ECTs?

Had them to try to get the depression under control. Didn't work. Just wondered if anyone here has had them? And if so did they work?
Pugnose and her peeps

yes, i had them. no, they didn't work. ect sucks. and it totally messed up my memory...

I had ECT as well a couple of weeks ago. It didn't help me at all, besides adding a nice few things to my list of triggers.

I don't think its an affective treatment whatsoever, tbh. I think it just screws you over more. At least for me it did.

ECT Does SUCK!!!!
Until the new SSRIs and atypical anti-psychotics came out, about 15 years ago, I didn't respond to medication at all.
So, I did ECT. I had so many series, I lost count. I was even on maintance ECT--where you get it once a month whether you need it or not. But, they did help. They were the only thing that ever helped. But, because of the ECT, I don't really remember several years of my life, so I really don't know how much they helped. I was just told I benefitted from them.
I do know of a lot of people that have been helped by them. But, I would think long and hard if I were considering them again.
ECT comes with a price!
There is also the stigma attached.
I was even afraid to tell people here at PC, I'd had them.

what is ECT?

Electro-Convulsive Therapy. AKA Shock Treatment. The stuff they've added an element of horror to through the movie One Flew Over the Cuckoo's Nest. Not that it's so fearsome anymore... they knock you out and shock your brain, trying to make it work right. Side effects are stuff like seizures, headaches and memory loss.

It's not very useful unless you're catatonic, really...

electroconvulsive therapy (aka: 'shock treatment')

i had a course of 12. subjectively: no change. objectively: i seemed perkier, apparently. not sure if it was wishful thinking, or justificatory thinking on the part of clinicians. it was very much considered a last resort strategy. i withdrew consent because i didn't feel that there was a change. i'm not quite sure what to think...

bi-lateral ECT has a risk of messing up linguistic abilities (categorizing objects etc). i think i have 'directory issues' that i'm fairly sure i never had before. but without extensive cognitive testing both before and after it is hard to know.

there is an argument that the effects of ECT are correlated with the amount of memory disruption that is caused by it. basically... the memory disruption might be precisely what is responsible for its efficacy. in other words: the more you damage / disrupt the brain the more effective ECT seems to be with respect to lifting mood. so... alleviation... at what cost?????

personally... i'm skeptical about it. the best theory we have currently of epilepsy is the 'kindling theory' where seizure activity tends to promote seizure activity. as such... anything that promotes seizure activity in the brain (e.g., ECT, TMS) might well result in epilepsy. something to be avoided methinks. that being said for the most part ECT is considered a last resort strategy that is utilized only after alternative options have been exhausted. that being said there are a few doctors who swear by it and are (by my lights) a little too 'trigger happy' for my tastes...

last resort IMHO. we simply don't know enough about how or why it works (and i'm concerned about the research which is mostly carried out by the manufacturing companies that stand a lot to gain if it catches on).

Yeah... didn't work that way for me, anyway. No help, plenty of memory loss. I'm convinced ECT is crap.

> didn't work that way for me, anyway. No help, plenty of memory loss. I'm convinced ECT is crap.

cognitive testing would be required in order to establish the extent of the memory loss (from mild to moderate to severe) and the extent to which the loss has been recovered. i'm fairly convinced it is crap, too... but then i've heard that it can work wonders for catatonic varieties. guess once catatonia kicks in there ain't a lot to lose (though i don't know about rates of spontaneous recovery or liklihood of relapse after treatment. actually i've heard relapse is a problem 6 months post which is why follow up studies after that happen to peter out).

in hindsight... wish i never had it. know people who swear by it, however. and ultimately (as with any other med) need to average data across a number of people rather than paying too much attention to outliers...

interesting discussion, thanks for starting this.

i haven't had it, but my pdoc has suggested it to me twice. the first time i was so far depressed i didn't even understand what he was saying. oh sure, the words were sinking in, but informed consent?! if i had my wits about me enough to make a decision that big, i wouldn't be needing ect.

the second time he suggested it, it was more along the lines of... "we'll try xyz drugs first, and as a last resort ect". i was functioning at the time, so i gave it a lot of thought, and i've come to the conclusion that i dont think it'll be something that's right for me. i'm scared about the memory loss, the stigma, and also the fact that no one knows why it (apparently) works. i think it's too much of a gamble - risk losing your memories for something that might not work, and which may relapse anyway.

I haven't had them, but a girl who was in the same psych. ward as me for a month did.. did absolutely nothing for her.

Apparently there's some sort of test that they use to score our depression and treatment;
Level A to B = Mild depression, Therapy is sufficient
Level C to D = Depression, Antidepressives is sufficient
Level D to E = Severe depression, Antidepressives accompanied by therapy is needed
Level E to D = Emergency, no medication will work, ECT is needed.

My friend was like.. on level Q. I think the ECT-level is around 40-50, she scored 80.
It's gotta be a freagin enormous blow to your soul when you discover that ECT doesn't work for you. I saw what the treatments did to her; she lost all her energy, she slept all day long, she got sick really fast, she got seriously confused alot, she forgot things very easily, even stupid things like where she put her soda bottle when the bottle was in her hand - and when she took a look at how she was reacting to the treatment she'd start crying. She didn't even have the energy to walk on the ECT days, we had to roll her around in a wheelchair.

It was so painful to witness that, she was a good friend of mine. ECT is horrible, and I don't think that many people know that they still use ECT as treatment.

I've read that Psychiatry doesn't even know, by way of scientific studies, how any psychotropic drugs work, or why. They only theorize they prevent normal brain functioning by blocking neuroreceptors in the brain. They never correct imbalances. They work by impairing the brain and dampening feeling is various ways. Sounds a lot like ECT, to me.
It's very difficult to do double blind experiments with psychotropic drugs, as well. Because the scientists know the common side-effects of the drugs--hands shaky, dry mouth...It's not really blind, is it? They know which subjects are taking the placebo and which are taking the real drug that they are testing, so how can they be objective?
Don’t misunderstand me, I am not saying--don't take your meds. I take mine and they help ease my pain, so I take them.
What I am saying is, drugs are no better and no worse than ETC, as far as if they will help you, who they help & who they won’t help, how they work, and how long the effects will last and the price you pay as far as brain impairment.
And remember, plenty of people, including me have relapsed taking a medication that at first helped them.
I have had ECT, tons. The first time, I was deeply depressed and it was like a gigantic weight was lifted off of me. It was such a wonderful relief. But, 6 months later—depressed again. And so it went, for years. Now the new drugs help me. But, if I had to do it all over again, if I became that depressed again and no meds helped, if it was a matter of killing myself or ECT? I’d do it again. And I wouldn’t care how it damaged my brain. At least I’d be alive.

Lbien6, no that's not how SSNRI's work, and ECTs don't affect the noradrenaline level as far as I know, it only stimulates the production of serotonin.

The two major mood-controlling chemicals in your brain is serotonin and noradrenaline. Noradrenaline is the neurotransmitter that shoots information (serotonin) to the rest of the brain. The brain cells absorb (nulling) most of that information, SSNRIs decreases the amount that the brain cells absorb.
When you're depressed, your brain - including noradrenaline - is underactive, meaning it doesn't shoot out that much information to begin with; and the majority of little that it manages to shoot out is absorbed into the braincells.

So instead of increasing the serotonin level like SSRIs do, SSNRIs simply block some of the absorbtion. So no, they don't dampen feelings nor impair the brain; and yes, they do correct imbalances. I'd say they're crucial for bipolars. And the medical/psychiatric researches know perfectly well why and how both SSRIs and SSNRIs work - the epileptic medicines (toperimate and lamotrigin) are still a mystery though.

You can't put all of the different medications in one box, and I'm pretty fed up with this doomsday-propaganda buzzing around about medications.

If a med doesn't work for you, or if you experience negative side effects: Change medication. It's not any worse than that. I don't understand why certain people make such a big deal out of it.
Everybody runs into a medication that doesn't work for them, we're individuals after all. If there was one medication that worked for everybody, we wouldn't have 1838143742 different types of antidepressives, mood stabilizers and antipsychotics.

Brain impairment, jesus. Please, spew your propaganda elsewhere.

oh, that was a bit harsh, theama. whilst i dont agree that anti-depressants work by "impairing" brain functioning, i do agree with Lbien6 that, at best, we only have theories as to how depression works and how to treat it. the serotonin hypothesis of depression, for anyone who has cared to look at it, does seem to be a load of bunk. it misses a huge part of the story.

Lbien6 - i'm glad ECT worked for you when you needed it. i think i would be scared of the memory loss. i am lucky in that i haven't experienced too many adverse side effects from the drugs i've been on - the worst that has happened is i had a severe allergic reaction to one and passed out for 15hrs. but my memory - my intellect - whatever, that's such a huge part of my identity that i would personally be too scared to gamble it away.

I certainly didn't mean to offend you. It seems I hit a sore spot. Which I can understand—I'm sorry. I don't think you needed to be quite so personal in your disagreement with my opinion. I am glad for your information, though.
I was just relaying some info I found on the Internet that seemed to make sense to me. I didn't mean to use it as propaganda. I will study what you posted and see if I can wrap my head around it, too.
But, basically, I was trying to say something similar to your main point. Aside from how or why meds work or how and why the brain works--Everyone reacts differently to different meds and then I just wanted to point out that it is the same for ECT.
I also want to make it clear that I wasn't suggesting meds don't help. I think they do. But I also think they can and do have a price just as ECT can and does.

No, you didn't offend me. ^_~ I'm just sick and tired of the terror-propaganda being spread around about medications, I've seen it -one- too many times, and I've seen how people who are newly diagnosed get confused and screw things up for themselves.
There are people who can function without medications, and there are people (like myself) who would be dead if it wasn't for these apparently brain impairing medications. The best we can do is to lay all the cards on the table for them, without taking a side in whether SSRIs and SSNRIs is the right way to go or not.

There's a lot of false information out there, and I think because we all would prefer NOT to munch chemicals day in and day out - it's tempting to believe everything we read. I have felt this 'brain impairment', my memory and my vocabulary is horrible now thanks to me having to try a gazillion medications before I found the right one. It doesn't bother me one bit. I'd rather have small issues with my memory and vocabulary than being suicidal.

I apologize for my outburst It's just one of the things that ticks me off.

And I agree with you about ECTs as well, but I think that they should be a last-resort thing only; just like how people should try therapy and other non-chemical methods before they take medications.

The causes for depression can be sociological as well as chemical. And no, the serotonin"theory" is hardly bunk. The old theory, the "low level of serotonin = depression", yes - that one is bunk. Actually the whole chemical imbalance hypothesis is the only one that makes any sense at all. And tbh, I think that the scientists know more about it, and understand it better, than we do - so if the chemical imbalance hypothesis is what they're putting their money on - I'm with them.
I've read up on chemical imbalances quite a bit since I don't know why I'm bipolar (no genetic link), and I had to dig deeper than most bipolars to find some answers.
The answer is: No one has any clue what so ever what causes bipolar disorder, except that it's biological and causes a chemical imbalance in the brain.

The part of the brain known as the hippocampus is smaller in people who have a history of depression than with people who's never been depressed. A small hippocampus = fewer serotonin receptors (bipolars have a constant level of serotonin btw).
That only applies to recurring depression of course, depression can be caused by stress, grief, chronic pain, etc. But for whatever reason the person is depressed, depression leads to this:



An underactive brain = the neurotransmitters are underactive = not enough serotonin, noradrenaline or dopamine is being passed around. And to add, the brain cells absorb the little that is being passed around. The absorption is the real problem.
There's constant progress in the research that's being done on the chemical and biological aspect of depression, and bipolar disorder.
SSNRIs work beautifully on bipolars, as opposed to SSRIs which do practically nothing. For non-bipolars, SSRIs work like a charm.
Walk like a duck, quack like a duck..

http://www.brainexplorer.org/bipolar...etiology.shtml
http://www.allaboutdepression.com/cau_02.html
http://www.anxiety-and-depression-so.../serotonin.php
Read more there. Brainexplorer is a good site for this topic, the other ones tend to 'dumb' things down and leave out various theories and variables.

Theama,
Haven't checked out those websites yet, but thank you for them and I plan to visit them!

One question that popped up, and you seem pretty knowledgeable in these matters, was--I'm on Wellbutrin XL and have been for years and years. It "seems" to really help me not descend into a deep, prolonged depression. It is a unicyclic aminoketone, which is unrelated to SSRIs, SSNRIs, MAOs, and any other type of anti-depressant.
As far as bipolar I disorder goes, is it uncommon for it to help? Is it in any way plausable to come to a conclusion that I might not be bipolar because this helps me instead of a SSNRI?
In your opinion. And I know you aren't a pdoc and can't diagnose here at PC, blah blah blah...
I just want your opinion based on your research.
Like you said, Walk like a duck, quack like a duck..

i don't follow the research on bipolar disorder anymore. i do follow the research on depression. there are physical correlates of depression found even in people who are 'just' (and i use that very lightly) bereaved by a death in the family.

i dont think anyone would seriously hypothesise that it's the lack of serotonin/dopamine/whatever that is causing the depression. rather, that their mood is normal reaction to social events.

if you read around enough, you'll find that not even 'the scientists' are in agreement over the chemical imbalance hypothesis and the likes.

i'm not posting to stir you up, just respectfully putting forward my own (informed) point of view.

People who vote democrat vote differently from people who vote republican. That is a scientific fact.

The brain scan on the left looks different from the brain scan on the right. That is a scientific fact.

The brain looks different before compared to after ECT.

Neurotransmission looks different before compared to after taking neurotransmitting altering substances.

While there are differences in the above... When are we justified in considering a difference to be a dysfunction? That is not a matter for science. The objective facts can't tell us...

> I'm just sick and tired of the terror-propaganda being spread around about medications

Well... Others are sick and tired of the terror-propaganda being spread about how people with a dx of mental disorder are 'dysfunctional'.

'Terror propaganda' is probably a term best avoided...

> I'd rather have small issues with my memory and vocabulary than being suicidal.

And that is a reasonable decision to make. It doesn't undermine the claim that the problems with memory and vocabulary are dysfunctions that are caused by the treatment, however.

> Actually the whole chemical imbalance hypothesis is the only one that makes any sense at all.

We don't know a great deal about neurotransmitters. Most probably haven't even discovered them all yet. We know next to nothing about glial cells and what they do. We know next to nothing about how genes express so as to create neurotransmitter or the receptors they bind to. We really... Don't know very much at all about the brain. This isn't to say that we have a well developed alternative theory to the chemical imbalance theory as yet... But we know that the chemical imbalance theory is basically false... Or at least... Only a small part of the story.

It is pharma that puts their money on the chemical imbalance hypothesis. No prize for guessing why.

> The part of the brain known as the hippocampus is smaller in people who have a history of depression than with people who's never been depressed.

On average or in every single individual with a history of depression? On average. As such... My personal hippocampus could be bigger than average even though I have a personal history of depression. As such... The hippocampal theory of depression doesn't explain MY PERSONAL depression. AT ALL. There are other conditions that also result in a smaller hippocampus. Smaller hippocampus is neither necessary nor sufficient for depression.

What you have to say about the biochemistry of depression... Is basically the 'party line' of the pharma companies and the pharma funded studies...

i'd be interested to know
a) what kind of scan that is so i know what the activity is measuring
b) the co-ordinates of the slice (so i can tell left from right and the depth - or at least front from back)
i'm assuming the groups were matched with respect to task (what kind of task are they doing?)
c) how many people is the data averaged over?
d) do you have a key on what the colors mean?

my concern is mainly that it looks a little like the people on the right are performing a visual task whereas the people on the left are not.

how do we know that the chemical imbalance theory is basically false? this is a sincere non-snarky question. I haven't heard that before.

i tend to feel that people go overboard demonizing meds. i know there are lots of bad side effects and the pharma industry is no model of ethics. but a lot of the time (no not all the time) the meds work. it seems to me that people are frankly superstitious about meds, maybe holding old, strange cultural values about the value of suffering, like how some people want to give birth without painkillers.

still this is just an intuition on my part. i'm sure people have reasons that are good enough for them and that's their own business. i'm very glad i don't have to make a decision for anyone else.

Touche I love that! Both points.
Dysfunction is a subjective lable. It has nothing to do with science. It's a judgement, usually a moral or cultural one.
I feel that my medication alters my personal experience of pain. This is my subjective opinion. I would like to make the decision as to whether I take those meds or have a procedure done, like ECT, based on the scientific evidence and/or theory I have available to me and my subjective experience of what it does for me.
A response or rather a reaction to your other point, Kim:
I personally feel objectional about using the term dysfunctional to describe myself or anyone, with a mental illness diagnosis. This word emphasizes a failure on the part of the mentally ill to perform what is expected of us in our society. I personally believe every human being has the potential to contribute to society, no matter what their mental or physical faculties may be.
I also believe using this word, dysfunction, reinforces our personal feelings of worthlessness, that those very mental illness are causing us to have.
I realize it is a matter of semantics. I definitely believe that it is not intended as derogatory by anyone on this thread or anyone belonging to PC in general. I believe they do not mean it negatively at all.
I just want to point out that it could be interpreted this way, even if only sub-consciously, and that we shouldn't use such a deprecating, devaluating word to describe ourselves. I also believe people unfamiliar with mental illness, should hear us described in a more positive light--as contributing and deserving members of our society. Not as defects!
I'd much rather describe maybe even celebrate our "dysfunction" as a "difference" a "uniqueness" instead.
At the same time, I am not saying that we are not disabled. We are. I am not saying that these "differences" do not cause us hardship or pain. They do!!!! I am saying that, in my opinion, every human being must live life according to their personal strengths and weaknesses and everyone finds their journey through life hard and a lot of times painful, whether or not they have a mental disorder.

If the problem was a chemical, or neurotransmitter imbalance, the effect of anti-depressants would be immediate rather than 4 or 6 weeks later. The changes the medications make are not solely at the neurotransmitter level. Incidentally. Talk therapy produces similar, and as effective treatment in most cases. We don't know why medications work, we just know they do work.

> If the problem was a chemical, or neurotransmitter imbalance, the effect of anti-depressants would be immediate rather than 4 or 6 weeks later.

Bingo. Does take some time for medication to cross the blood brain barrier to build to therapeutic levels in the brain... Trouble is that even when we take that into account there is still too much of a time delay between that and behavioral alteration.

This is the case for medications for depression and medications that work to alleviate the symptoms of psychosis as well (e.g., antipsychotic medication). To be fair... I'm not sure whether this applies to lithium. But then... Not every case of bi-polar is responsive to lithium.

If the problem was with neurotransmitters then one would also expect to find evidence of this on autopsy. Such things as an increase or decrease in the amount of transmitter in synaptic vessicles, an increase or decrease in the cells that metabolize transmitter while it is in the synaptic cleft, an increase or decrease in the number of receptor sites that the neurotransmitter binds to... something like that. unfortunately... such 'differences' have not been forthcoming...

These were developed ages ago. For all the hype... There really haven't been significant advances since then... Except to anti-anxiety medications, I guess (though problems with addiction and abuse arising)

differences that have been found between the 'disordered' and 'non-disordered' brain haven't been adequately controlled for either. especially in the case of schizophrenia it is unclear whether the differences are CAUSED BY the medication that the person has been taking over the years rather than the differences themselves being the cause of the disorder. The Nazi's carried out many an autopsy on the brains of people who had schizophrenia in particular. This is important because this is before the development of anti-psychotics. The running joke was: 'It is easy to tell the brains of people with schizophrenia. They are the ones that look normal'. While we have microscopes etc that are able to make finer discriminations the problem... Is recurring...

Talk therapy might work by changing neurotransmission. Unless therapy works by divine intervention... It must work by altering the brain in some way. Trouble is... This assumption (kind of needed for a lot of science) that you can alter a single variable and expect that everything else will remain fixed except for the downstream effects. Problem is that the brain is immensely complicated. It has lots of feedforward and feedback. When you alter one thing (e.g., provide something that mimics a neurotransmitter) then the brain basically does what it can to minimize / counter the alteration. So... Increase in transmitter will result in decrease in sensitivity in the receptors that are present or increase in the cells that metabolize transmitter or whatever. The serotonin and dopamine system are interactive, too such that alterations to one result in alterations to the other... Big ****ing mess... Scientists are trying... Are making progress (don't get me wrong). But... ACADEMIC scientists (as opposed to those who are funded by pharma) will typically say: BIG ****ING MESS

Also... With respect to efficacy... Psychiatry is typically regarded as one of the most underdeveloped areas of medicine. Not doing to well as neurology (we better understand peripheral neural processes such as reflex circuits than we understand central neural processes like language and memory and attention etc). Treatments... Basically... Aren't very effective. The best cases of efficacy for psychiatry are 1) Lithium (problem: lithium is a naturally occurring substance that therefore can't be patiented. Hence considerable efforts to develop other medications that are just as effective that can be marketed as having 'less side effects' or for being 'safer' in some way. We don't have anything else as effective as lithium for bi-polar, however. But there are other reasons why people might want to avoid that (possible complications arising). 2) Chlorpromazine. for delusions and hallucinations. also works (this is cited in medical textbooks) as a 'chemical straight jacket'. That is thought to be a considerable virtue. ethical issues to do with physical restraints are 'less overt' with chlorpromazine. Took 10-15 years for the Parkinsonian like tardive dyskinesia symptoms to be acknowledged by pharma. That corresponded (interestingly enough) with a whole 'new generation' wave of anti-psychotics with the virtue that the patient on Chlorprom had run out whereas the patient on the 'new generation' had just begun. Whether the 'new generation' will also be found to result in Parkinsonian like symptoms or not is something best assessed as we near the 10-15 year end of patient mark...

There are some interesting ones for anxiety, too.. Pharma made more money off anxiety treatments than they made off any other medication in the history of the world. Imagine that. More off anti-anxiolytics than they have made off cancer treatment. HIV treatment. Unbelievable... And very very very very very lucrative.

SSRI's were never thought to be (or marketed as being) more effective than MAOI's (most of the response to SSRI is placebo - even the pharma findings show us that). But 'less side effects than previous generations'. No need for the MAOI diet. We will see whether SSRIs are relatively low side effect as we near the 10-15 year mark... Pharma has already backpeddled on 'discontinuation syndrome' (withdrawal from stopping taking it). Sexual dysfunction... Starting to backpeddle on that, too. Suicide warnings on anti-depressants for those who have 'paradoxical reactions'. An acknowledgement that they probably aren't best given to kids...

History of psychiatry is an interesting read. I'd reccomend Edward Shorter as a reputable historian of psychiatry. Try and avoid the 'pop science' type reads... Basically... Go with the academics who are writing to an inter-disciplinary academic audience as much as possible. That way they feel some compulsion to reference their claims and be accountable for them... But they shouldn't assume a medical background in particular (so they should explain what they mean). Richard Bentall 'A history of madness' is also an interesting read. American Psychological Association prize winning... Also... There is the complication of 'undisclosed financial interest' which basically means that pharma is funding a psychiatrist or a doctor or an academic. It can be very lucrative to receive pharma funding. There is a term we have for it: selling out.