Electroconvulsive Therapy

It’s been about a month since I started getting electroconvulsive therapy treatments (colloquially known as “ECT”), and I have to say I’ve noticed a big shift in the quality of my daily life. Before I get too far into what that shift is, though, let me tell you a little bit about ECT so you’re familiar with the process.

ECT is an antidepressant treatment that’s commonly given to people whose depression is medicine-resistant; in other words, pills don’t work. We are people who have struggled unsuccessfully to treat our depression with pharmaceuticals, often for a very long time. Don’t get me wrong; many people find great success in treating their depression with medicine, and it’s still the first-line treatment for anyone who is diagnosed with a depressive disorder. Some of us more unfortunate patients, however, seem to have a natural resistance to antidepressants. That’s where ECT comes in.

ECT is a recurring process in which a depressed patient is given general anesthetic to render them unconscious. Then, using electrodes placed gently on the skin, they’re given an electric shock, either bilaterally (on both sides of the brain) or unilaterally (on one side of the brain) depending on which kind of treatment the doctor deems appropriate. (I’d tell you which kind of treatment I get, but for the life of me I can’t remember. That’s one of the downsides of ECT.)

Then, due to the controlled electric stimulation – this is the critical part – the body experiences a seizure. This isn’t a scary seizure where the patient stops breathing or jolts around. Those things are controlled with an oxygen mask and muscle relaxant drugs administered intravenously. This is a very safe process.

Because of this (very well-controlled!) seizure, the brain naturally releases anticonvulsant chemicals to stop the seizing. This chemical release not only slows the neural hyperactivity associated with the seizure – it also acts as a natural antidepressant. (That’s why medicines like Depakote and lithium, which are anticonvulsants, are often prescribed to treat bipolar depression. Incidentally, that’s also why it’s important for ECT patients not to take those drugs less than twelve hours before they’re scheduled for electroconvulsive treatments. Because anticonvulsant drugs obviously inhibit seizures, they can interfere with ECT.)

Please bear in mind that it isn’t totally understood by physicians why anticonvulsant chemicals also have antidepressant properties. We have, however, observed beyond a shadow of a doubt that they are useful antidepressants, which is why ECT remains a popular treatment. Please also understand that the technology we use to administer “shock therapy” has improved greatly since the days of Ken Kesey and other authors who penned novels like One Flew Over The Cuckoo’s Nest that demonize medicine. The shock treatments given in those books are used as a punishment and a means of controlling insubordinate patients. Nowadays, by contrast, electroconvulsive therapy is a highly-regulated, opt-in, for-therapy-only treatment.

It’s also very effective. ECT has a high success rate, often clearing up depression when other medicines cannot. Since I started receiving electroconvulsive treatments about a month ago, I’ve found myself taking significantly fewer depression naps, concentrating longer on tasks that require my attention, and generally experiencing a better mood for longer periods of time. In fact, it has been several weeks since I would describe my mood as “despondent” or “miserable”, though those would have been accurate descriptions of the majority of what I was feeling prior to ECT.

The procedure is not without its downsides, however. I would be remiss not to mention the lapses in memory that accompany ECT, and the resulting difficulties that come along with them. ECT patients are heavily warned by their doctors that they shouldn’t drive while treatments continue for that reason: It’s extremely easy to forget where you’re going, even if the way is one you’ve driven many times before.

There are, unfortunately, other downsides of receiving ECT as well. Being subjected to general anesthetic always comes with certain risks. However, these risks are very slim, and most people consider the antidepressant benefits of ECT to far outweigh the dangers of being anesthetized.

Of course, there’s also the downside of waking up from general anesthetic. Doctors must be on standby to make sure ECT patients awaken slowly and safely from every procedure, and even then there’s no avoiding the inevitable confusion the patient experiences upon waking up after a treatment.

So, there are clearly many logistical considerations that must go into planning the ECT process. Patients must fast the night before each ECT treatment, and count on a reliable person to drive them to and from the hospital (or wherever treatments take place). It’s not a simple or uninvolved treatment by any means, which is one reason why it’s considered a second-line antidepressant option after the much more convenient pharmaceutical route.

ECT is also not without other side effects. Assuming a patient is able to healthily metabolize general anesthetic, there are still commonly-occurring adverse effects. Headaches, for example, are frequent, as are digestive difficulties, and cognitive side effects, which are all inconvenient at best.

Fortunately, these effects fade as treatments become less frequent. ECT patients are usually weaned off of the procedures slowly. They start at three or so treatments a week and then gradually decline in frequency until they only happen about once a week. I just recently started doing them weekly. If all goes according to plan, I should be completely done with the procedures very soon.

And I’ll be grateful to be done. ECT is an extremely effective antidepressant procedure and I’m incredibly glad to have been given the opportunity to do it, but the side effects are beginning to catch up to me. The limited mobility that comes from not being able to drive is frustrating, as are the slowed cognitions that are responsible for the extended break I’ve taken from updating this blog. Writing is everything to me, and taking a break from Miss Misery leaves my days empty of the contact I so value from my readers. Hopefully, ECT will continue to be an effective antidepressant treatment for me; just as hopefully, I won’t have to continue to do it for much longer, so that I can resume updating this blog.

If all goes according to plan, a shiny new version of me will emerge from these treatments, refreshed and ready to write. I look forward immensely to a long-awaited (and if I may say so myself, long-deserved) improvement in my quality of life. I anxiously await seeing the ways in which my writing reflects that improvement – just as I anxiously await seeing a world that doesn’t hurt for the first time since I was twelve.