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ECT for depression

Aug 26, 2004

I have been diagnosed Poz for four years and have had depression and fatigue for all of this time My Doc has prescribed many antidepressant medications and the upshot is none of them work. I asked him about Electro Convulsive Therapy and although the thought scares me I am interested in finding out more about it. Ihave researched it online and feelmore comfortable now knowing that the procedcure is performed under general anaesthetic. My Doc says it is unlikely a patient would qualify for ECT unless they were catatonic (I'm not). He did, however say he would talk further with me about it at our next meeting. What are your thoughts on opting for ECT when all else has failed. I have been tested regularly for all other causes for fatigue as related to HIV infection and nothing has surfaced as being the primary cause. My Doc and Psychiatrist are competely sure I am suffering from chronic depression. Thanks. I look forward to your reply

Depressed in San Francisco

Response from Dr. Horwath

I would advise that you first get a consult from an expert in the pharmacologic treatment of depression. You may have tried a number of treatments, but some very effective options may have been overlooked. For example, MAO inhibitors are extremely effective antidepressants, but are underused in this country because of the potential side effects, which can be avoided with appropriate dietary precautions.

ECT (electro-convulsive therapy) is extremely effective, and with the modern techniques (general anesthesia, muscle relaxants, unilateral and low dose ECT) it is much safer and associated with fewer adverse effects. The main shortcoming it has for chronic depression is that, although it is quite effective, the response is short term. It needs to be followed up with maintenance medication, so you would need to work with an expert to find an effective antidepressant maintenance regimen.

Since you are in San Francisco, you may also want to look into some new treatments that are now available, such as Transcranial Magnetic Stimulation (TMS) and Vagal Nerve Stimulation (VNS). Both of these techniques are being actively developed. You may be able to join a clinical trial at a local medical school (UCSF or Stanford). VNS is particularly suited to the treatment of chronic depression. Good luck.

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