My Doctor Gives Me Seizures – ECT

Originally published ProfessorPuig.com on March 7, 2020

Personal Experience with Electroconvulsive Therapy, or ECT

Content warning: ECT, needles, intravenous lines (including photo of a hand with an IV), some suicidal ideation

MY DOCTOR GIVES ME SEIZURES

Sorry; you have to understand, I’ve always wanted to start a conversation that way.  Then again, it is true–my doctor, a psychiatrist, applies electricity to my scalp until it induces a grand mal seizure, in the interest of reducing my chronic depression.  Don’t worry, I’ve been rendered unconscious for the event, with a nurse anesthesiologist at my side the entire time. They even give me a muscle relaxant, to prevent me doing myself harm while I seize.  

The idea of electroshock therapy was rendered in about as disturbing a scene as possible in One Flew Over The Cuckoo’s Nest, but today goes by the relatively-harmless Electroconvulsive Therapy, or ECT.  

The weird part is, ECT actually seems to help with my depression. 

My therapist swears she notices a difference, and in my current outpatient treatment, we fill out a daily “self inventory” form, including a brief sum that represents how in-distress we are.  My first week, I was consistently in the 30’s, the “not-ok” territory. Now, two weeks after ECT, I’m barely scoring above 10–in the “generally ok” territory.  

I am, after all, an experienced psych patient.  I was diagnosed with Major Depressive Disorder in 2004, and gained modifiers–treatment resistant, chronic–as time passed.  I’ve tried–and failed–a solid half-dozen SSRIs. I’ve received a genetic analysis specifically geared towards finding the right psychiatric medications, and now I take so many that my husband helps me load my pill-minder each week.  

And I get shocked.  

I have to speak lightly of it, because there’s still an aspect of it that, frankly, terrifies me.  I generally refer to it as getting zapped, and I generally expect to sleep most of the (or the entire) day of a treatment, which are thankfully fairly early morning.  

MY STORY 

I’ve noticed that people are generally reluctant to ask me about ECT, until I assure them it’s ok–I don’t mind teaching.  And then–oh, boy, do people have questions. What’s a treatment like? Why do I do it? Their (elder relative) got ECT and then dementia and then died.  What do I think of that?  

If they want to talk anecdotal data, I generally tell people that so far, it’s mostly a good thing for me.  It helps with the depression. One could make the argument that it’s saved my life. One shouldn’t compare one’s experience with ECT to a perfect life, but to the likely life without treatment.  I think it helps, and I think it’s worth the side effects (mainly memory loss, which is much less-bad the further-apart treatments are).  

Then again, before each treatment, a herd of patients–generally 5 to 8, maybe ⅓ younger folk (under 50) and the rest, older, file into the pre-treatment room, complete with recliners and a flat-screen television.  A good quarter of the time, we watch The Sandlot.  People generally don’t look happy.  Sometimes, to be perfectly honest, I’m crying in that pretreatment room.  It’s a bit embarrassing to cry while Frozen is on, but as heavy as I am, I’m not an easy stick (that is, it’s not easy to begin my IV before ECT).  Sometimes it involves digging, and rarely, they’ve tried my hands, which are significantly more sensitive than higher up my arm.  Plus, I still have irrational fears about anesthesia, which I can generally talk myself through, but oh, boy–combine general anxiety with a potential hand-stick, and I’m a sobbing mess.  

And then, after I wake up, I’m not crying.  I might be confused for a bit, but they don’t return me to my ride home until I can answer certain factual questions.  I recognize my husband after treatments, and sometimes even remember to text my parents that I’m alive before I crawl into bed.  I sleep 4-10 hours, wake up, eat something, goof around for an hour or two, then go to bed for the night. The next morning, I’m generally myself, but somewhat happier.  Less burdened, somehow.  

There are those that argue the memory loss is the only reason people experience relief from depression–they forgot why they were sad.  I’ve thought a lot about this, but my depression is genetic, entrenched within me no matter my life situation. I was depressed in high school, before I was diagnosed with anything.  I was depressed in college, in grad school, in medical school, as a teacher. Depression is always riding my back, encouraging me to hunch a little more, to worry, to cry… and ECT lightens the load.  

Here’s what psychiatry.org has to say on ECT.

I came across this article on myths about ect that I’m glad I read.  

Before we go on, I do want to make one thing clear: I believe in Psychiatry.  When I was a medical student, I was president of the Psychiatry Club.  

I know ECT is controversial, but I write from the perspective that it does help some people (*waves hand*) and is worth the risk of likely side-effects.  It’s really nothing like old movies portray. 

Some History

I’m one of a rare breed of teacher that doesn’t hate Wikipedia.  I used to, I’ll admit, but I think their history of ECT section is pretty good.  

FAQs about ECT

WHAT IS A TREATMENT LIKE? 

I wake up early–actually, I initially wake up around 3:30 to take my propranolol, because if I wake up later I generally don’t fall back asleep.  We try to leave around 5:30–ECT is generally first come, first served, which strikes me both as odd and as oddly fair. Whoever signs in at the lobby desk first generally receives treatment first, with rare exceptions: inpatients always go last, and if someone is losing their shit, they may get bumped up in line–this has been me before, and I swear I didn’t to it to cheat in line.  

So.  You sit in a common room and get vitals taken, including weight and blood oxygenation–so at least one fingernail needs to be polish-free.  Once the IV is in, you may get a bonus advance dose of headache medicine or anxiety medicine, depending on your individual needs. (I’m sure there are others; those are just my usuals.)  Eventually, they call your name, and you walk about 20 meters down the hall into the treatment room–relatively narrow, but space enough for a gurney, a CRNA, the psychiatrist, a nurse, and sometimes a medical student.  

Personally, I enjoy telling them I went to medical school, and watch them squirm as they realize medical students and psych patients can and do overlap.

Anyways.

You take off any jacket, hat, gloves, whatever you piled on to stay warm in pre-treatment while still having accessible veins (they’re less likely to aim for hand veins if you’re wearing gloves)–and take off shoes and socks.  

Lie down.  

People start reaching under your shirt to attach sensors, and some get stuck to your forehead.  Someone may move or adjust your hair without warning you. Earrings will be complained about. You chat, briefly, with the doctor about how life has been, so he can decide if treatments are the right space apart, too far, or possibly close enough and we can toy with longer.  He avoids questions about what the long-term plan is. Once, the doctor complimented me–at least, it sounded like a compliment, so I chose to take it that way–about requiring less electricity than most to induce a seizure. Another time, he complimented me on having a natural part in my hair right where the electrode needed to go–terribly convenient.  

You agree on a date, he writes it down, then someone covers your face with an oxygen mask and tells you to breathe slowly and deeply.  Within a few minutes, possibly with warning, the CRNA gives you the night-night drugs, and that’s it for a while.  

For me, it’s like being asleep for who knows how long, but I wake up much more confused.  The first thought I’m aware of, in hindsight, is when are we going to get around to my treatment?  I know they ask me a series of questions to see how conscious I am, and I do have a few memories of being terribly confused about what year it is, but mostly I don’t remember that entire part of the wake-up process.  As far as my memory is concerned, it never happened.  

I come to understand I’ve already received a treatment and that it’s ok to be confused, and eventually the nursing staff judges me fit to release on the world.  I’ve gotten a lot of treatments by now (March 2020 marks treatment #42), and my husband and my mother win the prize for driving me home the most often. I got treatments 3 times a week for a while in 2016 and 2018, but right now I’m getting treatments about every 3-4 weeks.  

I generally sleep the rest of the day, but I’ve heard rumors of people being active by that afternoon, or taking the entire weekend to get back to normal.  I am awake a few hours, in the evening, after a morning treatment–I eat something, read a bit, then go back to bed for a regular night’s sleep.

DOES IT HELP?

I’m not totally depression-free, but I’m also not actively suicidal–or passively, for that matter, very often at all.  And that’s a win for me.  

I still take antidepressant pills–yeah, more than one, at relatively high doses.  And anxiety pills. And I do phototherapy and schedule regular hard exercise and I journal like my life depends on it–and I’m always listening to rumors of new or potential treatments.  So, ECT is a big, scary part of my depression management regimen, but it’s a part that seems to help.

WHAT DOES YOUR THERAPIST SAY? 

She’s absolutely convinced it works.  She’s compared notes before and after a treatment and notices a definite trend.  She is on Team ECT.  

WHAT DOES YOUR SPOUSE SAY? 

He is willing to drive me to and from morning treatments, even if he has to get up particularly early.  He is, however, worried about my memory, and gets frustrated when I can’t remember things. Let’s just say: if my doctor said no more ECT, my husband would not be sad.  

What’s next?

I’m scheduled for another treatment later this week. Until then, I’m reading this book, The ECT Handbook, that I found on Amazon: https://ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ss&ref=as_ss_li_til&ad_type=product_link&tracking_id=profpuig-20&language=en_US&marketplace=amazon&region=US&placement=1911623168&asins=1911623168&linkId=21ea8eb1c6e717c734e20659041c66a4&show_border=true&link_opens_in_new_window=true

I’m especially interested in the chapter on ketamine, which is considered a “novel” treatment for depression.

Believe me, I’ll update you as I learn more. Until then, what do you want to know? 

As I like to say in class: questions? comments? concerns??