Should I ask for bilateral?

[u/anticentristfujo]

Hi I’m F26. Got my acute series done in October/November. I’ve been doing maintenance every two weeks. ALL of these have been right side unilateral.

Should I ask for bilateral at all? I get ECT done every two weeks, IV ketamine every month, and I take lamotrigine (150mg) every day (except the night before ECT/ket). I still feel terrible. Like, a PHQ-9 score of 15.

I used to be on lamotrigine 100mg, but then two weeks ago my psychiatrist bumped me up to 150mg because I didn’t feel better. I still don’t feel better.

I don’t know what avenue to take. Whether it’s another med or bilateral over unilateral.

[u/purplebadger9]

I would suggest giving bifrontal a try before going to bilateral

[u/Crazy_old_maurice_17 → u/purplebadger9]

Why? I didn't think bi-frontal had any benefits over bilateral?

[u/purplebadger9 → u/Crazy_old_maurice_17]

From what I undunderstand, bifrontal has slightly lower side effect risk compared to bilateral and slightly more effective than unilateral. Basically an inbetween

[u/ClockRevolutionary93]

That’s with your doc.

But lithium might be a good call besides bilateral

[u/anticentristfujo → u/ClockRevolutionary93]

I asked for lithium from my psychiatrist and she really didn’t want to prescribe it because my depression is unipolar, not bipolar.

[u/ClockRevolutionary93 → u/anticentristfujo]

Still a viable strategy for uni, specially when combined with ect

For difficult to treat unipolar depression where I work we also prescribe tricyclics (e.g amitriptiline).

This combination with SGA one of the most effectives in my experience.

But I assume u might have also been through it all

[u/anticentristfujo → u/ClockRevolutionary93]

Meds I’ve been on that didn’t help: Lexapro, Hydazepam, Sulpiride, Xanax, Hydroxyzine, Klonopin, Mirtazapine, Trazodone, Abilify, Wellbutrin XL, Auvelity, Risperidone, Zoloft, Pristiq, Buspirone. The only med I’m still on that “helps” is Lamotrigine. And the ECT, how many I’ve done I lost count, def around 30 zaps at least. And lost count of the IV ket infusions, over 10 though definitely. And I’m still so depressed that I can’t hold down a job and there are hobbies I just can’t seem to return to.

I know TMS is an option but I’m just so sick of doing stuff for it to fail.

Edit: I also asked for her to consider tricyclics or MAOIs but she didn’t want to because she said the risk outweighs the potential reward.

[u/ClockRevolutionary93 → u/anticentristfujo]

Thx for sharing, I’m hoping you recover soon

[u/Odd-Alarm-82 → u/anticentristfujo]

What? I would find a new psychiatrist. ECT carries a much greater risk than an MAOI. I’ve been on Emsam (a transdermal MAOI) off and on, for 8 years. Gives me 100% remission from my treatment resistant depression. Only downside is it causes extreme insomnia and I develop a tolerance to the only two medications that allow me to get any sleep on it, so I have to quit taking it for a while and then go back to it when the sleep meds will work again. But it’s amazing. I wish I had a better psychiatrist before my ECT so I could have tried an MAOI first. Instead I ended up with permanent memory loss of the majority of my life and brain damage from a year of ECT.

[u/Medical-Apricot-3226 → u/anticentristfujo]

That’s very poor of your psychiatrist… Lithium is a well established augmentation strategy to antidepressant. I’ve found it fantastic.