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Some Info From A Pdoc Who Specializes In Ect


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#1 Suzani

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Posted 10 August 2009 - 03:47 PM

About me: 25 yrs recurrent major depression, 30+ meds tried, still depressed, considering ECT.

The Dr. I met with today has administered ECT to thousands of patients. He was in charge of ECT for many years and participated in nearly every treatment while in that position. 6000 have had ECT at this hospital in the last 10 years. Statistics on these patients were analyzed a couple of years ago.

This info is not at all complete - we didn't get to everything, and I just realized I didn't take great notes. If I took notes like this in 8th grade I would still be in 8th grade. I can't fill in the missing parts of notes because I'm having memory problems :mad: I am depressed and withdrawing from effexor. I didn't even recognize this Dr. and I met with him for 90 minutes 2 weeks ago. I did recognize his office, for what that's worth.

Almost all of the info below is from my notes re: his responses to my questions I asked. Meeting with the head of ECT soon for more information.

First, he said he recommends reading a booklet published by the Madison Institute. I just ordered it - it is 19 pgs and costs $5.95, search for Madison Institute ECT. They also have online info, I haven't read it.

STUFF ABOUT HO)W ECT IS DONE AND PREP FOR IT:

At this hospital, 4 MDs are present during an ECT treatment: a psychiatrist very experienced in ECT, a psychiatry resident, an anesthesiologist, and an anesthesiology resident. (Teaching hospital) Never would a resident of either specialties do this without a certified specialist. Presumably nurses are there too. I did not ask questions about the anesthesia. I will ask the Dr. who will do the treatment. I'm pretty comfortable knowing an anesthesiologist will be there. This Dr. looked shocked and horrified when I told him people didn't know if a pdoc performed the treatment, or if an anesthesiologist was also present. Apparently it would be unthinkable any other way. So anyone who had that concern can let it go.

Prior to ECT, it is recommended that patients stop taking (in manner directed by a pdoc) anti-convulsants. I am to titrate down to zero on lamictal, and reduce my dosage of xanax ER as much as I can tolerate. This Dr. did not feel that I need to reduce levels of drugs that lower the seizure threshold, like adderall. I will try very hard to be completely off effexor (down to 9.375 mg/day if I can stick to it), but it is not essential. The first few days during ECT I should expect to feel bad - headache, muscle ache, nausea, and exhaustion, so in a way the effexor effect would just be part of that mess.

STUFF ABOUT ECT AND MEMORY LOSS:

I told him that one thing that confused me is that pdocs and things written by pdocs about ECT talk about memory loss, and don't distinguish between memories lost during the treatment (which maybe many patients could deal with) and ongoing memory loss after treatment. Just sitting there today I had to keep asking - wait, do you mean during treatment or later? I wish he would have just left out the stuff about memory loss during treatment so that I could be clear on problems with ongoing memory loss.

1) You will have memory loss - you will lose and never remember certain things that happened prior to and after the treatment. Everyone loses memories from the day before and the day of treatment. Many/most lose some memories (not all, but you don't know which) throughout the "acute phase" of treatment - 3 treatments a week for 2-4 weeks.

2) I have a partial note that is about memory loss - it may mean that within 3 weeks after the last treatment (last of the 3x a week treatments? Last ever treatment), 80% of patients have no memory problems. I don't remember what he said about the other 20%. One thing I noticed is that when this guy talked about memory loss, he seemed to treat any memory loss, however small, the same as "I don't remember going out to a movie last night."

I will try to follow up on that 80% number.


3) He has never had a patient unable to continue their career/do the same job/kind of work after ECT - even if the work was pretty complicated.

4) This Dr. has had 3 patients in his career lose selected autobiographic memories from the past. Just a few memories, but still not a good thing (example, you took a trip to Hawaii 10 years ago and look at pics from trip but still have no memory of trip.)

5) Memory loss due to depression: Depression shrinks your hippocampus which is (mainly? exclusively?) involved in long-term memory. Alzheimer's also shrinks your hippocampus. Thus, memory problems. The longer you have depression, the more it shrinks. If you then kick the depression, you will still have some memory problems. Happily, the hippocampus is one of the only (the only) part of the adult brain where new neurons can be produced, hurray! (producing new neurons is called neurogenesis.)

One plus to ECT is that research shows that production of new neurons in the hippocampus occurs much faster after ECT than it does if depression is stopped by medication. (I think I have that right - I know ECT causes the fastest neurogenesis.)

AFTER ECT:

1) You still take meds.
2) This is anecdotal: It seems that if ECT does not help you, the meds still won't work very well.
3) IF ECT does work, meds will probably work better for you than they used to (they aren't working or you wouldn't be getting ECT, right?)

ECT MAINTENANCE:
Didn't discuss today. Discussed it 2 weeks ago. Won't go into it now.

INTERESTING TRIVIA:
ECT is used much more often on the east coast (U.S.), especially in the Southeast. NO THIS IS NOT A SOUTHERN HICK, DELIVERANCE KIND OF THING! This is because Duke, Emory, and UNC (Univ of North Carolina) have studied it and used it a lot. Duke in particular has a large ECT treatment program. These are all very good hospitals, not shacks in the woods.

The west coast is much more against ECT, Berkeley even voted to make it illegal 25 years ago (treatment was much harsher then). Not sure what has been going on lately in CA but it is not illegal! Not clear on why this is - seems a little odd. But people in San Francisco area do tend to have an activist mentality (Berkeley even more so).
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#2 SoLongThanksForAllTheFish

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Posted 10 August 2009 - 05:44 PM

Thanks for the info Suzani. Sorry to hear you are still depressed today.

Please keep us posted. Altough not cosidering ECT for myself, as a curions/scientific psych patient, I am very interested in your results as you progress thru the treatment.

I think you're making the right choice given your history. Good luck.

Edited by Bones, 10 August 2009 - 05:45 PM.

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#3 Suzani

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Posted 10 August 2009 - 09:47 PM

Thank you for the kind words, Bones. Having to get off more meds was a nasty surprise. Don't mind the lamictal but the xanax xr is like my blanky - can't imagine going without. My regular pdoc told me to hold off on reducing the xanax until I see him - maybe there is a gentle way to deal with it.
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#4 Anna

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Posted 10 August 2009 - 10:28 PM

A good friend of mine, suzani, had ECT and her experience pretty much mirrored what the doc you saw said. She did not end up needing maintenance ECT. She feels ECT saved her life.

She did, however, feel that "overall" her general memory was poorer than prior to ECT, but it did not impact her ability to do her job (SW) and felt it was a reasonable trade off.

Ann
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#5 In_Remission_ECTetera

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Posted 14 January 2012 - 01:21 AM

I am in the trailing-off phase of ECT treatments. 16 so far. Under treatment at theoretically one of the best hospitals in the country. I've noticed some fairly significant short-term and immediate memory issues - I'll form an intention, then it will vanish. Then again, I had memory issues prior to any treatment, likely as a result of depression. I'll keep you posted, answer questions as I can.

ECTetera


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