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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Nadezda on November 28, 2008, at 13:30:22
There have been discussions of ECT here, and I personally am strongly concerned about the adverse effects. I personally wouldn't have it, at least in any circumstance that I've experienced, including severe depression, because of the importance to me of cognitive functioning.
I have a relative, however, who is undergoing a very severe period of melancholic depression, also with some extremely persistent delusions that may prove life-threatening, unless she receives some effective treatment.
Her doctors, whom I don't particularly trust, recommend ECT. However, my pdoc, whom I do trust, thinks ECT is by far the best treatment in certain cases, among which would be my relative.
I'm wondering if anyone has any knowledge about the distinctions between different types of depression, and response to ECT, particularly cognitive problems. Also, there seems to be so much controversy about long-term vs. short-term side effects-- Has anyone looked carefully at Sackheim's study? Anyone have any references that might be helpful?
thanks,
Nadezda
Posted by Phillipa on November 28, 2008, at 13:39:48
In reply to Ect for melancholic depression: concerns, posted by Nadezda on November 28, 2008, at 13:30:22
No but was in a group about 12 years ago the girl had ECT had to drop out of school asked the pdoc why the ECT he said she was so suicidal that was why she received it and was hoping she'd be cognitively normal in about three months. Never saw her after that. But that was one personal experience. Phillipa
Posted by desolationrower on November 28, 2008, at 21:16:12
In reply to Ect for melancholic depression: concerns, posted by Nadezda on November 28, 2008, at 13:30:22
> There have been discussions of ECT here, and I personally am strongly concerned about the adverse effects. I personally wouldn't have it, at least in any circumstance that I've experienced, including severe depression, because of the importance to me of cognitive functioning.
>
> I have a relative, however, who is undergoing a very severe period of melancholic depression, also with some extremely persistent delusions that may prove life-threatening, unless she receives some effective treatment.
>
> Her doctors, whom I don't particularly trust, recommend ECT. However, my pdoc, whom I do trust, thinks ECT is by far the best treatment in certain cases, among which would be my relative.
>
> I'm wondering if anyone has any knowledge about the distinctions between different types of depression, and response to ECT, particularly cognitive problems. Also, there seems to be so much controversy about long-term vs. short-term side effects-- Has anyone looked carefully at Sackheim's study? Anyone have any references that might be helpful?
>
> thanks,
>
> NadezdaWell one thing is unilateral is less likely to cause cog. problems than bilateral, make sure it isn't sine wave, and ultrabrief stimulus. I think older techniques are still used though, so i'd want to know that.
endogenous depression w/psychomotor retardation, delusions, is indicative of better response
is this the study you talk about? the fulltext is free here http://www.nature.com/npp/journal/v32/n1/full/1301180a.html
-d/r
Posted by Nadezda on November 29, 2008, at 0:14:16
In reply to Re: Ect for melancholic depression: concerns, posted by desolationrower on November 28, 2008, at 21:16:12
Hi, desolationrower. Thanks for the reference--I had found the study- and am reading it.
It's an agitated depression with insomnia and delusions, but I've pretty much given up on getting any definitive answers-- except that right unilateral (RUL) with ultra-brief pulse, and seizure threshold calibrated to patient seems the least problematic.
It's frustrating that pdocs seem to ascribe so little importance to cognitive deficits (and to patients' claims), that one can't really base anything on their work-- since there isn't any. Plus-- while Sackheim talks about retrograde amnesia, he doesn't really address anterograde amnesia-- at least in the quick look-through that I've done.
I hope he does consider that.
I was wondering if anyone knew of any other valuable research on the subject.
Given that my relative is an older woman, I'm a bit more concerned. There is some urgency because of other health conditions that need to be addressed, so fast treatment response is much more important. I'm extremely uncomfortable in advising anyone to do ECT, but I also worry that I'd be doing her a disservice not to, also.
Nadezda
Posted by linkadge on November 29, 2008, at 7:39:48
In reply to Re: Ect for melancholic depression: concerns, posted by desolationrower on November 28, 2008, at 21:16:12
Some doctors are quick to use ECT in certain cases. I would personally seek a second opinion. I would look for one good non ECT alternative from another doctor.
What is the medication history?
The use of TCA's can sometimes be remarkably effective for this form of depression.
Linkadge
Posted by Sigismund on November 29, 2008, at 20:40:23
In reply to Re: Ect for melancholic depression: concerns, posted by linkadge on November 29, 2008, at 7:39:48
>The use of TCA's can sometimes be remarkably effective for this form of depression.
Yes, a psych nurse mentioned one in particular for agitated depression, but I have forgotten.
Posted by linkadge on November 30, 2008, at 8:23:07
In reply to Re: Ect for melancholic depression: concerns, posted by Sigismund on November 29, 2008, at 20:40:23
If the psychotic tendencies are mild to moderate then usually an effective treatment for depression does not need to be accompanied by an antipsyhotic.
For instance, in one study of psychotic dperession, the antidepressant nortryptaline was particularly effective and performed just as well as nortryptaline + AP.
I just wouldn't personally jump to ECT unless all other good options have been exhausted.
Linkadge
Posted by Nadezda on November 30, 2008, at 10:09:08
In reply to Re: Ect for melancholic depression: concerns, posted by linkadge on November 30, 2008, at 8:23:07
Thanks for the suggestion, Linkadge. I'll ask her pdoc if he's aware of this, if she doesn't respond soon to the regimen they're using.
On one hand, this pdoc does ECT; on the other hand, he says he doesn't recommend it very often. I agree with ECT as a last resort. And I worry that its effectiveness is being presented as a miracle cure here because the situation is so agitating-- when it may not work.
Time is a bit of the essence-- but I'm certainly going to ask about what other options they've considered. He seems willing to wait for the moment--
Nadezda
Posted by bleauberry on November 30, 2008, at 11:08:47
In reply to Ect for melancholic depression: concerns, posted by Nadezda on November 28, 2008, at 13:30:22
There is always something that will work. Some combination. Some augmention. Some medical condition that has been ignored. Something.
I've said it before, just opinion, I believe ECT is a cop-out for doctors who have gambled wrong in their drug choices. ECT is a way to point the finger at the patient instead of the doctor. The doctors have not been creative enough with the meds at their disposal. All too often they stick to only meds within the guidelines of the so-called diagnosis, and seem to ignore that any psychoactive med has the potential to do benefit, even if it has nothing at all to do with the diagnosis according to some man-made (and because of that, flawed) textbook.
TCAs for psychosis. Prozac+Ritalin for Fibromylagia. Parnate for Fibromylagia. Low Dose Naltrexone for autoimmune, fibro, chronic fatigue, MS, Chrohns. Prozac+Zyprexa for treatment resistance. Lexapro+Abilify for treatment resistance. Not to mention, how obvious are Parnate or Nardil, and yet almost universally ignored? I mean, give me all day and I'll fill up this entire page with stuff. Some of it will make sense. Much of it will not. I will show you the actual case reports of someone that was cured or improved dramatically by some creative combination of drugs, in which the drugs were not first choice, or even third choice, they were not drugs for their "so-called" "assumed" diagnosis.
In my opinion the best thing any doctor could say in a tough case is, "Ya know, we humans are flawed, we make mistakes, we are not anywhere near as wise as we think we are, there is more we don't know than we know. We gotta be open minded and creative and try some different stuff."
ECT should be last on that list, or not on the list at all.
As an ECT survivor, my negative bias is obvious, so please consider where that negative bias came from. I not only did ECT, but I have studied it and studied it and studied it. Hundreds of hours. It aint what they say it is, is all I can say to keep it short.
ECT is not a final hope. The best hope is to go back to that prescription pad, and go back to that lab draw, urine draw, and stool draw. Find something. Try something different. Break out of the box. Put the textbook and regular protocols back on the shelf. Those are for the easy straight forward cases. They do not work for the tough ones.
Posted by neal on December 4, 2008, at 1:41:45
In reply to Re: Ect for melancholic depression: concerns, posted by bleauberry on November 30, 2008, at 11:08:47
Nobody walks into a ECT session lightly. It's usually the last resort, when nothing works and the patient is threatening suicide and there isn't time to throw away the book and try more meds.
ECT works on a statistical basis fairly well, I believe, but check that.
If there's time, try other classes of meds, tryciclics, etc., even opiods if necessary
This is the end of the thread.
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