Resolved question:
I am a 35 yo female with a history of anorexia and bulimia and self harm (all resolved), but more recently of bipolar type 1. I had ECT in the past due to refractory depression, in which I had 3 serious suicide attempts, including a nearly successful hanging. I had 6 sessions of unilateral ECT, until, on the last session, I completely lost all of my memory for a few days. They cancelled all future sessions. It had been working beautifully. I eventually achieved euthymia around November and have been completely fine until recently. The depression is coming back. My psychiatrist bumped up my Lamictal and my lithium, but nothing is helping. The hole is just getting deeper. I am on 40mg Celexa, 300 mg Lamictal, 2,100 mg lithium, 180 mg Geodon, 60 mg propranolol, and 30 mg Adderall XR, with 200 mg trazodone prn sleep. I do not want to become chronically suicidal again because with each attempt, my technique has improved. I do not wish to leave my husband and children. My psychiatrist is a 3rd year resident without much experience. When I asked her if ECT could be an option again for me, she had no answer and when I asked about vagus nerve stimulation, she said she had no experience with it. This can't be the best it gets and I refuse to spend my life institutionalized. Could ECT be tried again or is VNS a good next option?
Submitted:
4 Days
Category:
Psychiatrist
Hello,
Thanks for posting your query at DoctorSpring.com
I have gone through your question in detail and I can understand what you are going through.
I totally agree with you that bipolar depression is a difficult illness to live with and at the same time its a difficult illness to treat. The medicines that you are on are good and should have controlled your bipolar depression but unfortunately there is a relapse. There are some other medicines which could have been tried like Divalproex sodium, quetiapine, oxcarbamazepine. These options can be tried until no suicidal thoughts are there. If you get suicidal thoughts then there is no other option but going for ECT. You need not bother about the memory disturbances with the ECT. They are temporary and will not last for more than 6 weeks. At-least your suicidal attempts can be prevented by this. VNS has been successful in treating unipolar depression but not so much in severe bipolar depression. Further its not indicated when there re suicidal thoughts. Do discuss the above mentioned three options with your psychiatrist and get them prescribed. Otherwise ECT would still be the best bet for you.
Hope this helps,
In case if you have any further query, do let me know.
Kind regards
Dr. Srikanth Reddy