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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by PCB on August 16, 2020, at 10:34:56
Hey Everyone! Considering ECT but afraid of memory loss. Has anyone here had ECT? Did you have memory loss? Did you need maintenance ECT?
Thank you!
PCB
Posted by undopaminergic on August 16, 2020, at 13:50:04
In reply to Anyone have ECT?, posted by PCB on August 16, 2020, at 10:34:56
> Hey Everyone! Considering ECT but afraid of memory loss. Has anyone here had ECT? Did you have memory loss? Did you need maintenance ECT?
>I think the risks of ECT are too high, even though I've been depressed since 1999 and tried dozens of drugs. The adverse consequences, or whether maintenance treatments are necessary, cannot be predicted.
Someone (maybe here) said, that he had a whole college education erased.
-undopaminergic
Posted by SLS on August 16, 2020, at 22:38:18
In reply to Re: Anyone have ECT?, posted by undopaminergic on August 16, 2020, at 13:50:04
> > Hey Everyone! Considering ECT but afraid of memory loss. Has anyone here had ECT? Did you have memory loss? Did you need maintenance ECT?
> >
>
> I think the risks of ECT are too high, even though I've been depressed since 1999 and tried dozens of drugs. The adverse consequences, or whether maintenance treatments are necessary, cannot be predicted.
>
> Someone (maybe here) said, that he had a whole college education erased.Yes, I have seen this in a friend of mine. Perhaps you should try one of the other neurostimulating treatments first. The list of treatments keeps growing. Deep TMS (dTMS) is supposed to be better than the original rTMS. It goes deeper beyond the skull.
- Scott
Posted by Hugh on August 17, 2020, at 14:49:55
In reply to Anyone have ECT?, posted by PCB on August 16, 2020, at 10:34:56
A friend of mine had ECT. It helped his depression quite a bit. I think he had some short-term memory loss. He would get a maintenance dose about every six weeks. Then he needed them less frequently.
Undercurrents by Martha Manning has a detailed account of her ECT experience. The book is one of the best depression memoirs I've read.
https://www.amazon.com/Undercurrents-Beneath-Surface-Martha-Manning/dp/006251184X
Posted by rjlockhart37 on August 17, 2020, at 16:30:36
In reply to Re: Anyone have ECT?, posted by Hugh on August 17, 2020, at 14:49:55
yeah but i've known people who have depression and still are too resistant too it, it helped them for a while, but then it went back down. These TDCS stimuation devices are good for depression because they don't cause siezure and memory loss, its a mild stimuation. You can buy it on the net, highest setting recommended is 2ma, 5ma would very intense, and its usally expensive. You place the nodes on difrent setors of skull, each has diffrent effect, google tdcs stimuation devices, you may can buy one, without having to go through the hell from ECT.
But it's been documented, for a long time. ECT helps depression, but then it lingers back. I wish some people in the past posters could post their experince. Baseball55 if you read this, i rerember you told me about your ECT sessions, it would wonderful if you ccould post.
memoy loss is just the main thing
Posted by PCB on August 17, 2020, at 17:00:21
In reply to Re: Anyone have ECT?, posted by Hugh on August 17, 2020, at 14:49:55
> A friend of mine had ECT. It helped his depression quite a bit. I think he had some short-term memory loss. He would get a maintenance dose about every six weeks. Then he needed them less frequently.
>
> Undercurrents by Martha Manning has a detailed account of her ECT experience. The book is one of the best depression memoirs I've read.
>
> https://www.amazon.com/Undercurrents-Beneath-Surface-Martha-Manning/dp/006251184XOh .... I have read that book. Its amazing. Im reading Shock, now about Kitty Dukakis.
https://www.amazon.com/Shock-Healing-Power-Electroconvulsive-Therapy/dp/1583332839/ref=nodl_
I knew most patients undergoing acute ECT usually require maintenance. But after watchimg Gary Gulmans, The Depresh, he made it seem like you one one set of acute treatments and then your set for life. My interest in ECT was rekindled at that point.
https://www.hbo.com/specials/gary-gulman-the-great-depresh.
He didnt talk about maintenance which most doctor Im talking to tell me most patients need. I dont not want lifelong ECT at this point I guess.
Thank you so much Hugh! Your the best!
Posted by Hugh on August 17, 2020, at 23:53:50
In reply to Re: Anyone have ECT?, posted by PCB on August 17, 2020, at 17:00:21
You're welcome! A couple months ago, you were posting about your TMS treatment. Did you receive any lasting benefit from that?
> > A friend of mine had ECT. It helped his depression quite a bit. I think he had some short-term memory loss. He would get a maintenance dose about every six weeks. Then he needed them less frequently.
> >
> > Undercurrents by Martha Manning has a detailed account of her ECT experience. The book is one of the best depression memoirs I've read.
> >
> > https://www.amazon.com/Undercurrents-Beneath-Surface-Martha-Manning/dp/006251184X
>
> Oh .... I have read that book. Its amazing. Im reading Shock, now about Kitty Dukakis.
>
> https://www.amazon.com/Shock-Healing-Power-Electroconvulsive-Therapy/dp/1583332839/ref=nodl_
>
> I knew most patients undergoing acute ECT usually require maintenance. But after watchimg Gary Gulmans, The Depresh, he made it seem like you one one set of acute treatments and then your set for life. My interest in ECT was rekindled at that point.
>
> https://www.hbo.com/specials/gary-gulman-the-great-depresh.
>
> He didnt talk about maintenance which most doctor Im talking to tell me most patients need. I dont not want lifelong ECT at this point I guess.
>
> Thank you so much Hugh! Your the best!
Posted by Lamdage22 on August 18, 2020, at 0:03:13
In reply to Re: Anyone have ECT? » PCB, posted by Hugh on August 17, 2020, at 23:53:50
Hey PCB,
the first time I was taken off Nardil was rough. It was being done in hospital because of Phenelzine induced psychosis. I don't know what advice to give you. Does Phenelzine help at all? Maybe if it doesn't, it is easier to get off. Personally, I wouldn't get ECT and try other stuff like Ketamine first. And before that, maybe a blood test for nutrient deficiencies. I had 4 and fixing them really made me better. If you have any questions, please ask.
Posted by Lamdage22 on August 18, 2020, at 0:19:18
In reply to Re: Anyone have ECT?, posted by Lamdage22 on August 18, 2020, at 0:03:13
Sorry, you werent asking about Nardil withdrawal here. I have talked to about 10 patients who did ECT, none of them were glad they did it. They seemed more indifferent to their feelings than before. Other than that, one had trouble finding his way home in the city he grew up in... Cognitive problems in most of them though not all as severe as this one guy.
Posted by PCB on August 18, 2020, at 6:11:09
In reply to Re: Anyone have ECT? » PCB, posted by Hugh on August 17, 2020, at 23:53:50
> You're welcome! A couple months ago, you were posting about your TMS treatment. Did you receive any lasting benefit from that?
I am on week five of bilateral rTMS. I feel about 70% on my low dose Nardil combination with lithium/lamicital. So with 4 weeks of TMS I would say I am about 10% better. My TMS doctor wants to see if I could taper down off Nardil during TMS. I tried 3 times to go down 10 mg without success last week. She wants me to try to go down 5 mg next week.
My understanding TMS is it is an augmenter of an antidepressant medication that is not working well. So I thought would get off Nardil and start something strong like effexor/lithium (what they use during ECT). I thing that would get me about 25% improved. And then we would start TMS and hopefully get me up to 60 to 80%.
But my TMS provider wants to do it backwards as I have described. She says she does it often tapering patients off meds with TMS. But Im my reading, I have yet to find any TMS talk about that. Yes, maybe they might say, patient did so well on TMS they need less of their antidepressant. But no TMS provider writes, patient is having sides effects with drug x, so I will start TMS and after 3 weeks taper them off drug x. And because TMS really does not work without medication, I will start drug y once they are off drug x(drug x is an MAOI and needs a 2 week washout). Unfortunately the patient will have completed 36 TMS and I guess will have to pay $15,000 for 36 more treatments to get drug y to possibly work. I dont get it, unless she is trying to boost her revenues by having me do TMS twice even thought I have tapered off Nardil at least 10 tens or more always without TMS.
If this doesnt work, I am going to another TMS provider and self pay for 36 more sessions and see what he suggest. I better he will agree effexor/lithium with TMS.
I havent tried thyroid because my TSH is low. But I do have the folate gene for which Deplan is suppose to help. And despite my great resistance, Im finally thinking of adding Seroquel at night. I have only tried Zyprexa 2.5 mg once and I felt almost catatonic.
Posted by linkadge on August 18, 2020, at 6:51:13
In reply to Re: Anyone have ECT? » Hugh, posted by PCB on August 18, 2020, at 6:11:09
Random musings here ...
ECT does have a high relapse rate. This is admitted by even the strongest proponents of ECT. There was a study suggesting that the nortriptyline + lithium combination extended the time till relapse. Actually when nortriptyline was administered alongside ECT, it also reduced cognitive side effects.
As for rTMS, I wouldn't say that nobody responds without also taking antidepressants, but there is plenty of evidence suggesting that rTMS can hasten or improve the response to antidepressants. As some know, I build my own rTMS machine about 20 years ago (don't do this). It actually worked well (but I got concerned about demyelinating my brain or something). It improved my sleep wake cycle dramatically (powerful drive to easily fall asleep at night for at least a month afterwards). I then attempted to stop the citalopram. Although I did this, and wasn't 'depressed', I was quite a bit more irritable. From what I've read rTMS is probably more dopaminergic than serotonergic (which is why it might augment SSRI meds). The rTMS has the strongest effect on my apathy / anhedonia. It probably had pro-cognitive effects as well. I remember I hadn't played the piano in years (loss of interest) and I sat down and played several complicated songs perfectly.
Ketamine seems to have serotonergic and dopaminergic effects (as well as modulating glutamate, gaba, opiates etc). It's really a multi-mechanism drug.
Side note here - I really think more of you should order some agmatine. Seriously, it's like 14 bucks on amazon, and I have been noticing some serious improvement. I'd like to hear some reports (positive or negative). In mice, it works as well as ketamine (some overlap in actions).
Linkadge
Posted by undopaminergic on August 18, 2020, at 6:52:00
In reply to Re: Anyone have ECT? » Hugh, posted by PCB on August 18, 2020, at 6:11:09
> ... and I guess will have to pay $15,000 for 36 more treatments to get drug y to possibly work. ...
>
> If this doesnt work, I am going to another TMS provider and self pay for 36 more sessions and see what he suggest.
>You are at least fortunate to be able to afford that. It is quite out of my range.
-undopaminergic
Posted by PCB on August 18, 2020, at 7:42:23
In reply to Re: Anyone have ECT?, posted by linkadge on August 18, 2020, at 6:51:13
*I bet none of this is new, so sorry if this is repetitive
So Nardil stopped working for me in 2001 and I volunteered for ECT with Harold Sackiem. I was in that study which compared cognitive function with different ECT settings. And it was found time to relapse was about 8 months with nortripline and lithium and 5.5 months with effexor and li. Lithium given during ECT worsened cognitive function and nortriptyline as you mention enhanced cognitive function. I think 6 month months out of ECT, all cognitive function parameter were improved except one. But of course your cognitive function is zero in deep depression. I did well and dont remember any cognitive problems.
I have somewhat gotten away from the serotonin, norepinephrine ways of describing mood disorders. TMS they say activates the underactive neurons in the L prefrontal cortex. And if you think of a seizure in ECT, that is a massive synchronized back to back activation of all the neurons in the brain .... unfortunately the hippocampus as well were your memory lies. Makes sense ECT is more potent,
*although Dr McMullen says if you continue on to 60 or even 90 treatments of TMS, you can get 70% remission like ECT.*
My doctor doesnt say that. Also, nortripline is stimulating with the norepinephrine. So if you take a stimulant or even coffee before TMS is works better. If you take a benzo, TMS works less.
So this thought of neuronal activity as the main player in depression kinda makes sense. If your L prefrontal cortex neurons are underactive, they are not producting neurotransmitters, BDNF and microglia are not working. But send a little electricity through them with TMS and the system starts working again. Take a sledgehammer to them for 10 seconds with ECT, they are really working with some collateral damage to your hippocampus ( interconnected nerves holding memories break apart and start moving due to ECT.
Now come full circle and Dr McMullen claims Dr Sachkiem state TMS is doing something different then ECT in addition. He says that TMS intrinsically heals the brain an that how TMS get durability rates of over a year. I tried to look up Dr Sackiems paper on TMS and couldnt find much ... or him saying this.
Lastly ketamine I heard is like a ski slope. At the end of the day you have several trails that people have repeated gone over. This is like depression or PSTD, where peoples depressive thoughts get deeply ingrained in the brain and cant be removed easily. That deep ski trail with no snow is like a persons memory of Vietnam war. I bet those neurons are superglued together. So what I heard ketamine is like the morning snow or snow machines. They cover the whole mountain with fresh snow, especially those trail that were permanently overskied. Add some therapy to that so the person doesnt not rehash the traumatic event and you got a healthy brain.
The end.
(Except why so most of us here do not respond to this revolutionary stuff)
Posted by linkadge on August 18, 2020, at 9:43:18
In reply to The Grand ECT, TMS and Ketamine Thesis, posted by PCB on August 18, 2020, at 7:42:23
Interesting that you were involved in that study (that was the exact one that I was referring to).
ECT, rTMS and Ketamine share a neurotrophic mechanism. They all increase BDNF, although allegedly ketamine does so after a single dose.
I suppose too you could look into psilocybin. I don't know if it is yet approved in Canada for TRD.
Posted by SLS on August 18, 2020, at 22:36:27
In reply to Re: The Grand ECT, TMS and Ketamine Thesis, posted by linkadge on August 18, 2020, at 9:43:18
> Interesting that you were involved in that study (that was the exact one that I was referring to).
>
> ECT, rTMS and Ketamine share a neurotrophic mechanism. They all increase BDNF, although allegedly ketamine does so after a single dose.
As suggested by Linkadge, increased BDNF production might be a common pathway of the therapeutic effects among most antidepressants.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763983/
- Scott
Posted by Hugh on August 19, 2020, at 13:22:48
In reply to Re: Anyone have ECT? » Hugh, posted by PCB on August 18, 2020, at 6:11:09
Before you pay $15,000 for 36 more TMS treatments, I'd suggest that you try neurofeedback. This has helped people who have failed to benefit from TMS and/or ECT. I've had neurofeedback treatment, and I'm very glad that I did. It helped my depression somewhat, and it helped my anxiety significantly.
Neurofeedback can also be an effective treatment for bipolar disorder. I know of two NYC neurofeedback clinicians who are highly regarded in the field:
Merlyn Hurd
https://www.nyneurofeedback.com/
Mark Smith
https://neurofeedbackservicesny.com/
>Unfortunately the patient will have completed 36 TMS and I guess will have to pay $15,000 for 36 more treatments to get drug y to possibly work. I dont get it, unless she is trying to boost her revenues by having me do TMS twice even thought I have tapered off Nardil at least 10 tens or more always without TMS.
>
> If this doesnt work, I am going to another TMS provider and self pay for 36 more sessions and see what he suggest.
Posted by phidippus on October 6, 2020, at 4:54:36
In reply to Anyone have ECT?, posted by PCB on August 16, 2020, at 10:34:56
I have had ECT a couple of different times. I did experience memory loss, which sucks but is not a steep price to pay for the relief ECT can bring. I had some maintenance ECT but did not complete it because I felt good enough not to continue it.
This is the end of the thread.
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