Electro Convulsive Therapy for depression?

[Saira128]

                   I had an appointment with my psychiatrist on Sunday, and as I have not shown any positive response to the various anti-depressants she has tried till date, she has recommended Electro Convulsive Therapy for me.
                    She seemed a bit disappointmented, because of the lack of improvement in my mood. She also talked with my parents, and they agree that I should take the treatment.
                    According to my psychiatrist, ECT shows considerable improvement in patients of depression.
                 I personally am a bit sceptical about this treatment. Mostly, this is due to portrayal of shock therapy as something bad, or cruel in television and media.
              ECT is given under general anaesthesia, and shows rapid improvement in the mood. It requires alternate day sessions for a period of 4 weeks. Mostly, patients start seeing improvement in the first week itself.
             I wish to get better, and this is a last chance for me.
           I hope I can fight my depression and start focussing on my gender issues.
         What do all of you beautiful people think?

[AnonyMs]

If you're depressed because you're trans then the only thing that's going to help long term is addressing that. HRT and transition probably. I can't imagine ECT is going to help much or we'd all be doing it, and there's probably risks associated with it.

I've refused anti-depressants from my psych because of that - I'd rather fix my real problems than spend years on medication and not really living properly.

[KristinaM]

What they said ^

Have they at least identified the root cause(s) of your depression yet? Try treating the disease and not just the symptoms.

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[Elis]

I live in the UK and I have never heard electro convulsive therapy being used still; either private or on the NHS; which makes me extremely skeptical about the 'research'. Depression is caused by your brain not having enough serotonin so I don't get how being shocked would increase the hormone production.

I agree with AnonyMs that you need to treat thd cause of your depression which is most likely GD if you're not already living and being treated as female. For me even after transitioning I was on antidepressants due to realising I had other issues apart from being trans which helped me to cope a lot better. I think antidepressants may be good for you now just to help you cope.

Btw; I was on SSRI type pills which caused me to feel zombified; have you tried pills which aren't part of this group?

[KathyLauren]

Electroconvulsive therapy is not something that I would allow them to do on me for any reason.  According to what I read, it is used only after all other treatments have failed, and it has a high relapse rate.

I am not a doctor or a psychologist.  What I know about you comes only from your posts.  But, from what you have written, it sounds to me like the depression is a result of untreated gender dysphoria.  Since they haven't tried treating that, ECT is premature.

[Saira128]

My doctor says, she cannot start with the gender issues till I am mentally stable, according to the guidelines.
   

[Saira128]

But how will I be mentally stable, till I start doing something about my gender issues

[Saira128]

 Its a catch-22

[AnonyMs]

Find another doctor.

[Sarah.VanDistel]

Dear Saira,

As you know, I'm not a Psychiatrist, but ECT is apparently still used, albeit no so frequently nowadays. Actually, there has been a renewed interest in this modality of treatment recently, including in the UK (see https://www.theguardian.com/society/2017/apr/17/electroconvulsive-therapy-on-rise-england-ect-nhs). There is a nice Q&A on the site of the Royal College of Psychiatrists: http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/electroconvulsivetherapy,ect.aspx. What's a little confusing is the fact that despite being quite effective, no one knows how it works... There are plenty of theories, but no certainties. But again, nobody knows why I am transexual, but that doesn't make it less real.

But I agree with the others... You say that you've tried several medications. But did the psychiatrist try to address your transgender feelings? Because if they are the cause of your depression, with ECT you'll be just treating a symptom, when there is a proven treatment for the possible root cause (gender dysphoria): transition.

I was on several antidepressants (amitryptilline, fluoxetine, sertraline, venlafaxine) and mood stabilizers (sodium valproate, topiramate) successively for several years, with only temporary and partial responses. About a year ago, I aknowledged that my root problem was my gender dysphoria, so I just quit all my medication (gradually) and began taking only St John's wort... A few months ago, I started HRT. And after a few days I magically began to see the brighter side of life. No mood swings. No blues. Just a constant state of zen punctuated by moments of extreme happiness. No longer taking anything else, except for multivitamins, calcium and fish oil.

Take-home message: ECT might be a valid option, but I wouldn't try it before addressing the gender dysphoria (perhaps including a trial of low-dose estrogen?)

Hugs, Sarah

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[Elis]

Find another doctor or show this one the WPATH guidelines.

[Saira128]

Dear Saira,

As you know, I'm not a Psychiatrist, but ECT is apparently still used, albeit no so frequently nowadays. Actually, there has been a renewed interest in this modality of treatment recently, including in the UK (see https://www.theguardian.com/society/2017/apr/17/electroconvulsive-therapy-on-rise-england-ect-nhs). There is a nice Q&A on the site of the Royal College of Psychiatrists: http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/electroconvulsivetherapy,ect.aspx. What's a little confusing is the fact that despite being quite effective, no one knows how it works... There are plenty of theories, but no certainties. But again, nobody knows why I am transexual, but that doesn't make it less real.

But I agree with the others... You say that you've tried several medications. But did the psychiatrist try to address your transgender feelings? Because if they are the cause of your depression, with ECT you'll be just treating a symptom, when there is a proven treatment for the possible root cause (gender dysphoria): transition.

I was on several antidepressants (amitryptilline, fluoxetine, sertraline, venlafaxine) and mood stabilizers (sodium valproate, topiramate) successively for several years, with only temporary and partial responses. About a year ago, I aknowledged that my root problem was my gender dysphoria, so I just quit all my medication (gradually) and began taking only St John's wort... A few months ago, I started HRT. And after a few days I magically began to see the brighter side of life. No mood swings. No blues. Just a constant state of zen punctuated by moments of extreme happiness. No longer taking anything else, except for multivitamins, calcium and fish oil.

Take-home message: ECT might be a valid option, but I wouldn't try it before addressing the gender dysphoria (perhaps including a trial of low-dose estrogen?)

Hugs, Sarah

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She wants me stable mentally, before we start talking about my gender dysphoria.

[Saira128]

Find another doctor or show this one the WPATH guidelines.

Its even in the WPATH guidelines.

[AnonyMs]

You can find doctors with all sorts of ideas, good ones bad ones, everything. Find another one, or at least get a second opinion.

Are you living somewhere that really backwards on trans issues?

[Dena]

Electro Convulsive therapy was still in use when I transitioned and seems to work by doing a reset on the brain. If the effects are long term is very debatable and because of the danger of the procedure, it would be the absolute last thing I would want to try.

I would explain to the doctor that on this site we have seen dramatic improvements in as little as 2-4 weeks after starting HRT. There are no visible changes in 4 weeks so if HRT doesn't work, it can be discontinued and something else tried. It's low cost as you only need a blocker and low dose hormone with the primary cost being the Endo visit.

If you doctor continues to ignore your gender dysphoria, you should seek out another doctor because this one is not knowledgable in the areas of treatment you require. I am sorry to see that it's so difficult for you to receive the treatment you need and I hope you are able to convince your doctor to treat the Gender Dysphoria which  is known to result in extreme depression in some people. I was one of them who had depression much like yours and never had medication other than HRT. I am completely free of the depression I once had and I hope you see the same results.

[Gertrude]

Seems like just a step above drilling holes in the head to let the evil spirits out. I would think it's heavy handed and imprecise at best. I'd like to know what the downsides are. I mean, sure, it fixes mood, but what are the consequences?


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[Saira128]

Seems like just a step above drilling holes in the head to let the evil spirits out. I would think it's heavy handed and imprecise at best. I'd like to know what the downsides are. I mean, sure, it fixes mood, but what are the consequences?


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I read that it can cause temporary memory loss. Death in 4 out of 10000 cases I read.

[Dena]

It can stop the heart from beating and the heart needs to be shocked to restart it. It's bad enough to deal with a heart attack or to stop it when required by surgery but to stop it when there may be a far simpler solution is like visiting a witch doctor.

[zirconia]

Hi, Saira

For a couple reasons reasons this subject is difficult for me to discuss—so I'll just say what I feel I can.

I have never administered, received or directly observed electroconvulsive therapy, but based on what I've heard I'd try to avoid it if possible. The foremost reason, put simply, is that my teacher (who specialized in brain research before getting a stipend to study counseling under Carl Rogers) does not hold it in high regard.

He still practices counseling, and has for many decades been requested by psychiatric hospitals to take on clients whom they have been unable to help. Generally he can.

While it may be possible that ECT has evolved to become absolutely safe and invariably effective, I tend to trust his opinion on the matter.

[Sarah.VanDistel]

Its even in the WPATH guidelines.

The WPATH guidelines say: "The presence of co-existing mental health concerns does not necessarily preclude possible changes in gender role or access to feminizing/masculinizing hormones or surgery; rather, these concerns need to be optimally managed prior to or concurrent with treatment of gender dysphoria."

Notice "prior to or concurrent with..." Both problems could be addressed at the same time. I am under the impression that you psychiatrist is trying to avoid discussing the gender dysphoria. Could it be that she has little experience with GD and feels intimidated? Could it be that your parents are making some pressure in order to direct the treatment towards a socially more acceptable problem, such as a depression? Humm... I agree with the others: I would seek another Psychiatrist for sure.

Hugs, Sarah

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