Posted by SLS on July 4, 2005, at 7:06:13
In reply to Re: What all medications have you taken Denise ??, posted by Denise1966 on July 4, 2005, at 5:49:15
Hi Denise.
Well, as I've said before, it appears that the drugs chosen for you were judicious and followed a course of varying mechanisms. I am curious, though, what combinations you have tried.
I would not dissuade you from trying ECT at this point. Still, I don't think you are at the point in treatment to take on procedures with substantial great risk. My feelings about the risks of ECT are mixed. I haven't even decided which hemisphere of the brain is best stimulated in unilateral treatments, although unilateral right seems to be most often used today. Mine was unilateral left followed by bilateral. I read something recently done by Harold Sackeim MD and Sarah Lisanby MD indicating that high dosage right unilateral is as effective as bilateral but with a much reduced occurence of cognitive side effects.
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Arch Gen Psychiatry. 2000 May;57(5):425-34. Related Articles, Links
A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities.
Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, Fitzsimons L, Moody BJ, Clark J.
Department of Biological Psychiatry, New York State Psychiatric Institute, NY 10032, USA. has1@columbia.edu
BACKGROUND: Controversy persists about the use of right unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT). While RUL ECT results in less severe short-term and long-term cognitive effects, there is concern that it is less efficacious than BL ECT. METHODS: In a double-blind study, 80 depressed patients were randomized to RULECT, with electrical dosages 50%, 150%, or 500% above the seizure threshold, or BL ECT, with an electrical dosage 150% above the threshold. Depression severity and cognitive functioning were assessed before, during, immediately after, and 2 months after ECT. Compared with baseline, responders had at least a 60% reduction in symptom scores 1 week after ECT, and were monitored for relapse for 1 year. RESULTS: High-dosage RUL and BL ECT were equivalent in response rate (65%) and approximately twice as effective as low-dosage (35%) or moderate-dosage (30%) unilateral ECT. During the week after the randomized phase, BL ECT resulted in greater impairment than any dosage of unilateral ECT in several measures of anterograde and retrograde memory. Two months after ECT, retrograde amnestic deficits were greatest among patients treated with BL ECT. Thirty-three (53%) of the 62 patients who responded to ECT relapsed, without treatment group differences. The relapse rate was greater in patients who had not responded to adequate pharmacotherapy prior to ECT and who had more severe depressive symptoms after ECT. CONCLUSION: Right unilateral ECT at high dosage is as effective as a robust form of BL ECT, but produces less severe and persistent cognitive effects.
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> Also, I thought you were going to give mifepristone a trial, what happened to that idea?Well, I was all set to proceed, but I started responding to Trileptal. All the paperwork is complete, the FDA granted me an IND, and I can begin treatment within a month if it were necessary. I must first more fully explore Trileptal by pushing the dosage. I moved up my appointment to see my doctor to later this week. I really would like to jump up from 900mg to 1200mg. I am so tempted to self-medicate, but I think it is important to exercise a little discipline at this point. I can't sit too long on the mifepristone thing, though. I believe there is a limit as to how long the IND remains in effect.
- Scott
poster:SLS
thread:522086
URL: http://www.dr-bob.org/babble/20050702/msgs/523229.html