another answer to ECT questions

Yesterday, we discussed seven bullet points on ECT.  I disclosed that I have a personal agenda in pursuing knowledge and community awareness about ECT.  (Maniacal laugh! j/k)

In my questions at the end, I asked for ways to continue to improve in this effort, and happily, Nance responded with these scintillating questions!  I’m listing the questions in her words, and responding to them one at a time because really, they are what I hear asked about so often from many others that it’s a no-brainer.  We have to talk about it.  🙂

Good looking lady

1.  Please help those of us who fear good memory loss to understand (or feel better, at least) how ECT is still a viable option. Is the good memory loss permanent?

Studies demonstrate, as does the collective opinion of physicians anecdotal experience, that ECT memory loss is temporary.  Some mild memory loss happens during treatment of course because of the seizures, (also known as convulsions.)  Within a few weeks of the index treatment course ending, the memory returns to normal.

When we have seizures, it is typical, whether artificially induced, such as with ECT, or because of pathology, for us to feel sleepy, not remember events surrounding the seizure and even possibly disorientation.

After a seizure, the brain has a period of “quiescence,” or becomes quiet, when its natural electrical activity rests.  During this time, (the index treatment,) it makes sense therefore, that we will not imprint memories well.

ECT starts out with what we call the index treatment – around four weeks of ECT dosed generally three times a week, on Mondays, Wednesdays and Fridays, for a total of twelve treatments.

Index treatment = 3 ECT treatments/week x 4 weeks = 12 treatments total

This is not set in stone and some people have fewer or more.

Furthermore, most people say that within fifteen days of initiating ECT, memory is actually better!  That’s pretty cool.  It ties in with our understanding that our perception of how we concentrate and remember things is worse with brain illness.  However, in many brain illnesses, it stops there.  It is just our perception, when in reality, our memory is just fine.

Soooo, connect that with what we said yesterday about ECT taking about 1-2 weeks to start working, (i.e. round 15 days!)  And, when the brain illness is healing, the symptoms of the brain illness, (in this discussion it is memory loss,) is better.  Yay!  The term to describe this kind of perceived memory loss is “pseudodementia” because there really is no memory loss in the first place.

2.  How often, after the couple of weeks that you mention, would ECT be necessary?

ECT, like most treatments for brain illness, is not a cure.  Healing does happen, but the genetic predisposition remains.  Most of the time when people c/o that their illness got better with ECT but just came back when they stopped, it is because they never transitioned to maintenance ECT.

After the index treatment is done, we need to taper the ECT doses down slowly, monitoring all the while for symptoms of brain illness resurfacing.  When we decide that the symptoms are just starting to come back, we stop the taper and continue the ECT treatments at that frequency.  For example, if you Nance were at this point getting one ECT treatment every three months, we’d continue you with that.  Every three months you would get one ECT treatment and we would monitor to see that your brain illness remained fully treated.

If you relapsed, we would increase the ECT dosing again until you responded fully and then try to taper down again.

3.  Would it completely replace the need for medication or talk therapy?

ECT works alone, as does medication treatments and talk therapies.  However, any of these work best when used together.  We know that our goal is full treatment response and not just – “Ah, she’s better.  That’s great!  We’ll just see how she does for now.  She soooo much better than she was after all.  We should just be glad and not complain.”

Our goal is not to only improve the illness some, but get it fully responding to treatment and allow for maximum brain health.

Leaving a brain illness only partially responding to treatment equals leaving the disease to progress.  When we fight for full treatment response, we are fighting for our brain health fifteen years from now.

One of the beauties about ECT is that is gets us to this great place where we are giving ourselves a healthier brain in our futures.  For example, we know that there is more dementia and earlier onset of dementia if brain illnesses are not fully treated.

Thank you Nancy for these questions and opportunity to further discuss this important, underutilized treatment option for brian illness!

Thank you readers for joining us in this discussion.  Let us connect with our community, increase community awareness and decrease stigma together.

Everything starts and ends with Me.  Keep on.

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5 thoughts on “another answer to ECT questions

  1. I respect the information given here, and I don’t dispute it. I think that is one’s depression is severe and nothing else works, it could be a good option. If I went through that kind of depression again, I might try it again.

    Having said that, I do believe that the memory loss is individual. I experienced a lot of memory loss. My treatment was over 3 years ago, and I still come upon evidence of memory loss frequently. My best friend has commented on this as well.

    Also, it is difficult to work and have ect. So maintenance ect would need to be given a wide berth.

    Still, despite the memory loss and ect’s failure to help me – if I were in that situation again, I might still try it.

  2. Thank you, Sana, for answering my questions so quickly and so completely. Obviously (at least to me!), I absolutely did not understand the procedure for healing with ECT. As a result, although you answered what questions I posed perfectly, I have another. My daughter works with severe and profound special needs students. In a school community maintaining an average student body size of approximately 100, an average of three children have died every year of the over 20 years my daughter has worked there, and the greatest majority of those deaths are caused by seizures. Of course, with these children, there are a whole lot of other physical problems along with the problem of seizures, but, eventually, it is a seizure that finally ends their lives…whether they are 3 years of age or 21 years of age (3 to 21 being the ages during which the children attend that particular school).

    I am not questioning whether ECT would kill a patient. I’m sure that, as in all medical procedures, there are a huge amount of possibilities for a huge amount of things to go wrong. (Signing my life away just to have button hole surgery to remove a gall bladder last year was amazing!!) However, I was shocked when I read, today, that I, as your patient, would have three seizures a week for several weeks and then have them each time I needed them to maintain or ramp up my treatments depending on how my brain illness progressed (positively or negatively). I’ve watched my daughters’ kids seize. I’ve seen the nurses and EMTs work frantically with them and then take them off in an ambulance. I would need to know that the seizures that occur during an ECT treatment are nothing like what I have observed with my daughter’s school children. I am hoping that your response would be similar to that of my daughters’ doctor who, when putting them on birth control pills to regulate the flow and pain of menstruation, said that the amount of medication in those pills was so much lower than that given to women to actually keep from getting pregnant that my kids shouldn’t even think about testing that theory out.

    Thank you for your work with this subject and for sharing your knowledge with us. Keep on! 🙂

    • ok. i’m awake :).
      so some medications produce an increased risk of seizures and electroconvulsive therapy (ECT) deliberately induces a seizure for treatments to brain illness.
      Interestingly, ECT is also the most effect treatment for depression caused by seizures. This is important, as suicide is dramatically increased in those who suffer from seizure disorders.
      To get down to the summary of your q: why is ECT not brain damaging and seizures are? In its reduced form, I’ll answer, methodology. A seizure disorder is a uncontrolled quantity, quality and location of stimulus. ECT however is much more refined from blasting the brain indiscriminately with stimuli as happens in seizure disorder. Imagine a ray of sunshine helping a plant to grow verses what would happen to us if we were walking on the sun.

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