Me and ECT

Today's post was inspired by a blog posted today on the Dr. Shock MD PhD blog. Dr. Shock has a very interesting blog on which he addresses Treatment Resistant Depression and Electroconvulsive Therapy (ECT), among other fascinating things. Today on his blog he has posted videos by people who have first hand knowledge of ECT, because they have received ECT treatments.

I did not create a video when I went through my ECT treatments, but I did the next best thing; I wrote about my experiences with ECT on a Bipolar/Depression Discussion Board as I was going through the 8 treatments I received.

After viewing the videos on Dr. Shock's website I went and found those old posts and I thought I'd share them with you:

written 1/18/2004

I will be in the hospital all this week (voluntarily) to receive the ECT treatments Mon, Wed and Friday, then I will go home for the weekend and, if all is working well, will go back to the hospital the next week. I am able to leave the hospital on non-treatment days so I will update the group if I can on those days. If not I will do so on the weekend.

My 1st treatment was Friday. As my brain is super important to me I had all sort of concerns about the procedure and its effect on my intellectual abilities. I read tons. The document on this website: http://www.mheccu.ubc.ca/ has lots of info. The Drs told me that I may have some short term memory loss for around the time of the treatments, but that most of those would come back within a few weeks of the treatments ending. The literature and studies I have read say the same thing.

On Thursday, I was given a physical, blood work, chest x-rays (I had a cold) and they checked my heart with a heart monitor. I met with an anaesthesiologist to discuss the process. She said I would be under anaesthetic for approx. 10 mins and would be given a muscle relaxant so my body would remain still through the process. The Dr who does the actual ECT then visited me and I asked him tons of questions. He calmed my fears about my brain and the process.

On Friday morning at 9:30 I went into the treatment room. I panicked when I saw the Dr and nurses...thoughts like, "I think I've made a mistake, I don't think I want to do this, I'm scared", were going through my mind. The anaesthesiologist held my hand and said, "it's okay [Aqua] we are all here to make sure you are safe". I was still terrified, but that made me feel better.

The next thing I knew I woke up to the sound of myself crying (I had been crying as I went under the anaesthetic. The doctor said this sometimes happens during the first treatment). For a few moments (seconds) I was pretty scared. It felt like I was in a nightmare crying and trying to get up, but my body was still asleep. Within a few seconds I opened my eyes. I felt really drowsy and it took maybe 3-4 minutes for me to fully come to. I was in the recovery room, it was approx 10 minutes after I went in for the treatment. They took me back to my room and I rested for about an hour. I then got up, had breakfast and woke up a bit more.

At 1pm my husband came and took me out for a walk and some lunch for a couple hours. I really enjoyed the walk. The rest of the day I had a bit of a small headache and some muscle tension. All in all I felt pretty good. In fact by the evening my mood had lifted considerably. Dr said this might be a placebo effect as the treatments generally take 3-4 treatments to start working.

I haven't had any memory impairment from the 1st treatment and I feel much more confident about tomorrow's treatment.

written 1/20/2004

I had my 2nd ECT treatment yesterday. I was quite a bit calmer as I knew what to expect. I will find out the name of the muscle relaxant for next time I write here. Yesterday I did not have the crying when I woke out of the treatment. It took a bit longer to come out of the anesthetic, so they may have given me a bit more relaxant than the time before.

I was a bit more confused yesterday while I was coming out of the anesthesia. For instance forgot the nurse had given me my medicine, forgot when I had come back to my room. Every once in a while I can't find the word I need to complete a sentence. All in all though it hasn't been that bad and I don't think someone who didn't know me would even notice.

My mood feels quite a bit up today. I visited with my regular psychiatrist today and he said it is probably too soon for this to be the result of the ECT treatments. Generally it takes 6-8 treatments to feel better. It may be that I feel much better on the mood disorders ward than I ever expected to feel. I feel safe. I thought I would feel bad about being here [in the hospital] (i.e. like I'd failed, I was never going to get better etc.). In fact, I feel like I can be me for the first time in a long time.

[At this point in my posts on the BP Discussion Board a member posed a question]
1/24/2004

"Dear Aquamarine,
You don't give all that much of your history - 2 1/2 years of trying various antidepressants doesn't seem all that long - personally, I would rather keep trying other treatment options. Have you tried cognitive therapy, or some of the older antidepressants?
You must be in a lot of pain to risk permanent brain damage. Hope it works out for you.
Best Wishes
V"

written 1/24/2004
[My Response]
Hi V,

I have been struggling with my depression for at least 20 years. I have been through so much, and so many kinds of therapy and nothing has worked. I do not believe I am risking any kind of "permanent brain injury". I did not take this step lightly. I read tons about the procedure. I asked lots of questions, I spoke with others who had gone through it.

[Also, in my city the Mood Disorders Ward/Clinic is at the forefront of research on depression and bipolar disorder...this, along with the fact that they treat so many people with depression and bipolar disorder, and the fact that I trust my own pdoc's opinion 100% made me confident I made a sound choice]

I have been in the...hospital for a little over a week now and it has been a great experience. I cannot believe how much better I feel. The ECT has given me back my hope. I can see that there is something to live for. I was getting pretty desperate before I went into the hospital. I couldn't keep going the way I was.

I have had 4 treatments now. I am having some short term memory difficulties. For instance when I came out of the anaesthetic yesterday I had no idea where I was, or who the nurse was. Once they told me it came back to me. I have taken to writing my plans in a daytimer because I cannot keep everything straight in my head like I did before.

This is a small price to pay when the reward is feeling like living again. Over the past few days all my suicidal thoughts have disappeared. I feel hopeful again. I feel like I have been given back my life. This has been an incredible experience for me...and I hope others might consider this path when they see how it has helped me.

written 2/17/2004

It has been two weeks since my last ECT treatment. (I had 8). I have had very little memory loss. Maybe just a bit of confusion about things that happened around the treatment times, but even then I do not feel I lost much, and nothing that important. When I came home my Pdoc started me on some lorazepam to help me sleep(because I have been so anxious and wired for so long) and lamotrogine to stabilize my mood.

Before I came home I had a bit of a hypomanic episode for 8 days in the hospital (1/2 way through my treatments). I thought it was the ECT, but the Pdoc said no way, not so soon. Anyways, the day of my last treatment my mood crashed ...This is usual for me as I have been rapid cycling for a couple years now.

I went through one week of really bad depressive symptoms, then voila, my mood lifted and I feel AWESOME!!! Maybe verging on hypomanic, but that feeling you get when everything is perfect. I have tons of energy. Tore my house apart, from top to bottom and cleaned it like crazy. I've been going out with friends and generally feeling like life is so good. It has been 5 days of this incredible feeling. Everyday I have been waking up and thinking, "Am I okay still?" Each day I breathe a huge sigh of relief when I realize I still feel WELL...Please, please, please, let this last!!!

written 3/16/2004

[In response to a later question]:
I had 8 ECT treatments..(each Mon, Wed and Fri for 2.5 weeks). Since my last ECT treatment approx 2 mos ago 2 things have happened:

1. It appears the ECT helped medicine finally work. The medication I am taking (Lamotrigine, Lorazepam and Trazadone) seems to be working. I had tried the lamotrigine before and it had not worked. ...(I have tried so many meds. without success...it would make your head spin if you saw the list!!!)
2. I have had more GREAT or GOOD days in the past 2 mos. than I have had in the past 2 years. There has been a lot of really rapid cycling with my mood since the ECT, however:

• My "downs" are not quite as low as they were before..3 or 4 on a scale of 10 vs. my lows (before 1 or 2 out of 10)...10 being manic/1 being suicidal
• My downs are definately not lasting as long as they were before...usually 3-4 days then I go up again. (my ups have been high, but not TOO high!)
  

My theory:

• I may be cycling because my meds are trying to lift me out of a very long-lived and very awful depression.
• I get up, but my brains natural tendency is to take me back to what I am used to (i.e. Major Depression).
• I've used the learning to ride a bike analogy before(cycling...ha, ha): Each time I get on the bike and try to ride I get a bit better, and go a little farther, but I fall down a bit before I take off and KNOW how to ride!
  
  One really important thing for me is the fact that I do not feel like I have lost any of my intellectual or cognitive capabilities at all. I have had some memory loss, but nothing that I have felt was important. In fact I think when I am depressed I have a much harder time remembering things. For me, ECT was a godsend. I cannot believe my progress since I left the hospital.
  
  written 4/14/2004
  
  Couple things about my experience following the procedure:
  
• I was having many good/great days following the ECT...for approx. 1.5 months.
• I did however rapidly cycle up and down. I tend to cycle, but in the past my cycles had been tons of depression, with a day or 2 a month being okay.
• After ECT I had more okay/good days than bad for approx. 1.5 mos, but cycled up 4-8 days, down 2-4 days over and over.
• For the month or so following the treatment I did not see much memory impairment...
  I am now having a bit of difficulty in that area (remembering words sometimes, or someone telling me something and two seconds later it is gone...

HOWEVER... I'm not sure if these were caused by ECT because:

1. Could be side effects of the meds I have been taking for my depression / anxiety (one of the side effects of ativan can be confusion/attention difficulties).
   
2. I also broke both elbows in the interim, so that stress and all the pain meds I have been on may be contributing to these difficulties.
   
3. I have had to withdraw from all sorts of pain meds and I am withdrawing from my ativan right now...this is/has been hard.
   
4. As well, I am depressed again...so that can cause memory/attention dificulties.
   

Sorry I cannot be more definitive about the ECT and how it affected me...
All in all...I think it was worthwhile and I am hoping that once the pain, frustration and limited mobility caused by my toasted elbows disappears, that my meds will work again. I do believe the ECT helped the Lamotrigine work for me...a miracle given I have tried 20 different medications with no success.

Written today:

The Lamotrigine did not work again, and was causing balance problems, so I stopped it. I would definately try ECT again if I needed to. This time I would ask for maintenance ECT, where they give ECT once a week, then once a month and maybe even less frequently, in order to keep the depression at bay, or the medications working. I am confident it was, and is, a good treatment option for me.