Posted by Elizabeth on March 26, 2002, at 20:11:59
In reply to Re: Anyone had success with ECT?, posted by OldSchool on March 25, 2002, at 22:12:17
> I dont know what type of depression I have at this stage anyway. I dont think any of my doctors do either.
It might very well be like you said, that they just don't think in any terms that are more exact than "major depression." Anyway, "major depression" isn't at all exact; I think that, as you suggest, it's probably not "a" disease, but many different diseases.
> Its changed probably ten times thru the years.
That's possible; I've read that it isn't always consistent over the course of a person's illness. And of course, there really haven't been many different types that have been identified; the only ones I know of that predict treatment outcomes at all are psychotic, melancholic, and atypical features. I think the majority probably don't fit into any of these categories; this is called "simple mood-reactive depression," although it really doesn't tell us anything to say something this vague (that it doesn't fit into any known subtype, that is).
I think that you're right that it would help if we worked on the biological research, although I also think that we're limited by technology.
> I personally think I have melancholic depression with some psychotic depression mixed in with it.
Psychotic? What sort of delusions or hallucinations have you had? I can see the melancholic part (not sure if it's "technically" right, but it's probably at least close), but you never struck me as psychotic. I'd be careful about going on that assumption.
BTW, are you taking any medication now, and if so: 1) what? 2) how much is it helping? 3) what is it not helping with (or only partially helping with)?
> So Im just gonna do the bilateral ECT thing. Ive also been told I have a retarded depression but with "mood reactivity" and a "rigid" personality. whatever that means.
"Mood reactivity" means it's nonmelancholic: your mood changes, somewhat, in response to things that happen around you (i.e., environmental stuff). "Retarded" means you're slowed down rather than agitated. Anything a psychiatrist says about your personality probably tells you more about the psychiatrist than about you, but FWIW, "rigid" would mean "not amenable to change."
> And Ive had atypical depression dx a few times.
Huh. That is sometimes associated with irritability and moodiness, as well as psychomotor retardation and reactive mood, but that stuff alone isn't sufficient. I wonder why they thought that.
> I also have the EPS symptoms now, mild parkinsons type symptoms, mild rigid right arm and stuff.
Oh god, that sucks. How did that happen? Have you tried any antiparkinsonian drugs, like Cogentin, Benadryl, Artane, Symmetrel, etc.?
If you really think that psychosis is involved, and if you think you could deal with the regular tests required, Clozaril might be something to consider; it hardly ever causes EPS (like, very rarely even compared to other atypicals) and can even be used to treat them. Psychotic depression pretty much requires either a dopamine antagonist, or maintenance ECT (the latter being rather a PITA).
> Frankly, I think the only thing anybody knows is Ihave some sortof mood disorder and thats about all.
If it's any comfort, that's all they know about anybody, pretty much!
> Is it really that much different in Boston?
Yes, very. I guess that I should really say it's different if you see a pdoc who's affiliated with Harvard, because those are the only ones I have experience with. I don't know if doctors at BU and Tufts, or non-academic psychiatrists, are similar.
> I realize its an elite academic town and all. But when it comes to psychiatry, which is so primitive about wherever you go, I find it hard to believe the psychiatric services there would be much different than in Winston, or Charlotte...or NYC..or wherever. Are there really experimental drugs there available for the taking?
There's an awful lot of research there. (New York is probably similar, I'd think.) I was thinking more of the willingness of the doctors there to try off-label stuff, though. Like, at some point I was told by a pdoc here that they were starting to use Neurontin for mood disorders. I said, "yeah, I tried that three years ago," and he seemed startled. I think that pdocs here are much less likely to suggest something like selegiline (or indeed, to be comfortable with MAOIs in general), pindolol, ketoconazole, that amoxapine-Parnate cocktail that I've heard such good things about, etc., and most of the ones I've spoken to have been downright hostile when I mentioned that I take buprenorphine. (I'm afraid that all the publicity about its use as a treatment for addiction has given it a bad name.) I've been having a problem getting my pdoc to let me take 20 mg of Ambien (10 mg is useless for me -- not tolerance, just the way my body works), or even to let me try more than 300 mg/day of Effexor XR. (Strangely, the labelling for immediate-release Effexor recommends a higher maximum dose than the labelling for Effexor XR -- 375 mg vs. 225. I guess they just didn't bother studying Effexor XR at > 225 mg.)
> I realize people up there are probably more open minded than down here. But are there really more treatments up there?
Not that so much, no (although there really is very little research down here) -- but practically speaking, it's a lot easier to get newer off-label treatments there than it is here.
> Bilateral is just plain stronger and it doesnt require a titration procedure so the first treatment is not wasted like in unilateral. I figure I should just go for the gusto and go for bilateral and expect memory loss. At least Iknow it will be powerful.
Running out of patience? I can understand it, although on the other hand I'd really think twice about rushing if it might mean that even recovery would be bitter. Wasting one session of ECT doesn't seem so bad from that perspective. On the other hand, I wouldn't mind forgetting what it was like when I was depressed (unfortunately I don't think you get to choose what you forget).
> Bifrontal is supposed to have the effectiveness of bilateral, but without the memory loss side effects. Its the best of both worlds. The electrodes are placed above the eyes, on the forehead instead of the temples. Its making a comeback from what Ive read.
I looked it up after reading your post. It sounds promising. Why do you want to have bilateral ECT when something like this is an option?
Whatever you decide, I hope it helps turn things around for you.
-e
poster:Elizabeth
thread:97068
URL: http://www.dr-bob.org/babble/20020322/msgs/100398.html