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. 🙂
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.
- Elderly Depression: 5 Effective Treatments (assistedlivingtoday.com)