Category Archives: Depression

Depression & ECT

Clinical Case Studies, Depression, Treatment Approaches

“I’m single. I don’t want to trouble my family. Let me end my life.”

She repeatedly stressed that she’s single (I’m quite sure when she was well she never minded it). She seeks for all different kinds of methods to end her life. But because of how caring and loving her family is, she is still living, and maybe to her, suffering. She has had at least one attempt of suicide in the past in which she cut her wrist.

This is a woman in her 60s, not married, currently staying with her nephew and nephew’s family. Her sister used to look after her, and live with her, but over months, sister was upset by her, affected by her negative energy and mood, and has temporarily withdrawn from her role of looking after her. She has a lot of very negative thoughts, lacking drives and interests, just feeling lazy and not wanting to go out, see anyone, do anything. She has lost interests to those that she used to find pleasurable (Remember I said in “Depression & Suicidal Risk”? Lacking interests & drives!)

I spoke to her nephew and nephew’s wife quite a number of times. They are both very empathising. They are feeling pretty helpless, not knowing how to look after a severely depressed auntie. Sometimes they have to lock her in the house or bring her everywhere with them, being worried she will commit suicide if she’s left unattended.

She’s still on quite a high dose of anti-depressant medication, she’s very regular with it, after all these years. Sometimes even the family is a bit doubtful whether the medicine is helping, the patient is the one that knows clearly things are going to be so messed up and so wrong if she stops it. But it seems that the medication has stopped working for her, as she grows more and more depressed and negative.

Consultant psychiatrist suggested Electroconvulsive Therapy (ECT) for her. On the day before her ECT, she jumped off the sea, and perhaps she’s meant to live a lot longer, a passerby saw her and dragged her back. She has had two sets of ECT done about 4 years ago. This does appear to be the fastest and perhaps the last resort for her current condition. It’s a controversial treatment, yet I’ve seen people benefited from it. Memory loss is one common side effect reported, yet perhaps it’s best for the patient to temporarily forget certain things?!

I’d say if ECT is likely to do more good than harm then people should really go for it, but it should always remain as the last resort, after patients have tried all other therapies.

 

Subsequent follow up of this patient: Can we allow a severely depressed patient to make the decision?

Depression & Suicidal Risk

Clinical Case Studies, Depression

She has a long history of depression, but due to financial constraint, has stopped following up in private clinic and gone to the general hospital. After few months she came back to us, not being well, but still not that bad, able to smile and chat with others a little bit.

Few days later she made a call to us, saying she’s feeling really low in mood, not having any interest, she didn’t know what to do with herself, still regular with med, but didn’t think it was helping with her problems. Nothing happened in particular that led to her mood being that way, she said. Her medication was adjusted. Couple days later I rang her again, she took the extra dosage, but remained the same, not happy, lacking drives and interest. She did try, she went out for group exercise with friends, but she kept feeling her mind was somewhere else. She was told to come back so that she could get a better review and a medicine regime that helps with her current condition better.

She didn’t come back for review. She never called us again. About 3 or 4 days later I called her house numbers again (which I usually did), somebody else picked up, saying she is no longer here. At first I didn’t get it, I thought she was just away. Then this lady said the patient committed suicide yesterday. I sent my condolences and ended the call.

Lacking interests and drives is one very important suicidal risk factor. They try to get engaged in something, but they don’t find their mind with them. It isn’t them, it’s their illness.

I used to think as long as they find some pleasurable things to do they will get better. Sometimes it just isn’t that simple, maybe it isn’t just the behavioural intervention or medicine alone, they need cognitive, behavioural and pharmacological interventions all together.

Genuine Suicidal Attempt or Attention Seeking?

Clinical Case Studies, Depression

She was told by the doctor to come to the clinic to collect her medication and for an injection, after seeing the doctor in the hospital.

When she got here she looked like she was on the phone, but nobody heard her talking at all. Staff told her to come in to the treatment room. She gave no response, made no eye contact – as if she was so concentrate on a spot in the air. Then she walked towards the door, went out, and stood by the stairs. She looked down to the lower floors. A colleague said, “she isn’t going to jump down is she?” I was going to say “Is she looking for someone downstairs?” but before I even completed the sentence, her feet were already in the air, hanging her body on the rail. we all ran out. She didn’t do it fast as her left hand was still holding the stairs handle/rail. So one of the colleagues managed to grab her legs, another her arm.

She was brought in. She continued to say that she wanted to leave, and of course she wasn’t allowed. It took some time till she was injected and given stat dose. The doctor came from the hospital to see her.

It appeared to be something related to drugs, she seemed to be taking illicit drugs, and according to her, she will be charged for distributing drugs (or bringing drugs in from another country). She said she was innocent.

She calmed down later as the stat dose kicked in. Family member was contacted to bring her home. I’m not sure how she is right now, I hope people will all stay away from illicit drugs.

If it was one of our busy days we wouldn’t have noticed and managed to stop this. Though we doubt if she really wanted to commit suicide, or she really just needed some attention and help maybe. Because of how the stair is designed, it wouldn’t be possible for anyone to jump down straight from 4th to ground floor (other than a small baby).  She could only fall to the third floor, though her head would have landed on the stair case below. I’m sure she was aware. So attention seeking through a suicidal behaviour?

Sometimes when it comes to mental illness (and I guess many chronic physical illnesses), family members get fed up and lose their patience after a period of time, due to the time, money and attention needed to care about the patient, but also the stigma that come with it. But without any support from close family and friends, it’s almost impossible for someone to completely recover from mental illness…

N.B. This was first posted at huibee.blogspot.com by the same author