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I’m starting electroconvulsive therapy.
Before you ask questions like “Isn’t that the barbaric shock treatment from One Flew Over the Cuckoo’s Nest?” and “Are you sure you need to do something so drastic?” and “Shouldn’t you consider other options first?”, let me clarify one crucial thing:
Electroconvulsive therapy is completely safe and very effective for treating depression.
I also need it very badly.
I’ve been suffering from an extremely destructive mood disorder for ten years. I’ve tried something like 20 medications and been to half a dozen therapy groups. Nothing has worked.
For me, the pills follow the somewhat unusual but extremely well-documented pattern of working for a few months, then rapidly losing effect. Keep in mind, I’ve been on at least five medicines at a time since I was in middle school, and they all stop working at different intervals, which means I live in a perpetual state of trying new meds. As you can imagine, that’s a psychiatric nightmare of constantly shifting side effects and breakthrough symptoms.
Living that way prevents me from making any progress with a talk therapist. New problems in my emotional state crop up before there’s enough time to fix any of the issues I brought up in therapy last week. To see improvement, I’d need so much therapy that I might as well live in a psychiatric ward, which would be pointless anyway because none of the pills they’d give me would work, which means I’d still be a terrible candidate for talk therapy.
So, yeah, it’s time to try something new.
I understand there’s a lot of stigma and misunderstanding surrounding ECT. I haven’t told many people I’m doing it until now, but those I have told all looked mildly panicked when I broke the news. So, to address the questions I’ve gotten most often about the procedure:
What is electroconvulsive therapy?
In a nutshell, here’s how it works: After a thorough consultation or two with a certified psychiatrist, patients who qualify for ECT start by going to treatment three days a week. After a couple of weeks, they taper down to two treatments, then one, for a grand total of about six weeks of procedures.
At the clinic, patients are put under general anesthesia, and a controlled electrical pulse is administered to their brain through electrodes that stick harmlessly onto their skull. When they wake up about five minutes later (that’s it!), they’re carefully monitored by the medical staff for a little while, and sent home just a few hours after they got there (or back to the residential ward of the hospital where they’re staying, if they choose to do the procedure inpatient, which is common).
How does sending an electric current through a person’s brain treat depression?
In short, no one knows exactly why it works.
Here’s what we do know. Stimulating a brain with that much electricity causes it to experience a seizure, not unlike the ones that occur in people with epilepsy. Two relevant things happen when a person has a seizure. One, their brain automatically releases anticonvulsant chemicals to stop the seizing. Two, the cells themselves experience fatigue from firing more rapidly than they’re supposed to.
Either or both of these effects may be the antidepressant mechanism that relieves depression. Maybe the anticonvulsant chemicals a brain releases during ECT also positively affect mood (which would explain why anticonvulsant medications like Depakote are also mood stabilizers). Or maybe when brain cells become fatigued, the organic process of repairing them again actually makes them work better than they did before.
These guesses as to why ECT works on depression are extremely educated, but no one knows for sure what the explanation is.
We do know that ECT works. It’s been tested for decades and found to be extremely effective. An experienced doctor can even tell in advance for whom it’s likely to work best. (Interestingly, healthy older women with sudden-onset depression are the best candidates for ECT. But it’s still a good treatment for a variety of people.)
Some people find their mood only mildly affected by ECT, but others recover from depression completely. Its antidepressant benefits may last weeks, or they may be permanent. The rate of recovery is high, but personally, I think the best thing about ECT is that if its benefits wear off, a patient can go back at any time for just one session to rejuvenate their mood. If the treatment’s benefits don’t last, there’s no need for weeks of medication trials and unpredictable side effects. One day of treatment every few weeks can bolster a person’s mood again.
Barring circumstances where ECT doesn’t work at all, that’s the worst case scenario.
I cried with relief when my doctor told me that.
Okay, ECT works. But isn’t it dangerous?
Hardly! The way ECT is depicted in midcentury works of fiction is completely dated and inaccurate. Doctors don’t shock conscious people. They don’t damage brain tissue. They don’t let patients break bones on the operating table. ECT is nothing like a lobotomy.
Medicine has vastly improved since the 60s, as have laws about ethics. And after decades of careful research, ECT has never been shown to cause permanent brain damage. The brain cells it impacts spring back to life very quickly after being fatigued by the electrical current.
Surprisingly, in and of themselves, seizures aren’t actually that dangerous, either. It’s their unmitigated side effects that harm people – specifically, constricted breathing (which ECT doctors control by manually administering oxygen) and muscle spasms that break bones (which also doesn’t happen to ECT patients because they’re given anticonvulsant medication before the procedure to keep them still during the seizure).
Of course, there are risks every time someone gets anesthetized, but those are minimal and well-understood by doctors. Every patient is evaluated physically before every single treatment to make sure they’re well enough to receive ECT that day. If they’re sick or otherwise compromised physically, they’re sent home and told to return when they’re well.
What are the side effects of electroconvulsive therapy?
Unfortunately, there is one common side effect of ECT: short-term memory loss. Keep in mind, this doesn’t happen to everyone, and those who do experience it usually regain their memories a few weeks or so after the whole process is done. But during the months when the procedure is actively happening, the brain may not store new memories. While a patient may forget what they had for lunch the day before, they shouldn’t lose important memories from years prior, like weddings or the births of children.
Certain short-term memories, like how to get home from the hospital, may be lost temporarily. For that reason, people doing ECT shouldn’t drive or live alone while they’re getting treatments. My doctor recommends twenty-four-seven supervision for the duration of the treatments.
To put it lightly, losing memories sounds like a bummer, but as several doctors have pointed out to me, ECT patients don’t typically mind forgetting such a dark time in their lives.
Apart from short-term memory troubles, there aren’t any major side effects to speak of. Again, ECT does not cause brain damage. The electric current, the seizure, and the patient’s muscle contractions and breathing are all carefully monitored and controlled.
ECT can cause temporary nausea, headache, and muscle soreness, but that’s fairly easily controlled with medication, which is given routinely to every patient before each treatment. People with preexisting conditions, like seizure disorders or heart problems, are likely at higher risk of experiencing negative effects, but the ECT doctor should be able to manage those risks with them.
So ECT is effective and safe. Why don’t more people get it?
ECT is only approved for depressed people who don’t respond well to medication. Often, those people – like me – have been very depressed for a very long time.
When meds do work, using them is usually much easier than the hassle of driving to the hospital and being anesthetized several days a week. Plus, a pill regimen can be followed at the same time someone is working a job, going to school, caring for loved ones, or whatever it is they do in their lives. With ECT, everything gets put on hold, because patients can’t drive or live alone, and they have to be at the hospital so often. That’s why depression medication in pill form is our first-line treatment, not ECT.
ECT is not considered a last-ditch attempt at helping people because they’re hopeless, or because it’s experimental or dangerous. It’s just a very inconvenient treatment that’s reserved for those who are usually so depressed that they aren’t doing much anyway.
Is it good for anything besides depression?
Not really, unfortunately. ECT isn’t indicated for, say, any personality disorder, which is my diagnosis (specifically, borderline). ECT won’t help me build a core personality, or change any bad habits I’ve developed for coping with the things in the world that I find scary.
However, there is good news: a huge number of mental health disorders are related to depression, so that when you treat one, you indirectly treat the others. Two of the most common problems that co-occur with depression are anxiety and sleep issues. My doctor tells me that those are two of the best symptoms to watch to determine whether ECT is working: if sleep and anxiety improve, the treatment is probably effective.
My condition plagues me with a variety of problems that aren’t a direct result of depression. While ECT won’t heal any of those problems, it will target the depressive center of my disease. I hope that by cutting out the cancerous core of my illness, ECT will send healthy ripples through the rest of my life. At the very least, it should take part of the emotional burden off my shoulders, freeing me up to address whatever symptoms may linger.