[testathon]

Hello everyone,

My partner's currently undergoing outpatient ECT for severe depression. I can't be with her this week but she's just completed her second session of bi-lateral ECT.

The doctor was a little disappointed that she didn't convulse today, i.e. they passed the electricity through her but she didn't 'cramp'/'seize' (not sure on how to describe this!). He tried a higher voltage but found the same result, although it had worked during the last session. He said that this was unfortunate and just happened with some people sometimes... He'd try the next session again on Wednesday, but this could be the end of the line for her ECT treatment.

I can't find anything about this online, so has anyone experienced something similar/can offer some insight? My partner's obviously disappointed, so some more information would be extremely useful.

Thanks!

[glok]

Hello, testathon.

Electroconvulsive therapy (ECT) Definition - Tests and Procedures - Mayo Clinic
An Overview of Electroconvulsive Therapy (ECT) | Psych Central
Risks of Electroconvulsive Therapy (ECT) | Psych Central

I could not find anything directly on point. In my view, more needs to be learned about how the induced seizure changes the workings of the brain.

I wish you well.

That can happen, particularly if patients take certain meds before ECT. It doesn't necessarily mean it will happen again though.

[Perna]

They have recently found that the seizure is necessary for a good outcome:

Response Predictors in ECT: A discussion about Seizure Threshold | British Journal of Medical Practitioners

[jjm51]

is she taking any benzo's like klonopin? thses are anti-seizure meds and one is often told not to take them before ect. just a thought.

what about the doc and the facility? not trying to cause problems, but starting with bilateral ect is not too common. somebody correct me if i am wrong on this.

hoping things go better with her next treatments.

john

[SkySailor]

You may want a second opinion regarding the ECT. From personal experience, McLean Hospital is the best location for ECT and has some of the best doctors. Perhaps you could call and ask for a phone consultation? The other very promising option, which has shown to be just as effective or more effective in some cases is ketamine infusions. There is a Dr. Keith Ablow that has a location in Newburyport, MA. You may want to call for a consultation a to a referral to a local doctor in your area. There are also allot of other locations, but it is very promising and done via IV / safe. In addition, Deep Brain rTMS is another alternative to rTMS, but the Ketamine Infusions has helped many as a very fast agent to relieve depress for several days. I hope some of this helps

[insilence]

i get mad when i hear about ect, ive only seen it cause severe detachment from reality, saw a woman who lost her basic sense of sanity from it, id prescribe marijuana if i were a doctor over ect

[testathon]

Hi everyone,

I've just written a long update post but it's disappeared!!

Thanks to everyone for your help, and apologies for the delay in getting back to you all. The links provided were incredibly useful. We were able to use the information to discuss options with the doctor for reducing my partner's seizure threshold. In the end we went for:

-250mg caffeine in addition to the anaesthesia
-Ketamine as a supplement to the anaesthesia
-Waiting two minutes longer before beginning the ECT (to weaken the anaesthetic effect)
-Having the anaesthetist hyperventilate my partner during the process

We've now had two sessions with full seizures, so a great result. My partner's also gone onto nortriptyline in line with recent research on its ability to enhance ECT's effects.

Re: starting with bilateral, I think it's because we're in Germany and that's just what they do here. I believe it's the same in the UK, and the Royal College of Psychiatrists is one of the world's leading ECT practice bodies. There's an increased risk of temporary memory loss with bilateral as I understand the situation (and I've already observed this in my partner) - but we're fighting suicidal ideation, so that's not our main concern. We're also working with the first doctor in Germany to be licensed to perform ECT on an outpatient basis, so I guess everything is strictly regulated to what they do in the hospitals. At the end of the day we're happy to try it, and I'm confident that we're being well advised. My partner has an excellent psychiatrist here in Berlin who recommended ECT to us and is monitoring everything; we've tried so much over the past few years with no results. ECT is a relatively safe and proven treatment, so it's our first choice at this stage in the game.

I have one more question for you all, if you don't mind! We have two more weeks before the doctor goes away on holiday for two weeks. If everything goes to plan, my partner will have had eight successful ECT sessions by that point. We're aiming for twelve in total, so does anyone know if a break will harm the results? I guess we won't have to start from the beginning again, but perhaps we'll essentially have to repeat a few of the sessions? Any links/advice would be greatly appreciated. I'll be able to ask the doctor in person when we speak to him on Tuesday, but some advice before then would be brilliant.

Thanks again for all of your support!

[Perna]

"Missing treatments during the acute series may cause setbacks in your progress": http://www.cwrupsychiatry.org/upload...y__ECT_mek.pdf

Does not sound like it would be your problem with 8 done, the acute series would be over?

I can only speak from experience. I've had numerous ECT's. I have found it to be extremely helpful with the depression. Going two weeks without a treatment made no difference. Although going three weeks did seem to make a difference. I am very grateful to these treatments. Everyone is different.
Sounds like you have a great doctor on your side.

[msandsm]

Hi testathon. This is only regarding uni- vs. bilateral electrode placement, and memory loss in general. Over the course of about 10 years, I've had 70 treatments. In all of them, the leads were placed bilaterally. I'm not sure I've heard of anyone having unilateral, but that's probably because I don't know many people who've had it. Regarding memory impairment, it's been fairly severe. Mostly it's been my autobiographical memory, and then long-term memory. And although my short-term memory seems ok, I have trouble moving things from short- to long-term memory. Re frequency, I was often hospitalized for two or three weeks for every-other-day treatments, but I eventually reached a point where I only needed one-month maintenance treatments. In its defense, I have to say that it was very effective for me, maybe even saved my life. But sometimes I wonder if the cost to my memory was worth it, that maybe we should have just kept trying other treatments. Although I am said to have 'treatment-resistant' depression.
Anyway, that's just my experience. I'm not trying to say that your partner will have the same issues. I'm glad to hear it's working for her now that they've found a way to get her to have seizures.
Good luck to both of you!