What to consider before zapping a depressed brain?

March 10, 2012 3:06 PM

Mom has gone from minor OCD behavior and compulsive thoughts to a severe depression with psychosis. The docs have started to recommend ECT, but she's terribly frightened of the possible side effects, namely the memory loss. If you have gone through ECT or have been involved in the decision to employ it, what information did you value when making the decision?

The process from non-symptomatic to light cleanliness OCD to obsessive thoughts (imps of the perverse) to now a feeling of "having died and being kept pretend-alive in a hell, toyed with by demons" took less than a year. The anti-depressants she received initially have been complimented with anti-psychotic medication, but except for being able to sleep now, we're not seeing any improvement, and she's feeling utter shit.

Because of the lack of progress, last week she was recommended to undergo ECT, but balked at the idea because of the risk of memory loss which she's read about and seen about on TV; not the short term retrograde memory loss, but rather permanent long term memory loss, as well as the inability to form new memories and loss of cognitive capacity.

Saying "there there" only goes so far, so I'm trying to read up a bit on what the benefit and risk of ECT is. Wikipedia gives a good overview of the controversies and sums up a few of the meta-analyses, and that's a start, as are the previous askme's. But I'm curious if the hive has any personal experience with ECT — as a patient, relative or caregiver — as to which information made you decide for or against it, or what situation forced the matter?

FWIW, she can manage herself, interacts OK with others, isn't suicidal. But assuming that the diagnosis is correct, her severe depression and psychosis can become worse and even though she's said that she'd rather exhaust all psychopharmacological alternatives before ECT, there's only so much time you can keep that up if it doesn't help. She has weekly talks with a psychiatrist as well as a CB therapist, and got the ECT recommendation when seeking a second opinion on her medications from another psychiatrist.

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posted by anonymous to Health & Fitness (13 answers total)

For a positive take on it, read Carrie Fisher's "Shock Treatment." It seems to work well for her, or at least the memory loss is worth it.

On the anecdata, my one relative who's had shock treatment was...well, nothing has ever really helped her, and ECT just made her more of a limp personality. Let's just say she was sunbathing in our backyard the last time she visited and a crow was pecking at her...and she didn't even try to shoo it off. But seriously, she is pretty much resistant to everything medical science has tried and she's been severely depressed since age 6, so I don't know if I could say she's an example you should look to. Like every damn depression treatment ever, mileage varies from person to person and some thrive and some wilt.

I gather ECT is for the most resistant of patients for whom nothing is helping, and it sounds like your mom is well...right there. The side effects might be worth dealing with compared to where she is right now.
posted by jenfullmoon at 3:54 PM on March 10, 2012

I did a series of six ECT sessions roughly a year ago and they helped me get out of a major depression. I was much better for almost a year. My depression has returned and I'm in the middle of another series. Having had it before, made it fairly easy to decide to do it again. I'm not having any confusion or memory issues this time and the benefit is immediate.

I did have issues during the first series. I was confused for a few days and had trouble laying down new memories. I felt like I'd lost some points off my IQ. I had trouble recalling words. It faded and I returned to normal.

I would try it.

If your mom would like to talk to me or you have any specific questions, feel free to contact me.
posted by orsonet at 4:02 PM on March 10, 2012 [6 favorites]

I'm so sorry to hear about your mother, anon. My heart goes out to you both.

This is completely anecdotal, but I know a friend-of-a-friend. a late-twenties university student, who went through ECT for severe depression and in the course of maybe nine months suffered extensive memory loss and significant changes in personality. He doesn't seem to remember many of the people he's met in the past five years and when I last talked to him he acted distant, almost dazed, and seemingly had lost his sense of humor entirely. People much closer to him than I am have stated that he is very much a different person after the treatments. He'll punch people when drunk, break up relationships and act erratic in general. Being in his presence is heartbreaking, exhausting and a bit scary so I had to distance myself from him.
posted by Orchestra at 4:04 PM on March 10, 2012

A close friend has had a dozen treatments for severe depression. It gave the person a new hope and they did improve on it. Their memory actually improved (severe depression causes memory loss) and there were no other side effects. I feel their post-op treatment (meds and talk therapy) was not optimum for their needs so they have not returned to their pre-depression self. They were scheduled for follow-up treatment but were discouraged by the advice of non-professionals who were judgmental about ECT and worried "they were losing their mind".

I think ECT can be very helpful as part of a larger treatment plan if the patient and their support system are educated about it and make informed decisions as well as continue meds, mediations, exercise, talk therapy and healthy living.
posted by saucysault at 4:24 PM on March 10, 2012

I would do some research on the less violent treatments for these symptoms like Colombia is doing via Transcranial Direct Current and Transcranial Magnetic stimulation.
posted by Rubbstone at 4:26 PM on March 10, 2012 [1 favorite]

I had ECT years ago as a teenager. I have no idea if it helped or not, because this was somehow to do with my parents who never discussed the period with me, and are now dead or estranged. I'm pretty okay now, and I have friends who've had ECT and are okay too, and the literature on it is positive for major depression. It is not like the movie version at all.

However, I would love to have records. Your mom is likely to lose the months directly before and after the treatment, and that gap is quite disorientating - "there is a hole in your mind" weirdness. A calendar of events, a letter I had written to myself in the future explaining why I was doing or video of me, the psychiatric records - all that would have been enormously helpful and reassuring. I try not to think about the gap, but it does bother me, over a decade later.
posted by viggorlijah at 5:37 PM on March 10, 2012 [1 favorite]

A relative of mine had ECT to stabilize during a major depressive period. He found it physically uncomfortable and stressful because it involved anesthesia, etc, but it did indeed help with his profound depression. He didn't suffer much memory loss, but then his memory was already affected by the depression so it hadn't been great to begin with. But he didn't lose big chunks of time like some people do. He says he'd be reluctant to do it again because it was an unpleasant process, but he does think it helped him during a time when nothing else was working.
posted by PussKillian at 5:49 PM on March 10, 2012

Two years ago I underwent a series of ECT for life-long (I was 50 at the time) major depression. I had about 12 treatments. It was quite effective for me for slightly over a year. It was not an overtly dramatic change, but it was a profound one. Essentially, I was more optimistic and was much more able to cope with life's vissicitudes (which were numerous and very, very difficult during that period). It was kind of a major attitude adjustment. I wasn't in some happy, cheerful mood, but life was just much better. I had hope in the future. Daily living wasn't the difficult slog that it always had been. I actually didn't mind waking up each day.

I had spent decades in therapy and trying several different antidepressants, none of which was effective on my depression. ECT was the choice of last resort for me.

I would not at all characterize the treatment as "violent" as Rubbstone has said. It was all quite "normal" feeling: no pain; lovely, solicitous treatment by the staff; actually kind of restful.

I experienced some minor short-term memory issues. But I never actually considered that possibility to be a serious obstacle; my short- AND long-term memories were of constant emotional pain. To me, losing a little short-term memory was an incredible trade-off for being depression-free.

My depression did return after about a year; I'm now making plans to get another round of ECT.

I would not consider ECT to be the treatment of last resort. For many people it can be remarkably--and uniquely, as antidepressants prove ineffective for such a huge percentage of depressed people--effective with no pain and relatively minor and few side effects.

If you would like more details on exactly what happens please contact me; I'd be happy to tell you more.
posted by primate moon at 5:55 PM on March 10, 2012 [4 favorites]

I'm sorry for your troubles.

Nothing to add here to the subject of ECT, but does your statement:

The anti-depressants she received initially have been complimented with anti-psychotic medication...

mean that there has been only one or two types of medication tried? Many people have to go through several different combos of meds before there is something that works for them.

If you have utter faith in your docs, that's great, but sometimes a new doc has a different take on things....

Couldn't hurt to try another viewpoint. ECT is pretty long-term.
posted by BlueHorse at 5:56 PM on March 10, 2012

I was thinking along the same lines as BlueHorse.

It's really not unusual to try several different medications before finding one that helps. If she hasn't tried at least a couple of the major families of antidepressants, she probably should before going to the next step.
posted by zug at 6:50 PM on March 10, 2012

I'm only aware of one situation where ECT was tried -- a friend's mother who was suicidally depressed. In his words, "It saved her life." That was almost a decade ago and last I heard, she's still doing fine.
posted by philip-random at 7:57 PM on March 10, 2012

I wasn't referring to the experience of the therapy I was referring to the fact there is a very real chance of permanent memory loss with ECT and there are other treatments that do the very same in terms of exciting or depressing regions of the brain without that side effect. Including some that have been approved by the FDA for that particular treatment.
posted by Rubbstone at 8:36 AM on March 11, 2012

Watching this Sherwin Nuland TED talk on his own experience with ECT was pretty interesting and enlightening from the medical and personal perspecives. Description "Surgeon and author Sherwin Nuland discusses the development of electroshock therapy as a cure for severe, life-threatening depression -- including his own. It’s a moving and heartfelt talk about relief, redemption and second chances."
Long story short- he had it and he is glad he did.

I'm no sort of doctor and I am not sure how many combinations of meds your mom has tried, but 1 year of experimenting seems short. It took my dad over 2.5 years to find a good combo for his depression. Then again, I don't know how severe your mom's symptoms are and how immediate the need to fix the problem is. Maybe you don't have the luxury of time to experiment with meds more? Maybe there are other meds or combinations of meds she can try?
posted by rmless at 8:53 AM on March 11, 2012