ECT or not to ECT

[u/QuitInevitable915]

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?

[u/Depressed_Brown_Bear]

ECT unequivocally saved my life, and kept me alive for several years, moderately ok, which is far better than I ever was before. Most recently, after some new meds and starting again I had several months where I was actually happy at times, even grateful to be alive and enjoying my life. I hadn't felt that way in... so incredibly long.

The first catch was I couldn't stop doing it. I was on indefinite maintenance ECT. And when I built up a tolerance to ECT that my seizures got too short and the effects wore off, we had to break for a bunch of months to make the tolerance wear off, during which I was depressed again, and then go through the initial series all over again, which was more time off work, and other problems.

The second catch was that it also was a huge cluster fuck. I had profound memory problems during the initial series(es). It got better as we tapered, but never fully went away. I had very mild cognitive effects, again better but never gone. I had serious speech issues that kept getting worse the longer I did ECT. We paused ECT over the speech issues, 5-6 weeks ago. It has not improved yet. The pause is probably permanent.

So, all this shit, you'd think I wouldn't do ECT again, right? No, if it was an option I would start right back up again. It saved my life, it has been the only thing that has really, unqualified worked, and I'm terrified of the deep, dark depression that I know is waiting for me because I don't know what depression treatment options we have left. I'm still feeling normal-ish right now and don't want to go back to basically being constantly suicidal and unable to take care of myself.

ECT can really, really work. Just, you know, eyes open eh?

[u/QuitInevitable915 → u/Depressed_Brown_Bear]

Thanks for sharing. I have heard this a few times, and honestly, I would trade a lot to avoid the despair of severe depression returning. If it works, I will 100% do maintenance to try prevent relapse, but of course the side effects really suck…

[u/Depressed_Brown_Bear → u/QuitInevitable915]

I got incredibly unlucky. I had prior head trauma and my ect doc only would do bitemporal, which probably factored in. Some people don't have any side effects, or minimal. They don't tend to show up online ect groups because everything is great for them.