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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
Posted by linkadge on April 13, 2009, at 20:10:59
In reply to Re: ECT » Sigismund, posted by Larry Hoover on April 13, 2009, at 20:09:08
Perhaps try the lithium nortriptyline combo before the ECT.
Linkadge
Posted by linkadge on April 13, 2009, at 20:12:19
In reply to Re: ECT, posted by Zyprexa on April 13, 2009, at 20:01:15
If you need a temporary break from your memories 25mg of scopolamine should do.
Linkadge
Posted by Zyprexa on April 13, 2009, at 20:17:28
In reply to Re: ECT, posted by linkadge on April 13, 2009, at 20:12:19
Or how about good old pot? Atleast it wouldn't be so bad.
Posted by Zana on April 13, 2009, at 20:37:48
In reply to Re: ECT, posted by Zyprexa on April 13, 2009, at 20:17:28
I was evaluated at both Mass General by the doc Kitty Dukakis was treated by in the book "Shock" (not just me, he evaluates any patient who comes to MGH) and at McLeans. I was told there was a 90% chance that I would have a complete recovery from my depression and a 100% chance that I would relapse without meds and continuing less and less frequent ECT for a year. The biggest predictors of relapse? Light, exercise and situational stress. Got lots of information about the different kinds of memory loss I could expect,I might forget where I parked the car or how to get to previously familiar placed. I would likely lose chunks of stored memories like a friends wedding and I would probably have trouble learning new information for a while. But what about the right hemisphere, the side where they place the electrodes to protect the left hemisphere where memory and language live. Ah well "a dancer might remember her correography but be unable to make her dance beautiful. A musican might remember his score but be unable to make his instrument sing." And would this be permanent? Might be. Might not be.
That's was soured me on the deal.
But I will tell you, if the current med changes are unsuccessful- the pristiq seems to be helping but I have been on lots of meds that helped for a while and then pooped out- if the depression returns I've got oral MAOIs to try and then we're down to ECT. And I think I would do just about anything to have a chance of killing the depression. Even risk ECT.Zana
Posted by Larry Hoover on April 13, 2009, at 20:48:24
In reply to Re: ECT, posted by linkadge on April 13, 2009, at 20:09:25
> Thats what I don't understand. Why is there is so called 'medical conscensus' that ECT is safe and effective, when the data to support the notion is not really existent.
>
> LinkadgeI have no idea. There is no evidence that it is safe. Max Fink claimed in his 1956 text that the basis for improvement from ECT is cranio-cerebral trauma. In 1966, Fink reported that his own research indicates that there is a relation between clinical improvement and the production of brain damage or an altered state of brain function.
Funny how none of the proponents make similar claims today.
The American Psychiatric Association publishes literature that claims that 1 in 200 subjects experience memory loss. Fink provided them with that "statistic", and when pressed on its source, admitted that it was not based on any scientific research, but was instead "an impressionistic statistic". In other words, he made it up.
Harold Sackheim, the APA's main public proponent of ECT, is not a medical doctor. He's a psychologist, whose Ph.D. was in self-deception. In 2001, he claimed (in sworn testimony) to never once observing a case of anterograde amnesia following ECT. In fact, he wrote the statement that ECT improves memory into the standard APA consent form.
If evidence-based medicine ever catches up to ECT, it's done for. But the devices were grandfathered in by the FDA because they were in use before medical devices came under regulatory control. As modern devices are substantially unchanged from the original, they are exempt from all regulatory oversight.
Lar
Posted by garnet71 on April 13, 2009, at 20:53:37
In reply to ECT, posted by bleauberry on April 13, 2009, at 18:15:12
Well if you forget what you were depressed about, you might not be depressed anymore.
what = childhood trauma that shaped your developing mind, etc. Yeah I can see why ECT might work sometimes
Posted by Sigismund on April 13, 2009, at 21:16:32
In reply to Re: ECT » Sigismund, posted by Larry Hoover on April 13, 2009, at 20:09:08
>"patients become more compliant and acquiescent with treatment".
That cracks me up.
Posted by Sigismund on April 13, 2009, at 21:22:12
In reply to Re: ECT » Larry Hoover, posted by Sigismund on April 13, 2009, at 21:16:32
Some of the people who have ECT perhaps do not care about the damage and even welcome it?
It has a bit of 'the road to Golgotha' feel about it, and certainly did when I saw it done on my mother.
Posted by Sigismund on April 13, 2009, at 21:27:05
In reply to Re: ECT, posted by Sigismund on April 13, 2009, at 21:22:12
But then she got cancer and therefore morphine, which (of course) worked.
Cancer is no fun, but it is a piece of cake compared to serious depression.
Posted by Larry Hoover on April 13, 2009, at 21:27:50
In reply to Re: ECT, posted by garnet71 on April 13, 2009, at 20:53:37
If only the memory loss was so specific, perhaps. But there are other kinds of cognitive losses, too. I've seen accounts of professionals, a nurse, an engineer, an accountant, who not only lost their professional training, they could not learn it again. Artistic people who lost their art. And the relapse rate is close to 100%.
Lar
Posted by sowhysosad on April 13, 2009, at 21:46:39
In reply to Re: ECT » garnet71, posted by Larry Hoover on April 13, 2009, at 21:27:50
Probably a stupid question, but why do these studies all seem to use nortip as the follow-up AD?
Why not something with a broader action, like an MAOI, clomipramine or an SRI+TCA combo?
Is there something about ECT responders that suggests they need noradrenergic drugs?
Posted by Phillipa on April 14, 2009, at 0:16:34
In reply to Re: ECT, posted by sowhysosad on April 13, 2009, at 21:46:39
I wouldn't do it I know opiods rid my depression anxiety if forced to would go that route. Heck if benzos worked for 37 years then at my age what do I have to lose might gain some years of quality. Addicted? Who would care not me. Love Phillipa
Posted by linkadge on April 14, 2009, at 21:25:41
In reply to Re: ECT, posted by Phillipa on April 14, 2009, at 0:16:34
That what I am saying. If you just take a drug to reduce memory formation and recall you can usually get it back by discontinuing the drug. Nothing like a highly anticholinergic TCA to forget what they hell the problem really was.
With ECT however, the changes may be permanant, unwelcome and more extensive than desired. As Larry mentioned, you are not just affecting memory formation, you are also affecting all aspects of the way the brain functions.
I think it is ironic how you have this whole branch of medicine emerging whose primary purpose is to research the neuroprotective effects of certain agents during animal ECT procedures. If ECT doesn't cause brain damage, then what needs is there to protect it during ECT??
Sure, if all you want to do is sit around and 'forget', then perhaps ECT is a viable option. Many people don't return to a state of wellness with ECT - i.e. being able to return to their jobs - or returning to the things in their life that require a full brain to perform and appreciate.
Linkadge
Posted by linkadge on April 14, 2009, at 21:27:58
In reply to Re: ECT, posted by sowhysosad on April 13, 2009, at 21:46:39
Thats the thing though. So your depression is almost certain to return - and now you're in a worse positon then when you went in - i.e. back to being depressed - and with potential brain damage - possibly less capable of climbing out.
Linkadge
Posted by magnox on April 16, 2009, at 20:12:49
In reply to Re: ECT, posted by linkadge on April 14, 2009, at 21:27:58
there are alternatives now, to this vicious and menacing technology. rTMS has been around for some time, and it approved to treat depression in the US. Quite why people submit to ECT in 2009 makes me depressed (pun) about the compassion in the world. Again why no rTMS in the UK? god knows. The agenda appears to keep the patient sick.
Posted by Sigismund on April 17, 2009, at 0:02:54
In reply to Re: ECT, posted by magnox on April 16, 2009, at 20:12:49
My experience of doctors from or in the UK has been limited, but they seem to have a bracing sense of discipline.
Posted by fattoush on April 18, 2009, at 8:00:43
In reply to Re: ECT, posted by magnox on April 16, 2009, at 20:12:49
Even in the US, you have to be rich, as in have some 10K to spare, to get rTMS. I was told that the Co who makes the machine would not subsidize treatment because I had health insurance, and that my insurance would not cover it!
Posted by fattoush on April 18, 2009, at 8:14:41
In reply to Re: ECT » Sigismund, posted by Larry Hoover on April 13, 2009, at 20:09:08
This is all quite discomforting. I have just had ECT, late Feb through mid-March. I was having such horrendous headaches from the minute I woke up from anesthesia until I went back and was put to sleep again, that I was given Butorphanol Tartrate. Nothing else would work. I got addicted to it, and that's a long story. I stopped my treatment because of the headaches, not knowing yet I was also dealing with a severe addiction problem.
I had 8 sessions, all ultra-brief rapid pulse right-side, assuming the doctors were honest. I had tried so many meds and combinations of meds prior, sticking to them, giving them the due time.
I haven't felt any cognitive impairment. Then again, as I was before ECT, I can't concentrate or read anything at all.
Benefits? As of 2d through 5th session, before I got so addicted to the barbiturate, I felt them. I was another person for all close to me. After that, I was getting stoned in-between sessions, because I had awful headaches.
Right now, all benefits are gone. I am very depressed. I have contemplated going back for "maintenance." Then again, why should I, if any benefit I had disappeared?
And reading this thread certainly makes me less likely to go back.
I blogged the experience in detail on fattoush.wordpress.com, if anyone cares.
Posted by YOGI BRONX on April 19, 2009, at 14:25:53
In reply to Re: ECT, posted by fattoush on April 18, 2009, at 8:14:41
The FDA recently banned numerous morphine drugs as well as ALL ECT machines because they were never determined to be safe and effective, having been in existence before the FDA started testing and having been grandfathered heretofore. Manufacturers are to stop manufacturing within sixty days of the order and to stop shipping within ninety days.
What this means to the future of ECT is anyone's guess. I don't know if it means that the existing ECT machines can be used beyond ninety days, (I suspect that the answer, for existing patients, at least, is yes), but what about repairing them when they malfunction?
As a columnist noted, the expense of obtaining FDA approval is likely to dissuade a current manufacturer from continuing production, especially since the safety and effectiveness of ECT IS constantly debated. Then there is the length of the approval process which, even if a manufacturer submits to it, will take years.
The FDA has already backtracked on one of the morphine drugs, a concentrated morphine that is the only drug available to treat terminally ill cancer patients without resorting to painful, or impossible due to physical deterioration, alternative delivery systems. Perhaps it will be compelled to do the same with ECT devices.
[Insert jeremiad here about ham-fisted bureaucrats.]
So, everyone considering ECT now has yet another reason to be anxious about their decision. It may soon be moot.
Personally, I think one resorts to ECT when nothing has worked and one doesn't care about a bad outcome because, if it doesn't work, one can always kill oneself as one had been planning prior to treatment. That is the degree of pain that I think one has to be in to consider the ECT alternative.
I know people for whom it HAS worked and know of people for whom it has worked very well indeed. I would hate to see the FDA remove choice from individuals once more in the name of safety.
Cordially,
YOGI
Posted by Phillipa on April 19, 2009, at 20:07:55
In reply to ECT machines banned by FDA, posted by YOGI BRONX on April 19, 2009, at 14:25:53
Yogi wow got a link? Love Phillipa
Posted by YOGI BRONX on April 19, 2009, at 22:44:57
In reply to Re: ECT machines banned by FDA » YOGI BRONX, posted by Phillipa on April 19, 2009, at 20:07:55
Dear Phillipa,
I mistook the number of days that the ECT device manufacturers are allowed before they have to answer the FDA's demand that they prove their machines' effectiveness. It is 120, (August 7), rather than 90. The 90 day deadline is for the morphine meds.
Here are two links:
"FDA Near to Closing Books on Grandfathered Medical Devices"
By Emily P. Walker, Washington Correspondent, MedPage Today
http://www.medpagetoday.com/Washington-Watch/Washington-Watch/13679
describing the original announcement, and:
"With FDA Change, ECT May Go the Way of the Dinosaur"
By John M. Grohol, Psy.D.
http://psychcentral.com/blog/archives/2009/04/15/with-fda-change-ect-may-go-the-way-of-the-dinosaur/
amplifying its possible effect on ECT treatment.
Cordially,
YOGI
Posted by YOGI BRONX on April 19, 2009, at 22:57:08
In reply to Re: ECT machines banned by FDA, posted by YOGI BRONX on April 19, 2009, at 22:44:57
Dear Phillipa,
Got the date of the ECT notice wrong, as well. It was April 8. The March 31 date was for the medications.
Cordially
YOGI
Posted by Sigismund on April 20, 2009, at 14:41:57
In reply to Re: ECT machines banned by FDA, posted by YOGI BRONX on April 19, 2009, at 22:44:57
>It is 120, (August 7), rather than 90. The 90 day deadline is for the morphine meds.
That's more in line with what I'd expect.
Posted by Phillipa on April 20, 2009, at 20:08:34
In reply to Re: ECT machines banned by FDA, posted by YOGI BRONX on April 19, 2009, at 22:57:08
Yogi that's okay. No problem. Mistakes happen your're human after all thanks. Love Phillipa
Posted by Phillipa on April 20, 2009, at 20:15:57
In reply to Re: ECT machines banned by FDA, posted by YOGI BRONX on April 19, 2009, at 22:44:57
Yogi you in the medical field as see you get the same CME newsletter I do. Babblemail if would like to remain anynamous. Phillipa
This is the end of the thread.
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