Aswad
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Joined: 4/4/2007 Status: offline
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quote:
ORIGINAL: Duskypearls Has anyone had any first or second hand experience with this sort of therapy in regards to treating depression? Second hand. First off, since there are so many different ideas about what constitutes severe depression, I will define it in the simplest way I can: if you're no longer eating regularly, sleeping tolerably or taking care of basic personal hygiene, then you've reached the level that is severe. Prior to that point, ECT is not a sound choice, in my personal opinion, unless you have persistent suicidal ideation (that is, recurring thoughts of suicide, or specific plans, or a sincere feeling that you would rather be dead than go on). Occasional suicidal thoughts usually don't lead to suicide, whereas persistent ones have a higher probability of that, making them more pressing as far as actually "jumping ahead" in treatment goes. With severe depression, it is necessary to establish a drug based regimen in order for ECT to have a lasting benefit. It in itself is a way to break out of the depressive state, not a way to end the depressive illness. You need something that will actually deal with the illness as well. Drugs are currently the gold standard for severe depression, as there is quite simply not enough to work on to get anywhere with behavioral therapy. When the literature diverges on this point, it is my experience that it comes down to these sources using a different definition of severe. Therapy is great. But it is insufficient to put a severe depression of chronic duration into remission. Sometimes, drugs are insufficient on their own, or there may be a time factor (e.g. risk of suicide). Most of the time, ECT will not give lasting loss of memories older than a couple of days prior to the treatment, and it is rare for people to experience a significant and enduring loss. Any time there's a lightning storm, someone will get struck by the lightning. The odds of it being you are slim. But you have to decide how severe the loss is, factor in how unlikely it is, and then weigh that against the odds of suicide (1 in 3)¹ and the loss endured due to the ongoing illness and the risks you otherwise take in life. Any time you drive a car, there's a chance you'll end up dead, a few limbs short, or vegetating in a hospital. Most of us take that risk without it giving us pause. Similarly, many psychiatrists advocate the same tradeoff as regards ECT in outpatients. If you draw the short straw, that sucks. If you don't, it will in most cases almost immediately reverse the depressive state, and allow the meds to stabilize you. ECT is a very useful treatment. I wouldn't do it unless I was downright catatonic for at least a year, but that's me, and it's rarely the right assessment. Drugs also have side effects. The potent drugs, the ones usually reserved for otherwise refractory cases and severe depressions, have severe side effects. Some, like Parnate, will require a strict dietary regimen to be adhered to. Some, like Anafranil, require regular bloodwork. Most have some contraindications that are not to be trifled with. All require a professional to keep an eye on the long term effects and can benefit from combination with therapy. In short, they're serious drugs for a serious illness. Much like ECT, which should only be used when you've found a drug regimen that will be adequate to stabilize you once the ECT kicks you out of the depression. Unless the right drugs are in place, you might as well use sleep deprivation, because the effect is the same: a reprieve of short duration. With the right drugs, the effect is a lasting remission. The drug regimen I used in my severe depression was a combination of 2.4mg/kg/dy Parnate, 16mg/dy Subutex and 3x5mg/dy Dexedrine. Makes you feel weak and nauseated. Takes a few pounds off your weight. Messes up your sleep for a while. Expect some vomiting. I had a cramp in my bladder muscles at first, requiring a week with a catheter. There were other effects, too. But it made me better. Realize I didn't just feel better, I got better. Started to function again. Got me on my feet. Took a long time for me to even learn to recognize such basic signals from my body as hunger and pain. But I improved. Achieved remission. Tapered it down to a maintenance dose of 1.2mg/kg/dy Parnate without the other two. Whatever route you take, it will be unpleasant, but you will recover in the end, and it's worth sticking around for that. Feel free to message me on the other side. I wish you well, — Aswad. ¹ For anyone reading, bear in mind that this suicide risk is well beyond what is seen with cancer and other horrific illnesses.
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"If God saw what any of us did that night, he didn't seem to mind. From then on I knew: God doesn't make the world this way. We do." -- Rorschack, Watchmen.
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