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About jeff70

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    Georgia, United States
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    Philosophy, ecology, parenting, computing

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  1. Thanks for that. Long time, no talk to! That lack of firsthand experience is kind of what prompted me to post. I knew I couldn't be the only one in that boat. I will keep updating as I process and organize my experiences. For now: There are options in the way that the treatment is performed that can reduce the cognitive risks. My VA medical center does the following, based on the current state of research: 1. Treatments two days per week, rather than three. 2. Administering current in a higher dose to one hemisphere, rather than bilaterally. (This can be slightly less effective as a tradeoff for the lower risk. I opted to switch to bilateral after we learned that I was tolerating the treatment well, in order to maximize the possibility of responding.)
  2. Hello, After 10 years of medication failures, I finally got a consult to the Treatment-Resistant Depression clinic at Emory University last year. The specialist psychiatrists there evaluated me for a full range of non-drug options and decided that ECT was the option most likely to help me. Add in a couple of months of confusion about whether the treatment would be done at Emory or the Atlanta VA Medical Center, then a few more months of delay due to a short-staffed anesthesia department at the VA, and I have finally started. I finished the fourth treatment today. I don't feel any improvement yet, and my attending pdoc says that it's still too soon to expect much, but I feel good that it's underway. I feel as though I'm trying something that has at least a chance of helping. I am tolerating it very well. I have memory and cognitive problems from the MDD itself, and there is no sign that they have worsened since starting ECT. I think a lot of people still have fears and stigma related to ECT, possibly related to its history. Modern ECT is a long way from 1950s shock treatment. It is done under general anesthesia. If you DO happen to have some side effects (headache or memory problems), they are generally confined to the period of weeks that you're going through the treatment. You may not form memories of things that happen during that period, but it is very rare (per my doctors) to "lose" existing memories. I find that the effects of going under general anesthesia twice a week (nothing to eat or drink after midnight, etc.) are more significant than the effects of the ECT itself. If your psychiatrist thinks it might be appropriate for you, I encourage you to try to overcome the fear of the treatment and to really evaluate it. It might be a good time to get a second opinion. In my case, I was seen by TRD specialists, and then a psychiatrist who specializes in ECT temporarily took over my case from my normal pdoc (who still follows my med needs) for the duration of the treatment. There is nothing to fear. It's safe, and if you do have side effects or find part of the experience unpleasant, the treatment can probably be modified to address the problems while remaining effective. Best of luck!
  3. Hello, I take 30 mg vortioxetine daily. My severe MDD is treatment-resistant in the extreme, and it doesn't do anything for me. I also don't experience any side effects from it, but I'm unusual in that respect, too: aside from withdrawal symptoms for things like Effexor, I don't really experience the "normal" side effects from psych meds. I'm not aware of research supporting CBD oil for major depression, but I don't keep up with the cutting edge in that area since the Veterans Administration isn't going to prescribe it in the foreseeable future.
  4. When I'm with my children or out in public, including with my therapist, I instinctively try to bury all outward signs of my depression. I can only do it for relatively short periods because it consumes a huge amount of energy and leaves me feeling worse than before. If I feel that I can't do it, I avoid contact with others (my kids know about my depression, of course, but I still try to shield them from it). I can't seem to turn off the "happy face", which makes me wonder if my therapist is getting a skewed impression of how I'm doing. Does anyone else experience this?
  5. jeff70

    Rough day

    I can't shake the suicidal ideation today. It's hard to think of anything else. I haven't called the Veterans Crisis Line because I don't believe they can do anything right now except to initiate hospitalization, and I don't think that would be constructive. I'm going to try sleeping for a while.
  6. Periodically, my clinicians have to complete standard assessments about my degree of suicide risk, whether I have had this vaccine or that lab work, etc.. Today was suicide risk evaluation day with my therapist. To no one's surprise, I'm considered an elevated/high risk. We had to go through my access to potential weapons and my degree of planning. Apparently, the VA has added a new feature since my last evaluation: I now have to meet with a member of my MH team weekly. Yay. Spending an hour with my pdoc or my therapist has a kind of placebo effect that lasts for an hour or so after the session. I guess I feel hopeful that something might happen to give me some relief, despite a ton of past experience to the contrary. Regardless, placebo relief does actually feel better, so I'll take it. It makes the 100-mile round trip worthwhile. My therapist and I are going to take this opportunity to do a round of CBT, so maybe something of lasting utility will come of this. In the worst case, I'll only have to white-knuckle battle the suicidal impulses for a week at a time between sessions, rather than the current three or four weeks.
  7. Unlikely. I wouldn't give the other me a chance to get to know this me...or did I get my selves mixed up? Anyway, that's a shame, because if you strip away the layers of mental illness, there's an interesting and funny person in there, or at least there used to be.
  8. @babypeanut I'm sorry for your loss. I can't imagine what you must be going through.
  9. 'Tis himself! Of course I remember you. How have you been? Just by chance, I decided to copy a forum post to my blog so that I could more easily track how I'm doing over time. I didn't realize just how long it had been since using my blog. I always have the intention of returning when I am doing relatively well and supporting others who are having a rough time, but it never seems to work out that way.
  10. Originally posted in forums on 2017-04-11, abridged I'm heading into week two of a deep funk. I had a period of relief this afternoon during my therapist appointment, but the storm clouds had returned by the time I reached my car. I take lithium to combat suicidal ideation. While it used to be extremely effective, it no longer does anything for me. Now, when I look at the pill bottle, I see toxic Skittles. Has anyone used clozapine or other agents to treat suicidal ideation? My pdoc is reluctant to prescribe clozapine, saying that it is used primarily for SI in schizophrenics. At this point, any risk would be justified. My suicidal impulses cause "pressure" to build up. Normally, it keeps building until I give in and go to the emergency room. While I've never tried it, I have this sense that nonlethal self-harm might also relieve the pressure. It's hard to see a future that doesn't involve my hospitalization in the next few days. In the past, they've always put me in a room by myself. I'm afraid that this time I might have to share a room. Having no place where I can go and exclude others is very frightening. The only thing that hospitalization can offer me is protection from myself. It's too soon for me to start MAOIs, and I've tried and failed on all the other meds in the VA's formulary, so I'm not going to be coming home with a shiny new med regimen and the accompanying hope. I've been evaluated for ECT and was told I'm not a good candidate, though my having worsened may change the equation. The VA is rolling out rTMS, but I'm not sure if my hospital is among those that have gotten the equipment. My pdoc is trying to get me into a non-VA treatment-resistant depression clinic at a nearby university hospital. Maybe there I could get access to ketamine or, in the worst case, DBS. I just need to live long enough. 2017-04-15 I've managed to avoid trying self-injury as a means of relieving the destructive urges. (If you're reading this and you have the password to the SI forum, please PM me with same.) Sleep seems to be the only reliable respite from the impulses, so I increased my Seroquel from 50 mg/night to 400 mg. That provides me with 18-20 hours of uninterrupted sleep. I'm sure my pdoc will be thrilled. My wife isn't. 2017-04-16 Well, immersing myself in music has failed, because the benefit is short-lived. Immersing myself in almost continuous sleep has failed, because even I must wake up sooner or later. As with music, the effect just doesn't last long at all. I have an appointment with my doctor tomorrow (Monday) afternoon. What are the odds that he has some magic pill that he has kept secret all these years, waiting for just this moment? 2017-04-17 I'm getting ready for a pdoc appointment in a couple of hours. It doesn't really take me a couple of hours to get ready and get there (yay minimal self-care), but going through the motions makes me feel as though I'm working toward something positive. I'm not looking forward to telling him that I've been self-medicating with Seroquel in order to sleep through the suicidal impulses. My thinking on the subject of intent has been getting more nuanced than it has been, when I could honestly say I had none. Now taking odds on my leaving his office under my own power. Just to stay positive, I'm not taking a toothbrush. --- The doctor visit went better than expected. He doesn't want to put me on a MAOI until after I've been seen by the TRD clinic, so we (and by "we", I mean "I") are trying another TCA: Norpramin. He was surprisingly laid-back about my taking 400 mg of Seroquel (instead of the 50 mg he prescribed) for sleep. I was afraid I had damaged his trust and our working relationship. Instead, he wrote me a scrip for 400 mg tablets so that I could continue sleeping through the worst of it. My wife isn't happy about my sleeping-twenty-hours-a-day strategy, but there are a number of worse alternatives. It seems that just meeting with my doctor or therapist has a placebo effect. When I'm there, I feel as though I'm doing something worthy of hope, regardless of how many times doing the same thing has failed. Normally, the window of lifted mood is shorter than my walk back to my car, but today it seems to be lasting longer. Good problem to have.
  11. Walking through the forest. Nature alone recharges my batteries.
  12. Cymbalta helped a lot with my osteoarthritis pain, but it numbed the sensation in my nether regions as well. Neither Viagra nor Cialis helped that particular problem for me.
  13. I have the opposite problem. I don't respond to meds, not even typical side effects. My doctor believes I may be an ultrarapid metabolizer. The relevant tests, GeneSight and one by a company called GeneCept, are not covered by the VA.
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