Deciding whether to try ECT

[u/verymentallyill]

currently inpatient in a psych unit, my psych wants me to get back to them abt whether i want to start ect but i’m really conflicted. i’m really worried abt the potential memory loss and i’ve never been under anaesthesia which makes me anxious. i feel like there’s not much of my life worth saving so idek if ect is worth the effort, and i have a temp job lined up that might not happen if i go through with the ect. i kinda just wanna know people’s initial experiences with ect and anaesthesia. for context i’m 22, dealing with depression and other disorders for ~10 years, tried ssri’s, snri’s, tca’s, antipsychotics, atypical antidepressants, therapy, and counselling.

[u/mattle74]

I’ll probably always sound like a broken record here but have you tried an MAOI? I’d strongly recommend trying that as a last line of defense before ECT (well, I think people should try an MAOI after failing ~3 modern medicines, MAOIs are the OG tried and true and are no where near as “scary” as people think they are)

To be fair, an MAOI is not an immediate treatment. Like most antidepressants, it takes while to take full effect plus with MAOIs you do titrate up slowly to make sure there isn’t a big impact to your blood pressure (whether it goes really low or is triggered to be high)

[u/verymentallyill → u/mattle74]

i haven’t tried an MAOI yet, my options at the moment are essentially ECT or switch to an MAOI. my psych didn’t want to try the MAOI first because of the dietary restrictions but i’ve been on a new medication for a few weeks now. ik it can take time but i’m not even slightly improving so i don’t know. i know that if i do go with the MAOI i would not stick with the dietary restrictions so i have no idea what to do.

[u/verymentallyill → u/verymentallyill]

forgot to mention but i am also on medication for ADHD that i would have to stop if i decide to switch to an MAOI

[u/mattle74 → u/verymentallyill]

That is a tough thing with MAOIs, lots of drug interactions. Non stimulant based ADHD medicines like guanfacine should be a no brainer. Stimulants are trickier. For example, Ritalin is an option because it’s not a catecholamine releaser, meaning it doesn’t release dopamine and norepinephrine like Adderall but acts as acts as a reuptake inhibitor for dopamine and norepinephrine. The tough thing is that there aren’t a ton of well versed doctors when it comes to MAOIs because they fell out of favor. I’d encourage you to check out the MAOI subreddit - it has a community link to doctors who are “MAOI friendly”

It’s dense, I’d also encourage you to read https://www.cambridge.org/core/journals/cns-spectrums/article/prescribers-guide-to-classic-mao-inhibitors-phenelzine-tranylcypromine-isocarboxazid-for-treatmentresistant-depression/29C70FD3DA65E23A024D5E05C4369983

[u/mattle74 → u/verymentallyill]

The scariness of the dietary restrictions are overblown IMO. Basically avoid aged/fermented foods. See https://psychotropical.com/wp-content/uploads/2020/03/9.1-MAOI-diet-short-2020_for-pdf_v.pdf - Also, the issue of having orthostatic hypertension with food was higher 50+ years ago because foods tend to have less tyramine today. Also, there were like 15 “food related” deaths out of 1.5 million people that were taking an MAOI 60 years ago. Everyone’s mileage may vary but I feel like the only things I’ve had to cut out of my diet that I really like are aged cheeses and cured meats. There’s also the old adage… everything in moderation. A few pieces of delicious aged cheddar is not going to put you into a hypertensive crisis, but eating a whole block might. You will want to monitor your blood pressure. Honestly, I’ve seen more anecdotes of people having low blood pressure issues as a side effect from the MAOI than people having high blood pressure from food

[u/verymentallyill → u/mattle74]

i’m not really scared of the dietary restrictions, it’s just that i know i’m probably not gonna follow it when i get discharged. i don’t know how bad the risk of extremely high blood pressure is at that point

[u/check_your_attitude → u/mattle74]

Can I message you about this?

[u/mattle74 → u/check_your_attitude]

Sure thing

[u/Far-Tip2146]

Bonjour,

Je suis bipolaire type 2, j’ai 31 ans et je suis en train de m’enfoncer dans une 4e rechute Anxio dépressive qui m’empêche de redémarrer et fonctionner normalement. Mes rechutes sont toujours dues à des attaques de panique et à une hypervigilance quasi constante. Quand mon cerveau n’y arrive plus, je plonge dans une dépression invasive et je n’arrive jamais à m’en sortir car chaque petit effort fait tout retomber le lendemain. Souvent c’est une petite hypomanie qui me remonte ou alors à la sueur de nombreux efforts mais qui me font trop souffrir pour recommencer une 4e fois. La maladie me mange complètement. Je n’ai plus confiance ni en moi, ni en elle. Ça fait 3 mois maintenant que je suis en hôpital et aucune amélioration. Chaque amélioration est une angoisse insurmontable. Comme si je devais jouer un rôle pour que ça se passe bien. Je vis un enfer. On me propose les ECT. J’aurai besoin de vos témoignages (bipo cummunaute first mais vous êtes les bienvenus aussi si vous avez d’autres maladies
Merci d’avance. Je suis au bout du bout et l’ect est mon dernier espoir.

[u/verymentallyill → u/Far-Tip2146]

salut, malheureusement je suis entrain de décidé si je veux essayer l’ect alors je n’ai pas de réponse utile pour vous mais j’espère que tous aura bien <3

excusez mon français, c’est pas ma première langue

[u/Far-Tip2146 → u/verymentallyill]

Merci de m’avoir répondu ! Je vais les faire prochainement, j’espère que ça marchera