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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by tensor on November 12, 2006, at 14:18:56
Often after a med trial failure, the pdoc asks if I've considered ECT and I reply with "yes, but isn't there a lot of other meds to try, combos?". I really looks at ECT as the very last resort, and reserved for persons with severe apathic depression. Some pdocs are convincing and I'm running out of ideas, are there any good arguments not to comply with ECT?
PS. I have not given up on Lamictal yet, just wants to be prepared.
/Mattias
Posted by blueberry on November 12, 2006, at 15:50:17
In reply to ECT, posted by tensor on November 12, 2006, at 14:18:56
Based on my own experience, ECT is an awesome way to go when tons of meds have failed...BBUUUTTT...it has to be done right. What do I mean? ...
The memory loss...demand some type of formal memory test, written or verbal, from treatment to treatment so that you can know when it is beginning to happen and how severe. They can not just wing it like they did with me and not formally monitor it.
Standard treatment is thrice a week or twice a week until about 12 treatments. I disagree. It should be customized for each person. I believe more spacing of treatments is better. There are tons of ways to customize treatment...sine wave or pulse wave, one electrode or two, the amount of power, the timelength of power application.
The most important thing though is to have a super strong monitoring system in place. At the beginning of each and every treatment, there should be a depression test, a mania test, and a memory test.
And you need to be able to get another treatment any time you wish with just a phone call and no more than 24 hours waiting.
Posted by tensor on November 12, 2006, at 16:07:31
In reply to Re: ECT, posted by blueberry on November 12, 2006, at 15:50:17
Hi blueberry,
to be honest, ECT scares me. And I don't see myself as a candidate, not yet anyway. It's not that I haven't responded to meds, I have responded to a lot of meds through the years. The problem is that they cease to function after a year or so, and when they function I have an unstable mood. I can be down a few days then fine for a week or two and so on.
The best combo so far was remeron+zoloft.
/Mattias
Posted by stargazer on November 12, 2006, at 16:27:32
In reply to Re: ECT » blueberry, posted by tensor on November 12, 2006, at 16:07:31
I see ECT as a last resort, as well, except I think if I came to that place, I would look into the vagus nerve stimulation procedure before ECT.
There are a million med combinations but that is part of the problem...there are too many combos and how does the MD choose what combination to try. I don't think there's enough docs who have the expertise needed to make these decisions, although I'm sure they would never say this.
Which leads me to my next post...How to find an expert in psychopharmacy.
SG
Posted by tensor on November 12, 2006, at 16:57:46
In reply to Re: ECT, posted by stargazer on November 12, 2006, at 16:27:32
>Which leads me to my next post...How to find an expert in psychopharmacy.
They are obviously rare, I've been suggested very strange combos. Most pdocs seem to lack knowledge about the mechanisms behind a particular meds action, i.e. what it's supposed to do in your brain. Most pdoc I've met have two-three "favourites" based upon which samples they have received from a med manufacturer, one had Lexapro as the firstline and if that failed it was either Remoron or amitriptyline. Sure, if Lexapro fails there's a great chance amitrip will work but that's going from a .22 cal to an AA-gun.
/Mattias
Posted by blueberry on November 12, 2006, at 17:54:49
In reply to Re: ECT » blueberry, posted by tensor on November 12, 2006, at 16:07:31
> Hi blueberry,
>
> to be honest, ECT scares me. And I don't see myself as a candidate, not yet anyway. It's not that I haven't responded to meds, I have responded to a lot of meds through the years. The problem is that they cease to function after a year or so, and when they function I have an unstable mood. I can be down a few days then fine for a week or two and so on.
>
> The best combo so far was remeron+zoloft.
>
> /MattiasBased on your description of meds, perhaps the only missing link is 300mg to 600mg lithium salts. Lithium needs a minimum of a few weeks to start working but over several months it stabilizes things and actually has all kinds of benefits in terms of improving genes and brain grey matter. Though its exact mechanism is still a mystery, they do know that one of the many things it does is stabilize glutamate to proper levels, which represents 80% of the neurotransmitter pool in your brain. All this other stuff we talk about...serotonin, norepinephrine, dopamine, etc...is the rest. Perhaps the ups and downs you experience are glutamate, genetics, faulty grey matter, or damaged neurons, all of which are fixed over time with lithium.
Considering all the heavy duty meds, it is nice to know lithium is natural treatment, just a salt of the earth, with an overall track record unmatched by anything manmade.
Choose the best meds you like so far and add 300mg lithium, then shoot for 600mg when you are ready. Give it a few months even if it doesn't feel like it is doing anything at first.
Posted by linkadge on November 12, 2006, at 19:23:35
In reply to Re: ECT » tensor, posted by blueberry on November 12, 2006, at 17:54:49
Lithium can mess you up. Especially when you combine it with other drugs.
Some have the suspicion that it can cause mild neurological insults over time. Lithium has an excitotoxic properties, and some believe this can manifest over time in bipolars even within the so called theraputic range. Some have theoriezed that lithium can induce brain dammage over time.
Fully read.
http://psycprints.ecs.soton.ac.uk/archive/00000524/
There are two sides to everything you read. For example, ECT induced BDNF increase may not be a good thing. Did you know for example, that the brain increases BDNF in responce to neuronal injury? BDNF is very high after dramatic brain injury. Some think ECT induced BDNF increase is just the brain trying to protect itself. There is a strong devide in the medical comunity over the safety of ECT. My psychiatrist won't administer it, he says he wouldn't be able to live with himself.
Linkadge
Posted by linkadge on November 12, 2006, at 19:41:59
In reply to Re: ECT, posted by linkadge on November 12, 2006, at 19:23:35
Note how it says that serotonergic drugs can enhance lithium neurotoxicity. But doctors routinely prescribe SSRI's with lithium. Do you think they test the combination in animals before giving it to humans, of course not, they're just la-de-da lets just throw this combination of drugs together.
Linadge
Posted by Meri-Tuuli on November 13, 2006, at 2:20:00
In reply to Re: ECT, posted by linkadge on November 12, 2006, at 19:41:59
> Do you think they test the combination in animals before giving it to humans, of course not, they're just la-de-da lets just throw this combination of drugs together.
Thats a very good point Link. I hadn't really thought about it too much before, mainly because I've been lucky enough not to have to combine meds.
Hmm.
Posted by tensor on November 13, 2006, at 5:26:42
In reply to Re: ECT, posted by linkadge on November 12, 2006, at 19:23:35
Hi Link,
>BDNF is very high after dramatic brain injury. Some think ECT induced BDNF increase is just the brain trying to protect itself.BDNF is very high after dramatic brain injury. Some think ECT induced BDNF increase is just the brain trying to protect itself.
Thank you for this contribution! I'm gonna add this to my list of ECT-cons.
/Mattias
Posted by tensor on November 13, 2006, at 5:45:33
In reply to Re: ECT, posted by linkadge on November 12, 2006, at 19:23:35
>http://psycprints.ecs.soton.ac.uk/archive/00000524/
That's interesting reading. As you said, there are two sides of everything you read. Lithium has a long record and is considerd being safe. But the therapeutic range is so close to toxicity which make you wonder how good it is for your brain.
/Mattias
Posted by tensor on November 13, 2006, at 5:51:12
In reply to Re: ECT » tensor, posted by blueberry on November 12, 2006, at 17:54:49
Hi,
>perhaps the only missing link is 300mg to 600mg lithium salts.
I've tried lithium for a few months as augmentor to remeron and zoloft. I can't remember which dose we reached but the serum level was 0.7mmol/L. Lithium did nothing for me. Thanks anyway.
/Mattias
Posted by linkadge on November 14, 2006, at 18:41:46
In reply to Re: ECT, posted by Meri-Tuuli on November 13, 2006, at 2:20:00
Well thats the thing, you take two psychiatric drugs which may be fine on their own, but in combination its no mans land.
Linkadge
Posted by Reggie BoStar on November 22, 2006, at 3:56:12
In reply to ECT, posted by tensor on November 12, 2006, at 14:18:56
I completed 7 out of 8 ECT treatments in July 2005. It was unilateral, that is, applied to only one side of my brain. The results:
1. No memory loss at all.
2. No change in depression at all.
3. A gradual increase in anxiety levels, until I became so stressed that I could not make it to the last treatment. I was diagnosed with Generalized Anxiety Disorder (GAD) for the first time in my life and put on Buspar.
4. Talked with the two other people in my group and learned that they suffered short-term memory loss and no change in depression.
5. Was informed by my psychiatrist that full benefit of treatment would take time to realize.
6. No benefit ever realized. No change in depression at first, marked increase in anxiety.
7. In long run, depression was made worse when I realized that yet another form of treatment had failed. In addition, I was now saddled with such a bad case of GAD that I had to be sedated.
8. This year, met one of the other people in my treatment group in another therapy group. He reported no change at all in depression after ECT and is still in therapy and on meds.
9. None of my requirements for Anti-Depressants and other drugs decreased as predicted. I am now on higher doses of everything.
10. I have since also developed symptoms of bipolar II and am on medication for that, too.ECT was a miserable failure for me. I know that the GAD is a direct result. Possibly the bipolar is too, but I can't prove it.
My opinion is that it's overrated. The pros who swear by it don't even know how it works when it does.
You may get different results. "Everbody is different," they commonly say when giving the usual disclaimer.
Good luck.
This is the end of the thread.
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