Mental Health Indications for ECT

[simco]

I'm curious if others could help me understand when/why electro-convulsive therapy (ECT) is indicated and worth pursuing.

By way of context, I'm in my mid-40's with a lifelong history of severe depression. Several suicide attempts and hospitalizations. For over 20 years I've been on an array of almost every family of psychiatric meds (anti-depressants, anxiolytics, mood stabilizers, atypical anti-psychotics, etc.). But as I've aged, my depressive episodes have only gotten longer and worse.

I feel like I'm nearing the end of my rope in terms of trying new meds on for size to see if they might happen to help me.

While I was in the hospital last summer I met several patients who were getting ECT. For some of them it seemed to be a godsend. For others, the response was basically, meh. My own doctors considered ECT for me, but came down on the side of not trying it, though they admitted that it was a close call, and that if things worsened, they might change their minds. (The hospital was out of state, otherwise I'd talk to those doctors again.)

My understanding is that ECT is usually indicated for treatment-resistant depression. It strikes me that this is exactly what I have (though maybe there's a more technical meaning to this phrase that I don't know). Yet, when I discuss the issue with my current doctor, he sort of rolls his eyes and says no, let's try some new meds instead.

I've been going through this for years, and it feels like I'm at the end of my rope. I'm very discouraged, and I'm getting freaked out b/c I can feel the depression taking another turn for the worse. Unfortunately, I live in a very small town with few psychiatrists. My current doc sees me about once per 6 weeks, so we don't have a particularly close relationship. Frankly, he's not very observant/insightful, either.

Sorry, I know this post is pretty scattered. I suppose I'm just seeking some input on the prospects of ECT for people in situations similar to mine. Would it be worth starting to push hard to find someone who would try me on it? Or maybe I'm just looking for a silver bullet where one doesn't exist.

Any thoughts on any aspect of this problem would be a huge help.

Thanks!

 

[herbavore]

For years I was not only a disbeliever in this but I actively protested its continued use (I had only known people that were effectively punished with it against their wills while incarcerated. My thinking on it changed after a very close friend elected to try it for her lifelong depression. She also felt at her wits end and was close to suicide. It helped immensely but unfortunately only for a matter of months. After two years she elected to try it again and it had no effect at all other than further convincing her that there was no treatment let alone cure for her depression.

This was several years ago. This same friend still suffers mild depression but after many years of firmly believing that it was completely chemical in nature, she got out of an emotionally draining marriage, recreated her life in a better way and she is much happier. That level of happiness allows her to take the more mild depression in stride when it comes (and it still does).

It is a fairly radical treatment and my only advice would be to read up on it as much as you can. It can create memory problems though that usually is from repeated treatments.

 

[Phil.McKeer]

This isn't the accepted medical consensus, but I consider ECT to be an archaic treatment. Yes, people report that it does work sometimes, but people also report that baking soda cured their cancer, so I take all these with a grain of salt.

One of the biggest things about it is that as a medical treatment, it has been in use for a couple hundred years. We haven't really had good medical science until the last 100-150 years. So it was discovered and gained it's air of legitimacy when medical science was still in its infancy, and most other treatments used back in those days didn't make it to now for good reasons.

From what I can tell, the ALKS-5461 buprenorphine/samidorphan ULD treatment for refractory depression seems like a good, low-impact solution. It is specifically for treating "treatment-resistant" depression and I've tested it myself in my "laboratory". My recommendation is try 0.25mg/buprenorphine/day.

 

[cj]

Last time I was on the phych ward I saw some people receive it. The words no thanks are all that come to mind. It's a drastic step but if your out if options and can't wait a couple more years for ketamine infusions to become Frontline medicine then I guess that's your call. The side effects sound downright brutal and my roommate would lay in bed after the treatment and moan and even cry. They put diapers on the patients so I'm guessing you shut piss yourself whicheck makes sense. I'm no doctor but it looked barbaric from my point of view

 

[DixiChik]

Hello again Sim...PLEASE DON'T DO ECT!

I have 2 viewpoints...I too suffer horrifically from depression @ almost 56. It has plagued me for decades, exacerbated by one health crisis after another. I have been suicidal, going so far as putting a loaded gun in my mouth in 1987. I was a mere babe @ 26.

Not gonna lie, I still retain that as an option with 24/7 physical pain. I tell myself I can't leave my husband of almost 37 years. We're all we've got.

I've researched ECT, hoping to erase memories of both my physical and emotional pain. I won't do it, even though I've witnessed it's "success" in both my aunt and my MIL. Both of those cases were beyond extreme for both women. My aunt had gone off the deep end (understandably) when her infant child died. ECT saved her life. She recovered and lived to raise her 2 daughters. My MIL was diagnosed schizophrenic. When all modalities failed, she underwent ECT twice. Although it brought her back from psychosis, it erased her memory and her cognitive abilities.

I agree that ECT is barbaric and should be used ONLY as a last resort. And "yes" I would exit this life at my own hand before I would risk ECT.

You are going through CRISIS with your withdrawal and the death of your mom. Although I know nothing personally of WD, I do know that your mom was in a NH (like mine is). I know the stress and heartache of witnessing slow demise. You are doing a phenomenal job of coping/holding it together! Be kind to yourself. Give yourself the gift of time to heal.

I'm here if you need to talk.

 

[simco]

Thank you all so much for the replies! And sorry for not chiming back sooner.

Yes, ECT is quite a big step (whether it's a step up, forward or waaaaay backward is another question). FWIW, I have researched it a lot--for many years. My *personal* feeling is that current practice has dialed back the scary factor enough to merit considering the procedure. Honestly, it's way less freaky than interventions I've tried on my own over the years.

Nevertheless, I suspect the consensus here is right (thanks, as always BL friends). I'm going to try to move on from thinking about ECT for now.

Again, I really appreciate both the insight and the kindness of everyone who responded to my questions.

Peace

Sim