![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 39. This is the beginning of the thread.
Posted by Phillipa on May 31, 2008, at 11:55:14
According to the same TV program on Depression It Was cited that ECT works I think it was 80% of the time. Is This true? If so it would seem a lot more people would opt for it. Said only a little short term memory loss. I saw a girl once had one treatment and seriously was back to normal and happy. True or not about ECT. Said it is so safe now and showed a woman elderly getting it and she was thrilled as well as her husband as she was back to the old her which was happy and outgoing? Love Phillipa
Posted by bulldog2 on May 31, 2008, at 12:13:56
In reply to Same Depression Program As Above ECT Works 80%, posted by Phillipa on May 31, 2008, at 11:55:14
> According to the same TV program on Depression It Was cited that ECT works I think it was 80% of the time. Is This true? If so it would seem a lot more people would opt for it. Said only a little short term memory loss. I saw a girl once had one treatment and seriously was back to normal and happy. True or not about ECT. Said it is so safe now and showed a woman elderly getting it and she was thrilled as well as her husband as she was back to the old her which was happy and outgoing? Love Phillipa
I thought you had ect many times. did you experience any success on it?
Posted by Phillipa on May 31, 2008, at 12:17:22
In reply to Re: Same Depression Program As Above ECT Works 80%, posted by bulldog2 on May 31, 2008, at 12:13:56
Hi No not had ECT did you? Foot massage only so far. Love Phillipa serious about the question did you see the program was quite impressive.
Posted by bulldog2 on May 31, 2008, at 12:47:45
In reply to Re: Same Depression Program As Above ECT Works 80% » bulldog2, posted by Phillipa on May 31, 2008, at 12:17:22
> Hi No not had ECT did you? Foot massage only so far. Love Phillipa serious about the question did you see the program was quite impressive.
I've had many ects..Today's Monday right..missed the program because I can't find the TV
Posted by IAMtheWalrus on May 31, 2008, at 13:06:52
In reply to Re: Same Depression Program As Above ECT Works 80%, posted by bulldog2 on May 31, 2008, at 12:47:45
> > Hi No not had ECT did you? Foot massage only so far. Love Phillipa serious about the question did you see the program was quite impressive.
>
> I've had many ects..Today's Monday right..missed the program because I can't find the TVECT didn't affect my memory...what was the question?
Posted by Racer on May 31, 2008, at 17:36:09
In reply to Re: Same Depression Program As Above ECT Works 80% » bulldog2, posted by IAMtheWalrus on May 31, 2008, at 13:06:52
If anyone has had a positive response to ECT -- even if temporary -- would you be willing to report on it? Just how bad is the memory loss? I've heard that it's horrendous, that the ECT itself isn't helpful, that it's a mistake -- but I've also heard that it's been a life saving choice for some people.
And I have heard doctors admit that they downplay the memory loss.
So, if someone has had a positive experience, would you tell us about it?
Thanks.
Posted by bleauberry on May 31, 2008, at 19:49:53
In reply to Same Depression Program As Above ECT Works 80%, posted by Phillipa on May 31, 2008, at 11:55:14
I would not trust a TV program. Trust real life people. When was the last time you saw someone here that had ECT and had good things to say about it? If that were the measuring stick, then success rate is about 20% not 80%.
As an ECT survivor, I won't go into my story yet again, just to say it is not remotedly close to what they claim it is except for a few scattered success stories. Risks aren't bad though...in a worst case scenario one would come out of it in about the same shape they went in, would have marked, and sometimes remarkable, permanent amnesia, as well as other unresearched but often reported on things such as super sensitivity to further medication trials. Another big risk is the wallet. ECT costs more than a brand new car.
Posted by Justherself54 on May 31, 2008, at 21:26:56
In reply to I'm curious, too, about the effects, posted by Racer on May 31, 2008, at 17:36:09
> If anyone has had a positive response to ECT -- even if temporary -- would you be willing to report on it? Just how bad is the memory loss? I've heard that it's horrendous, that the ECT itself isn't helpful, that it's a mistake -- but I've also heard that it's been a life saving choice for some people.
>
> And I have heard doctors admit that they downplay the memory loss.I had ECT...only 5 treatments as it stopped me from sleeping. The memory loss for me is more of an annoyance. If someone is talking to me about something and I don't remember I find that if they start at the beginning and give details, the memory comes back. It's not like I lost treasured memories...just day to day stuff that happened while I was in the hospital.
An example..my neighbour was in the hospital for gall bladder problems and we watched a movie...I remember watching the movie and the name of it, but I had no recollection of her being with me...
Desparate times mean desparate measures...I hold no grudges and have just learned to accept it. I've had more severe memory loss from being in the horrid depression than I did from ECT...
I have a friend that the only thing that helps her depression is ECT...she goes for maintenance treatments and is doing fine...
>
>I can't really say the outcome was positive as it was short term and didn't work for me...My pdoc didn't downplay the memory loss...at that time some memory loss was OK by me...better than the alternative. Given my circumstances I still don't feel it was a mistake to try it...
>
Posted by Zeba on May 31, 2008, at 23:41:24
In reply to Same Depression Program As Above ECT Works 80%, posted by Phillipa on May 31, 2008, at 11:55:14
I had only 7 treatments over a year ago and still suffer from short term memory problems. I can't read a book unless I read it all at once. If I were to read a chapter per night, I would be sunk as I would not remember what I read the night before.
Psychiatrists who favor ECT do not really know if it hurts their patients or not as they do not do follow up research for the most part. I proposed my ECT doc do this, but he opted not to.
I have yet to meet someone who did not have memory problems beyond some memory loss for a short time before or after the ECT. Ironically, I remember a lot about getting the ECTG and being wheeled down to the recovery room to be zapped. I also remember once coming out of it and struggling to sit up as I could not breathe. I remember them pushing me down and saying I could not get up. I think they gave me a shot and just decided I was delirious. Not so. I remembered and told them to elevate my head next time as I have pulmonary problems. They did (the nurses) and I did not have that happen again. I have now developed a seizure disorder since the ECT that includes visual hallucinations and brief blindness.
I could not recommend ECT to my worst enemy. I think you have to be careful about what is said on TV, and you need to read any studies with a critical eye for how the did the research and how they came to the conclusions they reached.
Posted by Crotale on June 1, 2008, at 13:16:51
In reply to I'm curious, too, about the effects, posted by Racer on May 31, 2008, at 17:36:09
I'm having ECT (unilateral) at present. Memory loss if any is minimal (I tend to have a sort of cruddy memory anyway!). I have mild headaches the day of treatments, relieved by OTC pain relievers like Advil. That's the only side effect so far as I can tell.
I've only had 7 treatments (my next one's tomorrow) but I really think it's starting to work. I was able to go on a trip out of town this past week, and I had a really good time, better than I've had in ages.
Just about any psychiatric treatment is expensive if you don't have insurance. Medicare covers ECT. Complaining about the cost of ECT is like, I don't know, saying you shouldn't get antivenom if you get bitten by a snake or something because of the cost. If I had a close encounter with a rattlesnake, I'd still rather get the antidote than not!
Yes, some people have bad experiences with ECT, but the 80% figure is accurate. Now, bear in mind that the percentage will be lower for refractory cases of depression (which I suspect is most of us here), but even then, the odds are higher than with most other treatments (more like 50-60%, IIRC).
I should note, too, that ECT is more effective for some types of depression than others. My doc says it's not great for bipolar d/o, for example, or atypical depression, that it's better for "classic" endogenous depression.
Bear in mind, some people have very bad experiences with particular medications, too. For example, I had a dreadful time on Nardil, and later on Cymbalta. But I don't say that these meds are evil or that they should never be tried.
Crotale
Posted by blueboy on June 1, 2008, at 18:51:45
In reply to ECT report » Racer, posted by Crotale on June 1, 2008, at 13:16:51
I've never had it. I went to a special diagnostic clinic which gave me a positive and convincing diagnosis of Bipolar II, for the first time in my life. I was one step from ECT as no antidepressants have worked well over the decades.
Anyway, I thought I would share some facts mixed with my opinions and impressions from a long bout of research I did when I was thinking about having it done.
1. The medical establishment has done a very poor job with objective, standardized ECT research, especially considering the length of time the procedure has been used (well over 50 years!), the considerable expense of the procedure (over $1000 per treatment for 7-12 treatments, I think), the inherent danger and high degree of patient trauma -- I mean, any procedure that requires deep anesthesia is per se serious, since the anesthesia itself has a mortality rate (I have heard .1%). Not to mention the occasional and unquantified reports from some patients of extreme mental damage.
There has been little actual double-blind testing of even short term memory loss, and what research I have seen is elementary with no qualification of the testing. The studies I have seen are so poorly designed that anyone with a bare acquaintance with research methodology should be aghast.
I have never seen even a hint of a rational, objective protocol for ECT based on individual patient reaction.
The psychiatric community really should be ashamed of itself. Profound long-term memory and even cognitive disturbance does occur. The main reaction to these cases, at least by pro-ECT commentators, seems to be to ascribe it to pre-existing memory deterioration, with no attempt at quantification or testing. The APA uses a figure of 1 in 200 cases suffering serious long-term mental effects, with no solid citation to research that would support it.
Almost the only long-term studies of significant populations involve Texas (and, I think, California), where laws have been passed requiring records of ECT treatment and minimal reporting of short-term side effects, but even these (as I recall them) lack longer-term assessment.
I don't want to sound like there have been no studies or research in the area. I just haven't found anything that approaches the breadth or sophistication that the procedure would warrant under the circumstances.
It is impossible to discount a number of people who claim that their minds have been ruined by ECT. The only response I have seen from the pro-ECT psychiatrists is "pooh-pooh", in effect, "these people were losing their minds anyway". Not impressive.
2. On the other hand, a lot of very good psychiatrists -- who are not monsters or modern-day Joseph Mengeles -- report abundant anecdotal evidence of excellent results for drug-resistant depression with ECT with tolerable side effects, especially when occasional ongoing treatment is given. (Again, repeated or adjunct treatements appears to be totally ad hoc, but one treatment every six months seems to me to be typical) and/or adjunct drug therapies.
The efficacy of ECt in some cases is nothing new. Sylvia Plath took the name of her great novel, "The Bell Jar", from the feeling she got after ECT (and this was in the 1960's) -- she felt as if she had been living in a bell jar vacuum all of her life, and suddenly, after receiving ECT, the bell jar was removed.
I had personally decided I would try sine-wave unilateral ECT rather than face a lifetime of depression and potential suicide. But thank heaven, I found out my condition is Bipolar II (which as far as I could tell has less success from ECT) rather than major depression before I did it.
Posted by bleauberry on June 1, 2008, at 19:45:45
In reply to Re: ECT report, posted by blueboy on June 1, 2008, at 18:51:45
Probably 30 people say hi to me by name but I don't know them. I previously worked with them, had lunch with them, or something. I do not remember them. But they sure know me.
Driving in my small home town like visiting some strange place I've never been. Don't recognize the corner store, the streets, the houses, business, schools, nothing. Every curve in the road is a mystery.
Don't remember what led up to ECT. How did it get there.
Don't remember quitting my 10 year job, applying for a lesser job, interviewing three times for that job, and getting that job. How the heck did all that happen? Don't remember.
Three months is totally permanently gone from memory. Another 6 months on both sides of ECT are quite foggy.
ECT did work after 12 treatments...for 2 whole days...for $20,000...and then pooped out. Both the docs and insurance said enough was enough. Me too.
The memory loss thing is deceiving. You don't know it is happening when it is happening. You only realize the extent of it months later as you look back.
For those who do get benefits from it, I am pleased. For those thinking of trying it, it is another form of hope and I wish the best.
Statistics are rather skewed because there is lousy followup. The only people followed are the ones that continue to get regularly. Ones like me, well, who knows what they wrote in the records. Probably said it was effective, with no mention of how short it was effective.
Long story, but statistics on ECT are quite inaccurate and skewed, due primarily in the specific ways they gather the statistics and interpret them.
Posted by Racer on June 2, 2008, at 16:31:31
In reply to Re: ECT report, posted by blueboy on June 1, 2008, at 18:51:45
Thank you so much for sharing the results of your research. I appreciate your time, and your clear explanations.
It's funny -- I really do know people who swear it gave them their lives back. And I've known people who swear it ruined their lives. It's not something high on my list to try, but I'm always happy to know that I've got some sort of option left.
And I very much appreciate your sharing the results of your research, since now I don't have to do the same research myself...
:-)
Posted by Crotale on June 2, 2008, at 18:15:47
In reply to Thank you for your input » blueboy, posted by Racer on June 2, 2008, at 16:31:31
\> It's funny -- I really do know people who swear it gave them their lives back. And I've known people who swear it ruined their lives.
Out of curiosity...when did the people who say it gave them their lives back have it, and when did the ones who say it ruined theirs have it?
I wonder if some of the side effects people report might result from the anaesthesia rather than the ECT itself.
Crotale
Posted by Racer on June 2, 2008, at 21:00:55
In reply to Re: Thank you for your input » Racer, posted by Crotale on June 2, 2008, at 18:15:47
> \> It's funny -- I really do know people who swear it gave them their lives back. And I've known people who swear it ruined their lives.
>
>
> I wonder if some of the side effects people report might result from the anaesthesia rather than the ECT itself.
>
> CrotaleThat's a great point. I'm trying to remember -- but I think the biggest ECT booster had it done in 2005, and most others earlier...
Honestly, though, I've attributed some of the face to face accounts of "ruined" lives to the underlying disorder. Those I've known both before and after were people who always struck me as suffering from something beyond depression. I hate saying that, but I truly believed them to be unlikely to benefit, because none of them were willing to examine whether there was anything at all in their behavior which might contribute to their condition. That's not the Bootstrap argument, by the way. I absolutely believe that depression is biological. I also believe that, as a result of depression, many of us learn behaviors which don't do us any good -- and that the best outcome results from exploring whether there are behavioral treatments which might augment either ADs or ECT/TMS/etc. (And when I say "behavioral treatment," I don't mean CBT per se. I only mean treatments other than the medical. Therapy of various sorts, exercise, changing careers, whatever it might be...)
(Man, I hope that makes sense and doesn't leave anyone feeling offended. If you do feel offended, please understand that I'm extrapolating from my own experience -- I *know* that no drug alone will fix my problem, because there are psychological issues that have resulted from the trauma, anxiety, and depression. As well as finding an effective biological treatment, I know that I have to work on those issues.)
Thanks for the comment -- it does bring up a very interesting point. Be interesting to see a study, huh?
Posted by Zeba on June 2, 2008, at 22:55:00
In reply to ECT report » Racer, posted by Crotale on June 1, 2008, at 13:16:51
I will just say that I did not notice memory problems with my ECT either until after I stopped. I am not sure why that was, but I thought I had no problems other than some body aches after the first treatment and a feeling like I could not breathe after, I think, the third treatment. I had unilateral as well. How many treatments are you having? I was supposed to have 6 to 12 and quit after #7. A different ECT doc did the treatment and did a seizure three times as long as my ECT doc who said this could have been the cause of my problems. My ECT doc agreed I should stop at that point as I was really feeling messed up a couple of days after #7. I was getting the ECT twice per week per my request rather than the typical three times per week. My ECT doc actually agreed that would likely be best.
I would suggest that you check for disorientation and other right brain sorts of things after around one week after you stop the ECT. If you do maintenance ECT, you may not notice for some time. I know someone who was gung ho about ECT and was getting maintenance ECT and thought she had very little memory problems while getting ECT. Turns out that she does, and now she is devastated.
Posted by Zeba on June 2, 2008, at 23:07:57
In reply to Re: ECT report, posted by bleauberry on June 1, 2008, at 19:45:45
Exactly right about the research, and as I said in a previous post, one does not always recognize the problems whilst in the midst of getting ECT. I tried to get my ECT doc to do some follow-up research with patients who had had ECT, and he seemed interested at first and then said he really did not have time. I don't think he wanted to find out that lots of people have memory problems after ECT, and some of it persists indefinitely and sometimes never improves.
I am seeing a neurologist tomorrow and then doing neuropsych testing after. My new pdoc thinks I am having seizures from what I describe (he's anti ECT). He agrees that my memory seems to suck big time now, at least my short-term memory. My husband notices it too. The only good thing about that is that I don't remember movies I saw in the past five years or so, and so it is like seeing a movie for the first time. I watched Clear and Present Danger the other night. I know I saw it in the past, but it was like seeing it for the first time. This is the okay part, but forgetting what I learned in school is not so okay. Some of that has come back, but very slowly. And I still have trouble finding my way from point A to point B even if I did it a million times in the past.
My ECT doc has done some pretty scary things with ECT like give daily bilateral ECT at 100% charge to someone who was highly aggressive. The person got 70 ECT treatments. So the guy is no longer aggressive. I wonder what he is like.
My ECT doc wanted to do bilateral 100% with me too but knew I would never agree and had concerns about how damaged I would be. He said I had cognitive reserve to handle any damage before I got the ECT. What he meant was that I had a very high IQ and could afford to give up 10 or 15 or 20 IQ points and still be able to do my job. He told me this after I quit the ECT. I thought I would throw up at the prospect of what he really wanted to do.
Posted by Zeba on June 2, 2008, at 23:19:22
In reply to Wow! Excellent point » Crotale, posted by Racer on June 2, 2008, at 21:00:55
I did a lot of research before getting ECT and even knew from Sackheim's study in 2007 that he found on 6 month follow up that people continued to show deficits after ECT. He had not thought this was so in the past. He found this even though some of his test measures were not the best.
Most ECT docs do ECT with people who are depressed and do not have underlying issues such as a personality disorder. They might have anxiety or something like that.
or myself, I changed my pdoc who pushed ECT from day one. I tried all sorts of antidepressants, but we never really stayed with any one of them for very long as he had his mind set on ECT which I finally did even though I was going to work every day and was not suicidal. He was doing therapy with me as well but would get angry when I would say I was feeling worse. Then, he would talk about ECT and pushed and pushed the issue.
Since quitting ECT, I now take Parnate, 40 mg. per day, and I am also seeing a therapist/analyst three times per week. To some extent I have PTSD from the ECT and from how my last doctor treated me. So, this stirred about other stuff too. I am actually doing much better now, given the therapy and not the ECT which still causes me some memory and disorientation problems over a year later. I don't know what ther experience is of others, but I have not been aware of people having long standing personality issues in addition to the depression, the people who have gotten ECT. Unfortunately, it is sometimes given to people with depression and trauma history and/or eating disorders, and it typically results in a re-traumatization. There is some research to back this up if you are interested.
Posted by linkadge on June 3, 2008, at 7:32:37
In reply to Re: Wow! Excellent point » Racer, posted by Zeba on June 2, 2008, at 23:19:22
There is a severe lack of long term data on people who have ECT. There have been a few studies more recently that are not too promising. The one study by Sakiem found that something like %70 of the responders relasped within one year.
The cognative side effects are real, there is no purpose of trying to play them down. The real issue in the varience of responce, IMHO, is simply the nature of ECT.
There are animal models of ECT induced brain damage. Infact some researchers were looking into pharmacological agents which might help reduce excitotoxicity during ECT. There are two problems with that. 1) Such drugs seem to reduce the effectiveness of ECT 2) You have to actually admit that ECT can cause brain damamge before you endorse agents to prevent it.
The conscenssus seems to be some sort of excitotoxic mechanism. It is evident in animal models of ECT. Even if you don't complain about memory loss, there are cumulative cellular effects of ECT.
Why some people don't complain of cognative impariment?
Possibilities include:
1) denial
2) lost memory but unaware of it
3) asked about memory loss too early
4) individual variences in antioxidant or cellular resiliance
5) Location and sevarity of excitationLinkadge
Posted by Zeba on June 3, 2008, at 23:15:59
In reply to Re: Wow! Excellent point, posted by linkadge on June 3, 2008, at 7:32:37
I completely agree with you. Very good points. I did not realize the memory problems until after I stopped, for example. I must have at least 100 studies, most of which are from outside the U.S. I also have some studies my ECT doc did with ECT and unusual cases. My husband did not want me to do the ECT and said to me why don't you just let someone take a sledge hammer and hit you over the head. It was a very difficult time, and I spend two weeks in the hospital for the first 5 treatments and was not aware of the memory problems. I can remember even saying that I had no memory problems. I journaled daily, but somehow do not remember washing my clothes in the washing machine on the unit, and it ripped up my underwear. So obviously I was just not aware of the memory problems.
Posted by linkadge on June 4, 2008, at 9:05:06
In reply to Re: Wow! Excellent point » linkadge, posted by Zeba on June 3, 2008, at 23:15:59
There was a big controversy about how data was collected about memory loss. Supposedly the majority of the (old) data was collected by asking the patient themselves about memory loss while the still in the hospital.
This is dumb because
a) it is very difficult for the patient to determine memory loss so soon after the ECT. The parts of their brain that are even capable of such a reflective task are probably not even functioning.
b) The sudden improvement in mood may mask such a task too. The rapid improvement in mood may leave the patient with an inacurate confidence of memory.
c) The ECT may improve and worsen memory. ECT may temprorarily lift the depression which will likely improve memory in itself, yet damamge the brain at the same time. In this way there is an initial precetion of no memory loss (or memory improvement) yet it is actually worsened. I.e. when the next depression rolls around the patient is worse off (back in depression with a worse brain structure).
d) There are things the patient may never realize are gone. If you wipe out a memory and its associated connections then certain memories are gone for good. Sometimes family members are more likely to notice the patient's poor memory. My mother would never admit that years of psychiatric drugs have worsened her memory but it is clear to the rest of the family.
e) Sometimes the brain is overconfident. Many brain experiments have shown that the brain is very quick to excuse its mistakes. Split brain operations are a good example of this. The left brain has a very hard time admitting that there is anything wrong aftr traumatic brain injury (perhaps a coping mechanism). The left brain is good at piecing together and excusing inconsistencies in behavior and thought. For instance, a patient may have a massive stroke that affects the right portion of the brain (so much so that behavioral manifestations are obvious) yet claim there is absolutely nothing wrong and that he is fine.
So now they do unilateral on the right hemisphere. Is this really causeing less brain damage or just less brain damage that the left brain (and ultimately the portion of the brain that answers the questions) will *admit* to?
Sure you may still be able to speak and may never admit there is anything wrong, but you may loose certain preceptions and abilities for which you will never fully recover.
Linkadge
Posted by Zeba on June 4, 2008, at 22:29:26
In reply to Re: Wow! Excellent point, posted by linkadge on June 4, 2008, at 9:05:06
Linkage
That is exactly what happened to me with the Right Unilateral. My orientation is messed up royally. I used to be able to find my way around and was great with directions. Now I just suck at it and easily get lost. I have a GPS now but also carry a detailed county map of my county and the surrounding counties. I also can't sing worth crap anymore--another right brain task. I am a "big picture" person so to speak, and that is right brain as well. That is messed up too. But so are some more or less left brain things. After all the seizure is over the whole brain. I was always good in math too and was in advanced placement math, etc. and a statistics whiz and why I could analyze the research with a critical eye. Now my math sucks too--another right brain activity. Most things are mixed brain, however, and this is why I believe my working memory is damaged as well. I am seeing a neurologist tomorrow as the thinking is I now have a seizure disorder as well, and then I will go for the neuropsych testing too. That should be more telling than the neurology exam and any medical tests.
Posted by chiron on June 5, 2008, at 1:13:31
In reply to Same Depression Program As Above ECT Works 80%, posted by Phillipa on May 31, 2008, at 11:55:14
I've heard the 80% many times. I tend to believe it, and of course it is reflecting a short term response (which the medical community readily admits). It is usually only used for extreme cases that need a quick response.
It was a miracle for me. Pulled me out of a deep hole a couple of times, and quickly. Somehow the seizures "rebooted/balanced" my brain out. I wish I could always feel that good (maintenance wasn't too effective for me based on the pros/cons).
I've only heard of positive personal stories. A nurse that takes a 2hr drive once a month for maintenance, a woman that had a bad reaction to a med & it saved her from suicide, and a few people I witnessed in the hospital that turned around.
I had a few memory probs - but completely worth it. Sometimes just took some Advil & went to work the same day.
And I'm still as freakin smart as I was :) Continuing to move up in my Information Systems career.
Posted by blueboy on June 5, 2008, at 8:30:43
In reply to Same Depression Program As Above ECT Works 80%, posted by Phillipa on May 31, 2008, at 11:55:14
The research I saw said something just under 50%, I think.
Posted by linkadge on June 5, 2008, at 9:41:02
In reply to Re: Wow! Excellent point » linkadge, posted by Zeba on June 4, 2008, at 22:29:26
ECT may actually precipitate a long term seizure disorders unfortunately.
Linkadge
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