I'm back. I am a mess and facing ECT....

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Registered: 03-26-2003
I'm back. I am a mess and facing ECT....
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Mon, 04-09-2007 - 6:11pm

I have been in the partial hospitlazation program for the last month. The official dx is major depression but they have still not ruled out BP2. I have been on every med available for the last 4 years. I finally just shut down and did not get out of bed. It took my 5 year old coming in and asking why I always cry and sleep. I think it was worse because the week of my "breakdown" was a day before the finalization of the divorce in court and a week after the sale of my house and movement into low income housing. So now, I am still not divorced, as court will not allow me to consent to anything, and still not doing much. My mom has moved in to help with the kids after I shut down. I have not worked since the end of february. Luckily, they are saving my position and keeping my insurance. Anyone have ECT? What are your thoughts? I have very mixed emotions about this but am desperate for help. I have had the prework up done and am waiting on the insurance to approve now. I am switching to one last a/d today to try. I am also on depakote now too. I hate this. Please help.

Missy

 
 
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Registered: 04-07-2002
Mon, 04-09-2007 - 7:35pm

{{{{{{{{Missy}}}}}}}

I have never had ECT myself, but I have seen it work wonders for people for whom meds don't work. Good luck with it!

Express!
Beth "Petrouchka"

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Registered: 09-01-2004
Mon, 04-09-2007 - 8:49pm

Missy,


I'm sorry to have you back under such circumstances, but still glad to hear from you!

iVillage Member
Registered: 09-01-2004
Tue, 04-10-2007 - 5:48pm

Here's a big article from McMan's Depression and Bipolar web:


Electroconvulsive Therapy - ECT




Nothing in the field of mental health is more apt to get a rise out of people than the subject of shock treatments, or electroconvulsive therapy (ECT) as it is now called. Movies such as "One Flew Over the Cuckoo's Nest" have portrayed the procedure as nothing less than an instrument of torture, and poet Sylvia Plath wrote "with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant."


Yet ECT is fully endorsed by the psychiatric profession as well as patients' groups, is used by the major hospitals, and many patients swear it has saved their lives. Long regarded as a treatment as a last resort - after all attempts at medications therapy have failed - more and more ECT is moving up to front-line status. According to a task force report issued by the American Psychiatric Association, depriving patients from early treatment could "prolong suffering, and may possibly contribute to treatment resistance."


Francis Mondimore MD, in his book, "Bipolar Disorder," asserts that: "ECT is perhaps the most effective treatment there is for severe depression and severe mania, and it often works more quickly than other medications."


With an 80 percent response rate for acute depression, antidepressants don't come close.


And Dr Kay Jamison in "Night Falls Fast" justifies ECT as a first-line treatment for suicidal patients, to stabilize their condition where slow-acting drugs and therapies are not an option.


ECT - What to Expect

ECT, which has been around for some sixty years, works on the principle of an electrically-induced convulsion, similar to a grand mal epileptic seizure. No one knows exactly how this makes a depression lift. Back in the bad old days when ECT was overprescribed - often against a person's will - the patient experienced violent, and sometimes bone-breaking, muscle contractions. Now the patient is given neuromuscular blocking agents which limit muscular activity to an involuntary twitching in the toe.


Immediately prior to the treatment, the patient is injected with a medication that prevents abnormal heart rhythms, then the patient is given an intravenous barbiturate which is used as the general anesthetic, and then the blocking agents. Electrodes are attached to the patient's scalp either on one side of the brain or two - a switch is flipped for a few seconds, the convulsion itself lasts about 30 seconds, and several minutes later the patient wakes up disoriented and groggy, and often with no recollection of the events surrounding the treatment.


Would-be patients may get the impression that the charge is conducted through the brain with far more surgical precision than in the past. Yes and no. The new machines break up the current into pulses, but generate more voltage, so depending on who you listen to this is either bad or good (on modern machines voltages range from 170 to 500 volts compared to the old models at 120 volts). Nevertheless, only a small proportion of this actually gets through the skull to the brain.


The standard course of treatments is about three a week for maybe a month, at a cost of between $300 and $1000 per treatment. Managed care providers apparently see this as a long-term benefit when compared to the costs of medication. So does the federal government, which pays psychiatrists more to do ECT on the elderly (mostly women) than to perform medication checks or therapy. But thanks to anti-ECT campaigns, the treatment is virtually unavailable at state hospitals, meaning the poor are effectively excluded. Those seeking out ECT must usually go to private or academic hospitals.


ECT and Memory Loss

The most pronounced side effect is short-term memory loss in about two-thirds of the patients. Some patients can also experience longer-term memory loss. The psychiatric profession has reacted defensively to the parade of patients who have come forward with their stories, equating their narratives to Cuckoo's Nest scare tactics, but the truth is psychiatrists have downplayed this rather disturbing invasion of the brain's hard drive. Part of this can be attributed to the politics of ECT, where many of the same people who are against ECT are also against medications and psychiatry in general, including psychiatry's antichrist Peter Breggin and the Church of Scientology.


Only recently has the American Psychiatric Association publicly owned up to the possibility of serious memory problems. In an article in Atlantic Monthly, Harold Sackeim PhD of Columbia University and a leading authority on ECT acknowledged he tells patients there will be short term memory loss, a small price to pay for getting well, but he also tells them that "in very rare instances it can be more extensive."

The same Atlantic Monthly article also pointed out that the great pianist Vladimir Horowitz had ECT, which didn't affect his ability to memorize the billions of notes to perform Tchaikovsky and Chopin. On the other hand, Ernest Hemingway, after a course of ECT, complained: "What is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure, but we lost the patient." Not long afterward, he shot himself.


A 2003 Institute of Psychiatry (London) review of 35 studies on ECT published in the British Medical Journal found the rate of reported persistent memory loss between 29 and 55 percent, which, unlike the rate of perceived benefit, did not seem to vary between medical or patient-based surveys. The authors of the study took issue with the Royal College of Physicians, who say in their fact sheet: "In most cases this memory loss goes away within a few days or weeks although some patients continue to experience memory problems for several months. As far as we know, electroconvulsive therapy does not have any long term effects on your memory or intelligence."


That article provoked spirited responses, published in a later issue, including the following sampling:



  • "In addition to memory loss, my patients have complained about inability to memorize new material. An example was a pianist who could no longer learn to play by heart."
  • "The review is seriously flawed by obsolete information (much of it more than 20 years old) and failure to consider advances in technique that have increased patient satisfaction and reduced cognitive side effects."
  • "Anyone who has spoken to patients recovered or partially recovered from major depression, or has suffered with it themselves, knows that major depression itself can cause amnesia and other cognitive impairments."
  • "All of the available research funding to study ‘cognitive consequences of ECT’ is locked up for the next decade by the man who designs the Mecta ECT machines. His team (and others) chooses hopelessly irrelevant tests like the MiniMental Status Exam and paired- words and then proclaims that survivors have no cognitive deficits or even that ECT raises IQ."

More ECT Facts

Two recent studies published in the Archives of General Psychiatry found that a high dose of right unilateral ECT (ie to one side of the brain) to be as effective but with less memory impairment than bilateral ECT. The maximum ECT dose allowed in the US is six times "seizure threshold," but there is talk of lobbying the FDA to raise the limit (even though the same studies found that "cognitive deficits" increased along with the dose).


Another unpleasant fact of life - one you will probably not be told about by your doctor or psychiatrist - is ECT's (lack of) performance in the long term. Ultimately, the American Psychiatric Association was compelled to acknowledge "disappointingly high relapse rates" in its task force report on the topic, especially in patients with psychotic depression and in those who are medication resistant.


The profession's response to this is "continuation ECT", which equates to an occasional booster charge. A recent study reported in the Dec 2000 American Journal of Psychiatry found that patients on continuation ECT and antidepressants had a 93 percent probability of no relapse after two years compared to 52 percent for those on antidepressants alone. At five years, the probability of no relapse was 73 percent for continuation ECT patients, in stark contrast to 18 percent for antidepressant-alone patients.


Still, we do not know how continuation ECT affects the brain in the long-term, but the same can be said of antidepressants and mood stabilizers.


For all of ECT's benefits, the psychiatric profession may be overreaching in selling ECT as a front-line treatment. A draft of the Surgeon General's Report on Mental Health raised howls of protest when its ECT content adhered too closely to the APA task force report (the final report by the Surgeon General retreated somewhat from its earlier position).


Then there was an article that appeared on CNN's website, in which a psychiatrist made the extraordinary claim that ECT used "a tiny amount" of electrical current and compared the procedure to "having your tonsils out" and that "memory problems normally go away."


Finally, there was a Mayo Clinic study, which reported a very high satisfaction rate amongst its ECT patients. The survey, however, was conducted near the end of the course of treatments, rather than months later which would have recorded a truer result. As one former ECT patient remarked:


"If you had asked me all those questions during a course I would have told you the sky is green. You are warned not to make any important decisions or sign anything during or for a while after a course, so why would these people qualify to be surveyed?"


Nevertheless, ECT does represent a viable treatment option for some people, and the life you save may be your own. But it is up to you to do your homework in advance and not be swayed by pressures subtle and unsubtle should you find yourself in need.


Should you decide - reasonably or unreasonably - that ECT is not for you, you may wish to make out an "advance psychiatric directive". The Bazelon Center has posted templates on its website, which you can print out and complete and sign in the presence of two witnesses and a notary. You may also assign decision-making authority over to a proxy, but keep in mind the legality of these directives may vary from state to state.


Update (April, 2003)


The UK’s National Institute for Clinical Excellence, part of the National Health Service, in an April 2003 report recommends that ECT be used to treat severe depression, catatonia, or severe or prolonged mania only after other options have proven ineffective or where the condition is potentially life-threatening. In addition, NICE also advises that treatment should be based on a documented assessment of the risks and potential benefits to the individual, and valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. Where informed discussion and consent is not possible, advance directives should be taken into account.


NICE further recommends: Clinical status be assessed following each ECT session, and treatment stopped when a response has been achieved, or sooner if there are adverse effects. Cognitive function should be monitored on an ongoing basis. The same criteria for initiating ECT should apply to repeating a course of ECT. ECT is not recommended as maintenance therapy for depression.


Other observations:


Despite the fact that it may be difficult to differentiate the effects of ECT from those of depression, “this should not detract from the fact that a number of individuals find their memory loss extremely damaging and for them this negates any benefit from ECT.” ECT and meds therapy were found equally cost effective.


NICE's interpretation of past studies suggests: "There was little evidence to support the routine prescription of a set number of treatment sessions per course of ECT or of the value of continuation (maintenance) ECT."


ECT achieved better results than antidepressants, but the trials were of "variable quality," often with inadequate doses or durations of drug therapy. Combination meds-ECT was not shown superior to ECT alone.


iVillage Member
Registered: 09-01-2004
Tue, 04-10-2007 - 6:10pm

Here's another article--this one from Everyday Health.com:


Treatment for Depression: Getting Help



Electroconvulsive Therapy





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Reality often fails to jibe with movies and books. While psychotherapy and antidepressants have garnered some positive fictional portrayals, electroconvulsive therapy (ECT) typically evokes only frightening pictures. More than 30 years after One Flew Over the Cuckoo’s Nest won its Academy Awards, the images from the film linger in many people’s minds. Yet ECT remains one of the most effective treatments for severe depression, with response rates of 80%–90% for people with major depression. ECT may also be used to treat mania when a person fails to respond to other treatments.

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Registered: 09-01-2004
Tue, 04-10-2007 - 6:23pm

Here's an article from www.mhsource.com,

iVillage Member
Registered: 09-01-2004
Tue, 04-10-2007 - 6:30pm

Here's one more article from www.mayoclinic.com .

iVillage Member
Registered: 03-25-2003
Wed, 04-11-2007 - 6:08pm

Hey there Missy...

Honey, please do the ECT. I'm a huge advocate, though I never went through it. I saw it save others though, while in the psych ward. Its a last ditch effort sometimes, but you have to do it. A lot of folks are scared of the side effects, but what about the side effects we experience from the psych meds? From the disorders themselves?

I know what you are going through. You know I do. I can also tell you it will be okay, though that is the last thing you want to hear right now.

You can do this...you have no other choice. I'm so glad your mom moved in to help. Lean on her. You will recuperate, but it takes time.

Depakote was my last resort med too, before ECT. Not sure what a/d you went on but I'm praying it works.

Keep us posted...let us help.

Love and Hugs,

Keli

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Registered: 09-01-2004
Sat, 12-01-2007 - 12:15pm
bump



iVillage Member
Registered: 10-31-2007
Sat, 12-01-2007 - 4:59pm

Marci,


Thank you so much for the articles. i did email you but noticed you said you had an email glich..thats all i will say right now i am not willing to discuss my story on the board. My good friend on onther board just got sick so i really dont have anyone else to talk to it about but i really do appreciate the articles it shows how much you really care


< 3




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Registered: 09-01-2004
Sat, 12-01-2007 - 5:05pm

My email seems to be working okay now--feel free to contact me offline, if you like: