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daisy

When should I consider trying ECT?

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This is a question I hoped I would never have to ask, but after my recent experience with Parnate, which was unhelpful even augmented with Wellbutrin, it's been on my mind. Though I'd like to try other MAOIs or try TCAs, the side effects that I experienced with Parnate (drowsy yet unable to sleep, headaches, constipation, weight gain, just to name a few...) left me more depressed. I believe if I had been able to handle a higher dosage than 40 mg, it would have been helpful, but the side effects made me SO miserable that I was unable to attempt a higher dosage. Not only did my depression increase, but my anxiety and irritability were at an all time high. Unfortunately, these side effects are supposed to be less common in Parnate than other MAOIs or TCAs, so I'm very hesitant to try another medication that will just exacerbate my depression.

Though I have not tried all of the SSRIs or SNRIs, I experience wild mood swings on those and have ended up with mild psychotic thoughts, so I don't think it's the best idea to go back to those.

I've dealt with depression since I was five... it's been a long 19 years! However, I've never experienced a depression this severe or this long-lasting. This depressive episode began in January-February 2009, and while there have been some short moments of freedom and some brief moments of what I think were hypomanic episodes, it has otherwise not let up. The severity of this episode is very frightening to me. I've been suicidal before, and I believe I know how to handle myself, but we all know that somebody with suicidal thoughts probably isn't the best judge of themselves. While I claim (and truly believe!) that I would never attempt suicide due to the pain it would cause my family, I've attempted suicide in a much less severe depression, so it's hard to trust myself even though I truly believe I wouldn't do it. I'm afraid it will only take one weak moment... and though I've had those moments and have been able to overcome them many times in the past two years, I am afraid that one day I'll succumb to those thoughts. I've begun to think of my life as something that won't last much longer, and that truly terrifies me. This is something I should tell my pdoc, but I'm so ashamed. I have such strong convictions against suicide that I'm embarrassed that I'm having these feelings.

I'm not afraid of memory loss. My depression has caused so much of that already that I barely remember many parts of my life, unless I'm reminded by reading journal entries or seeing pictures and wondering when and why they were taken. In particular, the past two years have been a blur and I barely remember much of anything. I don't even remember a moment of my college graduation because the depression was so severe at the time. Therefore, needless to say, the side effect of memory loss is not really important to me.

I quit my job in June and am still unable to have a full day of stability, so I don't see myself being employed for a while. In addition, it's getting harder and harder to leave my house without coming home crying out of pure exhaustion. It's gotten to the point where I can't even see my friends anymore because the effort to shower or brush my teeth is so difficult that once I do those things, I'm barely able to move.

Nobody here is an expert or can tell me what to do, but I don't know where to turn, as I don't know anybody who has done ECT. I question if I've tried enough medications or if I've done everything I can do. To be honest, both my pdoc and I are at a loss of what to do at this point, which is why I began researching ECT tonight. If you've had ECT, when did you feel that it was time for you to take that step? Even if you haven't had ECT, at what point would you personally consider taking that step? Of course, it's up to pdoc and myself in the end, but I am just so confused and scared at this point that I'd like to hear opinions of people who know what I'm going through.

Can you receive ECT as an outpatient? Has anybody here gotten any relief from the procedure? Is it something that you would do over again if you had the chance?

I apologize for the long entry and the many questions, but I appreciate anybody who can give me any input.

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I am no expert of this. I have, however, given a friend rides to and fro for outpaitent ECT. So it can be done outpatient if there is someone to take care of you.

Have you ever added a low dose of Lithium, 600 mgs? to augment your Lamictal and Wellbutrin? That helps some people with difficult depression.

Daisy I am sorry that your depression is so bleak. I hope you find a solution. Maybe a consult, 2nd opinion from some highly regarded bp expert at a university, perhaps?

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It's gotten to the point where I can't even see my friends anymore because the effort to shower or brush my teeth is so difficult that once I do those things, I'm barely able to move.

I've been there. It is pretty horrible. Hang on.

As ladybug asked, have you tried Lithium? I live on Lamictal and when I am going depressed, my pdoc adds more Lithium. It helps. It could also help with re-trying those SSRIs and SNRIs since as a stabilizer, you might not have an issue with psychosis. Speaking of psychosis, have you tried Abilify, Seroquel or Geodon? Or Lamictal/Lithium combo augmenting one of them?

If you pdoc is out of ideas, then it might be time for a fresh perspective, a new pdoc.

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AAPs don't seem to have any effect on me except for the oh so fun side effects, unfortunately. Otherwise, I think they would be a great option. It's too bad they don't seem to do much for me. (However, I've only tried Abilify and Seroquel.)

I have not tried Lithium, and that is something I'm seriously considering as well. I haven't gotten to talk to my pdoc about any of this yet, and he's a very smart guy who is willing to try whatever it takes to fix me, so I trust his opinion. I will bring up Lithium with him, and if he recommends Lithium, I'll be all over it. My only fear is that I seem to be more susceptible to side effects than the actual therapeutic effects of medications. Sure, I have unwanted side effects from the meds I'm currently on as well, but at least I get SOME therapeutic benefit out of them, so the side effects mean nothing to me!

I really do believe I will find a solution and get out of this black hole, but it's just pretty bleak right now. I'm at my wit's end, and I'm at the point that I'll try whatever it takes to just plain survive.

I really appreciate your responses!

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I would expect the Lithium to be in addition to Lamictal so that it can augment both Lamictal and WB. At least, that is how it works for me.

Ask to go up on Lithium slowly. It is common for one to have some nausea and water retention when starting. Those usually only last a few weeks. The slower you go up, the less significant the s/e's usually. I don't see why your doc wouldn't trial you up to serum level 1.0 before writing it off. Most likely, that's more than 600mg.

If you doc doesn't want to try the addition of Lithium, I would seriously look for a second opinion.

PS - Geodon and Saphris are two AAPs that work a little differently than Seroquel or Abilify. They might be worth a try. Still, I'd go with Lithium first.

Edited by Stacia

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spent a while writing a post and looked up to see it rendered irrelevant...

 

Edited by Moil

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Whenever I have changed doses on lithium I have always had the side effects lessen almost completely within a few days...so if you give it a shot keep that in mind.

I also found taking it with something on my stomach really helped.

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Whenever I have changed doses on lithium I have always had the side effects lessen almost completely within a few days...so if you give it a shot keep that in mind.

I also found taking it with something on my stomach really helped.

Yes, must take food with Lithium, at least I think most people need to.

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I was shown around my local ECT suite and had a long discussion with the doctor in charge earlier this year, as ECT was becoming on the cards, given a 25 year history of deprressive illness and, exactly as you say, experiencing an episode unprecedentedly severe and long-lasting.

I was prepared for it : "anything" was worth grabbing at., and it felt like I'd tried all combinatons of meds over the years. I recognised and accepted the risks, rather than just ignored them.

It would have been done unilaterally, as an out-patient if possible, but I'm a sufficient loner I have no-one who could transport me and check I'm OK for the hours afterwards. He said they'd "work out something".

However, the psychiatrist wanted to try a couple of different combinations of meds first: partly to keep the ECT in reserve, but also know what the best support meds would be after ECT, because it's not just a matter of "with one jolt Jack was free" a lot of the time.

Meds are individual, but the latest combination he suggested for me including high dose Venlafaxine and liothyronine (though my thyroid count is normal) is ... interesting.

I'm happy enough to avoid ECT but if these latest pills don't work, I'll be wanting to go for it.

Chris, in UK.

Edited by Emettman

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Stimulants and opiates are both worth trying before ECT. Frankly I'd have tried them before an MAO-I. Also try Nardil before ruling out the MAO-Is.

Try some of the funky temperal lobe effecting ACs like Topamax and Carbamazepine if you meet the diagnostic criteria for recurrent depression.

That said, ECT isn't so bad and is definitely worth consideration. So is VNS.

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If anecdotal evidence is helpful, my pdoc had a patient who she put on lithium whilst waiting for the ECT paperwork to go through. He had a total remission and didn't need it.

I would try a TCA; amitryptaline has been the best AD so far but I don't know if that could make you hypomanic.

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First, I want to thank everybody for their input on this. I've been putting off asking questions like this, simply because I feel like I'm always a whiner on this board, since I'm always searching for something new that will help. Your support gives me so much hope, and it means the world to me. I also appreciate everybody's recommendations and cannot thank you enough. I certainly have a lot of research to do! I apologize for the length of this message, but I'm trying to respond to everybody, and I do have some additional questions for some people.

I want to start off by saying that I'm not against getting a second opinion whatsoever. It may, in fact, be a good thing to do, and I bet my pdoc would even agree. However, my I trust my pdoc with my life, and he has gone above and beyond trying to get me out of this depression. He trusts me as well, which means a lot to me. I often suggest medications after vigorous research, and he really listens to what I have to say and gets into the research I bring to him, even though we only have a short period of time to meet. Though I'm in a dark hole now, I know I owe him my life. I'm not the best at trusting doctors (my last tdoc was the only other doctor with whom I've felt completely comfortable), but I trusted him from the very first appointment we had. He is willing to try any reasonable solution to get me out of this mess. A second opinion may benefit me, but I truly believe that in the end, I have the best pdoc for me. Unlike many doctors, he's not afraid to try new and different strategies. And to be honest, when I come into the office with all of my research, he always tells me that I'm his most informed patient, and actually LISTENS to my suggestions and what I have to say instead of blowing me off as a 24-year-old blonde sorority girl like most people do. He's the only doctor that I've never dreaded visiting, and that says a lot about his quality. However, even though I know he's the right doctor for me, I will bring up getting a second opinion during my next appointment. I don't think he would be offended at all, since I know he's been really looking out for me during this entire time. Basically, I just wanted to say that he's a great doctor, and I hope I didn't give any impression that he wasn't. He's certainly changed my life for the better, despite my depression.

.......

Stacia, I was unaware that AAPs like Geodon and Saphris worked in a different way. After the AAP route didn't seem to work for me, I stopped looking into it. I think it's time to start looking into those again, as I hear so many wonderful results. I am hesitant to try AAPs due to the fact that Diabetes runs in my extended family HARDCORE, but it hasn't hit my immediate family, so it's likely I won't have a problem. Plus, at this point, I feel that I could deal with Diabetes 2 much better than I'm dealing with depression! Thanks for bringing those medications to my attention!

VE, I've gone the stimulant route, mostly due to my ADHD, but they only ease my depression a minimal amount. All of them seem to mimic a rapid-cycling BP disorder more than anything, so I never know what the day will bring; however, ANY relief I can get from depression is worth it at this point, and I do need that increase in concentration not only for my ADHD, but simply because I couldn't even concentrate on a commercial when depressed before! I missed my Vyvanse while I was on Parnate because I wasn't able to concentrate on the smallest things. (Vyvanse seems to be better than the rest I have tried, as the ups-and-downs aren't as harsh and I can tell when they're coming on.) Topamax didn't do anything for me, but I was not on a therapeutic dosage. I do like that one side effect of Topamax is minimizing the cravings of alcohol. In addition, I have issues with my body, weight, and food (no eating disorder, though), so the fact that it is weight neutral is something I like. (I didn't lose weight last time, and don't expect to lose weight if I go on it again.) I haven't looked at Tegretol or Trileptal for depression at all; neither of them crossed my mind for more than a fleeting moment. I'll need to do some research in that area. In addition, I would LOVE to try Nardil, but am afraid to go through another Parnate experience again. I feel like the side effects just took away my life. (I only mentioned a few of them above.) However, if I could get to a therapeutic dose on an MAOI without having the side effects make me more depressed, I think that's really the best answer for me. Of course, that's only assuming my pdoc and parents would WANT to see me on another MAOI... I don't think I've ever been so irritable and mean to people in my entire life! I was a very unpleasant person! Thanks for the suggestions, VE. I'll definitely look into all of them.

VE, I am curious about your suggestion of opiates, however. I have heard of opiates helping depression, but the addictive properties worry me. I have never had any problems with addiction, or even dependence on medications, so I may be a good candidate for this. I'm interested to hear more about this sort of treatment. I've heard Tramadol is MUCH less addictive than other opiates and does increase mood, but I know it also messes with my serotonin. I clearly haven't ever thought about opiates as a medication, so I don't know much about Tramadol, but I would definitely need to ensure it doesn't mess with me like SSRIs or SNRIs. Or else I may just go crazy! :) What opiates are you referring to as treatment for depression?

As for the lithium fans, I think that sounds like a great option that I would like to discuss with my pdoc, and would really like to pursue. Nausea and water retention wouldn't take over my life like other side effects. Those are nothing! I'm mostly hesitant because of my body/food issues and because I don't want to go back to the days before Accutane when I had bad acne, but everybody's milage varies, so I may not even have to worry about that. I have thought about lithium for a long time and told myself that if Parnate didn't work out then I would try lithium next. It sounds like it has been a real lifesaver for a lot of people, and I can't ignore results like that, no matter how much fear I may have. I would be insane if I didn't bring this up with pdoc when I see him next.

Moil, thank you for writing a long post for me, even though you didn't get to post it. It is still very much appreciated! :)

Bluelikejazz, thanks for the suggestion about a TCA. To be honest, I don't know much about them and should do some more research before ruling them out completely. So far, the only meds that have mimicked a rapid-cycling BP disorder are SSRIs, SNRIs, and to a lesser extent that I'm able to handle, stimulants. TCAs are good meds and I ought to do more research before counting them out. I'm not diagnosed with Bipolar II, even though it has been discussed, so I may have no problems with hypomania.

Sylvan, thank you for your first-person experience of ECT. Unfortunately, the more depressive episodes I have, the worse my short term and long term memory become. I used to have the most amazing memory in the world, but it's definitely slipped away from me over the years. It clearly hasn't happened as quickly as it would with ECT, but I'm afraid that the longer these depressive episodes keep happening, the more my memory will suffer. (It sure is too bad that I can't CHOOSE what I forget!!!) I've had so many episodes in the past nineteen years that I'm afraid they will get worse and produce more memory loss as I get older. After all, I'm only 24, so I have a long life ahead of me, and I know the stressors of adulthood will be much more difficult and perhaps more triggering than anything I've experienced before. In addition, my episodes are becoming not only worse, but longer.

You're completely correct in that I don't understand the consequences of memory loss with ECT; I simply can't imagine that scenario without having done the procedure myself. However, I'm a little afraid that I'll end up there over time anyways. Permanent memory problems are a horrible thing, and it is the one thing that does make me hesitant about ECT. After all, if I recover on medications, I may find that my short and long term memory improve, but I do know that there's a chance that I may permanently suffer from memory loss with ECT. We actually joke that we have a family curse -- anything that can go wrong WILL go wrong. Even though it seems like most people make it out with minimal memory loss, I have to admit that I am scared I won't be one of the lucky ones.

exl2398, Emsam patches are a little out of my budget right now. (I'm unemployed due to my depression, and while my parents help me with my prescriptions and medical bills, I know we simply can't afford the patches. They're not covered by my current insurance, but I can always contest that, I suppose!) I realize that they are less effective or strong as other MAOIs, but since I couldn't handle the side effects of Parnate, it may be worth a try. I'll have to look into the patch more, and maybe I can try to contest this with my insurance company. If not, I'll have new insurance in January, so it may be a different story then.

.......

To be honest, there's a part of me who wants to try Parnate again and move up to a higher dosage. I know that side effects can be different depending on the dosage, so maybe a higher dosage would produce different side effects that I'm able to live with, and I truly believe it would help my depression if I could get there. I'm still keeping that in mind. Nardil and Marplan (though there isn't much anecdotal evidence since it just came back onto the market) are also possibilities, as MAOIs do cater towards atypical depression. My pdoc does have a discount card for name-brand Marplan, so that may be worth a shot.

You guys have given me a lot to research and think about. I think that this might be a thread to print out and bring to pdoc, as he may be able to guide us towards the best plan of action for me. (After all, we're on internet forums, not doctors, and nobody can really decide what's best for me except for pdoc and myself, despite the wonderful and plentiful recommendations you have all given me!)

We have mentioned the possibility of ceasing all medication to see what my symptoms are at this point in my life, since I have been medicated since I was ten, and then start from scratch. I think it's a great idea, but I'm hesitant to do that when I'm in such a dark hole. However, I was thinking last night that even though I'm having some fleeting suicidal thoughts, I haven't even thought about possible plans, so it might actually be a feasible option, as long as I ensure that my parents have my entire prescription and non-prescription medications in a place where I can't get to them. I currently live with my parents who can keep a good eye on me, so if I'm going to try that, now is the time. I'm not sure if I have the same symptoms that I had fourteen years ago when I first started medication, so maybe that's why I've had such difficulty finding something that works. Has anybody tried this method?

Edited by daisy

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VE, I am curious about your suggestion of opiates, however. I have heard of opiates helping depression, but the addictive properties worry me. I have never had any problems with addiction, or even dependence on medications, so I may be a good candidate for this. I'm interested to hear more about this sort of treatment. I've heard Tramadol is MUCH less addictive than other opiates and does increase mood, but I know it also messes with my serotonin. I clearly haven't ever thought about opiates as a medication, so I don't know much about Tramadol, but I would definitely need to ensure it doesn't mess with me like SSRIs or SNRIs. Or else I may just go crazy! :) What opiates are you referring to as treatment for depression?

It's usually not something to consider until pretty much all other medical routes has been tried, but sometimes something like tramadol is successfully used as a last ditch depression medication.

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Thanks, VE. I knew opiates could lift mood and help depression, but have never heard of them actually being prescribed for it. It's not something I would personally ever like to try, but it's interesting nonetheless. I think I learn something new from you in every post you make on the boards.

I don't think I'm going to mess with my medication now. All of a sudden yesterday afternoon, I felt like a human being again and still do. Maybe it just took longer than usual for this med combination to start helping without the Parnate. I don't care why, but I feel almost 100% better. If things go south again (hopefully not!) then I think pdoc and I will try Marplan, as it has less side effects than both Parnate and Nardil and the Parnate would have been very helpful had it not been for all of the side effects that exacerbated my depression. However, hopefully things won't go south and will keep looking up!

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Lithium changed my life. It had some initial side effects but without it I'd be dead. I recommend it.

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To answer your question: Never.

You say you are not worried about memory loss, but you should be. You don't just lose memories, you lose the ability to make new memories. You will get lost driving to a place you've been before. You will forget nice things that people have done for you. You will forget how terrible ECT makes you feel, and you will go in for more treatments, and make your brain worse.

I received ECT while in the hospital. I did not have the luxury of researching it before undergoing treatments. I didn't even have time to think about it before consenting. I went into it blindly after being told that it was my only way to get better. I was so messed up on drugs that I couldn't even walk to my first treatment. Use your freedom wisely and avoid going through what I went through. I received just 4 treatments and now I suffer from severe headaches every day. I don't know if they will ever go away. If you get ECT and it doesn't work, you will be much worse off than you are before. It is a short term solution to a long term problem.

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I had ECT, both inpatient and outpatient, for 12 total treatments. I was persistently suicidal over a period of months, with no relief from ADs, stimulants, lithium, a variety of add-ons. I had lost a significant amount of weight because I was unable to eat. I could think of nothing I wanted, other than to die.

I feel better now, in many ways. I am more interested in other people, and in life generally. I'm able to eat, and to look forward to things in a limited way. I can participate in life. On the other hand, the memory loss was devastating. It wasn't that I became more forgetful, it was that I became less intelligent. The memory loss goes forward, too. I have a graduate degree, but I have to write down anything that takes more than 3 steps. I apologize a lot (I tell people I had a brain injury, because it was) for not remembering names or even events. I will never work in my field again, I have lost too much.

Like Sylvan, I would have ECT again if I were in the same place. It saved my life, too. But the cost was very, very high.

Edited by JennyNixe

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Dear Daisy,

How are you doing now?

Sunshine Outside

This is a question I hoped I would never have to ask, but after my recent experience with Parnate, which was unhelpful even augmented with Wellbutrin, it's been on my mind. Though I'd like to try other MAOIs or try TCAs, the side effects that I experienced with Parnate (drowsy yet unable to sleep, headaches, constipation, weight gain, just to name a few...) left me more depressed. I believe if I had been able to handle a higher dosage than 40 mg, it would have been helpful, but the side effects made me SO miserable that I was unable to attempt a higher dosage. Not only did my depression increase, but my anxiety and irritability were at an all time high. Unfortunately, these side effects are supposed to be less common in Parnate than other MAOIs or TCAs, so I'm very hesitant to try another medication that will just exacerbate my depression.

Though I have not tried all of the SSRIs or SNRIs, I experience wild mood swings on those and have ended up with mild psychotic thoughts, so I don't think it's the best idea to go back to those.

I've dealt with depression since I was five... it's been a long 19 years! However, I've never experienced a depression this severe or this long-lasting. This depressive episode began in January-February 2009, and while there have been some short moments of freedom and some brief moments of what I think were hypomanic episodes, it has otherwise not let up. The severity of this episode is very frightening to me. I've been suicidal before, and I believe I know how to handle myself, but we all know that somebody with suicidal thoughts probably isn't the best judge of themselves. While I claim (and truly believe!) that I would never attempt suicide due to the pain it would cause my family, I've attempted suicide in a much less severe depression, so it's hard to trust myself even though I truly believe I wouldn't do it. I'm afraid it will only take one weak moment... and though I've had those moments and have been able to overcome them many times in the past two years, I am afraid that one day I'll succumb to those thoughts. I've begun to think of my life as something that won't last much longer, and that truly terrifies me. This is something I should tell my pdoc, but I'm so ashamed. I have such strong convictions against suicide that I'm embarrassed that I'm having these feelings.

I'm not afraid of memory loss. My depression has caused so much of that already that I barely remember many parts of my life, unless I'm reminded by reading journal entries or seeing pictures and wondering when and why they were taken. In particular, the past two years have been a blur and I barely remember much of anything. I don't even remember a moment of my college graduation because the depression was so severe at the time. Therefore, needless to say, the side effect of memory loss is not really important to me.

I quit my job in June and am still unable to have a full day of stability, so I don't see myself being employed for a while. In addition, it's getting harder and harder to leave my house without coming home crying out of pure exhaustion. It's gotten to the point where I can't even see my friends anymore because the effort to shower or brush my teeth is so difficult that once I do those things, I'm barely able to move.

Nobody here is an expert or can tell me what to do, but I don't know where to turn, as I don't know anybody who has done ECT. I question if I've tried enough medications or if I've done everything I can do. To be honest, both my pdoc and I are at a loss of what to do at this point, which is why I began researching ECT tonight. If you've had ECT, when did you feel that it was time for you to take that step? Even if you haven't had ECT, at what point would you personally consider taking that step? Of course, it's up to pdoc and myself in the end, but I am just so confused and scared at this point that I'd like to hear opinions of people who know what I'm going through.

Can you receive ECT as an outpatient? Has anybody here gotten any relief from the procedure? Is it something that you would do over again if you had the chance?

I apologize for the long entry and the many questions, but I appreciate anybody who can give me any input.

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