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Gabrielle J. Melin, M.D.
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Gabrielle J. Melin, M.D.
Gabrielle J. Melin, M.D.
Dr. Gabrielle Melin, board certified in general psychiatry and psychosomatic medicine, is looking for ways to empower patients and families dealing with chronic mental illness. She encourages patients to commit to working together with their physicians and health care teams.
Dr. Melin completed medical school at the University of Minnesota. She completed both her psychiatry residency and consultation-liaison fellowship at Mayo Clinic before joining the Mayo Clinic staff in 2001. She is medical director of Mayo Clinic Psychiatry Emergency Services in Rochester, Minn. She has special interests in emergency psychiatry, adult psychiatry and addiction psychiatry.
"Instilling hope is one of the most important things we can do for patients and families. Mental illness can be chronic and significantly impacts lives. Our goal is to provide the best treatment and education so that patients can manage their symptoms more effectively," she said.
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May 7, 2008
ECT is safe, effective treatment
By Gabrielle J. Melin, M.D.
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Electroconvulsive therapy (ECT) is a treatment that is available all over the country. It can be used to treat depression and is safe and effective.
The treatment involves the use of electricity while the patient is under general anesthesia and induces a seizure. This is done in a controlled setting and the patient receives 100 percent oxygen during the seizure, which lasts about 30 seconds.
The seizure causes the brain to release chemicals that we know are reduced in depression such are serotonin, norepinephrine, (also called adrenaline or the "fight or flight" chemical), etc. It is not for everyone and requires an OK for general anesthesia to be administered.
ECT can be used to treat other psychiatric conditions besides depression. It usually takes between 6 and 12 treatments (usually 2-3 treatments per week) and can be done either inpatient or outpatient, depending on the individual health status of the patient and other factors. Short-term memory loss can occur and varies for up to several months before and after the treatments.
Some people remember more than others, but ECT does not erase one's entire memory, prevent the ability to form new memories or change one's personality. Please know that there is a lot of misinformation regarding ECT and talking to a reliable source is important. Again, not everyone is a candidate for this treatment, just like not everyone is a candidate for surgery.
72 comments posted
November 23, 2009 11:11 a.m.
I had ECT from Nov 2003 to Jun 2004. I think it helped my depression a little, but it effected my memory significantly. Years later neuropsychological tests show that I have severe cognitive impairment in the areas of immediate attention and short term memory. Tests also indicate that my learning curve is low average. I assure you it wasn't low average before I had ECT. My post ECT memory deficit has a much greater impact on my life than depression ever did. My doctor has just started me on Cerefolin, which is a prescription megavitamin that he prescribes to patients with dementia. He says it also augments the effectiveness of SSRI’s. I’ve only just started on it, so I don’t know if it will work or not. Clinical trials indicating there isn’t significant evidence to prove ECT causes long term cognitive impairment are probably accurate. But that is another way of saying that there is some evidence to suggest it does cause long term impairment, however improbable. Antidepressants, mood stabilizers, and antipsychotic medications all carry the risk of potentially severe health problems. ECT absolutely carries serious risks which are likely to be permanent. Hope that you don’t join the very large community of statistically insignificant people who do experience permanent cognitive impairment.
- Steven
November 20, 2009 6:06 p.m.
I have been having ECT treatments for the last several weeks. It started out as twice a week, but now it is once a week. I am bi-polar II and have been suffering from extreme bouts of mania over the last several months. It interferred with my work.. my life. I was on cloziril, which helped tremendously, but lowered my white count to a dangerous level. I've been on depakote, lithium, prozac, zoloft, geodon, klonopin, seroquel, pristiq, lexapro, lamictal, etc., etc., etc. It's been going on for years. I've been hospitalized for suicidal thoughts half a dozen times. It all started when I was 20 years old. I'm turning 40 in December. It's been a long, hard journey. With the ECT, I have suffered some memory loss, but nothing major. I feel so much better after the treatments. My anxiety is GONE! I feel calm. I don't know if it's for everyone. I have read some horror stories about folks losing major chunks of memory. But for me, I classify the good it's done me worth the minor loss. I forget how to get places, but I have GPS on my cell phone so that helps. I have been doing some studying of SQL Server 2008, as I am a developer, and I seem to be retaining my memory of what I've read. I actually feel that I am thinking more clearly on the whole than I was when I was suffering from either mania or depression. I wake up after treatment, most of the time not remembering if I've had my treatment or not. On the whole, it's a pleasant experience. God Bless & good
- michael
November 19, 2009 10:37 a.m.
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- Mc.Com Staff
November 13, 2009 5:28 p.m.
I have severe clinical depression that has been getting worse over the past few years. I am 53 with 4 grown daughters who have all said they want thier mom back. Well I want myself back too. This past week my psychiatrist suggested ECT. That is what led me to this site. He explained it but told me to research it. I have no qualtiy of life. Like the other comments I've read here all I want to do is sleep and many nights pray to God that if he can't help me get myself back that he will call me home. I have talked to my girls and husband about this and they are all behind me 100%. I don't want to die but feel that the me who used to be has already done so. If ECT can help, even with the potential side effects then I am all for it. I don't and can't "live" like this anymore I merely "exist."
- Joanne
November 11, 2009 1:51 p.m.
Diagnosed bi-polar 2, 18 yrs ago. Have raised 2 children into adulthood, successfully. At age 55 I have tried virtually every med short of lithium. Most I have severe adverse reactions to and Depakote has been the only one I could tolerate long term. Now I can't even do that. I spend half the year severely depressed the rest of the time just barely above that. I use light therapy which worked in the past but now has little effect. I recently had a major depressive episode and for the first time came close to finding my way to the psych unit. I don't want to do this anymore. I don't want to use my body/brain to experiment with yet another drug that in all likelihood will not work. I'm just plain tired. I don't want to get out of bed, get dressed, shower, eat, no joy exists in any aspect of my life. If I went to bed tonight and never woke up that would be fine. My family is the only reason I am still here. Tomorrow I see my DR. We have put ECT on the table in the past but I "ride it out" and we move on. I'm ready to try something different. I cannot imagine spending much more time as I am today. Memory loss? My husband will talk about things we have done and I have zero recollection. How much worse can it get? I don't remember much of when my children were little. I'm tired. A little electricity sounds like a good thing right about now. Tomorrow we will discuss it. Thank you for all the open sharing here.
- Cynthia
November 10, 2009 4:12 p.m.
This is in response to the previous comments from Laura: Hi, Laura. I was a recipient of electroconvulsive therapy/ect in 1972. I just bought a book on ect today: Doctors of Deception by Linda Andre, who is also a recipient of ect. Stefan Kruszewski, M.D. ( graduate of Princeton University, Harvard Medical School, and trained in ect at Duke University) writes in the Journal of Risk and Safety in Medicine (2009): "This book is brilliant analysis. It is successful on many levels, including its most important task: presenting an overview of the history, safety, and efficacy of electroconvulsive therapy. The book is also a masterpiece of scientifc writing...." What I like about it most, it is written by someone who has actually experienced ect, not just read about it or administered it. Best wishes, Laura.
- Jack
November 8, 2009 8:51 p.m.
i am 44 yrs old and have had a long history with major depressive order and then was dx with bi-plolar 2 disorder. my meds make it difficlt to hodl dow a job, and invoke in me great unhappiness. I dont want to be around people. recently my psychiatrist said he felt i was a candidat for ect. This scares me. I don't want to be robbed of my memory. Are there any books out there that can help me make this decision
- laura
November 5, 2009 11:01 p.m.
What is to be expected for return to work? I am depressed, just recently left the hospital with a week stay at the psychiatric unit because of suicidal thoughts. I assume it would be best I take advantage of the long term disability our company offers for these treatments? I live near Chicago and I do not know where to go to find out more about ECT. What can I do for help?
- Billy L
November 5, 2009 8:01 a.m.
In the above article, Dr. Melin writes, "...there is a lot of misinformation regarding ECT and talking to a reliable source is important." Would Dr. Harold Sackeim of Columbia University be considered a "reliable source?" In the Wickipedia article on ECT, it is stated that, according to prominent ECT researcher Harold Sackeim, "despite over fifty years of clinical use and ongoing controversy", until 2007 there had "never been a large scale, prospective study of the cognitive effects of ECT." In the first ever large scale study (347 subjects), Sackeim and colleagues found that at least some forms...lead to "adverse cognitive effects",including global cognitive deficits and memory loss that persist for at least 6 months after treatment, suggesting that the induced deficits may be permanent. Dr. Melin writes that "short-term memory loss can occur and varies for up to several months before and after treatment." Nowhere does she suggest that memory loss may be permanent, as does Dr. Sackeim. I personally had ECT in 1972 and still have serious cognitive impairment, in my ooinion. Maybe now that Dr. Sackeim has made it official, people will at last take me seriously when I say so.
- jack
November 3, 2009 12:55 p.m.
I also read in the Wickipedia article on ECT effectiveness that "Most, but not all, published reviews of the literature have concluded that ECT is effective in the treatment of depression. In 2006, research psychiatrist Colin A. Ross reviewed the entire body of placebo-controlled literature on ECT and found that no study demonstrated a significant difference between real and placebo ECT at one month post treatment...Dr. Ross concludes that "claims in textbooks and review articles that ECT is effective are not consistent with the published data", and that consent forms for the procedure should state that "real ECT is only marginally more effective than placebo." The review was highly critical of other published reviews concluding that ECT was effective, because these reviews often relied primarily on studies that were not placebo-controlled." To me this raises questions on ECT's effectiveness. Please comment.
- jack
November 3, 2009 12:40 p.m.
I read in the Wickipedia encyclopedia article on electroconvulsive therapy that, according to prominent ECT researcher Harold Sackeim of Columbia University, at a California ECT conference with 200 practitioners present, when polled as to whether they think ECT can lead to chronic cognitive deficits, two-thirds raised their hands. Sackeim says this was "almost a watershed moment for the field", and was the "first time publicly that the field itself said 'no' to the position that it can't happen." Also, Wickipedia said that in July, 2007, a published study by psychiatrist Glenda MacQueen and colleagues concluded that ECT routinely leads to chronic, substantial cognitive deficits, and the findings were not limited to any particular forms of ECT. If this is so, how can Mayo Clinic psychiatrist Gabrielle J. Melin state that ECT is safe?
- jack
October 30, 2009 3:31 a.m.
I've been suffering with major depression for the last 8 years. Been through numerous medications - have had some results with them - took as many as 8 different meds at one time and now am down to 3 with some success. At least now I can function whereas 8 years ago I was a zombie. Never been suicidal but many times wished the good Lord would look upon me and decide I suffered enough and while I slept he would open the gates of heaven and welcome me in. I hate the depression life! I fight it by going weekly to therapy, take my meds and see my doctor each month. BUT I'm at a plateau, a flat point that seems to go on forever. I've found no more success, not improving at all, tried changing my meds again, nothing is working. Recently my doctor's discussed ECT with me and it's out there on the table should I want to go that route. I believe I do, I believe it will help but I am terrified, have visions of what I've seen in movies, of the pain I think one must go through.
- Sue Z.
October 27, 2009 7:06 p.m.
My mother started experiencing seizures last March the night of our father's funeral. We knew she had not been well and had not recuperated when he passed away. She had been a diabetic for the past 40 years and has had a pacemaker for the past 12 years. Her personality did not start to change until about a week after the seizures started. After trying all types of anti-seizure medications and also psychotropic medications which did not cure her delusions, we were introduced to this treatment at Generations at the Lutheran Hospital in Fort Wayne. She had not had any previous depression or mania but at 86 anything can happen. She was a very bright lady and seeing something happen suddenly in the hospital over night is not any type of normal dementia. My mother remembers all before my father died. Thank goodness she doesn't remember some of the things she did or the fear she had. She is still having treatments but we noticed a change and had our mom coming back to us after just one treatment.
- Susan
October 24, 2009 2:31 p.m.
I want ebveryone to know my friend had ECt and his memory loss and ability to form new memories are extreme , still after 3 weeks. What is the treatment for memory loss due to ECT? What are the contra-indications. I disagree with this information. " CT can be used to treat other psychiatric conditions besides depression. It usually takes between 6 and 12 treatments (usually 2-3 treatments per week) and can be done either inpatient or outpatient, depending on the individual health status of the patient and other factors. Short-term memory loss can occur and varies for up to several months before and after the treatments. Some people remember more than others, but ECT does not erase one's entire memory, prevent the ability to form new memories or change one's personality. Please know that there is a lot of misinformation regarding ECT and talking to a reliable source is important. Again, not everyone is a candidate for this treatment, just like not everyone is a candidate for surgery. "
- Ed C
October 20, 2009 10:30 a.m.
Olivia, Thanks for your interest. We are not aware of anything like that. Please ask your local provider about this- they may know of something. You could also contact NAMI and ask. Alternatively, you could consider starting a group, but would speak wtih your provider first as confidentiality of all involved needs to be protected. Best of luck.
- Mayo Clinic.Com Staff
October 16, 2009 2:55 p.m.
Does anyone know of a suport group for ect in Minnesota? Please post the details. thanks!
- Olivia
September 23, 2009 7:12 p.m.
My spouse has been struggling with major depression that has impacted his life in a numerous negative ways. Last resort was ect. Recently completed a series of 10 ect treatments in the hospital, now home and is overwhelmed by the memory loss. I trust the doctors and the small amount of education I have been given, but struggle how to best support him with his memory loss. I understand that it is temporary loss - at the same time am at a loss of what to do to to assure him this will pass and how long it may take. What experiences can you share to offer encouragement that the best is yet to come (in other words if you are a nah sayer - do not comment on this request). Thanks
- Jo
September 8, 2009 11:43 p.m.
It was good to read the success stories reported in this forum. As I write, a good friend is undergoing ECT after a nearly successful suicide attempt. When investigating the surface of any medical treatment on the Internet it seems there is always a group of people wishing to blame all their problems on a given procedure or drug, without any reasonable acknowledgement of the problems caused by the original condition. For example, a person with diagnosed manic depression, multiple suicide attempts, and a history of endangering himself and others post ECT complaining memory loss. No procedure is perfect and it would be good to see all people posting here put their agenda aside and perhaps report the full picture, instead of omitting the facts that do not support their pre established opinion. It is also my wish to convey to laypeople like me who are grinding around the internet that most posts are unsupported gobbledy gook - salesmen selling overpriced vitamins (or mystery healing remedies) who lack any integrity or real education medicine or psychiatry. On the internet a saleman's post carries the same weight as medical professional (with 12 years of advanced education). Seek out first hand information, which means, talk to someone who has had the procedure done. An evening searching a mixture of good information and garbage on internet does not equal a lifetime of field experience with real patients.
- RobW
September 6, 2009 7:07 p.m.
IT REALLY HELPED ME GET OVER MY DEPRESSION>>> I had a serious clinical depression five years ago. Medication and therapy didn't seem to work very well, so my psychiatrist suggested ECT. At first I balked at this suggestion, but then he got one of his other patients who had had ECT to meet and talk to me. She allayed my fears by telling me of her positive experiences with it. I started at two treatments a week for about 4/5 weeks, then slowly tapering off to a maintenance treatment once every three months. I had my last treatment two years ago. I have been depression free now for more than three years. I still take depression medication on the advice of my psychiatrist, changed my lifestyle and my view and approach to life, and constantly review my mood to identify any possible warning signs of reoccurence. I have some memory loss from the depression period itself, but understand this could well be because of the depression itself. I am now able to function well in all areas of my life and credit the ECT as having played a significant part in my recovery!
- Pat
August 23, 2009 3:11 a.m.
If you've had some life experiences that have created loss, depression, and emotional trauma so severe that your physical health is at risk (I have takotsubo cardiomyopathy, and your heart is supposed to recover in a few weeks, but this is the third occurrence and they think that because of the severity and the number of separate times it's happened that it may permanently damage my heart,) could ECT help? I'm wondering if it could soften the trauma of the memories? Therapy is out of the question, since "reliving" seems to provoke an attack. Takotsubo cardiomyopathy behaves like a heart attack (the heart balloons outward, and the blood flow and pumping is irregular, and it produces nausea, fainting, dizziness, pain, sweating, and shortness of breath) and, while it's a relatively newly discovered diagnosis, no one has died of it. But my doctor is worried because normally this only happens once, while this is my third occurrence, and that my heart isn't recovering like it's supposed to, and he thinks that I need immediate treatment. He actually suggested lobotomy, but I think ECT is safer. Do you think this is at all possible?
- Andrea
August 9, 2009 11:13 p.m.
I think it is a very risky form of treatment, actually more an assault than a treatment and it should be banned. I understand it is not done in the same brutal way it used to be done but often the outcome is brutal enough and irreversible. Before permitting such a method, that feels so wrong to so many people, like in Europe, the doctors have the duty to try everything else, psychotherapy, all sorts of, indigenous and modern healing modalities and Traditional Chinese Medicine. The simplest way to find out how doctors feel about it, is to ask them, if this were your child,. would you allow ECT to be applied? Nobody protests against surgeries if they are necessary. But never had ECT been necessary. It is just easier for a doctor to turn on a machine than to deal with a sick patient for many sessions. I am lucky my doctor does the latter. If he would not, I would look for another doctor. Fact is that doctors cannot control or determine the outcome of ECT. Thus it is irresponsible.
- L
July 26, 2009 10:10 p.m.
I have been receiving ECT for over 2 years now. At first they were for acute bipolar episodes that were not responsive to any medications, and/or they caused intolerable side effects. After the initial treatments series my Dr.s and I decided I would continue to receive monthly maintanence treatments as long as necessary to keep me feeling mostly well. It is not always easy. I still have my moments, it is not a "miracle cure". But it is better than taking 5-7 different medications that make you into a zombie with terrible side effects. I have some memory loss, but I don't believe it all comes from ECT. Most of us take other meds that affect our cognition. We also have had other trauma in our lives that lead us to lose some of our memories. But....ECT is just a good thing to put the blame on for these things. I don't think I remembered alot of the longer term things to begin with. ECT and my wonderful team of Dr.s and my wonderful fiance have saved my life. I would do it again in a heart beat!
- Kat
July 23, 2009 12:01 p.m.
i have been recieving ect treatments since the middle of march of this year. they have made a difference in my life for the better. i,m extremely pleased with the results. i have only a few treatments left. i havent experinced much short term memory loss. i,m on fewer meds now than i was before i started recieving the treatments. i,m responding better to medicine now than i ever did before. my counselor and family all say they can see a big difference in me since i been getting the treatments. the doctor who does my treatment educated me very well about ect. i,m very gratefull to the doctor and his staff at deaconess hospital in evansville,in. i would just like to tell anyone considering ect treatment to doctor with their doctor first and not to be scared of ect treatment.
- roger
July 12, 2009 8:07 p.m.
I have had very good results from ECT. I used to be nervous but now I look forward to having my treatment as I know I will feel better after it.
- Jane
June 27, 2009 12:37 a.m.
Even while I type this, I am holding back the tears. I underwent 17 treatments, of which more than half were bilateral and still I can see no marketable difference. Diagnosed as bipolar and a mother of two I wanted, needed this to work but instead I am suffering from gross memory impairment, cognition problems, in-decisiveness and even pain in my legs. I wish that my memory lost only extended to just a couple months ago, but instead I am missing years of my life, recollection of the birth of my children, work experience and even what I did yesterday or last week is gone. Oddly enough, I have a strong sense of vacancy and absenteeism of my own person. I am thankful to my husband for his support because without him I would not know if I were coming or going. Given the hardship I have had, as result of the treatment, I have decided to discontinue treatment (so far a week without) in the hope of regaining my memory and to restore my cognition I do believe that ECT works for some people, but I just happen to be apart of that 20% for which it does not. I can't even remember why I chose ECT, how it works, benefits and so-forth. I do not even remember meeting my doctor. Its odd however, I can remember how to get to the grocery store, (although, I am not suppose to drive), but I do not remember the layout of the store that I have shopped at for over 7 years weekly. - GOD BE WITH ME
- California
72 comments posted