Finally considering ECT (Electro-Convulsive-Therapy) as a depression treatment

[Ecdysis]

I've been MASSIVELY sceptical and resistant to ECT as a depression treatment.

Getting my brain electrocuted has always seemed like the absolute LAST DESPERATE attempt, when all else has failed and suicidality is so high that it's a much bigger risk than ECT f*cking up my (already somewhat f*cked) brain.

However...

I've finally heard an explanation from a pdoc now that actually makes sense to me:

So, I'll explain it as I understood it (and apologies if there are any inaccuracies in there - if anyone knows better, please correct me).

Dr's have observed for many decades/ centuries, that people with epilepsy will often experience an improved mood after a brain seizure.

So, if they're depressed, then coincidentally have a seizure, the depression will lift.

As I understood this pdoc's explanation, Dr's then started looking for a way of how to simulate an epileptic seizure in depressed patients without epilepsy, to have this same effect of raising their mood.

Historically, there's been unfortunate uses, misuses and abuses of this in an asylum system that didn't always have the patients' best interests at heart.

Plus, in things like movies and other social narratives, ECT is often portrayed as a patient strapped down, being "electrocuted" against their will.

Modern ECT, it seems, has moved far, far beyond that (at least if it's done in a modern context, with highly professional, science-based, compassionate health care providers).

These days you get a general anasthesia, so you're not aware the ECT is happening, you get a strong muscle relaxant, so that your body's muscles don't seize and cramp during your brain's seizure, and they've made good progress about how to use the right dose etc of electricity and you're also hooked up to an EEG during the procedure, so they can monitor your brain's response to make sure they're getting the procedure just right and not doing any damage.

So...

Now I'm actually considering this.

I have my next pdoc appt in a fortnight and will ask him about this option.

I think I'll get him to give me 3 options of where to potentially have it done, then read up on each place, pick one that seems the best fit for me personally and make an initial information appointment there and let them explain to me how it's done, the pros/ cons, etc etc etc.

Anyone here have experience with ECT? If so, how long ago? What was the effect? Would you consider doing it again/ recommending it to a friend or someone you care about?

Thanks!

 

[Sideways]

Yep. I tried ECT probably about 10 years ago now. Don’t regret it for a second.

With profound depressive episodes, ECT can be the silver bullet. For some people with bipolar, it can also be one of the things that keeps them reliably stable. Not fiction - I know many people for whom that is true.

I finally tried ECT for the first time when I’d been an inpatient in a psych ward for about a year. I’d seen a lot of people go through ECT and, in comparison to the side effects of medications I was trying, it was a no-brainer. It’s difficult from a practical perspective to people who are largely functional, because it requires at least day treatment, 3 times a week, because of the anaesthetic. But even then, one of my friends is a full time nurse, who has been having a monthly maintenance ECT for years to manage her bipolar.

The anaesthetic is, these days, actually the cause of most of the lingering effects of ECT, particularly in relation to memory. Now that I have a much better understanding of exactly why ECT seems to work, the neurology going on in our brains, I have absolutely no concerns about it at all. Our brains operate by firing off electric pulses, so a treatment that provides a controlled dose of electricity makes at least as much sense as adding a controlled dose of, say, serotonin.

However, ECT tends to not be a treatment we do when we’re functioning well (because of the practicalities of day-patient treatment). And losing memory of the days during treatment - for me, no love lost, those days weren’t worth remembering. I was incredibly unwell.

I went through one course, and it didn’t help. But the side effects were so mild that I ultimately undertook 2 more courses using different types of ECT to see if we could find a course type that would help. The ECT was totally fine for me (the side effects of some of the medications I was also trying? Not so much!).

Ultimately it didn’t work, for me. Which was (and is) incredibly frustrating, knowing how effective it can be for some people.

It’s very sad to me that people have the preconceptions that they do about ECT. The fact is that medication treatments can be an absolute nightmare, and ECT doesn’t even come close to being one of the worst options that I tried in my attempt to get better. Given I was in hospital anyway, apart from the anaesthetic, there were zero side effects for me.

 

[Stephybird]

Yep. I tried ECT probably about 10 years ago now. Don’t regret it for a second.

With profound depressive episodes, ECT can be the silver bullet. For some people with bipolar, it can also be one of the things that keeps them reliably stable. Not fiction - I know many people for whom that is true.

I finally tried ECT for the first time when I’d been an inpatient in a psych ward for about a year. I’d seen a lot of people go through ECT and, in comparison to the side effects of medications I was trying, it was a no-brainer. It’s difficult from a practical perspective to people who are largely functional, because it requires at least day treatment, 3 times a week, because of the anaesthetic. But even then, one of my friends is a full time nurse, who has been having a monthly maintenance ECT for years to manage her bipolar.

The anaesthetic is, these days, actually the cause of most of the lingering effects of ECT, particularly in relation to memory. Now that I have a much better understanding of exactly why ECT seems to work, the neurology going on in our brains, I have absolutely no concerns about it at all. Our brains operate by firing off electric pulses, so a treatment that provides a controlled dose of electricity makes at least as much sense as adding a controlled dose of, say, serotonin.

However, ECT tends to not be a treatment we do when we’re functioning well (because of the practicalities of day-patient treatment). And losing memory of the days during treatment - for me, no love lost, those days weren’t worth remembering. I was incredibly unwell.

I went through one course, and it didn’t help. But the side effects were so mild that I ultimately undertook 2 more courses using different types of ECT to see if we could find a course type that would help. The ECT was totally fine for me (the side effects of some of the medications I was also trying? Not so much!).

Ultimately it didn’t work, for me. Which was (and is) incredibly frustrating, knowing how effective it can be for some people.

It’s very sad to me that people have the preconceptions that they do about ECT. The fact is that medication treatments can be an absolute nightmare, and ECT doesn’t even come close to being one of the worst options that I tried in my attempt to get better. Given I was in hospital anyway, apart from the anaesthetic, there were zero side effects for me.

Sounds like you're a wealth of information! We are just starting this journey with a family member
Can you tell me more about the different types of ECT?

 

[Sideways]

Can you tell me more about the different types of ECT?

There’s now several different ways they can vary treatment, depending on the person’s presentation and treatment history.

The big one is altering the number and position of electrodes on the brain. Sometimes they use one, usually right at the front of the temporal lobe, or they can use 2, in different positions across the front and top of the brain (called Unilateral or Bilateral). This will target different areas of the brain being affected in different ways by different types of mental illness, as well as the intensity of the treatment.

The 3 other key variables are the intensity of the zap itself, and how long they stimulate the neurons in the brain, and how many treatments they continue for (varying from around 6-15, but sometimes even more, or even less).

Even though we’re still kind of guessing about why it works, ECT has been practiced fairly widely now for over half a century, so there’s a wealth of information available to the psychiatrists who specialise in ECT about those nuances of treatment.

It’s good to ensure that the treating psychiatrist has had a good ol chat with the ECT specialist you’ll be using, not just at the outset, but also as treatment progresses, so treatment can be modified over the course of those weeks if that’s appropriate.

 

[Midnightmoon]

I've seen incredible results with ECT with people who were catatonic, less so with people who were more 'able', but they were starting from a different point so possibly harder to see the changes as clearly? It's nice you've got such a good doc that takes time to explain it, most shove you out the door with a leaflet...

I've been in ECT suites supporting others in inpatient care. It's completely not what the movies portray. I was (wrongly) very anxious to what I was walking into, I shouldn't have been. Complete opposite to what I feared.

 

[whiteraven]

I haven't done ECT and won't, primarily because I was charge nurse on a unit that did it. Some folks saw amazing results, while some...well, did not.

Dr's have observed for many decades/ centuries, that people with epilepsy will often experience an improved mood after a brain seizure.

So, if they're depressed, then coincidentally have a seizure, the depression will lift.

Hm...I'd like to see that resource. I have epilepsy, have had many seizures, and NONE had this effect on me. On the other hand, orgasm does seem to improve mood. Go figure.