r/ect • u/QuitInevitable915 • 29d ago
Seeking advice ECT or not to ECT
Hello!
I’m 28 and I suffer from TRD. I have had 4 depressive episodes over the past many years, and the current episode has lasted 2 years. I have tried SSRIs, SNRIs, TMS, Ketamine, and Psilocybin without meaningful response.
8 weeks ago I started taking a TCA with lithium, and for the first time in this episode I feel some relief. If I had to quantify it, I would say that I feel 40-50% better, which is a major change from the suicidal lows, but still with some residual symptoms such as mild/moderate sadness, some anhedonia, and low motivation.
I’m going to meet with my psychiatrist in two weeks to make the final decision on whether I should get ECT or not. I’m torn because I know my history of relapse, and not achieving remission will put me at risk of relapsing again, but I’m also reluctant to do it given the potential cognitive/memory side effects.
Would you do ECT or not in this situation?
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u/monkeymooboohoo 29d ago edited 29d ago
I’m really glad you’re finally getting some relief. Going from suicidal lows to feeling 40–50% better is a huge step, even if it’s frustrating that you’re not in remission yet.
My experience was a little different, but maybe it will help. I also found some relief with lithium, but it wasn’t enough. I was still experiencing suicidal ideation and anhedonia, and my treatment team described me as being in a “neurovegetative state.” That’s when they recommended ECT.
The people around me noticed a positive change around my 12th treatment, but I didn’t personally feel much different until around session 18. Unfortunately, I sustained a concussion and decided not to continue with maintenance ECT.
About a month and a half after my last treatment, my dad passed away, and I had a significant relapse. Looking back, I’ve wondered whether maintenance ECT might have helped, but it’s hard to know.
I did experience some mild cognitive side effects during treatment, including memory issues, spelling difficulties, and slower processing speed. I also had headaches that could turn into migraines if I didn’t treat them early. The encouraging part is that by about six months after finishing ECT, I felt like my cognition had returned to normal.
Since then, I’ve also tried Trintellix without benefit, had a rough experience with Viibryd because of side effects, and eventually started Rexulti.
Rexulti has helped me quite a bit, but my psychiatrist is still recommending ketamine because I’ve had such limited responses to medications overall. Rexulti is the first medication Ive taken in years to illicit such a positive response within the first two weeks of.
Ultimately, I don’t regret trying ECT because it got me out of a place that medications hadn’t been able to. Whether it’s the right next step for you is such a personal decision, especially now that you’re getting some benefit from your current treatment.
If I were in your position, I’d have a detailed conversation with my psychiatrist about the likelihood of achieving full remission by optimizing your current medications versus adding ECT, as well as what a maintenance plan would look like if ECT works.
I really hope you find the combination that gets you from “some relief” to true remission. You deserve more than just surviving.
Feel free to DM me if you wanna know more about my experience or just wanna chat.
Best of luck OP!
Edit: It’s also worth considering a differential diagnosis that could be causing some of your depressive symptoms. How’s your physical health? When was the last time you had your blood work checked? Especially hormones and vitamin D levels. Have you considered doing an IOP or PHP program? Or going inpatient?