Electroshock

Electroconvulsive therapy prep. Electroshock devices are used to treat some 100,000 Americans, reinforcing a deepening acceptance of ECT.                                                       

Editor’s note: The following is an account by a person who underwent electroconvulsive therapy, formerly known as “shock treatment.” The writer is a longtime contributor to El Paso Inc. publications. Her name has been withheld due to the story’s personal nature.

At the end of season one of the popular Showtime series “Homeland,” Claire Danes’ character Carrie Mathison receives electroconvulsive therapy, or ECT, as treatment for bipolar disorder.

In the episode, Carrie is in a hospital. She is placed under general anesthesia. Electrodes are placed on her head. A seizure is induced; her eyes tightly squeeze shut as it wracks her thin frame – but Carrie feels nothing under anesthesia.

This may stand in stark contrast to the image that comes to mind for many when you mention “shock treatment,” a term that has fallen out of favor in describing ECT. In “One Flew Over the Cuckoo’s Nest” the patient is strapped in, held down, and awake for the treatment. It is horrifying to watch. It was likely horrifying to experience, when it was administered this way decades ago. But today, the “Homeland” version is much closer to reality.

I can attest to that personally, as I was treated with ECT in 2010 for depression. Treated successfully.

In an America still reeling from the abominable mass killings in Newtown, Aurora and elsewhere – where the shooters’ mental health has been called into question and many are left wondering how they “slipped through the cracks” – the way we handle behavioral health in this country is under a high-powered microscope.

To say it is a complicated issue is a spectacular understatement. As someone who has struggled with depression and anxiety for years, I can tell you that the amount of misinformation, misconceptions and downright ignorance about mental health is vast – not just in the general population, but even within the healthcare community.

Maybe my story can shed a little light on one small part of this overwhelmingly broad issue. Maybe I can save someone else some of the heartache and frustration I went through.

Maybe.

I won’t bore you with my long, sad story, but let me at least provide some context.

As I mentioned, anxiety and depression have been my long-time companions – perhaps even since childhood.

In my mid-20s it became unmanageable and I went to see the first psychiatrist. He diagnosed me with bipolar II – which is heavy on the depression and light on the mania. What followed was 10 years of psychiatrists, therapists and a laundry-list of medications. Some helped a little; most did not. The side effects ranged from annoying to nearly incapacitating. I would get better – for a while – but then I would get worse. Sometimes I could hide it. Often I couldn’t.

Fast-forward 10 years and I’m in the midst of yet another depressive episode, but this time it’s different. There was no inciting incident – as there had always been in the past – no break-up, no loss of job, no death in the family. Everything was going along swimmingly – and yet I could barely drag myself out of bed to go to work, and was spending more time crying than not. The latest pusher (psychiatrist) had me on lithium and I felt like it was making things worse instead of better. The crying episodes at work were out of control. I couldn’t go on like that.

So, my therapist sent me to the bin. Loony, that is.

OK, that’s not entirely fair or correct, but I went there, not you.

For five weeks I went to crazy school … er, excuse me, outpatient therapy, at a lovely facility with a happy rainbow on the sign out front. Classes, group therapy, a case worker and yet another shrink. When I was told to write a letter from my inner-child in my left hand to my adult self, my inner child wrote the following:

Dear ***,

This is bull$#!%.

Love,

****

Group therapy is great. For some people.

For me?

Not so much.

Meanwhile, aforementioned shrink was doing his best to find a medication that would help me – but to no avail. I had already been thinking about ECT prior to going in the bin, but my last doc had discouraged me until trying more drugs. But by this point, I was at the end of my rope. I felt like ECT was my only chance at getting better. Thankfully, this latest psychiatrist, Dr. M (whom I still see today), was on board with considering ECT.

“By the time patients get referred to me from other doctors, they are usually desperate,” says Dr. Arthur L. Ramirez, medical director for University Behavioral Health of El Paso. He is the only doctor within 250 miles who currently administers electroconvulsive therapy. (Dr. Ramirez is not my doctor and has never treated me.)

“They’ve probably been on many different anti-depressants; maybe they’ve been hospitalized. There may have been suicide attempts,” he says.

Dr. Ramirez says it doesn’t have to be this way.

“With my own patients, I like to counsel them about ECT as we go along – let them know it’s an option. I don’t want it to be a last resort.”

Dr. Ramirez’s reasoning for this approach is two-fold. First, ECT is extremely effective. He put his success rate at 95 percent. By comparison, Ramirez says, antidepressants have about a 30-percent success rate. He also says the more antidepressants you try, the lower that number gets.

He says the majority of patients he treats with ECT are women, mainly because women are more prone to depression than men. He averages 6-10 cases a year, and says of late there’s been a resurgence of cases as ECT has gained positive media exposure recently, the tools have become more advanced and the technique refined.

“I’ve been using ECT since the mid-1980s, and in all of those years I think I’ve only had two or three patients who did not respond to treatment,” Ramirez says. He also notes that the older a patient is, the better she responds to the treatment.

In July of 2010 I began my ECT treatments with Dr. W, to whom I was referred by Dr. M. Dr. W was essentially my mechanic. He tuned me up. Three times a week for four weeks – essentially, the entire month of July – I would go to the hospital first thing in the morning and be admitted. The nurses would put in the IV. I would talk with Dr. W briefly before each treatment about how I was feeling. The anesthesiologists were great – always talking with me before each treatment to see how I was doing with headaches, nausea, etc., and adjusting the medication accordingly.

They would roll me into an operating room of sorts – even though there was no operating going on, per say. At the time I actually looked forward to the treatments; or at least the anesthesia. That cold liquid would go in my arm, and then burn … and be followed almost immediately by a complete loss of consciousness, which I welcomed. If I dreamed while I was out I don’t remember it. It was nothing – and at that point, all I wanted was nothing – not the despair and frustration that had become a constant static in my head.

I would wake up in recovery, somewhat disoriented and usually with a BANGING headache. I would typically go home and sleep that afternoon. I couldn’t drive and had to have someone stay with me. Patients undergoing ECT tend to be forgetful – we might leave the stove on or the bathtub running. Patients often experience retrograde amnesia and for my part, much of July and chunks of June and August of that summer are either fuzzy or missing entirely.

The first two weeks I felt no different, except now I had a lot of headaches. Somewhere around the seventh (eighth? Ninth?) treatment, though, it was like someone flipped a switch. I woke up in recovery and wanted to go to aerobics class. I hadn’t been to aerobics in months – but prior to the onset of the depression I would go every Monday evening at 5:30 p.m. So I went. (Well, actually, my mom took me. And thank all that is holy for my mom during the whole process – but that’s another article entirely.)

There are no hard and fast rules with an ECT treatment plan – treatment is somewhat of an art form. The number of sessions, the amount of electricity used, and other nuances are up to the doctor’s discretion. My doctor prescribed 12; I completed all 12. And it took several weeks after that before I started feeling “normal” (what passes for normal in my world) again.

Dr. Ramirez tends to use eight, and he says he usually starts to see results around session four or five.

ECT is not a cure. It essentially breaks the cycle of depression. “No one exactly understands why it works, but this is what we do know,” Dr. Ramirez says.

“ECT induces a seizure that effects the neurotransmitters in the brain,” he says. These are the same neurotransmitters that antidepressants affect. “ECT showers the neurotransmitters, and changes the blood-flow.” The result – the depression (usually) goes away.

Can patients relapse? Yes, it is possible. In my case, I have not had a major depressive episode since before ECT in the summer of 2010. More than 2.5 years. The longest depression-free period in my life. I am on medication and probably will be the rest of my life. I’m OK with that. It’s been the same medication since the ECT was completed. Dr. Ramirez, along with my doctor, both say the chance for relapse diminishes if you stay on maintenance medication.

If I relapsed, I would do it again in a heartbeat.

Or in a brainwave.

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