[bos314489]

I just posted a thread titled ketamine but I thought this might catch more attention to answer my question. Since there is no test to measure the degree of someone's pain and suffering and misery of depression, how do doctors determine if someone is depressed "enough" to get certain medications and treatments (ketamine, ECT). For instance just because I have a job and can function how can someone tell me I am not as depressed as someone else? I have an extremely difficult time functioning and am in a great deal of misery and feel like my meds are not effective. I really just want to try a ketamine injection to get some immediate relief as I just went through a trail of abilify and had a horrible reaction. Thanks for reading, I hope this makes sense my mind is kind of jumbled.

[hamster-bamster]

Several things.

There is a functioning score that is part of psychological assessment. Usually a number from 0 to 100, if I am not mistaken. That is just functioning - not necessarily a degree of depression. You can be manic to the point of non-functioning.

There are questionnaires.

There is clinical observation and assessment.

Since I have not heard of the ketamine, it must not be the first line of defense.

ECT is a last resort measure, after medications have failed. ECT is not given just based on the severity/degree of depression but based on the history of medication failures. So it cannot be the first line of defense either.

[BlackPup]

As HB says, ECT is usually used in med resistant depression.

Ketamine has shown promise to have a fast acting effect on depression but I don't think that the effect lasts very long. I don't think its widely used yet and I would be very cautious using it in conjunction with a BP diagnosis because it is a dissociative anaesthetic which can cause "trip like" hallucinations. I know my hubby used it as an anaesthetic for a BP patient once and sent the poor girl into a dysphoric hallucination - not pleasant.

Finding the right antidepressant is unfortunately a slow and painful process as you need to try the different ADs for about a month at each dose before you try the next one. Hopefully you have a good doctor who will work with you to find a good combination.

Its really important to have your mania resolved or you will continue to experience depression cos manias tend to end with a depressive episode. And anything that acts as an AD can send you into mania so that needs to be monitored to make sure you are not having AD induced manias.

[Anneinside]

You got a very good answer from hamster. One last thing that they use is observation. Someone who is severely depressed is likely to have a flat affect, move slowly, and be suicidal. Being suicidal automatically puts you in the severe category. In July 2011, I was suicidal and had an initial series of ECT. I started to improve after the 3rd treatment. I have had ECT before and this time we went with maintenance ECT so right now I am having ECT every two weeks. It keeps me pretty stable. Another reason it is not a first line of treatment is that it requires, for many, hospitalization. It can be done outpatient if after some treatments it is evident that they do well afterwards and don't need inpatient observation. But, the treatment requires a psychiatrist trained in ECT, anesthesiologist, nurse, recovery nurse. It is more expensive than most pill cocktails. For me, I go in and am in a pre-op room to get my IDband, intake interview, IV. Then on to the ECT room where electrodes, cardiac monitor, oxygen monitor are applied. Then the anesthesiologist puts me on oxygen and I am put out and a muscle paralytic is given. ECT stimulus of just a few seconds is given and there should be a seizure of about 60 seconds. It shows up on the EEG and your toes wiggle. On to the recovery room for about 30 minutes, back to the intake room for 30 minutes and then on home where I sleep for several hours. About 100,000 people a year are given ECT. It is 80% effective.