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Dr. Okun

New Study: ECT to Treat Depression in Parkinson's

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Dr. Okun    409

Dear forum members,

 

For many years we have successfully used electroconvulsive therapy to treat very severe depression that does not respond to medications in our PD patients. There has been some stigma against using this therapy, but in our experience and in the experience of many NPF centers worldwide it has been very helpful. Below is a recent review article tauting the positive benefits of ECT for severe depression in PD.

 

Med Hypotheses. 2009 Aug 4. [Epub ahead of print] Links

ECT for Parkinson's disease.

 

Popeo D, Kellner CH.

Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, United States.

Parkinson's disease (PD) is a chronic, progressive, degenerative disorder that affects over five million people worldwide. Pharmacotherapy with dopamine enhancing medications is the mainstay of treatment. Neurosurgical techniques, ranging from pallidotomy to deep brain stimulation (DBS) are used in refractory patients. Another treatment, electroconvulsive therapy (ECT), has repeatedly been shown to have beneficial effects in PD, but has never gained acceptance as a clinical treatment option. We review the literature on the use of ECT in PD, pointing out that ECT has beneficial effects on both the core motor symptoms of PD as well as the commonly occurring psychiatric co-morbidities. ECT is hypothesized to act in PD by enhancing dopamine neurotransmission, including increasing sensitivity of dopamine receptors. The beneficial effects of ECT in PD persist for variable periods. Maintenance ECT has been used to increase the length of benefit. The stigma surrounding ECT has likely been responsible for its lack of use in PD. We suggest that ECT has a role in the treatment of PD, both in patients with PD alone, or PD with co-occurring depression.

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It sounds like the study shows the value of ECT for PD in general, and not just depression.

 

If so, would you recommend ECT for a PWP who does not respond to medications (still has extreme tremor and stiffness), but who is not depressed?

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Dear forum members,

 

For many years we have successfully used electroconvulsive therapy to treat very severe depression that does not respond to medications in our PD patients. There has been some stigma against using this therapy, but in our experience and in the experience of many NPF centers worldwide it has been very helpful. Below is a recent review article tauting the positive benefits of ECT for severe depression in PD.

 

Med Hypotheses. 2009 Aug 4. [Epub ahead of print] Links

ECT for Parkinson's disease.

 

Popeo D, Kellner CH.

Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, United States.

Parkinson's disease (PD) is a chronic, progressive, degenerative disorder that affects over five million people worldwide. Pharmacotherapy with dopamine enhancing medications is the mainstay of treatment. Neurosurgical techniques, ranging from pallidotomy to deep brain stimulation (DBS) are used in refractory patients. Another treatment, electroconvulsive therapy (ECT), has repeatedly been shown to have beneficial effects in PD, but has never gained acceptance as a clinical treatment option. We review the literature on the use of ECT in PD, pointing out that ECT has beneficial effects on both the core motor symptoms of PD as well as the commonly occurring psychiatric co-morbidities. ECT is hypothesized to act in PD by enhancing dopamine neurotransmission, including increasing sensitivity of dopamine receptors. The beneficial effects of ECT in PD persist for variable periods. Maintenance ECT has been used to increase the length of benefit. The stigma surrounding ECT has likely been responsible for its lack of use in PD. We suggest that ECT has a role in the treatment of PD, both in patients with PD alone, or PD with co-occurring depression.

 

Dear doctors,

My father had shock treatment twice and it worked wonderfully. His doctor tried all the medicines available to mankind and it did absolutely nothing. The shock treatments worked as well as Jesus raising Lazarus from the dead. I would try it first instead of last for depression. Unfortunately, doctors are bound to a certain code, whereby they have to try every medicine before they try shock therapy. It does no harm if done right, the only side effect was short term memory loss. But I am afraid that so many doctos are ignorant about the effectiveness of the treatment that many patients are not well served. The second time my father had the treatment, I had told the phsychiatrist at the nursing home that my father had shock therapy 3 years prior. He said he knew and that my father had said it did not work. I told him he had to be kidding. You don't ask a patient if the treatment worked because if it did they don't remember how bad they were before the treatment. Unbelieveable! Right now my father is in the hospital with pnuemonia after having a fecal impaction a month ago. He got both in my opinion because his doctor and my mom and siblings refused to give him shock therapy again, which in my opinion, should have been done a couple years ago.

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Thanks for sharing your experience.

 

As striking as ECT has been for your father, it really should be reserved for patients who have failed oral medications. Why? Because the majority of patients will respond to these medications.

 

Some patients, however, will not, just like your dad. So in this case, ECT is reasonable.

 

Yours,

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orangewine6    0
Thanks for sharing your experience.

 

 

 

As striking as ECT has been for your father, it really should be reserved for patients who have failed oral medications. Why? Because the majority of patients will respond to these medications.

 

 

 

Some patients, however, will not, just like your dad. So in this case, ECT is reasonable.

 

 

 

Yours,

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