This probably got answered here, but thread is too long.
Has anybody here had some experience with ECT treatment? My mother has had severe depression and panic attacks for many years and she will start the ECT treatment soon. I heard good things about it and it's apparently one of the most effective ways to treat depression, so... Is it really that effective? Is it worth it? etc, etc.
Thanks
Wow, good timing! I came here to post about ECT.
So I had a patient when I was on hospital service who was on a medical floor to get some other problems stabilized, but she was also suffering from the worst case of depression I have ever seen - curled in the fetal position all day, crying, did not make eye contact, flat affect, could barely speak (and I don't mean didn't feel like speaking, I mean she was physically incapable of speaking above a whisper), not eating, just completely hopeless and debilitated.
I followed the case - this was "my" patient, even though, as a medical student, all I really did for her was be a friendly face, accompany her to ECT, and have a long heart-to-heart talk about how I suffer from depression and I got better.
The most important bit: she saw noticeable improvement with three treatments, and after 7-8, I visited her (I've been off the service for about a week and a half but I promised I'd visit) and she was smiling, could walk up and down the hall, was off of fentanyl for severe chronic pain, laughed, talked in a normal voice, and discussed with me her long term plans. That was genuinely amazing. In a field where the drugs are notoriously slow to act, we made her noticeably better in one week and, after two, she was incredibly improved, ready to go home this weekend (with some follow-up outpatient ECT). She hadn't done a Beck Depression Inventory, as the medical floor wasn't really doing complete psych care,
so I said "after 7-8 sessions of ECT, if 1 is the most depressed you've ever been and 10 is the happiest you've ever been, how many points of improvement would you say you've had?" Her answer? "7" That's incredible! This is about the closest thing to a medical miracle I've ever seen.
So what is ECT like? I've only observed it, but I can tell you it's
nothing like what you'd see in a movie. The patient was anesthetized and had her muscles paralyzed. The seizure is seen on an EEG tracing. The most you'll see from the patient is
maybe a little eyebrow wiggle. There's no actual full-body "convulsion". She woke up after maybe 20 minutes and we took her back to the floor. She had a slight headache, was a little woozy, but remembered everything up to being put under, and had no loss of earlier memories (the big risk in ECT). For session 2, she had a Tylenol before the procedure and woke up without a headache.
The big thing in ECT right now is unilateral ultra-brief ECT. So they minimize the amount of electricity they zap you with, and apply it to a smaller area of the brain. The side effects are
dramatically improved.
If you have failed with several antidepressants and are profoundly depressed, ECT is definitely something to aggressively pursue. Seriously, if you feel like things are hopeless, and nothing has ever worked, consider ECT.
So why doesn't everyone get ECT? Part of it is the bad public perception, based on the way they did EEG decades again, it requires general anesthesia, so there is a tiny risk of death (you have a 1 in 250,000 chance of dying from anesthesia), and it's expensive. You can do it outpatient, but you need a nurse/technician to set up the electrodes, an anesthesiologist, a psychiatrist, another nurse or two in the room, and a nurse in the recovery area. Add in the drugs and equipment and the costs jump up again. Insurance companies would also like to pay to have you on cheap drugs forever, a little bit at a time, than make an initial large payout and have you effectively cured. Okay, so that's not entirely true - even after ECT, they'll probably keep you on an antidepressant, and many patients will need to repeat ECT at some point in the future. Still, insurance companies like cutting lots of tiny checks rather than one big one, it seems.
ECT is absolutely amazing. They do a ton of procedures every day here at a huge, famous teaching hospital, so they're really good at it. You definitively want the unilateral ultra-brief variety. There's still a risk of memory loss (I'll research the numbers on side effets), but it's way less than it used to be.
There are some meds that make it so you can't have the procedure, ditto with some medical conditions. To qualify, you're going to need good mental health coverage in your insurance, and you need it to be documented that you're
very depressed and have failed a number of drugs/talk therapy.
Having said all that, super-depressed GAF, really push for ECT. If you think about it, an infection will take seven days of antibiotic, recovery from surgery can easily take more than a week, but here's psychiatry, where you don't know if the drugs are working for several weeks, with a treatment that can make you better in a week. I can't stress enough how amazing it is if it works.
And there's the other sticking point - it's not going to work for everyone, but the odds are pretty good. Don't go off and end your life or something similarly awful without giving ECT a trial for a week.
I'll talk to the physician who did "my" patient's ECT, to get the other perspective on things and report back.
Questions? Hit me with them here or over PM. Honestly, seeing this patient talking and smiling and even laughing was the most rewarding moment I've experienced in my time as a medical student.
