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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Crotale on July 27, 2008, at 15:10:22
I've been experiencing mild cognitive side FX (mild anomia, i.e. word-finding difficulty) for about a week, maybe a little more, and it already seems to be going away. Of course I've dropped down to once every 2 weeks which may well have something to do with it. I'm pretty impressed by how few side effects I've experienced, but I will say this stuff is still pretty annoying/embarrassing for someone such as myself who is accustomed to having multiple dictionaries (English, Latin, and some Greek) at her fingertips. I really hope it will either go away, or my pdoc will be willing to prescribe something which will help.
Has anyone encountered or heard of any cognitive side effects (particularly with bilateral or bifrontal ECT, but in general, with any electrode placement) that are *not* memory-related? If so could you let me know? I'm curious. (This is a sure sign of improving mental health in my case: curiosity.)
-Crotale
Posted by bleauberry on July 27, 2008, at 19:43:43
In reply to ECT cognitive side FX, posted by Crotale on July 27, 2008, at 15:10:22
I did 12 sessions of ECT. I warn everyone not to go that route. But, you're already there. So I won't say anything. I believe mine were bifrontal, but I can't remember.
It has been a year since my ECT. The 3 month memory loss is still 100%. Never came back. I still have cognitive difficulties that seem to have stabilized but not gotten back to the sharpness I once had. I do not believe there are any meds you can take to recover the brain damage from the trauma of electric shock. My dad who is a doctor noticed the similarity of post-ECT symptoms compared to soldiers in Vietnam who suffered concussion from grenade blasts.
My ECT worked somewhat a little bit maybe kind of sort starting around session 6, and then I was in remission at session 12 and that lasted 2 days and then I was back in deep depression again. It just didn't work.
My immune system and hormones are all whacky now too. That was new since ECT.
For representative comparison, if my mental sharpness pre-ECT was a 10 on a 1 - 10 scale, I am now about a 8. Or another way to look at is if I was once an A+ student, and I was, I am now about a B- student.
Posted by Crotale on July 27, 2008, at 21:48:41
In reply to Re: ECT cognitive side FX, posted by bleauberry on July 27, 2008, at 19:43:43
Well, obviously this is an individual reaction. When not coping with depression, I consider myself an excellent thinker (would have been a mathematician if depression hadn't stopped me from getting my doctorate). I've found my concentration improved since the ECT started working: for the first time in years I've been able to review some higher math, and I've been seriously considering going back to school.
The only side effect I've noticed (other than things that I'm pretty sure are caused by the anesthesia, not the ECT itself) is the word-finding difficulty. I'm at the point of maintenance ECT now so I'm hoping the anomia will go away or at least decrease.
Interestingly, one of the (many) pharmaceuticals that has been studied a bit for treatment/preventation of ECT's cognitive side effects is naltrexone, an opioid antagonist. I take the partial agonist buprenorphine; I wonder if that might have prevented me from having worse side effects. On the other hand, it might just be plain old good luck on my part. Regardless, I think whether it's something you should try or not depends on how bad your illness is, whether your condition is one of the types for which ECT is considered most likely to work (e.g., "classic" melancholic depression, catatonic schizophrenia, etc.), and the general cost/benefit analysis. I wouldn't recommend it for everyone, but I wouldn't tell everyone to avoid it, either.
One other thing: up until yesterday I've had right unilateral (RUL) ECT which mainly affects the temporal lobe; as such most of the cognitive side effects from RUL are memory-related. Bifrontal ECT may be more likely to affect your thinking. The reason I was particularly curious about side effects from bifrontal ECT is that my depression has returned to an extent since I dropped down to once every 2 weeks, so I've switched to "modified bifrontal." It's not true bifrontal but it is somewhat similar, including being 2-sided. It's a relatively new placement, so far believed to cause fewer cognitive effects than BF (and many fewer than traditional bilateral) but to be more effective than RUL.
I'll say I've had fairly good luck with ECT, to the point where I'm doing better than I have been in years. I may even be able to decrease my use of buprenorphine to as-needed rather than around-the-clock (which would be nice since it has a lot of side effects). I consider it a great success so far.
-Crotale
Posted by okydoky on July 29, 2008, at 14:28:51
In reply to Re: ECT cognitive side FX, posted by bleauberry on July 27, 2008, at 19:43:43
I have complained about my declining cognitive skills for a long time. I always wondered if they were ECT related. Here I see it as a possibility. I was an A+ student and fast tracked at college. But broke down and quit. I say this to provide a sense of where I came from. Cognitively I would be about a D student now. I don't know how to cope. Everything else most especially my depression I always had hope but with this I have none. Word retrieval is terrible as is short term memory among other things. I have a difficult time having intelligent conversations with intelligent people yet have little in common with people who have never attempted to sharpen their cognitive skills. I feel like there is no social stair for me to stand on.
I feel left behind as I can no longer keep up with and learn new skills. This has been in part due to years of not addressing depression I know. I had 6 bilateral treatments and several years later 12 unilateral ones. None of them helped and I was put on a large amount of tranquilizers for several years at a community mental health center where keeping everyone quite and non functioning was the name of the game. I have never recovered but it is unclear from what?
How to cope?
As you can tell I have a difficult time putting my thoughts into concise sentences. Sorry
oky
Posted by cumulative on July 31, 2008, at 3:08:03
In reply to Re: ECT cognitive side FX, posted by Crotale on July 27, 2008, at 21:48:41
methylphenidate, for one
Posted by bleauberry on July 31, 2008, at 19:32:13
In reply to we might look into meds used following head trauma, posted by cumulative on July 31, 2008, at 3:08:03
> methylphenidate, for one
Interesting you should say that. Since ritalin acts rapidly and reliably in restoring me to close to "normal" within an hour. Fierce rebound anxiety, weight loss when already severely underweight, and fears of tolerance...these keep me from using it. But once in a while, when I do, it does seem to bring me back to the good days pre-ECT pre-depression.
Also interesting, I read somewhere that though the mechanism is different and it is not a stimulant, Milnacipran is similar to Ritalin in several ways. No surprise that Milnacipran is the only AD that has helped me post-ECT? But Adderall was aweful. So it isn't as easy as just saying take a stimulant, or tweek NE/AD, or anything like that. It may be specific to certain meds.
Posted by Crotale on August 3, 2008, at 17:04:57
In reply to Re: ECT cognitive side FX, posted by okydoky on July 29, 2008, at 14:28:51
oky -
You seem to me like a perfectly intelligent person, and I think your sentences are just fine. I'm just guessing, but I think you may be underestimating your intellectual abilities.
When you mention that you have problems with word retrieval, are you talking about the same problem I've been having? aka "word finding difficulty" or "anomia?" It's kind of embarrassing, although it is the only side effect I've experienced. Otherwise my concentration is improved, I assume as a result of the efficacy of the combination of ECT, buprenorphine, and Parnate in treating my depression.
For a long time depression has been my downfall, cognitively speaking. Now for the first time in years I'm actually considering returning to school. (probably not in math...nonetheless it does feel good to be able to review some of the material I learned in college.)
Various researchers have been looking into about a half dozen different classes of drugs for treating or preventing cognitive side effects from ECT. There really hasn't been enough research to say for sure whether any of them work, much less which ones work the best, but here are some of the drugs and classes of drugs that they've been looking into:
- cholinesterase inhibitors [note: cholinergic drugs such as these may cause depression as a side effect so I recommend caution]
- calcium channel blockers
- piracetam (I'm not sure if this is available in the US)
- memantine (Namenda), an NMDA (glutamate) recetor antagonist recently approved in the US for treating Alzheimer's; it has various effects at a number of other receptors which may also be of significance
- cyclooxygenase-2 inhibitors
- glucocorticoid receptor antagonists
- NO donorsStimulants might also be worth a try. I'd try modafinil before methylphenidate or amphetamine.
Don't give up!
best wishes,
-Crotale
Posted by bleauberry on August 4, 2008, at 21:17:39
In reply to Re: ECT cognitive side FX » okydoky, posted by Crotale on August 3, 2008, at 17:04:57
> oky -
>
> You seem to me like a perfectly intelligent person, and I think your sentences are just fine. I'm just guessing, but I think you may be underestimating your intellectual abilities.
>Hey, I'll take that as a compliment. Cool. Thanks! Actually, weird, I do ok typing. In a conversation it is harder. Very often I just cannot find the word, or I am slow to talk and slow to think how to say it.
The intellectual part that is gone is in the memory. Whatever I study today will be distant in 2 weeks. 2 months, forget it, it's gone. Good thing though it does come back fairly quick with some refresher. Isn't so hard to learn the second time. It's like the memory is there, but hidden, and I just have to open the door and then, ahh ahh, ok, now I remember. Ya know? Weird.
Still today, an entire 3 months of my life is completely erased. No recall whatsoever. 6 months leading up to ECT, and 3 months following it, are very very sketchy. I remember bits and pieces, but there are huge gaps and fog.
What is really weird is that I can remember striking details about some little silly thing, and yet have zero memory of something anyone would definitely remember.
Names. People's names. Gosh, I am so bad at that now. I used to be so good at it. People I've worked with for almost 3 years now, well, don't tell any of them, but probably 3/4 of them I don't know their names, even though I see it on their name badge every day. Thank you for name badges!
Posted by SLS on August 5, 2008, at 5:45:53
In reply to Re: ECT cognitive side FX, posted by bleauberry on August 4, 2008, at 21:17:39
Do you think that ECT disrupts long term potentiation (LPT)? Has it been mentioned in any studies you have seen?
- Scott
Posted by bleauberry on August 5, 2008, at 18:51:29
In reply to Re: ECT cognitive side FX » bleauberry, posted by SLS on August 5, 2008, at 5:45:53
I don't know, Scott.
I found it interesting that my Dad, who spent a year as an MD in the Vietnam war, said ECT after-effects were very similar to the head trauma suffered by grenade blasts.
Maybe ECT works by shocking the HPA axis and all the master glands back to baseline where they were pre-disease. Maybe it kills hidden micro-organisms or parasites causing nervous system inflammation or disruption (my own theory). Maybe it stimulates the release of all neurotransmitters. I have no idea. And neither does anyone else.
All I do know is logic...that is, an electric shock to the head, strong enough to induce seizures, is not harm-free to the head.
> Do you think that ECT disrupts long term potentiation (LPT)? Has it been mentioned in any studies you have seen?
>
>
> - Scott
Posted by Crotale on August 7, 2008, at 22:12:09
In reply to Re: ECT cognitive side FX, posted by bleauberry on August 4, 2008, at 21:17:39
Hi. Thank you very much for the details re: memory problems. I've been wanting to know more about what specific difficulties people have so that I know what to keep an eye out for. Having heard about some of the problems other people have had, I feel rather fortunate that I only seem to have gotten mild anomia. Especially since I seem to get bad side effects with a lot of medications.
I have been getting some side effects related to the anesthesia & sedatives, like feeling confused when I wake up, although I usually come out of that pretty fast. Last time I was groggy all day and into the next day; that's the first time that's happened. I think they might have increased or otherwise altered the anesthesia because it was the first time I tried the modified bifrontal (note to self: find out if there is a more specific term for this).
> Hey, I'll take that as a compliment. Cool. Thanks! Actually, weird, I do ok typing. In a conversation it is harder. Very often I just cannot find the word, or I am slow to talk and slow to think how to say it.
That's the same problem I've been having. With typing it's easier for me too, I think because I can take the time to find the word I'm looking for. Sometimes it just takes a few seconds, occasionally I just can't think of the word at all. I keep a journal, and lately I've been using a thesaurus (seriously!). My friends and family have been really understanding which is nice, but it's still kind of embarrassing. I talked to my therapist about it and he helped me with some ways of working around it, like stalling or substituting another word.
Speaking of substituting...another weird thing I've noticed is a few times, rather than just not being able to think of a word, I unintentionally substitute a different word than the one I meant to use. This is apparently another aspect of anomia.
I haven't noticed that I'm any worse with names, but then, I've always been bad at remembering those.
I may have asked this before, but how long has it been since you had ECT? I've been hoping this problem will go away with time as they sometimes do. You're in my thoughts and I hope things get better for you too.
Thanks again & all my best,
-Crotale
Posted by okydoky on August 8, 2008, at 9:05:24
In reply to Re: ECT cognitive side FX » okydoky, posted by Crotale on August 3, 2008, at 17:04:57
Meant to get to this a few days ago.
> You seem to me like a perfectly intelligent person, and I think your sentences are just fine. I'm just guessing, but I think you may be underestimating your intellectual abilities.
Thanks. I realize my ability to be subjective about this topic is directly related to my depression.
> When you mention that you have problems with word retrieval, are you talking about the same problem I've been having? aka "word finding difficulty" or "anomia?" It's kind of embarrassing, although it is the only side effect I've experienced. Otherwise my concentration is improved, I assume as a result of the efficacy of the combination of ECT, buprenorphine, and Parnate in treating my depression.
I sent you a rather long babble with the Summery of Results of Neurological testing I had in 2007 in an attempt to try and explain myself.
The ECT did not help me in the past. Parnate was miraculous but pooped out. I wanted to try buprenorphine with Parnate or Amineptine but cannot find a doctor who will prescribe buprenorphine. I continue to search. It would take care of my pain I am hoping also.
>For a long time depression has been my downfall, cognitively speaking. Now for the first time in years I'm actually considering returning to school. (probably not in math...nonetheless it does feel good to be able to review some of the material I learned in college.)> I'll say I've had fairly good luck with ECT, to the point where I'm doing better than I have been in years.
So glad for you and your sharing gives me some hope.
I was thinking of trying Namenda. Perhaps first give the above combination try?
I tried modafinil and was extremely agitated but perhaps I needed to stay on it longer. I have been on Ritalin for years. I am unable to take other amphetamines because they "flare" my interstitial cystitis.
Thanks for being concerned. I was not going to post here for a while but I find there are loose ends most especially people caring about me and willing to be involved. I am not used to it.
oky
Posted by Crotale on August 11, 2008, at 17:50:25
In reply to Re: ECT cognitive side FX » Crotale, posted by okydoky on August 8, 2008, at 9:05:24
> Meant to get to this a few days ago.
I sympathize, I seldom answer these things immediately.
> > You seem to me like a perfectly intelligent person, and I think your sentences are just fine. I'm just guessing, but I think you may be underestimating your intellectual abilities.
>
> Thanks. I realize my ability to be subjective about this topic is directly related to my depression.Well, I'm certainly familiar with the whole low self-esteem thing!
> I sent you a rather long babble with the Summery of Results of Neurological testing I had in 2007 in an attempt to try and explain myself.
Will check that out & write back. If there's one thing I'm pretty terrible about, it's keeping on top of my email. (Need to get off a couple mailing lists that fill my inbox with a lot of rather empty messages.)
> The ECT did not help me in the past. Parnate was miraculous but pooped out.
Nardil felt miraculous (enough that I was willing to put up with the massive weight gain), but pooped out for me. In retrospect, I think I was hypomanic on it. (I'm not bipolar, nor do I usually have this problem with ADs, but a couple of ADs might have caused this side effect for me.)
> I wanted to try buprenorphine with Parnate or Amineptine but cannot find a doctor who will prescribe buprenorphine. I continue to search. It would take care of my pain I am hoping also.
I think it would be a good med for chronic pain - you might ask your mdoc about prescribing it for that, rather than trying to find a pdoc to prescribe it. I used to get really dreadful menstrual cramps and upper back/neck pain, and I don't have problems with either of these anymore (and haven't for the last 9 years, since I've been on buprenorphine). My experience is, as far as tolerance goes, there is some, but I'm still way better off with it than without.
I'm not sure I'd recommend Parnate for you, since it pooped out in the past. A lot of people find it a good med, but I actually tried Nardil twice and it pooped out both times.
I don't know a whole lot about amineptine, although it sounds like an intriguing med, based on its mechanism of action and its chemical similarity to tricyclics, and it's supposed to be faster-acting. I would expect it to be rather stimulating, so since you've had problems with jitters from stimulants in the past, you might want to "start low, go slow" (i.e., start with a low dose and increase it gradually). Especially if you do want to use it in combination with a MAO inhibitor, as the combination could cause elevated BP (although probably they can be used together with caution, as can MAOIs and amphetamine).
> So glad for you and your sharing gives me some hope.
Well, thanks! That makes me feel really good.
> I was thinking of trying Namenda. Perhaps first give the above combination try?
Whatever you do try, I will be interested to hear how it goes. I very much hope you find something that works for you!
> I tried modafinil and was extremely agitated but perhaps I needed to stay on it longer. I have been on Ritalin for years. I am unable to take other amphetamines because they "flare" my interstitial cystitis.
Maybe a lower dose? I find that when I take too high a dose of a mu-opioid agonist (including buprenorphine, but also full agonists like hydrocodone and morphine) I get overly jittery (not to mention sick to my stomach). Had the same problem with amphetamine and related stuff, too, including selegiline/l-deprenyl. (Selegiline is metabolized into l-amphetamine and l-methamphetamine. I recall being hospitalized once when I was on selegiline - this was before Emsam - and getting accused of abusing speed (they always do a tox screen when you're admitted to the phospital, at least in my experience)).
> Thanks for being concerned. I was not going to post here for a while but I find there are loose ends most especially people caring about me and willing to be involved. I am not used to it.
Well, I can't help feeling for someone who seems to have a lot in common with me, including a lot of the same problems. The more I learn about you, the more I empathize.
Take care! You are in my thoughts!
Best wishes always,
-Crotale
Posted by Sunkistcat79 on January 2, 2009, at 11:37:43
In reply to Re: ECT cognitive side FX » okydoky, posted by Crotale on August 11, 2008, at 17:50:25
Hi Crotale,
I just read your posts and am responding in regards to ECT and burprnorphine.
I also just wrote two detaild posted regarding my general situation and my experience with burprnorphine.
I'm not sure if you're sill around so I won't rewrite those posts, but if you are interested, I'm sure they can be found easily as they were posted within the hour (or close to) of this post, same name. One was in the newbie forum and the other was in this forum.In short, I took buprenorphine too, it was nothing short of a miracle for me, but it stopped working after a month or so.
I am in a very very bad state now and am thinking of trying ECT.Thank you.
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