I survived suicide attempts

@jimhd did your doc explain why you would need to discontinue meds before trialing TMS?
Why does your wife oppose ECT and ketamine?
I would get your surgical records and bring them to your psychiatrist before trying any ketamine therapy. Like you mentioned before, it could be the dose. Or, it could be some other anesthetic problem. Sometimes it’s hard to parse them out since usually multiple types are used during surgery.
Benzos are usually contraindicated with ketamine but you’re still allowed low/maintenance doses.
Good luck with whatever you choose! I hope you have some good choices that help you. I know the financial, as well as practical, barrier to IV ketamine can be a big hurdle.

@mandrake70 that’s good to know about Spravado vs IV ketamine. I’ve heard/read the same thing. However as it has been mentioned, insurance only covers Spravado, so it’s tempting to switch.
I stopped IV ketamine for awhile last year to try a different oral medication and I got far, far worse. It took several ketamine treatments (plus all my other meds) to get back on track.

@mandrake70 Stopping the meds is the protocol for one agency I interviewed. They said that other groups might have different protocols, and I'm waiting to interview a second one.

My wife and adult children object to ECT because of the horror stories they've heard, even though those stories are a very small percentage of people who have the treatment.

I think they don't fully understand the effect MDD has on me. I'm too good at wearing the "I'm fine" mask, I guess. My wife asked me why I think I'll live with depression permanently. I told her that I had to accept that as a possibility a number of years ago. I think it's better than having false hope for remission.

Jim

@jimhd I would definitely get another opinion on stopping meds. I have gone to Mayo for IV ketamine and they helped me manage my meds before starting but certainly no blanket “stop all meds” (they had me start one, and stop another - not at the same time, it was a slow process to get everything stable). Just to let you know that this very reputable clinic doesn’t have you stop all meds. Even when I get treatment elsewhere, I continue to follow the Mayo protocol as far as dosing, and the frequency recommended by my Mayo psychiatrist.

Depression is often a horror story that only you see. I’m sorry that your loved ones don’t quite understand the depth of your suffering. It can be really hard to not be understood in that way. Maybe if you got a consultation for ECT and brought your wife along, the clinicians could reassure her it’s not like what is shown in the movies?
I personally have reservations about ECT because of the potential for memory loss, but otherwise it’s definitely on my list of things to try at some point.

@ashleyharris728 I've only interviewed at one TMS provider, and they hinted that others might have different protocols. That one would require tapering off Wellbutrin and Clonazepam. I take a number of others that I could continue taking. I'm waiting for another place to have an opening so I can hear what they have to say.

My wife did attend the appointment for ECT with me, and didn't express any serious concerns with the doctor. But after she talked with our kids she came up with a list of reasons for not doing it. Memory was the least of it. As a rule, it's short term loss of the time around the treatment. They hear the few horror stories and think that those things would happen to me.

So for now, I'm on hold with any new treatment like TMS. I'll just continue with all my meds and therapy, and hope depression stays level, without a suicidal component.

Jim

@jimhd @ashleyharris728 No idea if the memory loss I have is ECT or all of the meds the doctor had me on. Honestly, a toss up at this point. I have read Carrie Fisher's book on ECT and it did wonders for her. Not so much for me though. Still, a non-daily medicine that works would be amazing. I sympathize with you for having family that do not understand. I have a feeling you are greatfull that they don't understand exactly how you feel though. Last thing I would want is for my family to suffer from this crap.
Ashley is right that checking with other clinics is the best option. There are some new meds and a new version of TMS so potentially some help there.

@mandrake70 I know that TMS only works for some, but I've just been maintaining a tolerable level of mental health for a long time with medication and therapy, so if there's a possible treatment that helps me feel better, I'm open to it.

Unfortunately, living where I do, options are very limited. TMS and ECT are pretty much unavailable without a lot of driving. I'm fortunate to have a local therapist - who never stay long - and access to some good doctors, albeit mostly an hour away. So far I've only found one TMS provider within 30 miles, and they seem to have a long waiting list.

The advantages of living in a rural area generally outweigh the inconvenience.

Jim

I have attempted 3 times in 1992 as effects of brain surgery.... In fact I was developing Bipolar illness because of a chemical imbalance from brain surgery.
Most important of all, If you have suicidal ideations & are seeking serious medical help at the emergency department, be sure to admit to the staff there that you DO have a plan in mind, if you expect to be taken seriously or be admitted for any treatment! Without admitting you DO have a plan for your undoing you will not be taken seriously or receive any counselling to help you overcome your negative ideations. That I did in the long run and DID get admitted after saying I had a plan. I got the help I needed.

@micheljmarion198 going to the Emergency Room for suicidal thoughts does not always require an inpatient admission. Instructing someone to lie about their status in relation to their suicidal thoughts really obstructs them from getting the kind of help they need. If someone does not have a plan then they don’t need 1:1 observation or certain types of meds that might be utilized in this situation. The falsehood of the statement will eventually come out either in therapy, in group or through another patient. And once you’re found not to be truthful when you present yourself for help you will not be taken seriously or with a grain of salt. If you’ve encountered a difficult situation when trying to obtain treatment it’s no reason to create a worse situation going forward.