Expert: Ivan Goldberg, M.D. - 7/16/2011

Question
QUESTION: Sir, I am a patient of bipolar mixed for last 15 years...i responded to carbamazepine and clomipramine initially but later it stopped working....in between 10 years i was fully functional with only "racing thoughts" or agitation.since last 3 years i am not at all functional..almost bedridden..valporate and topiramate initally had a partial effect...but now the condition is that i am not able to tolerate a single dose of all anticonvulsants,lithium,olanzepine,aripripazole, permepexole etc...and the antidepressants which i am able to tolerate make me worse after minor initial improvement...rTMS made me worse...i am planning ECT...i am even thinking of suicide seriously...I beg to suggest me to save my life...

ANSWER: Hi Karan . . .

I have treated a number of individuals who had experiences similar to yours. Such people do very well when treated with ECT, and after ECT are able to take the very same medications that they were unable to tolerate prior to ECT.

Best regards . . .

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

QUESTION: Respected Sir, many thanks for your previous GOD sent message. I would be having ECT next month. Please clarify the following:
1.If I would be tolerating the medicines after ECT, would the tolerance be permanent or I would need maintenance ECT to maintain tolerance to medicines?
2.In a case of Mixed Bipolar with mainly depression, should an antidepressant be added to ECT to increase antidepressant response?
3.If I am put on maintenance ECT, would the efficacy of ECT be present life-long or will benefits of ECT develop resistance after few years?
With best regards,
God bless you an family,
karan

Answer
1.If I would be tolerating the medicines after ECT, would the tolerance be permanent or I would need maintenance ECT to maintain tolerance to medicines?

It is impossible to say how long the effects of ECT would last. I have seen some people where they last for years, and other people who require maintenance treatment as soon as the initial series of ECTs is comolete.


2.In a case of Mixed Bipolar with mainly depression, should an antidepressant be added to ECT to increase antidepressant response?

I am prescribing fewer and fewer antidepressants for individuals with any form of bipolar disorder. When an antidepressant seems necessary, I usually prescribe lamotrigine.


3.If I am put on maintenance ECT, would the efficacy of ECT be present life-long or will benefits of ECT develop resistance after few years?

Some people receiving maintenance ECT develop a severe depression. Th is rare, but when it happens the severe depression nearly always responds to a brief course of ECT given 2 or 3 times a week.

Best regards . . .

Ivan
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