Drs suggesting ECT for Dad....what to consider

[Feelingverysleepy]

DF doesn't seem to be responding to meds, he's been an inpatient for 2 weeks and seems to be getting worse - started as anxiety & depression, now there are constant delusional thoughts and 'my dad' just not 'there' anymore.
Dr said ECT might be the next option - he says it can be very effective. I have concerns, mainly about the potential memory loss side effects I've read about.
Would I be best to get a second opinion or some advocacy / support to discuss this?
How do I begin to weigh it up - or is the decision nothing to do with me? I can't see that the Dr would be able to get any meaningful consent from DF.

They don't necessarily need consent if he is detained under the mental health act - you don't mention if he is or not? It depends if he is able to understand about the treatment. If he is under MHA his consultant would have to get a second opinion from another doctor to go ahead with ECT. They should also discuss with his next of kin or 'nearest relative'. It's all quite complicated.

Have a look at
www.mind.org.uk/information-support/legal-rights/consent-to-treatment/mental-health-act/#.VSmO_VJ4WnM

www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/ect.aspx?theme=mobile

Memory loss is a risk. Having worked in the past with people who have had ECT I was amazed at the improvements in mental state that I saw. I did see some memory impairment especially in older people but it improved slightly over time.

Definitely discuss your dads specific case with his consultant.

And I hope your dad improves soon. It sounds very stressful

anti depressants work in 50-60% of people, ECT in 70-80%. It is particularly effective in severe depression with delusional ideas. It often works more quickly and dramatically than Medication. The initial memory problems usually settle down but some people find they lose some important memories from their past-such as family events -on a more permanent basis. Loof up the scottish electroconvulsive audit network or SEAN for some helpful info (( www.sean.org.uk/))

sorry rubbish at doing links

How old is your dad? Have they ruled out organic causes such as dementia? Ect is a terrible idea if there is something like that going on. If he's been an inpatient for 2 weeks I can imagine he's had a particularly thorough assessment, and they're also notlleaving an awful lot of time for the medication to take effect. How long has hebbeen on his current dose?

Can't imagine, not can! A thorough assessment would include waiting and observing changes... How can they do thatewithin 2 weeks of an acute admission?

I have had twelve sessions of ECT about nineteen years ago now. My memory loss spans about a fortnight I'm only sure it's a fortnight because it happened around the Dunblane massacre and I remember a birthday before and after but not the Dunblane tragedy being reported. To be honest I was so ill I doubt I would have remembered anything anyway.
For me it didn't work but an elderly lady who was having treatment at the same appeared to have a miraculous recovery and really was transformed.
I wouldn't refuse ECT again if offered (had no depression since I recovered from puerpural psychosis) it was quick and painless had a slight headache a couple of times but that's all.
I can't advise either way for your Dad but thought you might like to hear from someone with experience.

Thanks so much.
He's only 66, and i got it wrong in the OP - he has actually only been on the ward 8 days, before that he was at home with crisis team input for a week or so. So he's only been on any type of meds for 2 weeks - and within that time the Drs seem to have changed meds a bit. Sounds therefore like they've not given time for a course of meds to work??
I got the impression that ECT was being partly considered because he wasn't eating or taking oral meds. Eating is ok, but meds seem like a problem - he thinks its all 'poison'. It can take them half an hour to get him to take a tablet, and sometimes he just then holds it in his mouth and lets it dribble out.
I'd love to see a 'dramatic' improvement as described by some, but it just seems a bit soon to be talking about 'last resort' options as it was described to me?

Ps - thanks insanityscatching - it's v kind of you to share your experience. Really appreciated.

Well my ECT happened after being given various combinations of anti depressants, anti psychotics, tranquilisers, and medications for side effects and lithium for about nine months before I started ECT. The psych said at the time, I'm only five foot tall, that I was taking enough to floor a horse and yet I wasn't at all sedated. I took many of the medications at above maximum recommended dose and in fact the particular combination that worked was an above recommended maximum dosage.
I had ECT as an out patient and was admitted when it didn't work. For me I think the rest and the peace and quiet was possibly the key to getting better alongside tweaking the medications.
If it reassures you I have been absolutely fine now for years and years and was weaned of the medications and had no problems since even after having another baby.

I think trying ECT at this stage is wrong. Has he been screened for physical illness like urinary tract infections, stroke?

Screened for urine infections and had lots of blood tests. He mentioned about long term loose stools so is seeing Gastro next week. Stomach xray now showing really compacted bowel - so they're giving enemas. No head CTs or whatever investigations for stroke etc - perhaps I should ask?
I (stupidly) felt guilty for wanting a physical explanation- in the hope that that would be easier to diagnose and treat.

My personal opinion would be yes to CT head and treating constipation first. But if things are that bad then waiting for meds to work or not might not be the best option before proceeding to ECT. I'm not an expert but have worked in this area before, I would say if the consultants say ECT is best then it will be because they have already considered the other options. Definitely needs to be discussed with your dads consultant.

And don't feel guilty about wanting a physical explanation I think it's a normal feeling but mental illness is treatable too just harder to explain and understand.

I think they need to work on the medication first before ECT and OTs likely that they'll try drugs by injection first if he won't take them orally.

ECT a can be really effective, very quickly. I've seen remarkable results in people who have had ECT, so it's worth considering. Any treatment has side effects, taking a look of the pages of patient info that come with any psychiatric medication makes that clear.

It could well be that in your fathers case, ECT a could be the most effective way of getting a quick improvement. You need to speak to the Drs though. They'll have seen many cases like your fathers and will be working off that experience. That's much better than people on the Internet who have their own bias.

I can imagine that this is a very stressful and worrying time for you, but take heart that Mental illness is just as treatable as physical illness, and you'll get your dad back.

I agree that your dads consultant should consider doing a CT head and try to make sure that there is no physical cause for some of your dads symptoms. However there is always a danger in giving advice on a forum like this because it is impossible to know all the medical/psych details that your consultant will know. Your dad may be too unwell to tolerate a CT scan. Its wrong to say that ECT is a last resort. It would depend how unwell he was and how distressed. If someone is very distressed it may not be reasonable to leave them like that for any long period, and if he is not eating or drinking he may become physically unwell . Giving meds by injection is very traumatic esp if the person is already paranoid and antidepressants cant be given by injection. In some cases where someone is very unwell ECT may well be given early. But just as others have pointed out you should make an appointment with the consultant and write down beforehand what you want to ask. Any consultant in this situation should certainly feel that it is part of their job to make sure your concerns are addressed, and should be able to give you written information about ECT. If your dad is unable to give informed consent then treatment wont go ahead without an independant second opinion

Knowing how long it took to get medications that worked and at a dose needed for me then in hindsight I would have gone for ECT earlier if there was a chance it would be effective quickly.
Some of the medications had awful side effects and I had more medication for those. It was quite difficult introducing new medications whilst being taken off others and because I needed high doses they were being introduced quickly and the dose increased within days and at the same time I was being taken off high doses of others again quickly because taking the two consecutively wasn't adviseable.
So I was ill alongside having side effects from the medication I was on, side effects from the medication I was coming off and side effects from the medication being introduced quickly, horrendous really.
Of course I also needed regular ecgs and weekly blood tests to see how my body was coping with all the drugs and I think that's probably not really being considered. Some of the psychiatric medicines whilst being effective for some have their own and potentially serious contraindications too. People have a horror of ECT whereas in reality nowadays it's given under a light anaesthetic and so a patient is unaware and not subject to any pain or distress .

It sounds to me like t psychiatrists don't yet know what they're treating. If your dad is in his 60s and this is his first episode like this, unless he has recently experienced something deeply traumatic, they really need to be ruling out all things physical before doing ect. He does sound very distressed so I can imagine people wanting to treat him quickly. Any problems with eliminating (bladder or bowel) can cause psychotic symptoms in older people so I'd wait for that to clear first and see how he fares. If he's not taking meds they can give them in a different form eggs tabs that dissolve on the tongue (obviously not available for all meds). More expensive but worth exploring. I would question what they're doing every step of the way - some psychiatrists are very keen to use their 'favourite' intervention and often they will have their 'favourite' or go-to diagnoses. Is he with an older adults team or just general adult mental health?

i know someone close to me who had it done early 1970s when she was 40 and it saved her life.(her words)
she did forget things like recipes ect,,, but nothing too major.

Apologies if this is insensitive, but has he been a big drinker ? A relative of mine would 'go toxic' (and get mentally worse) if hadn't had bowels open for a couple of days.
Just a thought....

psychiatrists are usually aware of the impact of physical problems-esp old age psychiatrists and do have some skill in differentiating between delirium (caused by physical problems including alcohol) and psychotic depression. I dont know anyone who gives ECT because it is their "favourite " intervention-most consider it very carefully. I think the danger of coming on here op is that you may get a lot of uninformed opinions. As I said earlier you should ask questions of your dads consultant who knows all the details and not take the opinion of anyone on here(including me) because none of us have the required information to properly advise you.

If it was my loved one I would advocate for all the physical causes to be ruled out first; scans of head, bowel issues sorted, etc. I would also want to know if they could consider giving the medications by injection (forced if necessary?) before doing ECT.

But ultimately if it came down to it I would support/consent (do they even need you consent?) to the ECT, because I don't think it is the kind of intervention any doctor would recommend lightly. Sadly he must be quite bad if they are recommending such a treatment early on.

I have had two courses of ECT - it really works for me- the memory loss was short term, and afterwards I went on to do a BSc and an MSc, and so no lasting effects.

The relief however, was immense, and the effects kept me safe until they got the meds right, then the meds helped whilst the therapy worked...please feel free to pm x

ECT has had some bad press - but the results really can be amazing.

I have seen people going from not eating or drinking and being completely catatonic with severe depression, to eating and drinking after one treatment.

Nowadays people are aneathetised and given muscle relaxant - so it is not the barbaric act depicted in the movies.

Memory loss is a risk - but it is usually short term if it happens, and is a small price to pay if you get some of the "person" back iyswim?

Also ime physical causes are always ruled out. As a non-psychiatric doctor I am sometimes frustrated when psychiatrists delay receiving a referral for someone who clearly has a barn-door psychiatric problem until they have a head ct. So I think it is highly likely that your dad has had, or will have before he starts treatment, a head CT.