I have an evaluation for ECT next week, but have major reservations
I have dealt with severe depression, OCD and anxiety for over 10 years. My depression has only gotten worse. I have done all standard treatments and therapies, med augmentation and off label meds. I have done trauma therapy, ERP, ACT, CBT, DBT, somatic therapy, vagus nerve exercises, yoga. A bunch of things I have not listed here. I have done intramuscular ketamine assisted therapy. About 14 ketamine injections and therapy sessions. I have tried like 10 different supplements. For the past few years I have abused any substance I was able to get my hands on. Alcohol, Kratom, phenibut, nicotine, caffeine, DXM. I need it to be clear that I only started abusing these substances a few years after starting to get treatment.
So, all this led me to kind of obsessively research interventional psychiatry. ECT is the most effective treatment that is more or less widely available.
I did consider standard TMS but felt that the response rates were not worth the effort. Accelerated TMS on the other hand has very good response rates and potentially even better response rates than ECT. The problem being that accelerated TMS is not covered by insurance and so it would be self-pay. The place near me that does something similar to SAINT TMS is $9,000. The only way I would be able to do that is by starting a go fund me. Even if it works, it's likely going to have to be done again sometime down the line when the effects fade. It may be possible that my insurance would cover theta burst TMS which the timeline is somewhere in between accelerated TMS and standard TMS, but it does not include the fMRI guidance.
Next week I have an evaluation for ECT. They do both ultra brief pulse and right unilateral ECT. I want to hear about your experiences with ECT and if you did ultra brief pulse alongside bilateral or unilateral ECT.
I am very wary about ECT, but I am unsure if that is a result of my severe anxiety.
I have also considered something like VNS. Even though its moderately invasive and requires surgery, it still feels less scary than ECT. Although it takes a long time to start working.
I am lost on what to do because I need treatment soon or I will continue to abuse substances until they kill me.
TLDR
If you have had ECT what is your experience with it? Any long-term cognitive effects? Did you get bilateral or unilateral ECT? Did you get Ultra brief pulse ECT?
If you have had the VNS surgery, how did that go for you?
What other options might I have at this point?