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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 25 to 49 of 49. Go back in thread:
Posted by SLS on July 20, 2006, at 6:12:15
In reply to Re: Chill out Crazy Horse, posted by Karen44 on July 20, 2006, at 0:10:07
> There are also other things being tried now too--like the magnetic stimulation thing. I don't know much about it and if one takes medicaitions too along with it??
Yes, you can take medications along with it. You will find some debate about its success rate, but I believe it is worth a try as long as the expense isn't coming out of pocket. I don't think its limited success rate justifies the investment if you are treatment resistent. One of the foremost researchers of this procedure, formerly of the NIMH, recommended one of his former treatment resistent patients that she not bother with it. However, this was 5 or more years ago. They are constantly tweaking the settings on the machine. I believe they are currently using 20Hz on the right fronto-temporal placement. rTMS should be approved in the not too distant future. Insurance might cover it then.
- Scott
Posted by SLS on July 20, 2006, at 6:31:07
In reply to Re: Chill out Crazy Horse » Karen44, posted by SLS on July 20, 2006, at 6:12:15
Posted by pseudoname on July 20, 2006, at 8:56:31
In reply to Re: ECT and other options » pseudoname, posted by SLS on July 19, 2006, at 23:07:59
Hi, Scott.
> Is that bilateral?
My understanding is they use various pathways.
> Is there anywhere on the Net where information about this can be found?
There's a nice summary & more links here:
•The Body Electric: What is electrical brain stimulation used for? And is it safe?
By Amanda Schaffer in Slate, Jan 11, 2005
http://www.slate.com/id/2112151/
Posted by SLS on July 20, 2006, at 14:13:09
In reply to direct current polarization article » SLS, posted by pseudoname on July 20, 2006, at 8:56:31
Posted by linkadge on July 20, 2006, at 16:24:21
In reply to Re: Chill out Crazy Horse » linkadge, posted by Crazy Horse on July 20, 2006, at 0:02:32
No problem at all. Feel free to say what you feel.
Linkadge
Posted by Crazy Horse on July 20, 2006, at 17:43:22
In reply to Re: Chill out Crazy Horse » Crazy Horse, posted by linkadge on July 20, 2006, at 16:24:21
> No problem at all. Feel free to say what you feel.
>
> LinkadgeThanks Linkadge, but i was way out of line. Like i said, insomnia makes me mean and just flat out pissed off at the world..but that still doesn't give me the right to act like a total *ss at PB or anywhere else for that matter..and that's what i did. I am embarrassed and ashamed of that mean spirited post, and again i am truly sorry.
Monte
Posted by stargazer on July 20, 2006, at 20:02:00
In reply to Re: Anyone had ECT? » linkadge, posted by Crazy Horse on July 18, 2006, at 21:44:25
Hi,
Haven't posted in a long while. I worked in the ECT dept at a major university hospital in the Northeast and never had a good feeling about ECT. Although some people improved initially, many just went onto maintenance ECT which means you come back "forever" to maintain your mood status. I'm not even sure the mood was ever that great to sustain. And the chief MD did not seem too sympathetic towards the patients and he NEVER said "it's not working" or ever decided to stop the treatments. I felt his motivation was $$$(big surprise?)and his biggest goal for the day was to treat as many pts as he could in the least amount of time. I eventually had to leave because I didn't feel the patients were being treated as I would want any patient to be treated, especially depressed patients, unable make good rationale decisions. It was always the patients who decided to stop and in my opinion, they were blamed for not continuing treatment, never was their reluctance to continue ECT understood. Go figure, isn't psychiatry supposed to understand this type of resistance? I also saw people I felt should never have ECT, i.e. demented elderly, who couldn't give their consent yet "signed" forms saying they were agreeing to treatment. I told the MD they were confused and couldn't sign a consent but he minimized this and basically ignored my concerns.
Sorry for being negative, but that was what I saw and feel anyone who considers it should know. I you do decide it is your last chance, make sure you have a friend who can be your spokesperson, who knows you and will speak for you because you won't remember sh*t.
Posted by linkadge on July 20, 2006, at 21:24:33
In reply to Worked as RN in ECT dept., posted by stargazer on July 20, 2006, at 20:02:00
I think that what you have said is very important.
Linkadge
Posted by SLS on July 20, 2006, at 22:01:38
In reply to Re: Worked as RN in ECT dept. » stargazer, posted by linkadge on July 20, 2006, at 21:24:33
Individual experiences with ECT vary widely. Although I know that it works well for some people and can be free of side effects, such that it is deemed by many to be a miracle, I am reluctant to subject myself to another course of treatments. I guess I'm a little scared of them.
It is difficult to ignore the horror stories regarding memory loss and cognitive deficits as the result of ECT. It should be noted, though, that there are people whom have had over 100 treatments and whom seem none the worse for it.
I don't regard the necessity of taking maintenance treatments to be a monumental failure of the modality. It is what it is. It is an inconvenience. So is dialysis.
- Scott
Posted by Crazy Horse on July 20, 2006, at 23:23:47
In reply to Worked as RN in ECT dept., posted by stargazer on July 20, 2006, at 20:02:00
> Hi,
>
> Haven't posted in a long while. I worked in the ECT dept at a major university hospital in the Northeast and never had a good feeling about ECT. Although some people improved initially, many just went onto maintenance ECT which means you come back "forever" to maintain your mood status. I'm not even sure the mood was ever that great to sustain. And the chief MD did not seem too sympathetic towards the patients and he NEVER said "it's not working" or ever decided to stop the treatments. I felt his motivation was $$$(big surprise?)and his biggest goal for the day was to treat as many pts as he could in the least amount of time. I eventually had to leave because I didn't feel the patients were being treated as I would want any patient to be treated, especially depressed patients, unable make good rationale decisions. It was always the patients who decided to stop and in my opinion, they were blamed for not continuing treatment, never was their reluctance to continue ECT understood. Go figure, isn't psychiatry supposed to understand this type of resistance? I also saw people I felt should never have ECT, i.e. demented elderly, who couldn't give their consent yet "signed" forms saying they were agreeing to treatment. I told the MD they were confused and couldn't sign a consent but he minimized this and basically ignored my concerns.
>
> Sorry for being negative, but that was what I saw and feel anyone who considers it should know. I you do decide it is your last chance, make sure you have a friend who can be your spokesperson, who knows you and will speak for you because you won't remember sh*t.Damn, that's just flippin heart breaking. It makes me sick! All about the fu*kin' almighty dollar?? One thing for sure, if it does work..the effects are short lived. My pdoc wanted me to travel to Seattle 250 miles from my home town for maintenance treatments, which i did not do...i could tell even in the state i was in, that he was after money too! One thing is sure, i will/would never do ECT again!
Monte
Posted by stargazer on July 21, 2006, at 9:25:17
In reply to Re: Worked as RN in ECT dept. » stargazer, posted by Crazy Horse on July 20, 2006, at 23:23:47
I know how frustrating it is since I had considered ECT priorto working in that environment. My doctor said we should try more meds and I'm glad we waited because once your brain is traumatized like that it would never be the same. Many studies say the memory loss is short term but I'm not convinced of that based on what I saw. I would rather try a nerve stimulators than ECT.
One thing of interest was that although many people of all socioecomonic backgrounds try ECT, the more educated ones seem to stop the treatments and the ones who continue seem to just blindly continue I guess for lack of knowing what else to do. It's sad to see and wonder if they are being taken advantage of. If you have Medicare you can have ECT but most insurances limit the number of treatments.
I only saw one doctor's family members try it and they stopped after a few treatments. I would be to intrinsiclly fearful of brain damage that if I tried it I would only use it to get me from commiting suicide and then once out of that despair go back to medications.
who knows...it's not an easy choice especially when you are desparate. And for those of you who have gotten good results, God bless. I'm not a religious person, but someone is looking after you.
Posted by pulse on July 21, 2006, at 16:21:06
In reply to ECT and Memory Loss, posted by Denise190466 on July 19, 2006, at 13:49:55
< I'm thinking of pushing to have ECT again (this time the whole course and not just two treatments). I was thinking though, surely you would be aware of the memory loss and how bad you were being affected during the course of the treatments and the intervals inbetween.
so if you found that your memory was getting progressively worse during the treatments, couldn't you stop them?
The two treatments I had didn't seem to affect my memory at all, I know only two not enough to really know. But I can remember everything right up to lying on the table and waiting for them to anaesthetise me beforehand.
I remember the conversation I had with the ECT Nurse, the people who were with me in the waiting room and everything I said to them.
Neither do I have any other memory loss as far as I am aware. ...... >
(snipped)
i'm the ultimate believer in - and advocate for - ECTs.
yes, of course, you will know immediately (IF you ever even experience one iota of memory loss upon the initiating of ECT tx...or later). you then have the option -and supreme right - to simply leave.
denise 190466's above excerpt w/description has been exactly my experience, with one BIG exception:
i insist ALWAYS and ONLY on BILATERAL. i walked out ama, the only time unilateral was performed on me, and, after only 1 treatment.
unilateral FOR ME = extreme memory loss + migraine -level headaches. i'd no memory of talking to this incompetent doc. i have no idea what he even looks like (i was in need asap and was taken straight to from another center; my ECT doc was of vacation.) also, no memory of going to operating room, table, applying of electrodes, talking with this doc, nurse, or anesthesia person, as i'd always before, and right up to the seconds i was counting down from 100.
with bilateral, i've never once had memory loss upon initiating, nor, at any time, during the course of txs, nor afterward. i still have an extremely good memory at age 54. also, no headaches and no side-effetcs of any kind. this was from tx #1 through tx #12, i.e., the usual full-series length.
results were always the same, both in the other 2 full course series i've had, with years in between, and, also, when i only needed a 5 tx. course.
reiterating what i've posted numerous times: imo, the key is the expertize of the ECT doc. mine have both now retired.
i have no magic formula for finding such a doc.
*to randy - i don't find it odd at all that you were taken off meds. i always was.
as i'm now so side-effects intolerant (physical ones) to all ads, all classes, i will never take one again....no matter what. if i ever need ECT again, i will refuse to take them, afterward. that is a certainty. i could care less what the doc advises. this is my life.
i am now in full remssion without any ad. my correct diagnosis is mdd, recurrent & moderately severe to very severe. there is doubt re: this. so as not to confuse you, my last ECTs were in 1997. also, i don't mean to imply that any of the above is the reason that i'm now in remission, because i know that is most definitely NOT. but, at least, the ECTs sure didn't hurt.
monte, wishing you a good to great outcome!
pulse
Posted by pulse on July 21, 2006, at 16:27:06
In reply to ECT/Memory Denise190466; Randy:FYI; Monte, posted by pulse on July 21, 2006, at 16:21:06
correcting re: my dx, near the end of my above post.
it should read: there is NO doubt.
pulse
Posted by pulse on July 21, 2006, at 16:43:08
In reply to Re: ECT/Memory Denise190466; Randy:FYI; Monte, posted by pulse on July 21, 2006, at 16:27:06
long thread; 1st cup of coffee; bad sinus. please choose an excuse for my lapse.
monte, sorry for your experience.
pulse
Posted by pulse on July 21, 2006, at 16:58:11
In reply to Re: Worked as RN in ECT dept., posted by stargazer on July 21, 2006, at 9:25:17
really?! i've found just the reverse to be true of the many i've been in with for ECTs - who DID continue. my IQ is 160. several other's had higher to ...much higher.
my therapist was formerly the head psych nurse in a hospital (patients from all socio-economic brackets, such as your's) for 25 years. she would agree with my assessment, just for the record.
pulse
Posted by Crazy Horse on July 21, 2006, at 17:03:41
In reply to Re: Worked as RN in ECT dept. » stargazer, posted by pulse on July 21, 2006, at 16:58:11
> really?! i've found just the reverse to be true of the many i've been in with for ECTs - who DID continue. my IQ is 160. several other's had higher to ...much higher.
>
> my therapist was formerly the head psych nurse in a hospital (patients from all socio-economic brackets, such as your's) for 25 years. she would agree with my assessment, just for the record.
>
> pulse
>
>Dang, 160 I.Q. that's awsome! Isn't anything 160 or higher considered genius? Mine is 125-130..not too bad i guess..LOL.
Posted by linkadge on July 21, 2006, at 19:16:08
In reply to Re: Worked as RN in ECT dept., posted by Crazy Horse on July 21, 2006, at 17:03:41
I guess my argument was that the community of psychiatrtic patients is often taken advantage of based on the fact that treatment side effects are often pawned off to the underlying illness.
Memory loss from ECT does not necessarily have to present itself right away. The loss may not be obvious right away since you may not use a specific certain part of your brain everyday. Its just like how memory loss in Alzheimer's can often progress for a while without the patient being aware. The idea is that if you don't remember somthing, then you may not detect its absence.
The *dammage* detected in some animal models of ECT, extend beyond possable alteration to hippocampal formation. There is a lot of collateral damamge. You are sending an electic charge through the brain. It is not always 100 percent certain which path the current will take.
Its just like how two people can be physically electrocuted and one can die while the other doesn't, it really depends on the path that the current took through the body.
Many of the molecular actions of ECT are seen in patients who have had epileleptic seizures. Long term memory and cognitive complaints can often be seen in this patient group.
There is an article here which may be usefull.
http://www.ect.org/resources/memory_cognitive.pdf
For a psychiatrist to convince me its safe, I'd like to have him jump down on the table, and zap himself...."see.....its safe". They're not going to do that.
Linkadge
Posted by pulse on July 24, 2006, at 5:58:53
In reply to Re: Worked as RN in ECT dept., posted by Crazy Horse on July 21, 2006, at 17:03:41
actually, it's stated genious level is 140.
my dad's is 180.
so, your's is considered quite bright, rather than 'not too bad.'
pulse
Posted by pulse on July 24, 2006, at 6:53:33
In reply to Re: Worked as RN in ECT dept., posted by linkadge on July 21, 2006, at 19:16:08
we're not going to see them take our meds either, unless they have an m.i. themselves... AND have accepted it.
oh, i'd love nothing more than to see them jump up on the table and zap themselves. i would prefer seeing only the incompetent ECTs docs do this, as having ECTs, even under the best of circumstances and environments, is somewhat daunting, and can be for some (although never was for me) a humiliating, for lack of better word, experience.
it also takes far too much courage, while also in the midst of having this amount of despair, to get ECTs. so, i think we can safely put this fantasy to rest... far as the docs.
what i'd like to see MUCH more: ALL pdocs and gps prescribing them, then being required to try out any & all meds, in order to see what we do - or may - go through, side-effects wise. (yes, i realize - far as 'psych' efficacy, if said docs have no m.i. - that nothing will occur in that realm.)
Posted by deniseuk190466 on July 27, 2006, at 7:38:08
In reply to ECT and other options » Denise190466, posted by pseudoname on July 19, 2006, at 15:50:35
Hi Pseudonym,
> Nope. 18 sessions unilateral. But, in fairness, nothing else helped either — 36+ meds & combos, tons of therapy, exercise, light, life changes, love, sex, travel, and that other one I sometimes hear promoted, the passage of time…
Yes and they say time heals everything, not when you have Treatment Resistant Depression though.
What have you found to help you? sorry if it's already in your other posts.
Denise
Posted by pseudoname on July 27, 2006, at 7:58:53
In reply to Re: ECT and other options, posted by deniseuk190466 on July 27, 2006, at 7:38:08
Hi, Denise.
> What have you found to help you? sorry if it's already in your other posts.
Thanks for asking. I've taken the opioid buprenorphine (Subutex) since December. It's usually given to addicts in recovery, but I take it just for depression. It's the only thing that has worked on my depression for more than a few days. Very hard for a non-addict to get it prescribed, unfortunately.
http://health.groups.yahoo.com/group/psycho-babble-tips/links/buprenorphine_for_de_001146748536/
And it doesn't help with all my psych problems, so I also try to use mindfulness techniques and some parts of "Acceptance and Commitment Therapy", which are a truly novel approach to doing better with mental illness.
Posted by mayzee on July 27, 2006, at 12:49:05
In reply to What I found… » deniseuk190466, posted by pseudoname on July 27, 2006, at 7:58:53
> And it doesn't help with all my psych problems, so I also try to use mindfulness techniques and some parts of "Acceptance and Commitment Therapy", which are a truly novel approach to doing better with mental illness.
>Hi pseudoname,
Have you done therapy with an ACT therapist? Or are you doing it on your own? I'm curious about ACT. Have read a few articles about Steven Hayes & ACT. I've already learned about (though certainly haven't mastered) the acceptance part thru mindfulness/buddhism, but for me, I think the commitment part is what might make a difference.
What is it that you like about ACT?
--mayzee
Posted by pseudoname on July 27, 2006, at 15:18:48
In reply to Re: What I found… re. ACT » pseudoname, posted by mayzee on July 27, 2006, at 12:49:05
Hey, Mayzee.
> Have you done therapy with an ACT therapist? Or are you doing it on your own?
I found ACT online in 2003 & got the books and a bunch of journal articles. Then I found an ACT therapist who got her degree in Steve Hayes's program. She and I didn't hit it off, however: she didn't listen to me and it was like she was playing a tape with her ACT stuff. Terrible! I already knew the words to everything she was v-e-r-r-r-y s-l-o-o-o-w-ly reciting to me.
So that didn't last. I guess no matter what brand of therapy, you still need some personal connection and rapport with the therapist.
So I'm just trying the techniques on my own.
> I think the commitment part is what might make a difference.
I hope so. I think explicitly recognizing that one has (or can make) a commitment to a good project can be really helpful and keep one motivated and on-target.
But I think the Hayes/ACT treatment of commitment is specious and sloppy and can really waste time and put undue guilt on a person for "not committing" to something.
Hayes never says how to generate commitment or where it comes from, for example, but he implies that it's morally essential. His "Commitment" examples all seem to be simply people saying out loud that they have made a commitment, rather than actually showing us what a commitment *is* — apart from announcing that we have made one.
I think if you *have* a commitment, that's seriously excellent and being aware of it will be great! But if you don't have it, you're not going to just summon it or force yourself to get it. Commitment seems to be for Hayes some kind of feeling, but he's not able to be explicit (with himself) about that.
I think it might be better to look back at what one has already done and not done to see what sorts of commitments one apparently *has* made (or is capable of making). Like, maybe, one hasn't engaged in suicide (or hasn't tried it again) despite, it might seem, having "lots" of reason to. So, one is at least partially committed to Life. Despite getting what seems like minimal overall benefit, I've put tons of effort for years into psychotherapy and self-therapy; so, I'd conclude I seem committed to doing what it takes to get better. Now, it's better for me, I think, if I do in fact realize that I seem to have such a commitment and I use it and build on it, maybe.
But if I don't have a commitment in some area, what's the big deal? Absolute mountains of good have been done in this world by people who weren't really "committed" to what they were doing. Rather than wait for some frisson of commitment to seize one, I think it's fine to just do things half-heartedly.
I dunno. I find so much of what Hayes & the ACT people write to be poorly informed, maddeningly sloppy, smug and over-involved, with terribly weak reasoning. I also think Hayes is a bit of an intellectual fraud. For example, he MAKES STUFF UP about etymology and publishes it. He presents himself as some kind of linguistic genius (Oh, yes, he does), but he makes painfully embarrassing gaffes in pompously dictating little lessons with Latin words. He has not, to this day, answered a critique (to my mind devastating) of his RFT that was in the journal "Behavior and Philosophy". Hayes also does not tolerate dissent within his ranks of admirers, and he launched a hot verbal broadside against a woman on the ACT professional listserv who questioned whether one really needed to adopt ACT as a lifestyle rather than simply as a clinical technique. (Hayes believes ACT must be a life-choice to be most effective; I'm shocked that he thinks ACT *can* be a life-choice.) The ACT crowd chafed when the Time reporter smirked at Hayes's claim that ACT could bring about Middle East peace. But that's the way he thinks: grandiose ideas. I steer clear of those people while keeping a watchful eye for what they might impose on the rest of us in order to bring about their great visions.
> What is it that you like about ACT?
Thanks for asking!
More and more I suspect that mindful acceptance (as opposed to mere resignation or defeat) is the bedrock of therapy and emotionally "healthy" living. I also think it's obscured or denied in most of psychotherapy and American culture. Hayes's emphasis on it, and his techniques for & discussion of how to go about "finding" acceptance within yourself, I think, are excellent. He deserves my gratitude for that.
I also really like the idea that the client will decide what the therapy, and the client's life, will be "for". The client gets to say what she wants out of things; the therapist doesn't get to dictate it based on special professional knowledge. That's great. Though, again, I think the implementation of these ideas are the sticking point. The ACT "Values" treatment seems quite presumptuous and a lot like Sunday-school dictation, to me.
I also like the idea that the goal is a better life, not simply feeling better in this precise way right now or all the time. That's an insight and perspective for every single situation that can ever come up, I think. I should hang it on a sign off a stick in front of my head so I never lose sight of it: "Remember, Your Goal Is A Better Life."
I don't want to put anyone off ACT by my criticisms of it. A lot of people can get a lot of good out of it just as it is, I'm sure. But I think some components of it are much better than others, and I think the overall scheme that the acceptance portion is presented in is more encumbering than helpful.
Posted by mayzee on July 28, 2006, at 21:39:11
In reply to Re: ACT » mayzee, posted by pseudoname on July 27, 2006, at 15:18:48
pseudoname,
I didn't want to hijack the ECT thread so I posted my reply on the Psychology board
http://www.dr-bob.org/babble/psycho/20060721/msgs/671597.html
--mayzee
Posted by Dr. Bob on July 28, 2006, at 22:45:35
In reply to Re: ACT » pseudoname, posted by mayzee on July 28, 2006, at 21:39:11
This is the end of the thread.
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