Bipolar 2 From Inside and Out

Posts tagged ‘ECT’

When Depression Doesn’t Go Away

Back in the day, I suffered from treatment-resistant depression. (This was likely due to the fact that what I had was actually bipolar 2, but never mind that for now.) My psychiatrist prescribed me medication after medication, but none of them worked, or at least not for long. We got into a seemingly endless spiral of trying one drug, adding another, weaning me off one drug and ramping up another, then another and another.

Some of them just plain didn’t work. Others had intolerable side effects, from vivid horrible nightmares to making me feel like I was about to jump out of my skin.

All this went on for certainly months – maybe years. (Memory problems were one of the many intolerable side effects.)

Eventually, my doctor reached the correct diagnosis, and then there were months of trying medications that were targeted for bipolar disorder instead of plain depression with anxiety. Again, nothing worked, or didn’t work adequately.

Nowadays, there are non-pharmaceutical methods of coping with treatment-resistant depression, including ECT (better known as electroshock), TMS (transcranial magnetic stimulation), and ketamine treatment.

I never had any of these treatments, since my psychiatrist and I finally worked out a drug combo that brought me back to balance, with only minor tweaks in dosage over the years. Nonetheless, I’ve become interested in the alternate means of dealing with treatment-resistant depression, and here’s what I now know. (If you want a patient’s own experience with ECT, TMS, and ketamine treatment, look up Kitty Dukakis or read some of the Bloggess’s posts.)

ECT, or electroconvulsive therapy, is what used to be known as shock treatment. For a long time it went the way of prefrontal lobotomy, stigmatized as a cruel and harmful procedure. The portrayal of ECT in Ken Kesey’s novel One Flew Over the Cuckoo’s Nest and then the movie of the same name were major influences in terrifying the general public, leading to a nearly complete disavowal of its use.

It’s making a comeback, though. The theory behind it is that electric stimulation of the brain will shock the brain back into normal functioning. The American Psychiatric Association notes that it is now performed under anesthesia, with medical personnel attending the procedure. They report improvement in 80% of patients.

(ECT is the alternative treatment that I was ready to try when none of the drugs prescribed for me proved effective. Then my doctor wanted to try one last drug, and that was the one that did the trick.)

TMS, or transcranial magnetic simulation, is described by the Mayo Clinic as “a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.” It’s also called rTMS, or Repetitive Transcranial Magnetic Stimulation, because more than one treatment is generally needed. The theory is that the magnetic pulses stimulate areas of the brain involved with mood control and depression. It doesn’t cause seizures or require anesthesia. The exact mechanism of how it works isn’t really understood, but that’s true of many other treatments for depression, including medications.

Harvard’s Health Blog reports that rTMS helps about 50% to 60% of people who did not respond to drug treatment “experience a clinically meaningful response.” They do note that treatments, “while encouraging, are not permanent,” which is true of many other forms of treatment.

Ketamine is the newest of the treatments for treatment-resistant depression. Ketamine was once known as a “party drug” called “Special K,” described by the DEA as “a short-acting anesthetic with hallucinogenic effects.” As a treatment for depression, however, it is thought to “enable brain connections to regrow,” according to scientists at Yale. The American Association of Nurse Anesthetists notes that ketamine “is not a first-line therapy for psychiatric disorders,” but then, neither are ECT and TMS.

Ketamine can be administered via nasal spray, but for psychiatric purposes (including to treat bipolar disorder and PTSD) it is often given as a series of infusions. An article in The Lancet says that “Ketamine is thought to act by blocking … receptors in the brain.” Another article by doctors at the National Institutes of Health comments that ketamine “has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.” Repeated treatments are generally necessary.

I don’t know about other patients and doctors, but after years of drug therapy not working, I was ready to give almost anything a try. ECT was next on the list, and the only likely alternative, as TMS and ketamine were not available at that time. I’m just glad that now patients and their doctors have more options when depression resists drug treatment and “talk therapy.” And I hope that even more alternatives become available for people with depression who are desperate to find a treatment that works for them.

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Mental Health

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Would You Try Electroshock?

Photo by Mike T

In the course of dealing with my bipolar disorder, I had a near brush with electroshock. I managed to avoid it, but I did give it serious thought.

Now 60 Minutes has come out with a piece called “Is Shock Therapy Making a Comeback?” You can see the segment here: 60 Minutes.

ECT(electroconvulsive therapy, the modern name for the procedure), which is often done on an outpatient basis, works by inducing a brief seizure in a patient. The seizure, which lasts about a minute, releases multiple neurotransmitters in the brain, all at once. The patient is required to have someone to transport them to and from the appointment. Treatments are typically applied one or two times per week for 6-8 weeks.

In a brief article excerpted from the news show segment, Dr. Charlie Welch, of McLean Psychiatric Hospital, explains how ECT differs from how it was performed in the past: “What’s different first of all is that it’s done under general anesthesia with a muscle relaxant. So when the treatment is done, the patient is sound asleep and completely relaxed.” Call it a kinder, gentler shock treatment.

That was the procedure that my psychiatrist offered me after he had spent a number of years trying me on various medications that either didn’t work, or helped only partially.

My immediate reaction was negative. I recall thinking, “Fuck, NO! Keep away from my brain, you Nazi sadist!” After I calmed down a bit, I did some research.

ECT, my sources said, was a long way from the cruel, stigmatizing procedure portrayed in One Flew Over the Cuckoo’s Nest. The Internet was little help, though. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.”

Truthfully, I was appalled by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life.

Then I thought some more. So ECT sometimes causes memory loss. I already had that, thanks to some of my meds. I would be altering my brain with electricity. But hadn’t I been altering it for years with chemicals – medications that no one seemed to know how they worked?

So I went back to my doctor and said I would at least talk to the doctor who would perform the procedure. And I lined up a journalist friend to write about my experiences if her editor approved. (Note: In the 60 Minutes piece, former Massachusetts First Lady Kitty Dukakis gave permission to have her treatment filmed and broadcast.)

My psychiatrist, however, had one more medication that he wanted me to try before we took that next step. And it worked. So much for electroshock.

Now as to that side effect of memory loss – Dr. Sarah Lisanby of the National Institute of Mental Health in Maryland has developed a new treatment that seems to avoid that particular consequence.

The procedure is called Magnetic Seizure Therapy (MST) and it uses magnets (duh!) to stimulate more precisely focused seizures than ECT does. These focused seizures seem to avoid the parts of the brain associated with memories. As Dr. Lisanby told the 60 Minutes reporters, “For some people, ECT may still be needed. But if Magnetic Seizure Therapy could be effective without the memory loss who wouldn’t want to try that first?”

Would I try MST if I relapsed into treatment-resistant depression? I would certainly consider it, if it were out of the testing stage by then. And I’d do that before I signed up for ECT. While I have memories I’d prefer to forget, with my luck, those would be the ones left unaffected.

The cynical side of me says that these seizure-causing therapies are becoming more popular because insurance companies like the notion of a short course of 6-8 weeks of treatment instead of years of talk-and-medication. (Although Kitty Dukakis said that she has done ECT for years now and expects to continue into the foreseeable future.)

But I could be wrong. It is possible that some kind of treatment could be short in length but longer-lasting in effectiveness. I’m not ruling it out. At this point I’m not ruling out anything that could aid in my progress and my healing.

 

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Mental Health

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All in Our Heads

Well, mental disorders probably are mostly in our heads, or at least our brains (and genes), but I keep seeing news features that “offer hope” for new diagnostic tools and treatments that “may someday” alleviate the suffering.

Here’s an example from the University of Pennsylvania:

Many factors, both genetic and environmental, have been blamed for increasing the risk of a diagnosis of schizophrenia. Some, such as a family history of schizophrenia, are widely accepted. Others, such as infection with Toxoplasma gondii, a parasite transmitted by soil, undercooked meat and cat feces, are still viewed with skepticism. A new study used epidemiological modeling methods to determine the proportion of schizophrenia cases that may be attributable to T. gondii infection. The work suggests that about one-fifth of cases may involve the parasite.

Great. I am sure that schizophrenics will be comforted by the thought that their problems are caused by brain parasites and cat poop.

I noticed that the study showed that only 20 percent of schizophrenia “may” involve the parasite. What about the other 80 percent? Are those cases caused by some other parasite? And how will the parasites be detected? Blood test? Brain biopsy? Could be a world of horrors there for the already mentally unstable. And, perhaps most important, will real-world results back up the computer simulations?

Schizophrenia is far from the only illness being studied. Bipolar disorder and our old pal depression come in for their share of lab work too. USA Today recently reported on a procedure that might help with depression:

The treatment — transcranial magnetic stimulation — was approved by the Food and Drug Administration in 2008 for the treatment of patients with medication-resistant depression.

Magnets generate a directed, pulsed magnetic field — similar to an MRI in strength — to the prefrontal cortex, the front part of the brain behind the forehead. The magnetic fields induce small electrical currents, which encourage a mood-lifting chemical reaction in the brain.

The treatment is daily, for four to six weeks. If the patient improves enough, the treatment is then provided as a periodic booster.

Never mind that it’s entirely subjective when a patient has improved “enough” or even shows anything other than a placebo effect. And never mind the effects of having 42 MRI-strength treatments in a row.

Apparently scientists and insurance companies are battling it out on the money front (there’s a surprise).

Plus, as always, there are nay-sayers:

The National Institute of Mental Health describes the treatment as effective for some patients, but notes that studies of its efficacy have been “mixed.” The American Psychiatric Association’s guidelines for depression treatment states the procedure conveys “relatively small to moderate benefits.”

To the desperate, any potential “cure” or even palliative treatment eventually seems worth a try. I should know. I came that close (imagine several millimeters here) to having a go at electro-convulsive therapy (ECT). Formerly know as shock treatment.

The thing is, you only hear about theories that “might” be correct and treatments that “may” help. Studies are hardly ever published that say, “You know that treatment we said was going to relieve the suffering of millions? Turns out, not so much.” If the general public even gets to see the negative results, they may still cling to the hope offered by the earlier reports.

Just look at the anti-vaxxers. It has been repeatedly proved that childhood vaccines do not cause autism. The experiment that reported that finding was a fraud and the author (Andrew Wakefield) has been discredited – investigated and found guilty of “four counts of dishonesty and 12 involving the abuse of developmentally challenged children.” Basically, he’s been kicked out of medicine altogether and given the Lifetime Achievement in Quackery award by the Good Thinking Society. (I’m not making that up.)

And yet epidemics of measles and other deadly diseases continue to rise as parents yield to fear and refuse to have their children vaccinated.

I’m not trying to say that a parasite doesn’t cause some cases of schizophrenia or that magnetic therapy will never relieve anyone’s depression.

I’m just saying that if those theories are proved false, we’ll likely never hear about it from the popular press.

 

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