Posted by medlib on May 27, 2000, at 16:17:32
In reply to Re: ECT- Unilateral vs. Bilateral, Side effects ?, posted by SLS on May 27, 2000, at 11:27:48
Scott--
I could not be a candidate for ECT were I so inclined--which I am not. I had a major stroke (right parietal hemorrhagic CVA); my left side was paralyzed for a while. One thing I learned from that experience is how hard it is to recover anything from any type of brain insult. If people spent a little time in a rehab hospital, they'd have more respect for that organ. Also, my son has epilepsy; so seizures, therapeutic or not, are pretty much anathema to me.
The bottom line for the blather above is that I have done little research on ECT, as it was not personally relevant; I found the articles I mentioned searching for something else. For me, the articles' results pretty much reified common sense; a 1:1:1 relationship between dosage levels, treatment efficacy, and cognitive deficits seems intutively obvious.
Since, for most people, communication centers, verbal cognition and memory are located in the left hemisphere, zapping that side will produce more readily apparent, more distressing deficits. The right hemisphere is thought to contain major affect centers, arithmetic, creative, and musical areas. However, these approximations have been modified by PET scan studies showing that multiple areas of the brain are activated by most "higher level" brain functions.
I found it distressing that the "therapeutic window was only 2 months for nearly half of the patients. That's just not an acceptable cost/benefit ratio, at least for me.
Would you like to comment on this? Are the findings of these studies consistent with others you have read?
>
> Max Fink suggested that I get a hold of a book:
>
> TEXTBOOK BY RICHARD ABRAMS: ELECTROCONVULSIVE THERAPY (OXFORD U
> PRESS, 3RD EDITION, 1997)
>
> I would think this a bit out of date. I had asked him to compare left, right, and bilateral treatments with regard to efficacy and side effects. He replied that there was a wealth of study in this area, and that it would be better if I were to read the book.
>
> What do you think?Translation: He can't remember the details. For me, the role of a medical book is to "lay out the bones" of a subject and review the research in a comprehensive, yet clear manner. Med books take too long to write and publish to do more than that. Journals are expected to "flesh out" those skeletons with the latest research results. Medical libraries consider a book dated if it's older than 5 years (unless it's a "classic"), so 1997 seems okay. ECT is an established therapy whose major treatment improvements were made some time ago. I believe that the author is more important than the absolutely newest date.
> In 1991, I received a series of 6 left-unilateral treatments. When it didn't seem that much was happening, I asked for the remaining 6 to be bilateral. No success, except for a small improvement I experienced after the fifth unilateral.
>>
> I described to Dr. Fink my non-response to this course of treatments. He replied:
>
> THE UNILATERAL TREATMENTS WERE PROBABLY INEFFECTIVE... CONSIDERING WHAT WE HAVE LEARNED SINCE 1991, I WOULD NOT USE THAT EXPERIENCE AS A GUIDE TO WHAT CAN BE DONE TODAY.
>
>Translation: They zapped the "wrong" side with too little voltage.
> I don't think he was deterred by the description of my history of treatment-resistance to pharmacological treatment:
>
> ALL DEPRESSIVE CASES SEEM TO RESPOND THE SAME TO ECT. IT IS THE MOST BROADLY EFFECTIVE TREATMENT, WHEN PROPERLY APPLIED. NOT LIKE DRUGS -- EACH HAS A LIMITED RANGE OF ACTIONS.
>
>Translation: ECT does some good for nearly everyone--for a while. Any given drug treatment usually work well longer for fewer people. "You pays your money; you takes your choice."
> Another question:
>
> > What is the recommended number of treatments given before one
> is considered a non-responder?
>
> DEPENDS ON THE DIAGNOSIS. FOR PSYCHOTIC PATIENTS, WE OFFER 15-20 TREATMENTS. BUT MANY TREATMENTS ARE INEFFECTIVE, SO COUNTING TREATMENTS IS NOT USEFUL. ANY MORE THAN COUNTING PILLS.Translation: They "do it" until it works. (I would think that the ECT dosage level might have some bearing on the number of treatments needed.)
>
>
> Another question:
>
> > Can you recommend anyone in the NYC area who might be well
> suited to treat me pharmacologically?
>
> NO. YOU SEEM TO HAVE SEEN THE DRUG EXPERTS. PERHAPS YOU SHOULD SEE AN ECT EXPERT. ASK YOUR PRESENT THERAPIST TO SUGGEST ONE.Translation: Every area of human endeavor that has been around long enough to evolve into an acronym has its own resident experts. (I would think that is especially true of ECT because it employs such a unique treatment modality.)
>
>
> I had never considered that there might be experts in ECT as there are in pharmacology. This offers me a fresh perspective on an old idea. This morning, I tried to imagine myself going through another course of treatments. I cringed.
>
> Because treatment-resistance to medication still seems to indicate a reduced chance of responding to ECT, I am reluctant to look into it again.Scott, I would go with your gut on this one. It may be "new and improved," but I'd try everything else out there before revisiting what you didn't like the first time. In your shoes, I believe I'd give Dr. Jensen a try, and investigate vagal nerve stimulation first. Of course, you realize I really can't be objective on this one (or especially knowledgeable, either).
>
> I would really appreciate any input you can offer me.It feels great to be appreciated; sorry I couldn't be more helpful this time. I always read your posts (barring computer or medical disasters); you ask incisive questions and provide thorough, helpful information.
BTW, thought I'm flattered to be mistaken for one, I'm not really a psychopharm geek like Cam, Peter, JohnL, Andrew, et al. I just have an "ear" for the argot, a love of research, and some expertise in (and passion for) searching. I can understand, but I can't produce at that level. I'm grateful to have access to their and your knowledge.
I look to you as a role model for persistence and self education. Hope those good efforts pay off--soon; you have a lot to offer.
A life-long double dysthmic who's getting very tired of the struggle---medlib
poster:medlib
thread:33082
URL: http://www.dr-bob.org/babble/20000526/msgs/34907.html