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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on December 8, 2006, at 17:48:38
In reply to Re: ECT experience » blueberry, posted by Amadeus on December 8, 2006, at 15:29:52
>I have read some studies on ECT and what I have >understood is that the ECT has to >be "intrusive". It triggers release of growth >factors (BDNF) and vascular regeneration >improving blood circulation in the brain.
This may not be a good thing. I mean ECT does increase BDNF, but so does other traumatic brain injury. BDNF is not just a growth factor, but also a neuroprotective chemical. BDNF is greatly increased after certain neurological insult including epileptic seizures. It may just be a sign that the brain is trying to protect itself from what the hell is happening.
ECT also increases certain markers of cell injury such as GFAP, which is high after radiation and high in alzheimers.
I would not necesarily conclude ECT induced BDNF is a good thing.
Linkadge
Posted by Phillipa on December 8, 2006, at 19:58:03
In reply to Re: ECT experience » Bob, posted by blueberry on December 8, 2006, at 16:00:24
Blueberry I had no idea. That's so horrible. I always identified with your inability to handle regular doses of meds and minidoses. Do you remember me? And I'll never do ECT. Love Phillipa
Posted by Bob on December 9, 2006, at 14:20:36
In reply to Re: ECT experience » Bob, posted by blueberry on December 8, 2006, at 16:00:24
>
> "Amazing"...about a dozen times. "You opened the doors to heaven".
>
> These are comments I received from people when I played my guitar in church. The only way I knew this is by reading my diary. Those are probably the most cherished words ever said to me, and the most meaningful experience, and I have zero, absolutely zero, memory of it. If not for my diary, they wouldn't exist at all.It makes me realize how much a part of our lives our memory is. Truthfully, if your memory becomes significantly impaired, it causes me to reflect on how much life is worth living in that state. Just goes to show what a horrific tradgedy alzheimers is.
Posted by Bob on December 9, 2006, at 14:21:40
In reply to Re: ECT experience » Bob, posted by blueberry on December 8, 2006, at 16:00:24
>
> "Amazing"...about a dozen times. "You opened the doors to heaven".
>
> These are comments I received from people when I played my guitar in church. The only way I knew this is by reading my diary. Those are probably the most cherished words ever said to me, and the most meaningful experience, and I have zero, absolutely zero, memory of it. If not for my diary, they wouldn't exist at all.It makes me realize how much a part of our lives our memory is. Truthfully, if your memory becomes significantly impaired, it causes me to reflect on how much life is worth living in that state. Just goes to show what a horrific tradgedy alzheimers is.
Posted by Bob on December 9, 2006, at 14:23:09
In reply to Re: ECT experience, posted by linkadge on December 8, 2006, at 17:48:38
> >I have read some studies on ECT and what I have >understood is that the ECT has to >be "intrusive". It triggers release of growth >factors (BDNF) and vascular regeneration >improving blood circulation in the brain.
>
> This may not be a good thing. I mean ECT does increase BDNF, but so does other traumatic brain injury. BDNF is not just a growth factor, but also a neuroprotective chemical. BDNF is greatly increased after certain neurological insult including epileptic seizures. It may just be a sign that the brain is trying to protect itself from what the hell is happening.
>
> ECT also increases certain markers of cell injury such as GFAP, which is high after radiation and high in alzheimers.
>
> I would not necesarily conclude ECT induced BDNF is a good thing.
>
>
> Linkadge
>
>
Uh, I second that.
Posted by Karen44 on December 9, 2006, at 21:00:30
In reply to Re: ECT experience » Amadeus, posted by blueberry on December 8, 2006, at 12:21:39
It is your experience, blueberry, that scares the hell out of me with a recommendation for ECT. My pdoc thinks it would help me a lot as none of the antidepressants I have tried have worked for a variety of reasons. Some due to allergic reactions and some due to severe side-effects.
I am depressed but I continue to go to work everyday. I am a professional and need my memory to do my job. I do not want to lose verbal or nonverbal memory. I depend on both being intact. My pdoc says he has had other professionals who have been okay with ECT and even went to work after the treatments. He said I could even drive, though the hospital would not want me to due to liability issues. He said he has had around 70 patients that have gotten ECT, and he said only one had problems, that this was someone who had dementia to begin with. He said she ended up somewhat worse. I just don't know what to think.
In the past Parnate worked very well for me, and then I was off all antidepressnat medication for around 11 or 12 years and was fine until I developed all at once lots of physical problems such as COPD, sleep apnear, GERD, had to have cervical spine surgery, and surgery for a deviated septum--all this in 2005. This year, less, but I am going in for surgery on my hand/thumb on Tuesday. I have way thought why not just stay at U of chicago and let them zap my brain too. But then I decided that I will get a second opinion before I do anything of the sort.
Karen44
Posted by invisiblemanpa on December 10, 2006, at 4:07:43
In reply to Re: ECT experience, posted by Karen44 on December 9, 2006, at 21:00:30
Don't do it! I had been struggling with major depression for 10 years, social anxiety my whole adult life, it has cost me my family,successful career, you know the story....I have been on every major 2nd generation anti depressant combo....none work......only the benzos provide some temp. relief....so I agreed to ECT in late summer...I hate hospitals, needles, so that part was bad enough....but..the end after I think 12 treatments.....my mind is scrambled eggs..I have no memory of this fall and not of most of 2006, depression worse, anxiety worse, concentration shot, thoughts start and vanish.....I can't even follow the instructions on how to use my new cell phone....I have a masters degree, blah blah blah...it's all gone...before the ECT.... I could do a little bit, still had hope of maybe pulling life, career, back together.......now it's all gone....
ECT should be outlawed....it is experimental torture..in 50 years it will be looked upon as we do now when docs used to bleed people and use leeches....DON'T DO IT.........
I SAY THROW ALL THE MEDS AWAY AND KEEP SOME COLD ONES ON ICE..........JUST DON'T DRIVE.....
Posted by Karen44 on December 10, 2006, at 8:01:47
In reply to Re: ECT experience/Dr. Frankenstein Lives!, posted by invisiblemanpa on December 10, 2006, at 4:07:43
I think this is not such a wonderful idea myself. I have a doctorate, and I don't want to forget anything; I just hate that I developed so many physical issues, and just when something seems resolved and in remission, a new thing pops up like now I have psoriasis of the scalp and need surgery on my thumb. A joint is eroded and caused the two upper joints to dislocate so that I have a zig zag thumb and am in lots of pain. The other hurts too and will need surgery before the end of 2007. This is what gets me down.
I don't see how ECT would help this except that my pdoc seems to think it will allow the antidepresant medication to work better. So, I am at least curious as to which one he thinks he would try after ECT. I am also planning to make an appointment with another psychiatrist who is more analytically trained; this is my training as well.
I currently work as a forensic psychologist. Can't you see me going to court and saying I don't remember the person; or can't you see me not being able to recognize subtle nuances during the interview; or can't you see me being unable to remember how to do psy testing. I think I must be totally nuts to have considered it.
My pdoc says he does therapy, psychodynamic, and so I stayed with him after referring myself to him. He deals with people who have co-occuring medical and psychiatric issues. Later, however, I challenged him on this approach he said he uses as I felt I could do what he was doing on my own. I have advanced training in psychoanalytically informed approaches to therapy and from a hospital that was ranked number one in the country for psychiatry when I was there.
Anyway, you see my point about not wanting to lose what I learned, etc. My pdoc decided I was too hostile for him to work with me last summer when I challenged him on his expertise in "pychodynamic" therapy. Asked him first just how would he describe his approach, and it went down hill from there. I tried to patch things up when he said go find someone else and by giving him a b*llshit reason why I was getting angry, that I was trying to push him away because we were dealing with issues I found too sensitive. I think I just need to go see a therapist who is more knowledgeable. Hard to do as I have seen my current pdoc for over one year now.
Karen44
Posted by linkadge on December 10, 2006, at 8:28:15
In reply to Re: ECT experience/Dr. Frankenstein Lives! » invisiblemanpa, posted by Karen44 on December 10, 2006, at 8:01:47
I would agree. With any decision like this you would need second, third, fourth, and fifth opinions.
Doctor's opinion of ECT varies dramatically from what I have heard. Some doctors refuse to do it.
Some doctors say it never causes memory problems, but these are usually the ones who say SSRI's never cause sexual dysfunction.
Linkadge
Posted by Bob on December 10, 2006, at 10:55:00
In reply to Re: ECT experience/Dr. Frankenstein Lives!, posted by linkadge on December 10, 2006, at 8:28:15
> I would agree. With any decision like this you would need second, third, fourth, and fifth opinions.
>
> Doctor's opinion of ECT varies dramatically from what I have heard. Some doctors refuse to do it.
>
> Some doctors say it never causes memory problems, but these are usually the ones who say SSRI's never cause sexual dysfunction.
>
> Linkadge
>
>... or weight gain, or apathy, or have discontinuation syndromes.
Posted by gardenergirl on December 10, 2006, at 12:32:10
In reply to Re: ECT experience/Dr. Frankenstein Lives!, posted by invisiblemanpa on December 10, 2006, at 4:07:43
>
> ECT should be outlawed....it is experimental torture..in 50 years it will be looked upon as we do now when docs used to bleed people and use leeches....DON'T DO IT.........I'm sorry you had such a difficult experience with ECT. Different points of view are welcome here, but I need to ask you to not exaggerate or overgeneralize, please.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions. Thus, you can always appeal this decision to him, and he may choose a different action.Thanks,
deputy gg
Posted by invisiblemanpa on December 10, 2006, at 15:22:45
In reply to Please be civil » invisiblemanpa, posted by gardenergirl on December 10, 2006, at 12:32:10
Over generalize or exegerate......I was being nice...It is a gross invasive destructive process...brain salad surgery without the blood....No my friend, be afraid, very afraid....
Posted by chiron on December 10, 2006, at 19:10:48
In reply to ECT experience, posted by Amadeus on December 8, 2006, at 11:23:24
ECT has made a huge positive difference in my life. It got me out of a dark hole (created by the wrong meds) after only 6. Unfortunately, it wasn't a one-time cure. I have gone back & am currently on maintenance- but I have never felt this good in my life (of 34 years).
The main con is the memory loss. You don't lose everything, but it has definitely been a set-back (but worth it). Plus it is a little scary.
I just read "Shock" by Kitty Dukakis. I would recommend reading it.
Posted by gardenergirl on December 10, 2006, at 20:06:25
In reply to Re: Please be civil, posted by invisiblemanpa on December 10, 2006, at 15:22:45
>It is a gross invasive destructive process...brain salad surgery without the blood.
Please don't exaggerate or overgeneralize about a treatment intervention that others have had or are considering. I asked you to be civil, so now I am blocking you from posting for a week.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civilFollow-ups regarding these issues should of course be civil. Dr. Bob has oversight over deputy decisions. Thus, you can always appeal this decision to him, and he may choose a different action.
Regards,
deputy gg
Posted by Karen44 on December 10, 2006, at 22:23:01
In reply to Re: ECT experience, posted by chiron on December 10, 2006, at 19:10:48
> ECT has made a huge positive difference in my life. It got me out of a dark hole (created by the wrong meds) after only 6. Unfortunately, it wasn't a one-time cure. I have gone back & am currently on maintenance- but I have never felt this good in my life (of 34 years).
> The main con is the memory loss. You don't lose everything, but it has definitely been a set-back (but worth it). Plus it is a little scary.
> I just read "Shock" by Kitty Dukakis. I would recommend reading it.In what way has it impacted on your work, if any, and is it very important that your memory remain more than just "good."
Karen44
Posted by Dr. Bob on December 10, 2006, at 23:53:36
In reply to Please be civil » invisiblemanpa, posted by gardenergirl on December 10, 2006, at 12:32:10
> Follow-ups regarding these issues should be directed to Admin
Here's a link:
http://www.dr-bob.org/babble/admin/20061202/msgs/712406.html
Thanks,
Bob
Posted by chiron on December 11, 2006, at 7:48:35
Regarding the question about ECT affecting work:
A few times I would actually have ECT at around 6 am, recover, and then get to work around 10 (which is not suggested). I work as a business analyst on projects. Most of my memory remained, or it would come back to me with cues.
I also saw a guy recover with ECT from being catatonic - he became catatonic from the stress of his computer science program. This program is known to be extremely intense. I am also working on my Masters in Information Systems. So maybe ECT is effective for "computer brains" ...? :)
Posted by dessbee on December 11, 2006, at 13:19:44
In reply to Re: ECT experience, posted by linkadge on December 8, 2006, at 17:48:38
Most neurobiologists consider BDNF a good thing.
SSRI also triggers increased BDNF levels.I have read there is company working on producing BDNF. It could be a efficient medicine in many neurodegenerative diseases.
Posted by linkadge on December 11, 2006, at 16:21:33
In reply to Re: ECT experience » linkadge, posted by dessbee on December 11, 2006, at 13:19:44
>Most neurobiologists consider BDNF a good thing.
>SSRI also triggers increased BDNF levels.Thats a bit of a generalization. SSRI's do not consistantly increase BDNF levels in all studies. They do increase BDNF in some studies, but in other studies they don't. In addition, some studies have found biphasic changes in BDNF levels in response to SSRI treatment. Ie, the drug initially boosts BDNF, but then the effect drops off.
For instance:
http://www.aapsj.org/view.asp?art=aapsj070242
"Coppell and coworkers84 replicated this finding in rats with repeated administration of tranylcypromine, fluoxetine, paroxetine, or sertraline. Their data show BDNF mRNA levels were up-regulated in the hippocampus after long-term drug treatment. However, 4 hours after the last injection BDNF mRNA levels were down-regulated indicating that BDNF expression is differentially regulated in acute and chronic drug treatments."
Also, See:
http://www.jneurosci.org/cgi/content/full/24/12/2866
"potentially representing the activation of genes involved in initiating or mediating myriad cascades activated after brain injury. These injury-activated molecular cascades represent the activation of immediate early genes such as c-fos and c-jun (Raghupathi et al., 1995), cytokines such as interleukin-1 and TNF (Fan et al., 1996; Raghupathi et al., 1998), and neurotropins such as NGF and BDNF (DeKosky et al., 1994; Oyesiku et al., 1999)."
Interestingly enought, ECT activates cfos, cjun, and BDNF, NGF, as well as GFAP, which is considered to be a sign of neronal injury.
http://www.pnas.org/cgi/content/full/95/26/15635
"It has been reported recently that GFAP transcripts are induced to a similar degree after rTMS and ECS in astrocytes located in the hippocampus"
"GFAP in traumatic brain injury":
http://www.pnas.org/cgi/content/full/102/23/8333
"GFAP-positive cells increased by 83 ± 4.1% in the injured cortex compared with the controlateral region."
"Activation of such cells is responsible for reactive gliosis, characterized by hyperplasia, hypertrophy, and increase in glial fibrillary acidic protein (GFAP) immunostaining. Reactive gliosis is observed after CNS injuries, including ischemia and trauma.
>I have read there is company working on >producing BDNF. It could be a efficient medicine >in many neurodegenerative diseases."
Think of it this way. An infection increases white blood cells count. White blood cells are considered "good". This doesn't mean that infection is good. Ie ECT may increase BDNF, and BDNF may be considered "good", that doesn't mean ECT is good.
Linkadge
Posted by dessbee on December 12, 2006, at 7:11:42
In reply to Re: ECT experience, posted by linkadge on December 11, 2006, at 16:21:33
They have done studies on patients using ECT long term without finding brain damage.
Statistics show that 80% are helped with ECT.
So even if ECT is not all good, it still helps many patients, who can not find any other way out of their depression.
Posted by linkadge on December 12, 2006, at 20:03:27
In reply to Re: ECT experience » linkadge, posted by dessbee on December 12, 2006, at 7:11:42
>They have done studies on patients using ECT >long term without finding brain damage.
Thats not true. It really depends where you look, and who you ask. There is plenty of information on the internet regarding the capacity of ECT to dammage the brain.
If ECT did not have the capacity to dammage the brain, then why would you see scientific abstracts regarding the use of NMDA antagonists like memantine to prevent the indicdence of ECT induced glutamatergic neurotoxicity ????
>Statistics show that 80% are helped with ECT.
>So even if ECT is not all good, it still helps >many patients, who can not find any other way >out of their depression.Again, that depends who you ask. Statistics can lie, and they can be misleading. A number of patients who have ECT are not in a position to give an accurate discription of how the treatment affected them, as they have sustained memory loss.
This leaves the task of rating improvement from ECT to doctors. My doctor thinks I am doing better on antidepressants. Thats becase when I walk in the door he tells me I am doing better, he doesn't ask.
Some statistics say that only 10% of people have sexual dysfunction on SSRI's, where the true indidence is more like >50%.
Go to a site like www.remidyfind.com. You will not see an 80% sucess rate for ECT. This says something, as you would not expect severly depressed patients to take the time and rate it.
Even from the accounts I have heard here, I couldn't say more than half of the people who had it say it helped them.
Even if %80 of patients did get better on it, the relapse rate is extrordinarily high. Higher than for any other treatment.
So, when you lapse, you've got to deal with the prospect of living with a damaged brain, which would undoubtedly make the situation worse.
There is *not* an overwhealming conscensious in teh medical comunity that ECT is safe. Like I said, my psychiatrist refuses to administer it as he doesn't think it is safe, and he's a university doctor.
Linkadge
Posted by dessbee on December 13, 2006, at 7:27:04
In reply to Sorry...one more positive ECT post, posted by chiron on December 11, 2006, at 7:48:35
No need to apolagize. I am glad ECT helped you
Posted by stargazer on December 13, 2006, at 9:35:27
In reply to Re: No need to apologize » chiron, posted by dessbee on December 13, 2006, at 7:27:04
Same here...I'm all for positive outcomes no matter how we get there, meds, ECT, meditation, CBT, herbs....any combination of the above. Wish we could all figure the formula out before we die.
Posted by stargazer on December 13, 2006, at 10:43:57
In reply to Re: ECT experience, posted by linkadge on December 12, 2006, at 20:03:27
I agree with Linkage with being able to evaluate statistics and the like.
ECT outcomes vary wildly...some are helped, some are not, but it all is really subjective. I think anything as drastic as ECT can get you out of a depression since it is so physcially traumatic. But I also think the right drugs given in the right amounts can do this too without as much damage. Finding a doctor that can do this is the problem. There are not enough "experts" in psychopharm, and there should be since there are too many meds for most pdocs to get a handle on.
If you are a high functioning individual, I wonder how many of those people can return to the work they were doing before ECT. It's just to hard to quantify outcomes.
The best outcome I saw with ECT was on a comatose individual who did recover and return to her previous life, but she had MR and was not in a working situation.
Most people I saw having ECT were not working, they were too sick. Personally I think some of the work they did made them sick, but that's another theory of mine.
Stargazer
Posted by Karen44 on December 14, 2006, at 16:20:16
In reply to Re: ECT experience/Linkage, posted by stargazer on December 13, 2006, at 10:43:57
> I agree with Linkage with being able to evaluate statistics and the like.
>
> ECT outcomes vary wildly...some are helped, some are not, but it all is really subjective. I think anything as drastic as ECT can get you out of a depression since it is so physcially traumatic. But I also think the right drugs given in the right amounts can do this too without as much damage. Finding a doctor that can do this is the problem. There are not enough "experts" in psychopharm, and there should be since there are too many meds for most pdocs to get a handle on.
>
> If you are a high functioning individual, I wonder how many of those people can return to the work they were doing before ECT. It's just to hard to quantify outcomes.
>
> The best outcome I saw with ECT was on a comatose individual who did recover and return to her previous life, but she had MR and was not in a working situation.
>
> Most people I saw having ECT were not working, they were too sick. Personally I think some of the work they did made them sick, but that's another theory of mine.
>
> Stargazerthe problem for me is that my doctor is an expert in psychopharm and is still advising ect. i have taken every type of antidepressant made without help. i am on my last chance with ensam. i took parnate and it did not work as it did 20 some years ago. so, what to do. sorry for the poor typing. i had surgery on my right hand tuesday and have only one hand.
karen44
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