Expert: Ivan Goldberg, M.D. - 11/9/2011

Question
QUESTION: dear sir,

must thank you for this support.

my doctor has suggested me ECT next week for bipolar mixed depression...kindly advise
1) does have life long efficacy for those who respond to it? or will one become tolerant to its beneficial effects after some time?

2)like anti depressants cause short term gain and long term loss in bipolar illness...does ECT also does the same way?

grateful to you,
james.

ANSWER: If a person with a bipolar mixed state fails to improve despite the use of multiple trials with combinations of mood stabilizer and antidepressants, ECT is likely to end the current depressive spell.

Frequently, after ECT medications that did not work prior to ECT will be effective in preventing future episodes of depression.

I have found the combination of lithium, lamotrigine, and either bupropion or a MAO inhibitor to be quite effective in treating mixed states. If there is psychotic thought content I will add an antipsychotic medication.

Repeated series of ECT are as likely to be successful as the first.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Dear Sir,

i truly value your advice and therefore need second opinion to compare my treating doctors advice:

1)My doctor says after 30-40 sittings of ECT in a lifetime, the brain damage starts showing, so a person should be very judicious in using ECT.Is he correct?

2) he is suggesting methyl phenidate for my bipolar mixed depression...like antidepressants make my illness worse even if given along with mood stabilizers...does methyl phenidate also acts the same way?

ANSWER: James . . .

I have had a few patients who have required multiple series of ECT o control their melancholic depressive episodes. Some of them have had many more than 40 treatments and I have not seen any indication of brain damage. One of these patients is a physician and another is a judge.

Methylphenidate is not likely to help a bipolar mixed state.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Sir,

may god bless you in return for the helping!!

my doctor wants to prescribe me moclobemide ...

1) is parnate better than moclobemide for mixed state? will moclobemide worsen me like conventional antidepressants?

2)can carbamazepine be taken along with moclobemide or parnate? carbamazepine is the only mood-stabilizer that suits me best...lithium has no effect and lamotrigine is not being tolerated..

thanks and best regards ,
james

Answer
James . . .

Moclobemide can be used to treat people with mixed dastards. MAOIs are less likely to have a negative effect on mixed states that TCAs, SSRIs, or SNRIs.

While I have started an MAOIs in someone taking carbamazepine, I would never add carbamazepine after someone had been taking carbamazepine. The two medications can also be started simultaneously.

Best regards . . .

Ivan
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