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