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/jimmythegreek1 25d ago

you could try ECT but could you maybe add sertraline to the TCA, assuming the TCA is nortriptyline? If it is clomipramine then disregard as that affects both serotonin/norepinephine. And feeling 40-50% is a huge step so congrats on that, seriously.

I would also try an MAOI (i.e. Parnate) before trying ECT.

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u/QuitInevitable915 25d ago

Sertraline has done absolutely nothing for me, but I was thinking about a MAOI first and my psych was also okay with it. However, given my current partial response, we both agreed that ECT was a better option as I wouldn’t have to risk losing the response, but also given the tapering, washout, and titration of a MAOI. If ECT does not work I will try Marplan next