I’ve had a request for more information regarding my experience with ECT (Electro Convulsive Therapy). So I think the best way to go about this is start with my recollection from the time I walk in to the time they roll me out of the department. Please excuse the absence of humor in this particular post – there is simply nothing (ok, practically nothing) humorous about ECT. But as I mentioned in my previous post, I think it’s important to know what to expect before making the decision to proceed with this treatment plan because it’s a huge decision, possibly a life-altering decision. So follow me through.
You don’t eat the morning of the treatment, for anesthesia’s sake. So try to make an appointment for the first half of the day if you are anything like me and have no will power when it comes to saying no to a snack. My doctor operates out of the local hospital so I usually get a ride there about 15 minutes before my procedure is slotted to start. About three hours before my appointment, I put a Scopolamine patch behind one of my ears. This is a prescription patch that is used to combat motion sickness (I’ve seen them behind the ears of cruise ship passengers). However, after applying this patch you won’t be able to drive because it makes your vision a little blurry. But I can’t go without it, learning that one the hard way.
When you arrive, you might be given a “depression index” test. This is a series of multiple choice questions whose answers the staff uses to gauge your level of, well, depression. A question might be, “I do not feel sad today”, “I feel sadder than usual today”, “I have never been so sad”, and you color in the corresponding bubble. The staff adds up the “points” assigned to each question and provides your administering doctor with a score which they compare to previous scores to help determine your frequency of treatments.
The nurses take my vitals, test my memory with little quizzes (this will affect you after a couple of treatments), and give me a syrup called Theophylline which I believe is intended to increase the severity of my seizure once I’m “under the buzz”. The Theophylline can induce a little temporary nausea. Shortly after that, I drink what is possibly the NASTIEST tasting liquid ever to pass through my mouth. It’s called “Bicitra” and it’s intended use is to reduce stomach acid. Frankly, I can’t see how it doesn’t increase stomach acid because it is so unbelievable nasty tasting. I swear it’s increasing stomach acid because it makes my belly toss and turn. But if you’re lucky, you will get a tablet of Phenergan to put under your tongue immediately following the Bicitra and that will help get rid of the taste. Phenergan is like Dramamine.
You might have to change into a hospital gown and you will probably be given a stretcher all your own. My nurses start an IV in one of my arms while the effects of the oral meds kick in. I cannot continue without mentioning that the nursing staff at the hospital where I receive treatment is beyond remarkable. They are so kind and compassionate. They always remember my name, greet me with warm hugs and smiles. Now, this could just be because I’m part of some secret “frequent flyer” program they’ve established and I’m one of their best customers. But I’ve been told that my 40 visits in 18 months is nothing compared to some patients, so I’m going with the fact that they’re simply an amazing staff that cares deeply for their patients and truly recognizes the importance of their jobs in their particular department. Anyway…… Next, my amazing staff waits for the bell. Not like the Wall Street bell, more like the school bell my third grade teacher had on her desk. When the doctors are ready, one of them rings this little desk bell signaling that it’s time to wheel me in. (The bell cracks me up – it’s one of the only funny things about the whole experience). Then I get wheeled into “the room”. In my case, “the room” is a treatment room about 15’x15′ filled with beeping noises and flashing lights. I get wheeled in on my gurney and as I enter “the room”, all I see is ceiling. The nurse calls out a time to the doctor: “Time in: 9:35am”. That always reminds me of that TV show, “ER”, when Julia Margulies’ character would call out a time to announce “time of death”. It was unsettling the first time I heard her do it, but I’m trying to add it to my list of things that gives me a little giggle.
My anesthesiologist is fabulous. I’m going to call him George Burns in an effort to protect his superhero identity. George Burns not because he looks like the guy, but because he has that same raspy voice and dapper dress code. And he is in charge of making sure I feel nothing while sleeping like a baby. He is officially my best friend in “the room”. Not to mention his excellent taste in music: his iPad hangs on the wall and “the room” is filled with George Burns’ selection of the day. It all sounds like “Dueling Banjos” to me, but it is usually some funky bluegrass tunes that he keeps cranked to cover up the sounds of the beeping machines. I fall asleep to that music.
George Burns hangs my IV and pokes around for a good vein while my ECT doctor gets my update on how I’ve been doing, checks out my depression index and starts attaching very cold electrodes to my face and torso. I’m going to call this guy “Ted Danson”. Picture tall and handsome with glasses, gray hair and blue eyes. So, not “Cheers” Ted Danson, but a younger version of the “CSI” Ted Danson. Anyway, Ted Danson is a psychiatrist with lots of impressive degrees hanging on his wall, a potty mouth and a gentle bedside manner. He is the guy with the electricity. For the next few minutes, while I’m getting hooked up, I try to maintain my composure when truthfully, I’m scared shitless. In a couple of minutes, I’ll be unconscious and at the mercy of Ted Danson and his power. Literally, power.
The rest goes quickly. George Burns lets me know when I’m nearly out by saying, “See you later. Here you go”. And there I go. For me, I can feel the anesthesia enter my brain first. Have you ever seen “Lost”, the TV show from a few years ago? There was this black mist that traveled through the jungle in kind of a tube. I think they called it the “smoke”. For me, that’s what seems to enter my brain through my ears as I realize I’m falling unconscious. This thick, black mist comes through on each side of my head and fills my brain with a viscous fluid that eventually covers my eyes and my thoughts. My depression used to enter my brain in much the same way. Of course, that isn’t really what’s happening – simply my perception. I can hear the “Dueling Banjos” in the background and the sound of the doctors conferring with each other, the sound of my nurse’s voice speaking with the doctor as she makes the final preparations. From what I’ve been told, a mouthguard is inserted between my teeth to keep from either biting my tongue or cracking my teeth. A monitor is attached to the big toe on one foot, it’s purpose to track the intensity of my seizure. I have my very own little oxygen mask, although I’m not sure when they use that. Ever had an ultrasound? Are you familiar with that gooey gel they rub on your belly to help transmit the picture of the fetus? (If you’re a guy, this means nothing to you…..). Well, that same kind of gel is spread over one ear and on the crown of my head, because it is there that Ted Danson attaches the transmitters of electricity. The gel helps increase the effectiveness of the conduction. I’m pretty sure there’s an official, medical term for that apparatus, but I don’t know it. In fact, I don’t really want to know much of what happens after I’ve been knocked out. I know I receive a jolt. I know that if it works correctly, I am forced into a seizure for what I believe is less than a minute. If all goes well, that seizure is enough to shake things up in my otherwise unstable brain and that it’s typically enough to make a big difference in my, well, my mindset. I know what does NOT happen. My hair doesn’t stand on end like the Bride of Frankenstein. I don’t sit straight up in bed when the electric shock enters my body. I don’t scream with my eyes all aglaze. I believe my body tenses, but I don’t leap off the stretcher or arch up off the plane of the bed. I once asked George Burns if he watches “Homeland” and if ECT is anything like what Clare Danes’ character receives in the last episode of the first season. He laughed, said her character is annoying and he doesn’t like how she portrays a bipolar patient, and that no, ECT doesn’t really look like that.
I wake up within half an hour or so of the procedure. I’m groggy and drousy and the time passes pretty quickly. After my very first ECT, I vomited. I felt awful. That’s gotten better with each treatment. I’m offered gingerale and some Vicodin in anticipation of what typically is a horrific headache later in the day. I’m nauseous. I’m very unsteady, because the gingerale ends up in my lap half the time. I’m sitting up and fully dressed (don’t wear shirts with buttons – the nurses’ worst nightmare when trying to dress an unconscious patient!). And I’m ready to go home. If you are undergoing ECT as an outpatient like I am, you might be allowed to go home within an hour or two of your procedure. I am wheeled out in a wheelchair to where my ride is waiting. In my case, my “sort-of husband” picks me up because he’s the only person who can support my weight going up the stairs to my bedroom, where I will spend the rest of the day. The 15-minute ride home is the worst part of the whole ordeal – I feel motion sickness and I can hardly hold my eyes open. I do not ever remember any conversations I have on those rides home. When I get to my house, he has to get me to bed and usually it’s best if I drink a big glass of water and have a small snack before falling asleep. I will typically sleep 3-4 hours, after which time I have a pretty bad headache and am starving, but other than that, I feel pretty good. I think before my first treatment, I was most concerned with how I would feel later in the day. Surprisingly, I can usually eat dinner with my kids and even sit up and watch TV with them or hold a real conversation. The recovery is not bad. Not bad at all.
So, what to expect following ECT is also what nobody shared with me. If you wear the Scopolamine patch, take it off a few hours after ECT because it will start to affect your vision. I don’t know how cruise travelers wear those things for three days at a time. Also, I usually wake up the day following my treatment feeling like I’ve been hit by a truck. Or maybe like I’ve worked out really hard, but since I don’t ever work out I’m just guessing what that might feel like. Every muscle hurts. I believe that is as a result of my body tensing during the seizure. I ache quite badly for about 24 hours, and then I feel OK. The headache is gone by the next morning (which I believe is as a result of the anesthesia and has nothing actually to do with the shock), and I am back to performing my normal daily tasks the next day. The biggest issue I have noticed after 39 visits to ECT is my loss of memory. And it happens pretty quickly. Often, the day after ECT is a loss to me so I try to write down anything important I might have done. I constantly send myself emails because I’m afraid of what I’ll forget. Ted Danson told me that I can expect loss to my short-term memory, and that not all patients experience this loss. My memory loss has been quite remarkable. I have, essentially, forgotten most of 2011 and have not gotten it back (yet). Ted Danson said that most patients with severe memory loss regain a good percentage of their memories within a year or two of having started ECT. For me, it’s been 19 months and I’m still waiting. However, I had a spectacularly good memory prior to ECT. Blackmail-worthy, really. I remembered EVERYTHING from every little corner of my life. And now I remember very little that happened in recent months. But I’m hopeful, and I’m also apparently in the minority of patients with such extensive memory loss so hopefully that will not deter you from doing something that could potentially save your life, just to preserve a few memories. I will write a separate post pertaining to my memory loss…… if I can remember to do it.
When I first started ECT, I went three times a week for nearly two months. Then I decreased my sessions to twice a week, then once a week until I graduated to the maintenance plan of once a month. I most recently have been receiving ECT every 8 weeks. For me, the key was to have good help at home. I could not work at my job in retail during the initial phase. I have three children and at the time was married to a guy who is unbelievably supportive. He took over the household so I could take the time needed to get well. One of my aunts came for two weeks to care for the kids and cook for us, and my mom also made several trips out to support me and the family. That is the key. You need to have a good support system, or this will be very hard. Rely on people. Lean heavily. You will need it. This is something nobody told me, either. I didn’t know how much help I would need. I wasn’t used to asking for help. And you are forced to do so if you take on ECT. But I cannot emphasize enough to you how LIFECHANGING this was for me. The actual word is LifeSAVING. I truly do not believe I would have made it through the last two years if I had not tried ECT. It absolutely works for me. I IMMEDIATELY felt better, like a weight was lifted from my life. My life immediately slowed down, cleared up, calmed down. I swear things looked more colorful, smelled better and sounded nicer. My eyes were fully open for the first time in more than five years. I felt this weird sensation: happiness. Not manic happiness, but the real deal. I could get through a conversation without changing the subject nine hundred times. I smiled in pictures. I felt calmness. I felt amazing. And I have had only one manic episode in the last twelve months. Prior to starting ECT, I had them several times a month as I would roll in and out of mania. And for me, my mania didn’t always manifest itself in high-energy shopping sprees or power-production. Yes, I would start talking incessantly and constantly interrupt. I would have more energy than I knew what to do with. But after a couple of days of that, my energy would turn angry and violent. And destructive. And scary. I will talk more about my symptoms in other posts, but for now just know that something had to change. And I had tried everything else. ECT was my last hope, my last chance to save my family, to save my marriage, to save myself. I was truly at the end of my rope. When that final doctor suggested ECT, I didn’t walk out of his office in search of a new psychiatrist as I had several times in the past when my treatment option inevitably reached “ECT or bust”. I said, “Sign me up”. Those three little words set me on a path to three little letters that would change and ultimately save my life. ECT. Scary? Yes. But please please please don’t let the stigma attached to it keep you from trying it. If you have a doctor recommending this procedure, I urge you to put some thought into it before turning it away. I will be honest: I don’t know ANYONE around here who does ECT. Not a single soul. I don’t know if people do, but are too ashamed to discuss it. But I didn’t have anyone to talk to before I tried this. I simply trusted my doctors. I didn’t even do research. I just closed my eyes and signed on the line and that was truly the beginning of the rest of my life.
ECT. Maybe give it a whirl?