posted by dave1 on June 6, 2003, at 13:45:10
In reply to Re: Has anyone had ECT and not relapsed? » dave1, posted by SLS on June 6, 2003, at 9:59:30
Hi Scott,
I don't know if this would be helpful but some pdocs have told me that meds that didn't work before ECTs work afterwards. Maybe you should retry some meds and see if they work now.
Regarding the unilaterals, were you on high-dose
(2.5-5 times the seizure threshold), low-dose (seizure threshold) or you don't know?Thanks,
Dave
Posted by Mimi on June 6, 2003, at 15:03:23
In reply to Re: Mimi!!! » Mimi, posted by dave1 on June 6, 2003, at 13:41:16
> Hi Mimi,
>
> I looked up the brain damage thing on PUBMED and most of the research I read said no brain damage from animal autopsies, human autopsies, blood tests and brain scans. One article said the ECTS enhanced some neuronal growth. There were some articles that said that there was brain
> damage but I couldn't read those because there were no abstracts. I used to think my depression was caused by brain damage, but my doctor insisted it was biochemical changes. I guess that could also cause the memory loss in ECT. I guess no one knows for sure. But I no longer think my depression is from brain damage.
>
> Regarding PET, I think the main thing it shows is what parts of your brain are being used. In my case they were trying to see if OCD patients were using different parts of your brain than non-OCD patients.
>
> The magnetic study I'm looking into is a new thing where they use magnets to stimulate seizures with less side effect than ECT. It is more potent than TMS which gives no seizure and lasts about two weeks.
>
> Keep up the maintenance You are a great ECT success story and I would hate to see you relapse. I would stay on the meds and get a maintenance treatment if you start to feel bad.
>
> Bye,
> DaveDave--Thanks a bunch! Mimi
Posted by SLS on June 7, 2003, at 8:19:22
In reply to Re: Has anyone had ECT and not relapsed? » SLS, posted by dave1 on June 6, 2003, at 13:45:10
Hi Dave,
> I don't know if this would be helpful but some pdocs have told me that meds that didn't work before ECTs work afterwards. Maybe you should retry some meds and see if they work now.
Thanks for the suggestion. I didn't know that pdocs felt so strongly about that. I have gone back and retried the meds and med combinations that I had trialed before the ECT, but to no avail. However, that doesn't rule out that another course of ECT wouldn't make me responsive to the newer drugs that I have tried since. Effexor might work.
> Regarding the unilaterals, were you on high-dose (2.5-5 times the seizure threshold), low-dose (seizure threshold) or you don't know?
I'm not sure. Since I had my ECT treatments in 1991, I suppose the unilateral left treatments were low-dose. I read a paper a few years ago that indicated high-dose unilateral right treatments were almost as effective as bilateral and produced significantly fewer cognitive side effects. Max Fink, M.D., considered an expert in the field, told me that despite the lack of response to my initial trial of ECT, one could not rule out that the newer methods wouldn't be successful. He said that the application of ECT has progressed substantially since I had it. If I were to have treatments again, I'm not sure which protocol I would choose. One thing is certain, though. High-dose unilaterals are much more effective than low-dose unilaterals.
Have you made up your mind to have ECT? Which method are you leaning towards?
- Scott
Posted by dave1 on June 7, 2003, at 17:30:04
In reply to Re: Has anyone had ECT and not relapsed? » dave1, posted by SLS on June 7, 2003, at 8:19:22
Hi Scott,
I was thinking of trying the treatments again. They helped when I did them before but I had no follow up so I relapsed pretty quick. For some reason, I got a weird bad feeling or dysphoria along with the lifting of the depression. I thought I would try a different placement, either bifrontal or unilateral if I did it again.
My main problem was that I was really bothered by waking up disoriented and delirious after the bilateral treatments. I tried them a couple of times since, but dropped out after one or two treatments. Maybe I could get a them give more i.v. ativan or versed afterwards. I had 1mg before and that made a big difference.
Dave
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