ECT vs TMS in bipolar

I forgot to reply, but thank you both for the suggestions! I think I can go for a combination of approaches, keeping a note as to where the list is and maybe giving a copy to my wife.

I finally started ECT treatment last week, after nearly nine months of campaigning to get treated. I've completed two treatments now and I'm scheduled for the third tomorrow. Although I'm still a long shot from being "cured," it's already becoming clear that the treatment is helping, more than any med has helped so far. Hopefully the improvements will continue and the memory loss will stay at a minimum. So far I haven't noticed anything important missing, but I understand those effects can be cumulative. I have to say that general anaesthesia twice a week is pretty rough, but so far it's worth it, although the anaesthesia hangover does make it kind of hard to accurately judge the effects on my energy and concentration levels. It's too bad I wasted so much time not getting treated at that first hospital. Oh how I would love to tell those arrogant doctors "I told you so!" But I'll settle for getting better instead.

Well, it's about time, isn't it?! Honestly, the tone of your post sounds lighter and healthier than any of the previous posts of yours that I've read. Do you know yet how many treatments you'll be having?

Yes, it definitely is! I don't know yet how many treatments I'll need, but I'm hopeful it won't be twenty (which is the upper bound they gave me) and that I won't need bilateral treatment. They say some people are better by treatment number six. Right now I'm already noticing improvements and I'm kind of able to sleep without benzos or Seroquel again, so who knows, maybe I'll be one of those people.

It's strange, but as I'm starting to improve a bit, I'm only now truly starting to notice how bad it was. I guess I had forgotten what normal was like and I didn't really believe that things could be better anymore. Sometimes I still don't, but now there are also times that I do believe that things can be better and I can actually feel it. I think maybe I was so afraid to exaggerate my depression that I was actually underestimating it.

I'm kind of on the fence about whether I should pursue a complaint at the first hospital, where they kept me in the dark for months and then declined to treat me when I got angry at them and the lack of information because they claimed that my anger showed that I had "personality issues" and that therefore "ECT wouldn't work." Their impression of me was completely wrong because they never took more than a few minutes to talk to me and didn't listen to the information provided by my own Pdoc. So when I didn't immediately fit into their stereotype of what a depressed person should look like, they just wrote me off. I think that's bad practice. I don't think it was unreasonable at all to get angry after I waited for months, was refused any information, had to submit to a whole bunch of "examinations" without knowing the reason, and never heard back from them when they promised to call.

On the one hand I think it would be bad for my recovery to waste more time and energy on those people, especially since they're likely too arrogant to listen, but on the other hand I now have proof that the ECT is working and that the depression is real and they did delay my treatment by nearly four months for no good reason. It's hard to just set all that anger aside. I'm not sure what's the best thing to do.

I also find that I'm still really grieving about all the time I've lost to depression these past few years, and all the damage it has caused. But grief is different and a lot more manageable than depression. I think that's something I can work with and honestly I'm looking forward to it, to begin moving on, hopefully.

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Originally Posted by FluffyDinosaur Yes, it definitely is! I don't know yet how many treatments I'll need, but I'm hopeful it won't be twenty (which is the upper bound they gave me) and that I won't need bilateral treatment. They say some people are better by treatment number six. Right now I'm already noticing improvements and I'm kind of able to sleep without benzos or Seroquel again, so who knows, maybe I'll be one of those people. That is AMAZING! Good for you, for following your intuition about needing ECT. It's strange, but as I'm starting to improve a bit, I'm only now truly starting to notice how bad it was. I guess I had forgotten what normal was like and I didn't really believe that things could be better anymore. Sometimes I still don't, but now there are also times that I do believe that things can be better and I can actually feel it. I think maybe I was so afraid to exaggerate my depression that I was actually underestimating it. I understand so well, except with meds that have actually worked for me. In the midst of it you really wonder...Is this just 'me', am I exaggerating, and so on and on. But then there you are, feeling an immense improvement, saying I really was suffering from severe depression! You have to feel so proud of yourself, FluffyD, for making it through AND for persisting in reaching out for and obtaining help when you were struggling so mightily. I'm kind of on the fence about whether I should pursue a complaint at the first hospital, where they kept me in the dark for months and then declined to treat me when I got angry at them and the lack of information because they claimed that my anger showed that I had "personality issues" and that therefore "ECT wouldn't work." Their impression of me was completely wrong because they never took more than a few minutes to talk to me and didn't listen to the information provided by my own Pdoc. So when I didn't immediately fit into their stereotype of what a depressed person should look like, they just wrote me off. I think that's bad practice. I don't think it was unreasonable at all to get angry after I waited for months, was refused any information, had to submit to a whole bunch of "examinations" without knowing the reason, and never heard back from them when they promised to call. On the one hand I think it would be bad for my recovery to waste more time and energy on those people, especially since they're likely too arrogant to listen, but on the other hand I now have proof that the ECT is working and that the depression is real and they did delay my treatment by nearly four months for no good reason. It's hard to just set all that anger aside. I'm not sure what's the best thing to do. Filing a complaint is a strong consideration. Maybe give your treatments a bit of time, then decide? Just so you don't stress yourself so early on in the treatments. Just a thought. But my God, what they put you through...absolutely unethical. Inhumane. I also find that I'm still really grieving about all the time I've lost to depression these past few years, and all the damage it has caused. But grief is different and a lot more manageable than depression. I think that's something I can work with and honestly I'm looking forward to it, to begin moving on, hopefully. I have grief about huge pieces of my life given over to mental illness, too. I suppose we all do. But you're correct...grief can be managed, worked with. Whereas depression only needs immediate treatment. The bottom line is that you've hung in there and now you know what you were facing, the courage it took! I'm so very happy for you!

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Thank you, and thanks for all your help throughout this whole ordeal! I won't say I'm quite there yet, but yes, I'm starting to feel very glad that I did persevere!

I work in medicine and our psychiatrists say that yes, ECT is more powerful than TMS. I have seen patients who got ECT 2-3x per week for 8-10 treatments, then cut back to once every other week and are maintained at once monthly, some every 6 weeks.

I had fifteen bilateral treatments and it seemed to help I gues

Thanks all, I've had only three unilateral treatments so far and I already feel better than I did on Seroquel, which was the most effective drug for me. This is the first time in over a year that I've had moments when I felt anything like normal, and I had forgotten what it was like. A few days after each ECT treatment, the effect starts to wear off a bit and the depressed feelings start to come back, no matter how much I try to prevent it. The contrast underscores how bad it was, and I think it also goes to show that I can't consciously control this depression or force myself to "snap out of it." Still, I feel better than I have in a long time, and if all goes well the effects from the ECT should linger a little longer each time, until hopefully I get well enough to make the transition to maintenance treatment and start living my life again.

So far I haven't noticed any important memories missing yet, the only thing is I feel a little fuzzy now and then (but no more so than I did due to the depression) and sometimes I get these deja vu feelings, but I'm not sure whether those are real or I'm just imagining them because I'm afraid to forget things.

I went through ECT on two separate occasions. I honestly wasn't aware of what I wasn't remembering until after it was all said and done. So for instance, we went to see a moving while I was going through ECT. I completely forgot about it, and it wasn't until reminded that I had seen the movie that it very vaguely came to my memory. It was mostly things like that, and I was largely oblivious to the memory issues during the actual treatment. So, take notes, and have someone who can help you navigate any memory things that do come up.

My husband had bilateral and had much bigger memory issues - even more of a confusion. We had to really watch him more during treatment. Mine was unilateral and the memory issues were basically what I described above. I probably could have worked on days I wasn't having treatment (but it was summer and I was off).

I never did maintenance treatments and never really needed them.

There's a lot of talk about memory loss from ECT, but I experience (and I know some others do, too) memory loss as a side effect of some medications. Memory loss and other cognitive issues.

Indeed, not to mention the cognitive issues brought on by depression itself. I am taking notes, which I was already used to because my memory was impaired by the depression. The extent of things I'm forgetting, like others have mentioned, is more or less "did I see that movie already" or "did I say/do that already." It's not really a big deal to me so far, given that it's limited to the ECT time period, should be temporary, and it's hard to distinguish from the symptoms I already had. I can usually recover most of my memories anyway if I run through the "check list" in my head or apply some logical reasoning. If it doesn't get worse than this, then it's totally worth it in my opinion. Honestly I can't even really tell whether the memory issues are really due to the ECT treatment, or due to going under general anaesthesia multiple times a week, which is admittedly pretty intense.

Interesting take on the general anesthesia. I've never heard anyone mention it, but seems like the anesthesia could certainly be responsible for memory loss.


Oh, if people who didn't have mental illness only knew how challenging it is...

Yeah, sometimes I wonder if it's even possible to really grasp it if you haven't lived it (including for therapists and Pdocs). Most people who've never been clinically depressed can't seem to understand that it's much more than just "sadness" and that it's not necessarily "about something" that's wrong in your life, i.e. everything can be perfect and you're still depressed, it's more of a physical thing than a psychological thing in a way.

Right now I just try not to worry too much about what's causing what. I already had cognitive issues due to the depression, now it may be that the ECT and/or anaesthesia are contributing, but even if they are it should only be temporary. What matters is that my depression (as measured by standardized tests) has already "halved" after only four ECT treatments! There are times when I'm actually starting to feel a little enjoyment in life again, something I had started to think impossible after living for so long without any joy. There are also moments when the depression worsens, and I still can't sleep all that well either, but what matters is I'm finally seeing some real improvement.

The thought that really scares me now is the possibility that I might relapse. I really don't want to go through all that again... I just hope and pray that my maintenance meds after ECT are going to work as advertised. I guess when worse comes to worst I'd be willing to do maintenance ECT, if the cognitive issues don't get worse than this, but my first hope is still Lamictal.

I am so excited for you, FluffyD! It's only natural that you would feel anxious about the possibility of relapse. But that possibility is a long way off...for now your treatment is succeeding!

Thanks again for all the support! Just a quick update to let you know that things are still going well treatment-wise. Please feel free to ignore if it's getting tedious.

Right now ECT number seven is coming up tomorrow. According to the score we're using to keep track of my depression severity, I'm still at the high end of "moderate" depression, leaning towards "severe." It fluctuates a bit, some better days and some worse, which I guess is to be expected. Still, my score is currently only just over half of what it was when I started out, when my depression measured as "very severe," so the improvement is undeniable and I'm happy with it. Also, my irritability is almost entirely gone, which is good. Anxiety seems to be one of the last things to go, it's still pretty strong at the moment for reasons I can't quite explain.

I'm starting to remember what it was like to have the capacity to be excited about things, and I think at times I'm starting to remember what it feels like to be myself again. There are also times when I feel sadness and fear that the depression will worsen again, and sometimes it seems like those feelings hit extra hard now that I have something to contrast them with.



I am extremely eager to start working towards something again, like a project or anything worthwhile. However, though the excitement is starting to come back, it's still hard to do anything concrete because the ECT itself is just so exhausting, as I mentioned before. Also, I'm kind of afraid to overdo it and push myself too hard. I want to be careful to strike the right balance between pushing myself enough but not too much, just enough to optimize my recovery. I was wondering if anyone here had any advice in that regard?

Another question I wanted to ask is, any advice on how to estimate the right time to stop the ECT and transition to maintenance treatment? Like I said, I'm very happy with the results so far, and the side effects are still tolerable, but it's still a pretty taxing treatment and I'd prefer not to continue it unnecessarily long, especially since I feel like I won't be able to find the energy to get back to work or anything like that while I'm still doing the treatment.

Also, I have to say that I'm finding it pretty difficult to estimate the extent of the memory loss. I think I haven't lost anything important yet, just a little fuzzy thinking which I attribute more to the anaesthesia than anything else, and which I think will improve after the treatment stops. However, I'm starting to get a little paranoid about the possibility of memory loss, I keep feeling like I vaguely recognize strangers in the street and things like that, which is a little unnerving.

I'm sorry I don't have answers to your questions, FluffyD. I hope one of our members who has had ECT sees this thread.

How are you doing now?

No problem, I understand, and I appreciate all the replies so far! At the moment I'm feeling a little lower again mood-wise, which I'm guessing and hoping is just a random fluctuation that is to be expected. Or maybe it's just because I'm nervous about the upcoming week. I'm talking to my Pdoc tomorrow after ECT number eight, so hopefully he will have answers to some of those questions. I think it's important at this point for me to develop a proper recovery plan because I don't just want to lean back and assume that the ECT will do all the work for me.

I agree. Keep in mind that you are doing absolutely everything possible to treat your depression, and your hard work is something to be proud of!

Thank you! And for what it's worth, my mood has improved a little again, back to the point where I feel like I'm nearly ready to start trying some work and hobbies again, although actually doing it is another matter because I'm still pretty exhausted from the treatment itself. I feel like I'm close to a point where I just kind of need to "push through" to break a vicious cycle of feeling bad, not being able to do the things I love, feeling worse, and so on. I'll try to remember to discuss that with my Pdoc tomorrow. It almost seems too good to be true that I might be close to the point where I can start getting my life back, I'm having a hard time believing there isn't some catch that's going to jump out and bite me at the last second.

I understand. I think we get a PTSD reaction from having episodes of depression (or mania). It's that feeling of waiting for the other shoe to drop. It's so important to remember that change, positive change, really does occur.

Yes, well said, that's exactly how it feels!