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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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My son has had clinical depression for the past 18 years and

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My son has had clinical depression for the past 18 years and has tried most anti-depressants available today. He has been on Remeron and Valium at maximum permitted doses since 2000. Neither medication has helped with either his depression or severe anxiety. He has recently undergone 3 ECT treatments and has not experienced any improvement and he believes he has regressed, being unable to enjoy things he used to enjoy and an increase in anxiety. His doctor suggested that he needs a total of at least 5 or 6 total ECT treatments but he is fearful that things may get worse. What do you recommend? Should he take the extra treatments and are there cases where ECT can make his depression worse? We await your thoughts and thanks.

Dr. A. Rene :

“Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will spend its whole life believing it is stupid.” – Einstein

Dr. A. Rene :

Has he also tried standard psychotherapy?

Dr. A. Rene :

I am no expert on ECT so I will defer to another expert regarding any risks involved with his symptoms getting worse. I do know it can take several treatments to see any benefits.

Customer: replied 3 years ago.

Still no help, can you recommend someone who can be a little more specific as to ECT. I had hoped you might be more versed on ECT since I believe it is used quite frequently in severe cases of depression. I knew as much about the treatment than you did so your answer was not helpful, sorry. We are running out of time and need some real help, and yes he did try psychotherapy a few years ago with little success. Please respond.

Sorry for wasting your time. Unfortunately I do not have anyone to recommend as ECT is not used frequently in the area I reside. I will remove myself from this question and another professional can respond. Best of luck to you and your son.
Customer: replied 3 years ago.

Thanks for trying, not sure if you have anyone in mind who can solve our little dilemma. ECT is our last hope and we need to talk with someone who has experienced it or a professional who knows what to expect at various stages of procedure.

Hi! I believe I can be of help with this issue.

I can imagine how distressing this situation must be for you. You are clearly a loving and caring parent and seeing your son battling depression for 18 years without success must be very difficult. There are two factors here that would make consideration of ECT as part of the treatment plan worth the time and effort. First, given that medications have not helped over such a long period of time, alternative treatment is called for (though Cymbalta is a good medication to try as well). Second, after extended periods of time, depression will in many cases ease up even without treatment. Rarely does depression stay for 18 years as a severe problem unless there are physiological aspects to the disorder. So, ECT is often recommended at this stage.

ECT is an accepted and approved treatment for depressive symptoms. And it has helped many people. Can it sometimes exacerbate symptoms? Very rarely. But of course, as with almost any treatment, there are some cases of atypical reactions. There are side effects of ECT that can occur more commonly, however. How often they occur is a matter of debate.

The primary complaint is memory loss. This is what I hear of the most in terms of complaints. But like all psychologists, I can't tell you what percentage of patients who have this problem have it in a severity that is disturbing to their daily functioning. Physicians who administer ECT can't say either, because there are no definitive studies.

But it is something you have to consider and discuss with your doctor before agreeing to the treatment. Here are both the Mayo Clinic's entry and Harvard Medical School's. They are both pretty fair though they tend to downplay side effects (I mention this because I know you are concerned):

There are two types of ECT, unilateral and bilateral. Bilateral has more side effects associated with it. Different doctors have their opinions about the efficacy of each. So discuss this also with your doctor. Here is the page on it:

I think it is a matter of your own benefit vs. risk calculation. At this point, the benefit may be greater than the risk for you and so it is very worth your pursuing this to get informed and make a decision.

Dr. Rene's point about pursuing psychotherapy is also valid. If your son has not had therapy in all these years, then it might be an important part of the treatment plan to begin whether you choose to go with ECT or not. Therapy can help with tools and skills (CBT therapies). It can also help in working through life problems that have been in the background (psychodynamic therapies).

Okay, I wish you the very best!

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Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5220
Experience: Dr. Mark is a PhD in psychology in private practice
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