I’ve been taking imipramine for about five years. I think it is one of the reasons I do so well now, and it upsets me that many psychiatrists are unwilling to prescribe antidepressants to manic depressives.
Not all antidepressants work so well – as I said amitryptiline made me manic. Paxil did very little to help me, and Wellbutrin did nothing at all. There was one I took (I think it might have been Norpramine) that caused a severe anxiety attack – I only ever took one tablet and wouldn’t take any more after that. I did have good results from maprotiline in my early 20′s, but then decided to stop medication entirely for several years, until I got hospitalized again in the spring of 1994. I had a low-grade depression for several years after that (when I tried Wellbutrin and then Paxil). I wasn’t suicidal but I just lived a miserable existence. A couple of months after I started taking imipramine in 1998, life got good again.
You should not use my experience as a guide in choosing any antidepressants you might take. The effectiveness of each is a very individual matter – they are all effective for some people and ineffective for others. Really the best you can do is try one out to see if it works for you, and keep trying new ones until you find the right one. Most likely any that you try will help to some extent. There are many antidepressants on the market now, so if your medicine is not helping, it’s very likely that there is another that will.
What if Medicine Doesn’t Help?
There are people for which it seems no antidepressant will help, but they are rare, and for those who cannot be treated by antidepressants, it is very likely that electric shock treatment will help. I realize that’s a very frightening prospect and it is still controversial, but ECT (or electroconvulsive therapy) is widely regarded by psychiatrists as the safest and most effective treatment there is for the worst depression. Most effective because it works when antidepressants fail, and safest for the simple reason that it works almost immediately, so the patient is not likely to kill themselves while waiting to get better, as can happen while waiting for an antidepressant to yield some relief.
Those who have read such books as Zen and the Art of Motorcycle Maintenance and One Flew Over the Cuckoo’s Nest will understandably have a low regard for shock treatment. In the past shock treatment was poorly understood by those who administered it and I have no doubt that it has been abused as depicted in Kesey’s book.
Note: While you may have seen the Cuckoo’s Nest movie, it’s really worthwhile to read the book. The inner experience of the patients comes through in the novel in a way that I don’t think is possible in a motion picture.
It has since been found that the memory loss that Robert Pirsig describes in Zen and the Art of Motorcycle Maintenance can be largely avoided by shocking only one lobe of the brain at a time, rather than both simultaneously. I understand the untreated lobe retains its memory and can help the other one recover it.
A new procedure called Transcranial Magnetic Stimulation promises a vast improvement over traditional ECT by using pulsed magnetic fields to induce currents inside the brain. A drawback for ECT is that the skull is an effective insulator, so high voltages are required to penetrate it. ECT cannot be applied with much precision. The skull presents no barrier to magnetic fields, so TMS can be delicately and precisely controlled.
At the hospital back in ’85 I had the pleasure to meet a fellow patient who had once worked as a staff member at another psychiatric hospital some time before. He would give us the inside scoop on everything that was going on during our stay. In particular he had once assisted in giving ECT treatments, and said that at the time it was just starting to be understood how many times you could shock someone before, as he put it, “they wouldn’t come back”. He said you could safely treat someone eleven times.
(It actually seems to be common for those who have mental illness to work at psychiatric hospitals. “The Quiet Room” author Lori Schiller worked at one for a while, and even now teaches a class at one. A bipolar friend worked at Harbor Hills hospital in Santa Cruz when I knew him back in the mid-80′s. At her first job, Schiller managed to keep her illness a secret for some time until another staffer noticed her hands shaking. That’s a common side effect of many psychiatric medications, and in fact sometimes I take a drug called propanolol to stop the tremors I get from Depakote, which got so bad at one point that I couldn’t type on a computer keyboard.)
You’re probably wondering whether I have ever had ECT. I haven’t; antidepressants work well for me. Although I feel it is probably safe and effective, I would be very reluctant to have it, for the simple reason that I place such a high value on my intellect. I would have to be pretty convinced that I would be as smart afterwards as I am now before I would volunteer for shock treatment. I would have to know a lot more about it than I do now.
I’ve known several other people to have ECT, and it seemed to help them. A couple of them were fellow patients who were getting the treatment while we were in the hospital together, and the difference in their whole personalities from one day to the next was profoundly positive.
Coming Up: Schizoid Symptoms
In Part II, I will discuss the schizophrenic side of schizoaffective disorder, something that I have not felt comfortable to talk about much before, publicly or privately. I will cover auditory and visual hallucinations, dissociation and paranoia.
Finally in part III I will tell you what to do about mental illness – why it’s important to seek treatment, what therapy is all about, and how you can make a livable new world for yourself. I will conclude with an explanation of why I write so publicly about my illness and give a list of websites and books for further reading.
This article originally appeared on kuro5hin.org and is reprinted here by permission of the author.
Crawford, M. (2009). Living with Schizoaffective Disorder. Psych Central. Retrieved on October 21, 2014, from http://psychcentral.com/lib/living-with-schizoaffective-disorder/0001564
Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
Published on PsychCentral.com. All rights reserved.