ECT? Ketamine infusions??

I saw my psychiatrist this morning, and it turned out to be quite an…interesting…half an hour.

She realised the lithium dilemma without me having to explain it, and the upshot is that we’re reducing my dose from 800mg to 600mg nightly in order to reduce the side effects I’m experiencing. This means we definitely won’t be hitting our original target of a lithium level between 0.55-0.7, but she says that target is more relevant to bipolar patients than patients with depression. Hopefully 600mg will still be useful to me.

We’re also adding in another antidepressant to try and boost my serotonin levels: welcome back mirtazapine (/Remeron). I have to admit, I’m a bit nervous about this – I’ve taken it before to help me sleep (which is another reason my psychiatrist wants me to take it now), and in December I wrote myself a warning before discontinuing this med for being too strong. I’ve been told to cut the pills in half and see if a lower dose is tolerable, and then increase in a fortnight. 

The whole medication vs insomnia battle really sucks; the meds are either so strong that I’m barely conscious in the daylight hours, or so weak I might as well be swallowing chalk pills. The only med that hit the right spot in the middle was zopiclone (/Imovane/Zimovane), but I’m not trusted with it in case I overdose. Grrr.

With this all established, my psychiatrist sat back and said we should think about what the next step is. When I see her in two months time, if the mirtazapine hasn’t helped much she wants to add in aripriprazole (/Abilify), an antipsychotic. After my bad experiences of olanzapine (/Zyprexa), quetiapine (/Seroquel) and risperidone (Risperdal) I had sworn I never wanted to touch an antipsychotic again, so we’ll see how I feel if it is decided this med is necessary.

And then my psychiatrist said she wanted to say something that might horrify me…that I should consider ECT. I’ve read enough blogs on WordPress to know that for all the scary assumptions we hold about it, it can have it’s good points, and my doc was quite encouraged when I didn’t immediately say no. She reckons it’s really underused, especially with patients like me who are managing to function, but are having a miserable time of it. 

Apparently I should also consider ketamine infusion therapy, because a UK trial has just finished and found some patients respond really well, so it’s opening up to referrals. And yes, that’s ketamine as in the horse tranquilliser/Class B drug, but used at a much smaller dose. 

I was a bit shocked by these suggestions – I’d thought that ECT especially was for very severe cases of depression, but now I know that’s not true (..and I’ve been reminded that my diagnosis is ‘severe depression’). I’m not exactly shut against the suggestion of having ECT, but the memory loss bothers me. I’d also have to have it as an outpatient because the hospital is really short on beds, but I’d need to have someone to care for me for 24 hours, and that’s not an option. 

With the ketamine infusion idea, I was pretty skeptical, but having looked up the details of the study etc I’m actually kind of intrigued. But, hopefully none of this will be necessary because the mirtazapine will help. Or the aripriprazole if it comes to that.

All in all, it wasn’t a bad meeting. I really like this psychiatrist (and yes, I realise that means she’ll be next on the list to disappear off somewhere else), because she is nice, but not too nice, and she clearly knows her stuff (not surprising given she’s a consultant psychiatrist). The loss of Nurse L was mentioned in passing – as I suspected there will be no replacement, and I have no interest in asking for one. My GP won’t be happy because she specifically told me to ask about it because she thinks it makes me safer (true), but letting someone else in is also dangerous in it’s own way.

We’re already rocking the med boat, so lets leave the rest alone, at least for now.


19 thoughts on “ECT? Ketamine infusions??

  1. ECT is very scary to consider, however…. also very successful, not always involving memory loss either.

    Visit and chat with Paula, she is great. Tell her Amber sent you. Sometimes it is nice to talk to someone that has undergone treatments to see what their viewpoint is.

    • ECT is electroconvulsive therapy, where you’re given a general anaesthetic & muscle relaxants, and then an electric current is sent through your brain to trigger a seizure. Some people feel almost completely different after a course of sessions (different in a good way). It’s thought to be especially valuable for patients who haven’t responded to medication.

      It has a bad rep from being portrayed in films etc as something comparable to torture, presumably because it sounds extreme. The real controversial thing as far as I’m concerned is whether or not it causes memory loss: most patients don’t remember much about treatment, and some claim to lose memories from years before.

      If you’re curious, check this out: ReThink – ECT

  2. When I had ECT, I didn’t need someone to take care of me for 24 hours afterward. They’d keep me for an hour (I think) after I woke up, and I had to have someone drive me home. But after that I was fine and was able to do whatever I wanted. (Usually, the first thing I wanted to do was scrub the goo out of my hair.) I lived alone, and that was no problem.

    I’ve read about the ketamine studies. If I could get in on those, I’d try it, although I’d never qualify for medical trials because I have other illnesses and have failed too many antidepressants even for studies of treatment-resistant patients. (WTF? How can you be too treatment-resistant for studies on treatment-resistant depression?)

      • Well, different hospitals might have different policies on it, mostly (I assume) to keep from getting sued. I had mine done at McLean outside of Boston, and they’re one of the top-ranked psych hospitals in the US. But I know there are other hospitals that insist on doing ECT only inpatient. There seems to be a lot of variability.

        Honestly, it didn’t help me long-term. It helped a little bit for a little while, but only at the highest setting/dose/whatever you call it (bilateral brief pulse). It left me with severe memory loss–there are about 6 years I barely remember anything from–and cognitive issues that took a long time to improve–inability to read and problems with word retrieval. Those difficulties have mostly improved, but I still have some trouble, and it’s more than six years since my last ECT. If I could go back and do it over, I wouldn’t have ECT.

        But I had a lot more ECT’s than most folks (29), and I got the strongest dose they use. My memory loss and cognitive problems were much worse than what most people experience. I know other people who have really benefited from ECT, so don’t base your decision totally on my experience.

      • Yeah, no one warned me about cognitive issues, either. I’ve since heard from other people who’ve had ECT that they had similar side effects. The doctor who did my ECT did some testing every so many treatments, and my scores were going way down. They obviously knew it was a possibility but never warned me about it.

      • Yeah I’m sitting here kind of outraged on your behalf, but, at least I can say that with the info you’ve shared I’m going to be a lot more cautious about what I let docs do with my brain. Thank you for that x

  3. I’ve also had ECT if you have any questions. It was on an outpatient basis and I had like 80 treatments. I was observed for like an hour and all I needed was a driver to take me home because of the anesthesia. Like nobody I had severe memory issues and they really down play that aspect when they get you to consent. Think it over and do your research.
    As for Ketamine I hear there is a terrible crash and it’s not a long lasting treatment, they’re working on it here in the US also.

    • Thanks Marci. 80 treatments – wow. This may seem like a strange question, but do you think you would have been able to leave the hospital by yourself after a session and get the bus home? What did you feel like for the first couple of hours?

      And it’s interesting to hear a negative on the ketamine. Its a shame it’s at such an early stage; there’s not an awful lot of material out there.

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