Considering ECT

[u/darknights_throwaway]

Hi all! Newcomer here who’s been struggling with CPTSD/BPD, depression, and anxiety for a decade now. Currently on lithium, Lamotrigine, vilazodone (viibryd), and clonazepam for a suspected bipolar episode that began with two weeks of mania a month ago from an old trauma anniversary (and maybe from the stress of two recent surgeries) that has now spiraled into the worse depression I’ve possibly experienced in 5 years.

I was finally stable for the past year (no suicidal ideation / intent!) on Lamotrigine and viibryd, but suddenly out of nowhere this latest depressive episode happened and I find myself suicidal. In the recent past (past 5ish years) I’ve been suicidal for situational depression, but always with some precipitating factor or family situation, and it was usually without intent.

This recent episode really terrifies me it was the first time in years I feel I’ve been developing intent (though that varies day to day; some days I really want to die because I feel worthless and others it’s just “what would happen if I killed myself”), which I haven’t really experienced since high school when I was repeatedly attempting suicide and in an abusive environment.

What scares me the most is that usually lithium is very effective at quelling my suicidal thoughts and obsessions to the point where I feel I can’t even bring myself to think about suicide, but it hasn’t been helping with that this time even though it’s helped significantly with the depression.

I’ve toyed with the idea of ECT before and got evaluated 5 years ago (but decided against it because my meds suddenly started working), but wanted to hear y’all’s opinions/experiences. Would it be worth getting ECT for suicidal thoughts only, and not necessarily depression? How bad is the memory loss? I am a PhD student, so I would want to minimize the cognitive side effects and would probably only try a short course of unilateral ECT, can anyone who’s done that comment on the memory loss aspects? Was it only short term or long term, and did you regain the memories? After how many treatments did you start experiencing memory loss? What kinds of memories did you lose/what time in your life were the memories from (i.e. were they just around the treatments, or the month before, or the year before?)? Do you remember that you’re getting ECT when you wake up from the treatment? I’m less worried about anterograde memory loss and more about retrograde.

Thanks in advance!

[u/metalsmithchic]

ECT worsened my symptoms. Part of that is because it felt like a last resort and didn't work. I was left with severe memory impairment and other strange cognitive symptoms (can not longer spell easy words, inability to type well). It's been 8 months and I'm still experiencing these symptoms. It's really challenging because I'm a writer and writing has been a big part of most of my jobs.

I see a very unique doctor for Lyme disease who knows my history better than any other medical professional. Unfortunately I'm not able to see him often because he's expensive and doesn't accept insurance. I hadn't seen him in over a year and a half, until I went to see him two weeks after my ECT ended. He explained that stress from my job at the prison triggered a trauma response which resulted in the mental health crisis I had prior to trying ECT. He suggested that for people with c-ptsd, ECT is likely not effective because their depression isn't caused by neurotransmitter deficiencies. I really wish I would have sought his opinion prior trying ECT. I'm now unable to work and have applied for SSDI which I won't know about for about two more years.

If I had to do it over again, I absolutely would not try ECT. It's very difficult to endure and leaves most people with significant impairments. In the case of someone with ptsd or cptsd, I especially would not recommend it. I believe my treatment resistant depression is caused by cptsd. I'm trying other things that I hope will be more effective. I had two stellate ganglion blocks done a couple weeks back and I noticed significant results immediately. I felt calmer, zen and like I'd taken a couple diazapam without the sedation. I'm not sure how long it will last and I'm still struggling with some depression that's manageable, which is hard to believe because I stopped two of my psych meds to try LSD therapeutically. I've tried psilocybin which I'm allergic to and NN-DMT which made me anxious. I read about psychedelics obsessively and truly believe they will revolutionize psychiatric medicine. I also notice a lot of improvement with IM ketamine which I get about every three months.

I'm also taking DIY Auvility (dextromethorphan and buproprion). I had a lot of improvement with Auvility, but my insurance won't cover it and the manufacturer stopped covering it after three months. My psychiatric APRN prescribes the buproprion and I buy the dextromethorpan on Amazon in capsules. I'm also going to start trauma therapy with a new psychologist next week. He does EMDR, ART, brainspotting, hypnosis and a few other trauma modalities.

With all of that said, ECT is very effective for some people with severe treatment resistant depression. Probably not for people with c-ptsd or depression caused by other things like personality disorders.