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Are You Shocked That I Got Shocked?

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I'm still shocked that I had the guts to request ECT, otherwise known as electroconvulsive therapy or electroshock.  (Yeah, I like the third term "electroshock" best...NOT!)  There was nothing other than pure desperation that drove me to do something so frightening.

It was January of 2009.  I had been diagnosed with bipolar disorder two years before, and I was teetering on the edge of sanity.  Then my father died.  My relationship with my father was a close one, and I loved him unreservedly.  His health had been failing for several years before he passed away, but each time it seemed that he reached his end, he'd make a miraculous recovery.  No matter how many remarkable recoveries Dad made, I knew that it was inevitable that I would lose him forever.  I had been dreading his death every day since he became frail in his seventies.

Dad never liked to talk about death, unlike me.  I enjoyed discussing death, generally speaking, that is, and especially the afterlife.  I considered Elizabeth Kubler Ross, a pioneer in near-death studies ("On Death and Dying") and Dr. Raymond Moody ("Life After Life") to be among my favorite authors.  Dad, an avid reader, wouldn't have allowed me to discuss either of those books in his presence.  When I got the phone call that Dad died exactly the way he had feared: alone in a mediocre assisted living center, I became catatonic.  My depression plummeted into depths it had never reached before.

I had experienced the death of one other very close relative, my Granny, and while I fell into a clinical depression after she died, I was able to function more or less.  Not so with my father.  I asked to go to a hospital that had a locked-down mental health unit.  When I was hospitalized there, my depression was so severe that I felt passively suicidal - I had no plan, but I felt utterly devoid of hope.

Prior to this hospitalization, I had demonstrated that I was medication-resistant, meaning I had tried a plethora of mood stabilizers, anti-psychotics, and anti-depressants and none of those medications helped to lift my depression.  At the hospital I was given the option, which psychiatrists offer to their medication-resistant patients: electroconvulsive treatments, a.k.a. ECT, in which seizures are electrically induced in patients who are given general anesthesia and a muscle relaxant.  Along with so many people in our modern society, my first association with ECT was a photo of Jack Nicholson's character receiving it in the Academy Award-winning film "One Flew Over The Cuckoo's Nest".  I had never read Ken Kesey's book or seen Milos Forman's movie, but I had a very negative impression from viewing that disturbing image of Nicholson's grimace.

In my late twenties, after being diagnosed with clinical depression, I found a beautifully written book titled "Undercurrents" in which the author, psychologist Dr. Martha Manning, fell into a depression so deep that she opted for ECT.  The treatments helped her enormously, and while she struggled after ECT with fatigue and short-term memory loss, she made it clear that it was the right, lifesaving choice for her.  I loved that book so much that I contacted Dr. Manning for an interview for an article I wrote.  My "Shades of Gray" piece examined the connection between depression, women and exercise for the sadly defunct "Fit" magazine.  It was an honor to interview her. I kept our topics to exercise and depression only, for at that point I never imagined I would need, let alone demand, ECT.

When ECT was presented to me as a viable way to recover, I vaguely remembered Dr. Manning's book and I said, "Do it." I didn't care about its risks, I didn't care about anything. To say I felt desperate was a massive understatement. My psychiatrist “Dr. C.” told me that I would have unilateral rather than bilateral ECT, which meant that the electrodes used on my brain would be placed on one side of my head instead of both sides.  This meant for fewer side effects, most notably less memory loss.

The ECT treatments started promptly at the grisly hour of 6:00 a.m. in the unit used for outpatient procedures and ECT.  ”B.”, a longtime hospital aide who was compassionate, rolled me up to the floor above my room in a padded gurney.  If I had to be taken up to ECT by anyone, B. had the perfect kind of personality for the job.  After he dropped me off in a small, curtained room, I was prepped by a friendly nurse who immediately saw how down and scared I was and she did her best to set me at ease.  She started the I.V. line that would be used to inject me with general anesthesia.  I've never had a problem with needles or injections, so that did not faze me one bit.  I was looking forward to oblivion very much, thank you.  At 6:10 a.m. in walked Dr. C. holding a coffee mug, accompanied by an extremely handsome anesthesiologist.  (Even though I was in a depression-induced stupor, I was able to notice physical beauty.) Dr. C. gently placed several electrodes on my scalp and temple...it was no big deal.  A small, clear gas mask was placed over my nose and I remember finally being able to relax.  I wasn't scared at that point; I felt like I was being taken care of and I genuinely liked the staff surrounding me.  The anesthesiologist said "Count backwards from 10", which I started to do.  I reached "5", and boom!  I was fast asleep.  I didn't feel a thing. There was no pain.  Not during, and not afterwards.

When I woke up within the hour, I was a little groggy at first, but then I was completely coherent.  I was fed breakfast and I had the appetite to eat it.  My short-term memory loss was minimal.  While I was still heartbroken over the loss of my father, I definitely felt better than I had before and with each treatment I felt a little better.  After my week at the hospital I had additional treatments as an outpatient.

I firmly believe that ECT saved my life, and it was completely worth the risks in my case. My health insurance covered most of the procedures' cost, and I was able to arrange an extended payment plan for the remaining balance. 

Since I had the treatments in 2009, I have learned of another procedure used to treat major depression called transcranial magnetic stimulation, or TMS. Wikipedia defines TMS as a "noninvasive method to cause depolarization in the neurons of the brain. TMS uses electromagnetic induction to induce weak electric currents" and no anesthesia is required. Last month I read a book about a woman's experience with TMS.  After she made a suicide attempt, she was hospitalized and then tried many medications to no avail.  Finally she opted for TMS, which lifted her clinical depression.  (To read this fascinating memoir, check out "3000 Pulses Later" by Martha Rhodes.)

One important distinction between TMS and ECT (which have comparable success rates) is that with TMS one must commit to almost daily procedures for up to six weeks.  The good news is that the patient can drive back and forth to treatment unlike with ECT, in which a ride must be arranged due to the anesthesia. However, TMS does not usually start working until midway through the four-to-six-week series. ECT can cause the depression to remit much sooner than that timeframe, like it did with me.

Depending on one's situation, it would be most worthwhile to closely examine both ECT and TMS pros and cons before undertaking either treatment.  ECT is an enormous commitment and for many people it requires a major leap of faith.  It's expensive, even with health insurance.  (TMS can be costly as well.) Moreover, there are risks when undergoing any kind of anesthesia, or when subjecting oneself to potential memory loss.  I don't mean to sugarcoat what I had done to my brain by any means. Although ECT has been around for a long time, the brain is still mysterious in many ways, and doctors don't know all the consequences of such a serious procedure.  However, for me, I can unequivocally state that doing ECT was the best decision I ever made.

To read more of Dyane's writing visit her blog "Birth of a New Brain -

Healing from Postpartum Bipolar" at www.proudlybipolar.wordpress.com

Comments

Thank you, International Bipolar Foundation, for publishing this blog! I just received the following Facebook comment about this post from a wonderful anxiety expert/author named Lucinda Bassett. I am thrilled....so Lucinda Bassett, author of "Truth Be Told" and the bestselling "Panic to Power", wrote: Thanks for share the info. on the International Bipolar Foundation...what a great resource. Your blog was so interesting and I do admire your strength and courage to find the help you needed...ECT has come a long way. I know your willingness to share your experience will help so many. It sounds like your father was an amazing man. I appreciate your feedback. I believe we are all in this together. You are an incredible woman...so glad our paths have crossed:)"

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