How do you know if you need ECT?

I feel like Ive taken every med there is

Past Meds:
Paxil
Zoloft
Celexa
Wellbutrin
Prozac
Remeron
Neurontin
Vistaril
Effexor
Klonopin
Restoril
Ambien
Lithium (just for a few days & I wasnt drinking enough so the pdoc inpatient took me off if it - I'd be willing to try again)
Ritalin (I really really miss this drug, I have zero focus)

My current meds are on my signature and I don't feel that they are really helping either

Any thoughts?

I'm not a doctor or a psychologist but it has always been my impression that the ECT is needed if your depression is severe and it is often used as a last resort, once all other remedies have been tried and tested.

disclaimer: ECT scares the crap out of me and I am horribly staunch in my refusal to EVER be put through it...

That said, I highly recommend a specialized trauma treatment program for your PTSD before you consider ECT. It can make all the difference. I had been on countless meds (anti-depressants, anti-anxiety, mood stabilizers, anti-psychotics, off-label meds for depression and PTSD, all meds suggested for treatment of PTSD, several combinations of any or all of the above), and was in and out of the hospital roughly 20+ times in one year, several times close to death due to an OD or self-harm (not related to suicide attempts, but seen as such by the doctors because of their severity). That last time in 2011, the psychiatrist tried to force me into ECT (by attempting to have a judge declare me incompetent, but that did not work). My therapist (who specializes in trauma treatment) was against the idea of ECT, and i trusted her. She helped me advocate for a trauma specialty inpatient center, and I went to one in Washington DC. That 2 weeks made a HUGE difference and snapped me out of my cycle. Not only was there actual intensive therapy there, but they got me started on my trauma work in greater detail. I wish my insurance had not forced my discharge after a brief 10-day stay, but even that worked wonders. If you have the means, try looking into a specialized program for your type of trauma. The Sidran Institute has a comprehensive list of trauma centers throughout the US. (found here). Check it out, it may work better for you.

I was hospitalized for a really bad depression several times in one year, and it was so dark I no longer got out of bed, bathed or ate for weeks on end. No med helped and the ECT did bring me around...but at great cost. Too great a cost.

I've heard others talk about lingering effects from ECT. My cousin who is a pdoc talks about ECT like its just a wonderful cure-all and she tries to push it on some of us in the family with bipolar. Could you maybe share what you mean by "too great a cost?"

I had 15 ECT treatments - and for me the cost was at least 1 year memory, and short term memory issues, that I really had to work on to regain. That was particularly bad, because my kids were 7 and 10 - and socially active - and trying to remember other parents, and directions to places and stuff was terribly awkward for a while. Worse is that I was misdiagnosed forever - and was properly diagnosed during the treatments - started on ADHD medications and poof - no more depression - since it was probably resulting in misdiagnosis, and mis-medication for 10 years. I personally would never do it again - and I take no meds anymore. I do not credit ECT for seeing life differently - because while going through ADHD medications and being overwhelmed with all of the old frustrations and such - I could easily fall right back into a depressive mode - because of my circumstances. I do believe that it has helped people though. And not everyone losses memory.

Thank you Greenfrog. I don't see myself doing it because of stories like yours. I would like to see someone do a survey of people who have had it done, and if they would do it again. There just isn't enough information out there for people to make an informed choice IMO.

I had a number of breakdowns from '86-'92. I didn't respond to ADs (or APs) and my Dr. at the time was not sure of my diagnosis but my depression was very severe. I had an evaluation in the hospital with the Dr. who specialized in ECT and he recommended me. I had x16 during Summer '92 and I hit rock bottom but slowed my racing thoughts down just a tad. Didn't have any permanent side effects. PDOC in 2003 told me that ECT benefits BP patients more than unipolar depressed patients. Now I know that I'm agitated depressive (mixed manic) and took me yrs to find correct diagnosis and still looking for relief from certain symptoms. (I responded well to Paxil 1996-2000 but wore off.)

My depression is quite stubborn, but I would never agree to ECT. Its up to the individual though if its worth it to them I'd say just remember its important to educate yourself on the potential benefits and risks.

Otter, good balanced piece by someone who's been there and had the same problems you see:

Vicarious Therapy: ECT I: Making the Decision

That was very good Perma, thank you. The comments were interesting too. Seems like it can vary so much from person to person.

Many years ago I was training to be a Psychiatric Technician (I had to quit because of family problems). While doing clinicals I was able to observe someone receiving ECT.

My mom and uncle both had ECT back in the day when it was "One Flew Over the Cookoo's Nest" type of thing. They both had what clearly could be labeled as bipolar episodes when they were young and then never took meds or had another episode. My mom has always been against my sister or me taking that route. Maybe ECT is responsible for their lack of bipolar episodes. My mom believes it messed up her memory, but she has a better memory than I do.

My greatest concern is an account from a friend who saw his cousin go from a functional, intelligent person to a person who is not functional.

I think as that article points out, it is unfortunate that many of her doctors were dismissive of the side effects. Doctors seem to sometimes get tunnel vision and refuse to see what's in front of them if it doesn't line up with what they believe.

I have been through ECT twice, and it saved my life twice. It isn't something I would recommend to people lightly though. I get concerned when I hear people say they want ECT because "nothing else has worked". My fear is that they believe that ECT is a cure and will solve their problems.

ECT is a treatment, NOT a cure. As in all treatments, there is no guarantee it will work, it comes with potential serious risks, and the effects even when positive are rarely permanent.

I chose ECT both times because my depression was so severe that I had already been hospitalized for a fairly lengthy period of time because I was not at all safe to be out due to impulsive, serious suicidal behaviors (not just ideations). ECT allowed me to see very rapid improvement in my condition so that I was able to actually return home in a matter of days after starting treatments rather than remaining weeks or possibly months longer inpatient, away from my husband, my sons, and my livelihood. Things turned around for me that fast, and life returned to normality so much faster because of ECT.

It wasn't a cure, but I knew that going in. I had very little memory loss, only for isolated short-term things like what did I eat for lunch that day or details about my time inpatient (which was perfectly fine to forget as far as I'm concerned). I returned to work soon after treatments concluded and had no long-term memory or cognitive impairment.

In MY case, ECT was the right decision. I know several other people personally who went through ECT with almost the exact results and for the same reasons. It isn't a treatment to just try on a whim just because nothing else has worked. I personally would not have ECT on a maintainance basis though I know that works satisfactorily for some people.

Would I have ECT again? Yes, but it would only be if, God forbid, things unfolded similarly for me again. I have never quite been in that position again since then though, and will hopefully never have to make that decision again.