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Electroconvulsive Treatment (ECT)

Changing medications and moving to ECT

Most of the people we spoke to had been on a number of different medications throughout their lives. You can read more about the effectiveness of different types of medication and their side effects here: ‘Medication for mental health conditions: effectiveness and side effects’. This summary is about the process of changing from one medication to another and about moving from medication to ECT. 

Changing medication
Changing medication could sometimes be a difficult process and it often took time to find a drug that worked. It can take some weeks for the side effects of a medication, for a particular individual, to be known. While patients may not like certain side effects, doctors try to balance the side effects of a medication with its effectiveness (how well it works to reduce the symptoms). Some doctors try to include patient views in decisions about medication. Some people we spoke to said they themselves had had to weigh up the side effects of medication with the benefits that they might bring.
 

Catherine Y found that she had to keep changing anti-depressants because of the side effects or because they stopped working after a while. It was difficult but they did help her overall.

Catherine Y found that she had to keep changing anti-depressants because of the side effects or because they stopped working after a while. It was difficult but they did help her overall.

Age at interview: 41
Sex: Female
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Can you remember which antidepressant it was?

Yes, it was imipramine, I went on to imipramine. The lethargy got, the sedation got a bit too much over a period of time and I went on to the same group but without the sedation, a medication called lofepramine, which I think is the lower one of the group of tricyclics that doesn’t have sedation in it. And I was on that for a good couple of years before that kind of stopped working. I think antidepressants with me occasionally did have a habit of just stopping working, it would be a case of trying another one. But, no, it was, yes, and I still had a long way to go, there was still a long way to go and I still at times felt suicidal and, you know, self-harm and all that kind of stuff. So it was still quite difficult but I think it still helped me to, I think, work better within, certainly in psychotherapy sessions and things like that.
Some found that changing medication improved their wellbeing. For others, changing medication could have a negative impact because the new drug didn’t work, or because it took too long to work. Some experienced side effects from stopping taking a drug.
 

Tania found antidepressants were acting as a stimulant and contributing to her inability to sleep. When she tried to come off them, it triggered her mental illness.

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Tania found antidepressants were acting as a stimulant and contributing to her inability to sleep. When she tried to come off them, it triggered her mental illness.

Age at interview: 41
Sex: Female
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I knew I need to come off the drugs. I was still on one tiny dose of, of one antidepressant, but it wasn’t helping. It was actually having the opposite effect, because it was a stimulant and it was contributing towards me, towards me, my inability to sleep. And my feeling of being over energised. But the problem was, if ever I tried to come off it, coming off it, itself, withdrawal, would then trigger an episode. So I was sort of caught in a catch 22 situation.
When Sunil had his medication changed from carbamazepine to disodium valproate and then to olanzapine and lamotrigine over a few years to combat side effects, he linked the changes to a relapse of his illness. Tristan’s wife had her antidepressant medication changed just before she gave birth and he thinks that left her vulnerable for the time it took the new medication to take effect. She suffered severe postnatal depression and eventually was given another drug that “suited her much better” and “got her better properly in the long term”.
 

Yvonne had been ok for ten years, but the doctors changed her medication and it “kinda knocked [her] back” and she was admitted to hospital. She’s now asked for her medication not to be changed.

Yvonne had been ok for ten years, but the doctors changed her medication and it “kinda knocked [her] back” and she was admitted to hospital. She’s now asked for her medication not to be changed.

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How many admissions have you had?

Oh I don’t know. I’ve lost count

You’ve lost count?

I don’t know. I don’t even know if it’s 20, 30, 40. It could be anything. My last admission was two and a half years ago. And then before that the last admission previous to that was ten years. So I’d gone quite a bit of time, which I think was when the doctors changed my medication and it kinda knocked me back. But you know, these things happen. I’ve got a new psychiatrist and the first thing I said to her was, “Do not change my medication.” She said, “It’s okay I won’t if you don’t want me to.” That was fine, you know. Yes.
 

Carys said her daughter was taking many pills a day when a new psychiatrist said to “bin them” and start again. It made a dramatic change and she started being active.

Carys said her daughter was taking many pills a day when a new psychiatrist said to “bin them” and start again. It made a dramatic change and she started being active.

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And she started, she got, I mean she’s been through hundreds of psychiatrists over the years, because everywhere has got their own psychiatrist. At one point, well when she actually moved into [name of place] she was taking upward of 80 pills a day. She had ones to wake her up, ones to put her to sleep, ones to get her better, ones to get her worse. You name it, she had pills for everything and that was when I realised what all the dreadful… boils etc. were coming from. It was the lithium she was taking, and I discovered afterwards that that’s quite well known, having started talking to some service users. 

But… she had a new consultant psychiatrist who was a most amazing man. Absolutely incredible, and he said, “Right, we’re binning the whole lot, and we’re starting again.” He obviously kept the clozapine going because that was the most important one. But everything else went straight in the bin. Most of her tremors stopped. She woke up, she started taking part in life. She joined an aqua aerobics club, she started, oh she worked in an old people’s the day centre, voluntary. She started actually doing things. 
Medication and ECT
Medications were usually given before ECT was offered, and ECT was only suggested when medications had not worked. People had different opinions about moving from medications to having ECT. Some people felt ECT had worked well for them and wanted ECT to be offered to them sooner. Others thought medications were a better solution in the long term. 

Catherine Z had found ECT very effective for her and when her son was diagnosed with mental illness and medications weren’t working, she wanted him to have ECT from very early on. She felt it was “slightly barbaric” giving her son high doses of drugs that were having no effect, when ECT could have been given much earlier. However, when David Y’s wife was offered ECT she had only been given very low doses of medication (Depixol), because she was pregnant. They gave ECT saying it was a “last resort”, but he felt more therapies and treatments should have been tried first. Tristan felt that medications were, in the long term, a more “humane” and effective treatment for his wife, although in the short-term, ECT had improved his wife’s severe depression.
 

David Z didn’t get any great relief from antidepressants and found that ECT gave him a lift, which the tablets didn’t. He finds he is able to manage his moods better by himself than with tablets.

David Z didn’t get any great relief from antidepressants and found that ECT gave him a lift, which the tablets didn’t. He finds he is able to manage his moods better by himself than with tablets.

Age at interview: 44
Sex: Male
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I mean I don’t have much faith in antidepressants, rightly or wrongly. To me they don’t work really. They always tell me about what would it be like if I wasn’t on them, which is fair enough, but I don’t feel any great relief with antidepressants, I don’t feel any up. I, I kind of manage my moods better myself rather than from the tablets. But the one thing the ECT did give you that lift. When you came to you did notice a difference. And you don’t get that difference if you’re on tablets.
 

When Tania used ECT to help take her off medication it was “absolutely incredible”. Despite withdrawal symptoms from coming off the drug, she found she didn’t relapse.

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When Tania used ECT to help take her off medication it was “absolutely incredible”. Despite withdrawal symptoms from coming off the drug, she found she didn’t relapse.

Age at interview: 41
Sex: Female
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And I thought maybe if we combined the beginning of the treatment, when the treatments are closer together with kind of, with the withdrawal from the drug that I was on, then that might counter the beneficial effects, the ECT might counter for the negative effects of the drug and so we put together a plan.

I did a lot of research into it. It’s not a treatment when is widely used and so I, yeah, I did a lot of research. I contacted people in America. I contacted people over the UK to try and find people who were experts in the field and I was very lucky because I got put in touch with the, sort of, the leading UK expert into ECT and he, yeah, he’s an amazing man, I mean, he lives up in Scotland and he gave me, he called me, and we, you know, he gave me some advice by email and stuff and then he actually called and sort of took a very brief case history and I told him what was going on, and he suggested how to do the maintenance ECT in terms of how many treatments and how… And what he said to me was that, “You need to do one a week for two weeks, then one every fortnight for two fortnights, one every three weeks for two treatments and then go to one every four or five weeks. One every month, but the key was, that he said to me, because I’d had such a rough few years and I was so sort of vulnerable in my system I needed to continue the treatment for quite a while to build up the strength.”

But he also that because I’d had a long period in my life when I’d been symptom free, it, he didn’t necessarily think I would need to continue it for sort four or five years, you know, or continue it kind of forever. But you know, it’s possible, if I could get well enough, that I could have another period of remission. A long period of remission again and that’s a possibility, although he couldn’t guarantee it, but he said, you know, looking at my hospital it might be possible. 

So, at that stage we thought, you know, this is the right thing to do, and I, you know, discussed it with my consultant and he thought it was a good idea. So we started it and I did it, I started it in February of 2011 and I, and it was, it was an amazing success. It was absolutely incredible. 

Yeah, the first couple of months were really hard going, mainly I think because of the withdrawal effects from the other drug, but all of a sudden, once that was out my system, it started to get, it became like a virtuous circle, rather than a vicious circle. My having the drugs out of my system, I started to be able to, be able to sleep. I even came off the sleeping medication. After a few months I was able to sleep naturally for the first time in four or five years. You know, my appetite returned, my physical strength returned, and that contributed so much to my wellbeing. I went down to having the treatments every sort of four or five weeks, which I did for kind of 12 month period and really I just got, I just got better.
Occasionally when people were taking medications at the time of the ECT, there were concerns some medication could get in the way of its effectiveness. Sheila mentioned that her husband had 5 ECT treatments before they discovered that he was not having proper seizures because of medication he was on to stop the threat of a stroke. The one time that ECT didn’t work for Tania she thinks it was because they were giving her a minor tranquillizer, a benzodiazepine (clonazepam), at the time.

Last reviewed January 2018.
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