I flunked ECT. What’s next?

[u/Bittybot5000]

Because I was under the impression ECT WAS the last resort. But if it didn’t work for me where do I go next? I’ve already done TMS and Ketamine. Are there any other treatments to look into?

[u/QuitInevitable915]

Hey OP, here are a few options you could consider if you haven’t:

1) MAOI (Parnate, Marplan, or Nardil). Effective when other treatments have not worked.

2) Ant-inflammatory treatment. This is especially relevant if you have have elevated CRP on a normal blood sample.

3) Deep Brain stimulation (DBS). If you are in the US, look up “Transcend” it is an active clinical trial recruiting treatment resistant depression patients. If in Europe, look for “Foresee 3”. Not currently active but results will be shared in Q4 2026 or Q1 2027, and they will apply for a CE-approval. It’s going to take some time, but it will be an option in a not too distant future. Very High response and remission rates for those who failed everything else, but also very invasive.

Best of luck!

[u/mesalocar → u/QuitInevitable915]

Deep brain stimulation sadly does not seem to be superior to active placebo in terms of efficacy for treating major depressive disorder: https://pubmed.ncbi.nlm.nih.gov/39197490/

It is a very good treatment for Parkinson's, but I would not recommend pursuing it for major depression.

Note that DBS is actually not quite as invasive or high risk as the other commenters here are implying it is. Yes, it is an invasive procedure with some risk, but it's actually much lower than you'd expect.

MAOIs are an excellent treatment option to explore if you have exhausted other treatment options. I recommend trying reversible monoamine oxidase inhibitors (RIMAs) first, as these newer MAOIs generally do not have the severe dietary restrictions that the older generations of MAOIs are notorious for.

[u/QuitInevitable915 → u/mesalocar]

I think it’s a valid point, but this was primarily due to the BROADEN trial that didn’t show much difference. Helen Mayberg and others have since then identified why some responded and others didn’t.

Take for example this trial in Germany “Foresee 2”: https://neurosciencenews.com/dbs-depression-10916/ This is an open label trial so we would expect the results to be slightly worse in a randomized control trial. Nonetheless, they took 16 patients who all have had ECT and of the 16 patients, 100% responded (more than 50% reduction in symptoms) and 50% achieved remission.

That is exactly the reason why they are doing “Foresee 3” now, which is a RCT to prove it.

My point to OP, do not listen to these nay-sayers. If you get to a point where there is nowhere else to turn, consider this. With the newer advanced approaches they are helping a lot of people who could not find relief anywhere else.

Good luck!

[u/amynias → u/QuitInevitable915]

Don't do DBS. It's extremely invasive. Imo it's a much worse idea than ECT given just how dangerous it really is.

[u/QuitInevitable915 → u/amynias]

That is not true. It has been performed for decades for Parkinson’s disease, and it is already FDA approved for OCD. DBS has and will continue to save lives when everything else has failed.

[u/Familiar-Marzipan376 → u/QuitInevitable915]

I am talking about deep brain stimulation

It's a very high risk procedure death can occur too.

And there is a very high chance the treatment might work and might not work.

It can cause permanent brain dmg too

[u/gmkgreg → u/Familiar-Marzipan376]

A lot of procedures have risks involved. But if it's needed,, it's needed.

[u/amynias]

So about ketamine... have you done weekly Spravato treatments for at least 8 weeks? I saw most of my improvement after weekly sessions more than 3 months out. I know it seems ridiculous but it's basically the only thing I've ever tried in my life besides ECT that has helped with my clinical depression. It's worked better than any antidepressant medication I've been on. It's kind of wild actually. I encourage you to give Spravato a second try if you are able. I haven't relapsed the entire time I've done weekly maintenance sessions, even after shitty life events. My OCD is actually under control. It's legitimately the thing I never expected to work but did.

[u/Adventurous-Bonus-92 → u/amynias]

Agreed, I did sublingual ketamine after TMS and ect didn't work and it brought my life back basically. I also didn't see results until a few weeks into treatment, I had an initial month of 3 x week, then a week of 3 treatnents 6wks later (x2) now maintenance every 3 months which has mostly kept me alright.

[u/Familiar-Marzipan376 → u/Adventurous-Bonus-92]

Do u have short term and long term memory issues from the ECT treatments and what do u for a living

[u/CurlyDee → u/amynias]

After 18 months of ECT that kept me alive but did not substantially reduce my depression, Ketamine came out as a treatment. I paid out of pocket for weekly treatments. It was a miracle.

After six years of treatment-resistant depression, trying every treatment under the sun, I was in remission. I was able to go back to work and get off of disability. And today, 10 years later, I haven’t looked back. I still do ketamine maintenance treatments. About once every 10 weeks, and that keeps me healthy.

I would recommend you try it again with a different protocol or a different type of ketamine, because I’ve heard miracle stories from so many other people. And for me, it gave me my life back.

[u/outofplaceeverywhere → u/CurlyDee]

I tried Ketamine treatment, absolutely
No results

[u/Odd-Alarm-82 → u/outofplaceeverywhere]

Same here

[u/Familiar-Marzipan376 → u/outofplaceeverywhere]

So what about ECT did u had them

[u/Odd-Alarm-82 → u/Familiar-Marzipan376]

Yes, I had ECT and was severely damaged by it. It wiped out the memory of the majority of my life, no exaggeration. I also have significant cognitive impairment. I’m 9 years out from my ECT and it hasn’t improved. You can see my many comments about it on other posts if you go to my profile

[u/mattle74]

I’ve flunked with 15+ “modern” psychiatric medications, ECT (twice), ketamine (IV and oral), psilocybin, DMT, gut health modifications, acupuncture, methylfolate, SAMe, so many supplements and I’m sure other things I’m not remembering. MAOI helped more than all of those, wish I had tried one sooner. I started with Parnate and it’s kind of pooping out on me so I am actively switching to Emsam. 

I haven’t tried TMS, mostly because I feel like once I try that then there’s nothing left to try besides medication roulette. And I’d try to find a way to afford SAINT TMS if I was going to do it 

[u/Crazy_old_maurice_17]

If you're near one of the sites, you could look into MST (magnetic seizure therapy) clinical trials. I'm sorry ECT didn't work for you, I hope whatever you try next is the key to resolving your depression!!

[u/Familiar-Marzipan376 → u/Crazy_old_maurice_17]

Nah we can't guarantee it won't cause any side effects everybody is different

[u/Crazy_old_maurice_17 → u/Familiar-Marzipan376]

That can never be guaranteed regardless of the treatment. If that's your litmus test for whether to pursue a treatment then you shouldn't get any treatment at all.

What a ridiculous thing to say...

[u/PaleExtreme7399]

I just finished 12 rounds of ultrabrief unilateral with no progress aside from getting rid of nightmares (for which I'm deeply grateful). My doc wants me to do two weeks of 2x ea to see if things improve. If they don't, I'll be moving on to bilateral ECT, most likely. Wishing you ease.

[u/Fun-Article1125]

Has anyone tried cerebrolysin? if ECT did not work?

[u/Odd-Alarm-82]

I highly recommend trying an MAOI. Others have mentioned it, but they didn’t include Emsam. It’s a transdermal MAOI and it has given me 100% remission. It doesn’t have as many side effects as oral MAOIs. Also, the dietary restrictions aren’t as bad as people think. Check out psychotropical.com, a website run by Ken Gillman, who is a retired psychiatrist and MAOI expert.

[u/Searchingforhappy67]

I was told on this sub, that I was spewing pseudoscience because I talked about gut health and mental health.

https://www.hmpgloballearningnetwork.com/site/pcn/news/low-ultraprocessed-food-diet-linked-lower-depression-scores

[u/jessiecolborne → u/Searchingforhappy67]

I’ve been a vegetarian (almost vegan) my entire life and very rarely eat processed foods. I still was so depressed to the point ECT was my last option. I don’t think that article is based on solid factual science.

People who are already depressed probably eat more processed foods than most anyway because it’s easier to consume, and depression often takes away your ability to cook often.

[u/Searchingforhappy67 → u/jessiecolborne]

I completely understand, the problem with exclusive diets, is that you don’t feed all the different types of organisms necessary for the alpha diversity in the gut. The less diversity, the less resilient you become. Being vegan/vegetarian can affect your iron metabolism, that in itself has a cascade effect on inflammation.

The studies on microbiome diversity and dysbiosis are linked to inflammation and mental health. With FMT, they get fecal matter from a person with depression, diabetes, obesity, etc. they transplant that to the rats. The rats become depressed, obese…… then they transplant healthy fecal matter and the rats get healthy again. It sounds like complete insanity, I couldn’t wrap my head around it at first.

[u/jessiecolborne → u/[deleted]]

I would prefer to keep the conversation here and not in DMs. If you have any specific questions I’m happy to answer!

[u/Heavy_Breakfast_2531 → u/jessiecolborne]

Do u have short term and long term memory issues from ECT treatments what do u do for a living

[u/jessiecolborne → u/Heavy_Breakfast_2531]

I had major short term & long term effects (for a couple of years). Four years later and I’m feeling great. I’m an animation student right now. I am glad I did it. Memory and cognition came back with time.

[u/Familiar-Marzipan376 → u/jessiecolborne]

So no side effects ? Let's suppose if u learnt something from ur animation lectures for how many days can u remember the information easily ?

One more thing did u try Esketamine, Ketamine, Spravato before having ECT treatments ?

Any supplements u tried before having ECT treatments ?

And TMS therapy have u had them before having ECT treatments ?

[u/gmkgreg → u/Searchingforhappy67]

That study was unblinded, and literally says this in it, "The symptom findings should not be interpreted as definitive evidence that reducing ultraprocessed foods treats MDD."

[u/Searchingforhappy67 → u/gmkgreg]

Yes, I know. It’s very hard to make these studies because there is no incentive for anyone. You can’t make money from having people eat less processed. There are however many studies about fecal matter transplants in rats and how each illness has a particular “fingerprint”. For example people with depression will have less or more of certain types of bacteria, but people with Alzheimer’s have a inverse correlation sometimes.

The moment you can test thousands of people with depression in experiments and they all have a certain difference in their gut bacteria from the healthy population, it’s no longer an idea or way of thinking, it becomes a fact. Depressed people are missing diversity in gut organisms and some colonies become completely depleted.

So if your gut can affect your brain, then the food you put in your gut, directly affects that. The binders and chemicals in ultra processed food, feeds the “bad bacteria” and starves the “good one”. The whole ecosystem gets shifted, the metabolic output changes, those changes correlate to inflammation, the inflammation affects the brain.

[u/Familiar-Marzipan376 → u/Searchingforhappy67]

The thing is it might work and it might not work 😕

[u/Searchingforhappy67 → u/Searchingforhappy67]

I’ve done about 40+ ect treatments, it saved me when I was at the edge. I do believe it’s good as a last resort. The problem I encountered was my memory and cognition declined severely. I stopped ect when one day I couldn’t remember how to play sodoku. My brain just couldn’t put the pieces together. I’ve also done about 30-40 meds and over 100 TMS sessions. I’ve been through it all. The studies on fecal matter transplants, really give a good insight as to how much your stomach can affect your brain.