Electro Shock Treatment (ECT) and Transcranial Magnetic Stimulation therapy

[tee42people]

My sister has been diagnosed with severe depression, I think she is Bpd, as her behaviour fits with all I have read here.
I had to have her admitted to a mental facility and they were looking at giving her EST.
I spoke with her GP and with the staff at the facility and they told me that they have had great success with EST.
The staff told me that it resets the brain and seratonen levels,the only side effect that they told me about was memory loss of about 1 hr.

Has anybody heard of EST being used for BPD? Any other side effects?


Tee

[JoannaK]

I don't know about EST with bpd.  I do know that the more recent EST treatments aren't at all as damaging and disabling as older such treatments, but there is still some concern about memory loss.   But depression alone, even severe depression, is different than bpd.

[flex60]

According to clinical trials I read about in pubmed, those with bpd, progressed dementia, eating disorders, and extreme depression, have serotonin transmitters, SERTS,  probems.  They found about fifty percent were empty, in all four cases, how the transmitters work is a mystery.  The author proposed a theory in the eating disorders, in that those folks serotonin level changed rapidly, when it went up, they overate, then when it dropped they vomited their food.
I would think if EST would reset the seotonin level, it should be explored at length.
Please put EST in google search and you should learn a lot.
I do have an acquaintance that I work with, no meds helped him in the slightest, he has EST twice
and says nothing to it.  His first he got five years ago, and tells, if he fell over dead today, it would have been worth it.  He is about thirty years old, and must have had a miserable life up to the point of EST.
flex

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[nevergiveup]

I have a friend with schizophrenia who has regular EST. He says it really helps him mentally, totally clears his delusions, but leaves him with a constant headache. Don't know anyone with BPD who has had it.

[Bdawn]

My stepfather had EST back in the seventies and it helped him immensely. He had been in a catatonic state for weeks and the EST snapped him right out of it. There was memory loss in the beginning but eventually pretty much all of his memory returned. I find the idea of EST frightening but I have read that it has been very successful in treating patients with chronic depression. I have never heard of EST being used to treat any personality disorders.

[Abigail]

  It is supposed to be helpful in cases of severe depression that does not respond to medication.  I don't think it is used for BPD but it may help if the person has depression.  Have you mentioned to them the possibility that she might have BPD?

  Abigail

[bart11]

I believe the preferred term is Electro-Convulsive Therapy (ECT).  They don't like the word "shock" in the title of the treatment.  It is thought that the convulsions are what cause relief from depression.  They used to use large doses of insulin to induce convulsions but they found that electricity was safer.

Most of us know of the procedure from the movies or TV.  Hollywood spends little time on accuracy and goes for dramatic effect instead.  Today, ECT no longer resembles what was seen in ONE FLEW OVER THE CUCKOO'S NEST.  The procedure is done under a general anesthesia as is given during surgery.  Patients are monitored as with any surgical procedure.  Muscle relaxants are given as well to minimize physical convulsions of the body (toes twitch but that's about it).  It can be done to one hemesphere of the brain or both, depending on electrode placement.

Kitty Dukakis has a couple books out detailing ECT's use, effects and side-effects.  She has had ECT treatment for a number of years.  I think anyone considering the treatment for themselves or others should research the subject, both pro and con.

All that said, I would only use ECT as a very very LAST resort.  Medicines for depression are very good, but those who do not respond to talk therapy along with many attempts at antidepressant treatment may then consider ECT, but ONLY with proper information.

Best of luck

Bart

[JoannaK]

Please read around, google ECT, find out what is different about new ECT vs. old style EST, and, if your sister is willing and able, get a second opinion.  None of us are mental health professionals, so all we can do is tell you what we have heard or seen.  Research, and get a couple of professional opinions.

[free]

I agree that the research is very important, and weighing out the pros and cons. A friend of mine had ECT many years ago. There are large swaths of memory gone. She also suffers from many physical symptoms that she attributes to receiving ECT. It was no help over the long term, and she has very bad feelings about it.

On the other hand, I know someone who had tried many types of antidepressants, had done years of therapy, and tried everything she could. She received a couple of treatments of ECT and didn't suffer from depression again.

Like everything else, the response and perception is completely personal and can't be applied to everyone. I know that ECT seems barbaric, and I've certainly had concerns about it...but it's also cruel to keep someone alive who is in severe emotional pain all the time--I think that's barbaric too.

Free

[ian]

From what I understand ECT in moderation does not cause any real long term problems, but if performed too frequently it can damage memory.

[suzani]

ECT is becoming much more popular.  Kitty Dukakis puplished a book about her battle with depression and how ECT is the only thing that works for her. (Maybe I have that wrong, maybe she just does not want to take the meds?)  As others have mentioned, the treatment now is not nearly as harsh as what they used to do in the past.

Stanford has a special center for treatment-resistant depression.  They have recently purchased more ECT equiptment.  They have a 6 week waiting list to get in for ECT.

However I have never heard of it being used for BPD.  Does anyone know if it is frequently used for PTSD, because if so then it might be logical to try it for bpd.

[suzani]

Schnitzel,  I have to disagree that there is no science behind ECT and its effect on depression.  There is no definitive scientific proof of exactly how ECT helps with depression, but something is going on because the APA says ECT has an 80% success rate, while meds have only a 50-60% success rate.  Depression is a state of abnormal brain chemistry.  Sometimes you can correct the chemical imbalance by therapy, exercise, etc., sometimes you need meds.  ECT is usually a last resort because it does lead to some memory loss, headaches, etc.  But sometimes it helps where nothing else did.

The brain is really complex, there is not even a complete understanding of how antidepressants work.  I had a psychiatrist who told me that sometimes when he had a hospitalized patient and nothing else was working, sleep deprivation would somehow snap them out of it. (don't do this on your own!)

I can understand not wanting to do it, but there are a thousand medical journal articles out there that says it DOES relieve depression.

[suzani]

Well, of course it is great if therapy alone can alleviate depression, but so often that is not the case.  The truth is that no one knows how many of the approved drugs out there work (just like ECT).   The reason that they are allowed to be sold is that (1) they are not toxic/poisonous (or if they are, they are being used for something like advanced cancer, so it is better to tolerate the nasty side effects to kill the cancer cells) and (2) they have been proven to have an effect in clinical trials.  So we know that if you take X, you will get better (although we don't know why you get better).

I hope that none of you  ever have full blown, never-ending depression.  When you have it, unless you really have no sense of self-preservation, or no one around to help you, you try many things to feel better.  You keep moving down the list of possibilities.  For some people, ECT is the only thing that works.  It isn't electrocution, it is a medical procedure that is done very carefully, and it is definitely not the 1st, 2nd or 3rd choice for treating depression.

I just don't want someone on the board to feel like an idiot or a freak because they are getting ECT.  Depression can be just as nasty as schizophrenia, and if you get depressed enough you can even have a psychotic break.  The longer you have depression without getting it relieved in some way, the worse it gets and the harder it is to treat.

[free]

Well, of course it is great if therapy alone can alleviate depression, but so often that is not the case. 

 The longer you have depression without getting it relieved in some way, the worse it gets and the harder it is to treat.

Suzani,

This is so true. For many people, therapy alone is not enough to relieve depression; a change in body chemistry is also needed. I did years of therapy, bodywork, breathwork, art therapy, journal writing, etc and still had life threatening depression. I was fortunate to finally find an antidepressant that was effective without terrible side effects.

A psyc. that I saw had a theory that working through painful childhood stuff was very stressful on the body (although necessary to do). She believed that reliving a lot of the pain was a stressor especially on brain chemistry. She had worked with women who had been abused for over 25 years. She saw many women who had done extensive therapy and personal work, and sometimes needed antidepressants for several years in order to heal more fully. She was not quick to prescribe meds or ECT, but she felt they had an appropriate place.

I believe there is a difference between situational depression and chronic depression. The first more likely will respond to therapy and if possible, the change in circumstances. Chronic depression--not so likely. Also, once you have had a major depression, you are more likely to have more of them. When you have a string of untreated major depressive episodes, the treatment is much more difficult.

Free

[ThursdayNext]

Not sure which board to post this on so am posting here. Have just had panic-stricken phonecall from BPDsis, who has been in high dependency mental health ward for some months now (and on and off all year) after her 4th suicide attempt this year. She had day leave on the weekend and, being suicidal (still) but not having told staff that, decided to hitch-hike to another city and throw herself in front of a train. She stopped at a local town to see her boys, who are with an aunt, having been removed from her care. This was, in my  understanding of the orders, in breach of her current visiting rights but the aunt was very nice about it and allowed her to visit. The visit with them reminded her that suicide wasn't a good choice and she then drove her car (which is in no state to be driven) back to the hospital, having stopped off at the side of the road several times to while she battled her desire to run away and kill herself.

After having heard this from her yesterday, I phoned the nursing unit manager this morning to check that she knew what BPDsis had been up to on the wkend and that BPDsis now had her car parked in the hospital grounds and so was a flight risk and also had a vehicle for further suicide attempts if she chose to use it that way.

The panic stricken phonecall just now was to say that (a) her day leave has been cancelled due to her behaviour on the weekend (surprise, surprise) and (b) that the second-opinion psychiatrist who saw her last week had agreed with her treating psychiatrist that they want to try 6 ECT treatments. That if she didn't agree to it they would seriously consider treating her under the mental health act, which allows them to make the decision for her.

She is obviously terrified but has also decided that this is just proof that she shouldn’t have returned to hospital – that it’s punishment. Sigh.

The Drs have told her that they think it possible that her depression is not as related to her BPD as previously thought and that by using ECT they can establish this – sounds logical but also sounds like a rather brutal way of finding out. Their hope is that by doing this they can jolt her neurotransmitters to better levels very quickly, so that she will then be more responsive to medications and counselling. She’s currently not responding to most medication courses tried and is refusing to engage with therapy.

My question: does anybody have any experience of ECT in relation to a BPD in their life/acquaintance that they would be prepared to share?

My concern: that if ECT doesn’t ‘work’ according to my BPDsis’ definition  (i.e. makes her better) then she’ll be even more likely to kill herself. Mind you – at the moment that’s likely to happen anyway.

Thanks, people. I know there’s not much to be said here – BPDsis is a pretty severe case although her borderline behaviours are usually more on the ‘middle range’. She still has this attitude of waiting to be rescued, for someone to ‘fix’ it without her really participating in her recovery, which is very difficult and frustrating for all concerned. Main reason I’m still engaged with this in any way is because of her two small boys and her older children. 

[samsara]

An old friend of mine was treated with ECT for bipolar disorder.
She felt that it did help her when medication was no longer working, but it did strip away a fair amount of memory.  
She's on disability now, but at least she is no longer actively suicidal.
Are there no other medications that can be tried to help your sister?
Is anyone acting as her medical advocate and/or does she have a legal guardian to help with these healthcare decisions?

ECT is pretty heavy-duty stuff - defintely to be used as a treatment last resort when little else has worked.

I understand why you are trying to help your sister, but it is also a very heavy burden to carry.  If there was anything I could share, I would say to find someone who can be a legal medical advocate for her while she is hospitalized.   If anything to protect yourself (and your sister) should the docs treat her with the ECT.

[blackandwhite]

Thursday Next,

 xoxox

My mother had it. I was a small child, in the 70s, so my memories are jumbled and techniques have likely changed. I've heard it's much easier to handle now, but haven't done any research myself.

She did stop trying to kill herself after it, though I don't what causal connection there is, if any. She was very depressed as well as BPD. She left the hospital very bitter toward the mental health system, again, I'm not sure if that was due to the ECT.

Not sure how relevant, but feel free to PM me if you want any more info.

B&W

[LivingWell]

Carrie Fisher, aka Princess Lea is bi=polar she talks about it.  I actually knew her in the 70's and 89's and I believe she is also bpd.  A couple months ago she was on the Charlie Rose show talking about her life and mental health.  She has ECT almost monthly.  Says she couldn't do without it.  You may want to goole the Charlie Rose show and then sign in to see the interview.  She's a very interesting person.  Somehow she doesn't seem quite normal but she's definitely in better shape than your sister.  She swears she couldn't do without it. Says it does decrease short term memory for a period of time before the treatment.

You may want to look up the interview. 

[LivingWell]

What a mess to be going through.  The stress of trying to keep someone alive for their children,  concern for the boys, planning a funeral. And the whole time your sister has been, is, and will blame you.

It really all sounds like too much.  The hardest part is choosing the pictures, especially if you choose then all by yourself. If it's feeling like too much then slow down on the funeral.  It will get done when it needs to get done.

You may think you are doing this because you are the only one at home during the day. You are doing it because you care. Caring makes it hard. 

What you are saying is your sister isn't going to get any better because she doesn't care and isn't going to try.  Unfortunately you are probably right.  xoxox 

I will be thinking about you.   xoxox

[MiddleOne]

Thursday Next:

I'm very sorry to hear about your sister's current condition.  What type of hospital is she in? General, specialized, private, public?  My mom was hospitalized for bipolar disorder in all types of facilities and communication varied greatly from place to place. Pyschiatrists at a public hospital have taken over a week to respond to my phone calls which I attributed to overwhelming case loads rather than indifference.  Does the hospital know that you are the family's point person?  If yes, then the psychiatrists should return your calls, although they are unlikely to respond to a request for information over the weekend. Have you tried calling the nursing station and raising a little fuss about needing information?  Sometimes the nurses are so helpful in delivering a messages to the docs. I don't have anythng to offer regarding ECT, but I might ask the doctors if there are any less drastic steps that can be taken before trying ECT.  If you have the resources you might consider hiring a private social worker to help you navigate the hospital system and come up with a treatment plan. In the end, there's not much you can do to improve the situation if your sister is intractable. Sparing your niece this anguish is admirable of you.
MO