How This Stigmatized Psychiatric Treatment Saved My Life
Electroconvulsive therapy. ECT. Shock therapy. Electroshock therapy.
There are multiple names for electroconvulsive therapy. I prefer the simple ECT. So far it has saved my life twice. Out of all of the psychiatric therapies, ECT probably still carries the most stigma. People are terrified of it. Admittedly, I used to be terrified of it.
A psychiatrist first talked to me about ECT when I was 19, during my first inpatient hospitalization while I was in college. I had an abnormal psychology textbook with me in the hospital and had previously read the section about ECT; I then read it again. I immediately told the doctor I wasn’t interested. I didn’t feel I needed, what I considered, such a drastic treatment at that point. The doctor asked me when I would consider it, and I said if I were still depressed and suicidal in a year, I would think about it.
Things waxed and waned over the following years. I continued to be depressed and suicidal and there were more hospitalizations. It was much more than a year though before I considered ECT again. I don’t remember ECT coming up seriously again until I was around 27. I did a lot of research about it at that time and talked extensively with my therapist and psychiatrist. Ultimately I agreed to try it and had approximately 12 treatments — three per week for four weeks. I started with inpatient, unilateral ECT and moved to outpatient, bilateral ECT.
I did have significant memory loss from this time and I remember essentially nothing of that specific time in my life. I ended up being off from work for six weeks total; four weeks for the treatment and two for recovery. The clinical department at work — I am a clinical social worker — knew why I was off, and though few people were outwardly supportive, no one was negative. It was a lifesaving treatment, but I was never symptom-free, even afterward, and I struggled with the memory loss.
For several years, I dealt with the residual depression through medication and therapy. Then I celebrated my 31st birthday with an ECT consultation with a new doctor, recommended to me by my psychiatrist. I certainly wasn’t at my worst at that point. I didn’t need to be hospitalized and at worst I was “only” passively suicidal, but I was depressed and felt “stuck.” I thought it was worth at least meeting with this doctor to find out his thoughts on whether a very brief course of ECT could get me out of the rut and maybe relieve more of my symptoms. I liked the doctor and he thought ECT could help, but he felt we couldn’t bank on an abbreviated course of ECT. If I were to do ECT, it could be up to six weeks off from work again. I wasn’t willing to take an extended leave from work for something I felt was “elective” and not necessary at the time.
About 11 months later though, my situation wasn’t so elective. I had learned not long before that I had stage 3 chronic kidney disease, and diabetes insipidus from the medication I had been taking for severe depression. I had to stop the medication in order to save my kidneys. Nothing could replace the meds for me and since I had been through so many other medications, my best hope was a transition to a monoamine-oxidase inhibitor (MAOI). I was briefly hospitalized in order to try to start that change, which is challenging, as other psychotropics have to be stopped. Unfortunately, the inpatient doctors did not cooperate with the plan. So, I ended up making the change as an outpatient after all, but as expected, an MAOI alone just wasn’t enough. It quickly became clear I needed ECT again if I was going to live.
Since I had the ECT consultation less than a year prior, and that doctor was willing to work with someone who was on an MAOI (some doctors were not), I was able to start quickly. This doctor does bifrontal ECT and that made a huge difference for me. I was able to do all of the treatments as an outpatient, which was a relief to me, and ultimately I only needed two weeks of treatments, three per week. I then took a week to recover (and celebrate my birthday). After just three weeks off from work (I had prepared my current employer to expect six weeks off), I returned.
I considered doing maintenance ECT and therefore, about two weeks after returning to work, I did two more treatments. I just had to take off a day for each treatment. The doctor notified me he was retiring in roughly two months and I was having a lot of anxiety prior to the follow-up treatments, so after those two treatments, I stopped.
I was feeling better than I had in a long time and knew I could go back for ECT at any point, but no one could say if continuing with maintenance treatments for a couple more weeks or months would significantly reduce the chance of relapse after stopping. I know now I made the right decision for me, both with starting the ECT and with stopping it. About two months after I had my last ECT treatment, I realized I felt better than I had in about 20 years. I was almost symptom-free for the first time.
ECT is not free of side effects, but it is not what is pictured in media such as “One Flew Over the Cuckoo’s Nest” either. The type of ECT (unilateral, bilateral, bifrontal) a person receives and the number of treatments seems to significantly impact the seriousness of the side effects. I do have memory issues; some are confined to the time period I was receiving ECT and others are difficult to determine. Are other memories fuzzy because of ECT or because I was depressed and not encoding the memories well to begin with? I’ll never know. My side effects were minimal and limited during my second set of treatments when I did only two weeks of bifrontal ECT, especially compared to the first set of longer bilateral ECT. I remember much of the time during my more recent treatment.
As far as the actual treatments, I was asleep for all of it. Personally, I don’t like being put to sleep, so that was the worst part for me. Sometimes I had a headache afterward, but a little over-the-counter pain reliever took care of that. Finding a doctor I trusted and was comfortable with was more important than I expected. My second set of treatments was a thousand times more comfortable, less stressful and less traumatic because the doctor and the staff were so much kinder and more caring.
What I know for sure is that I would not be alive today without ECT. It is certainly not the only thing keeping me alive. Medication, my therapist, my psychiatrist, my friends and family, and even my work are all important to my survival. But, when all else failed, ECT succeeded. There is no doubt in my mind that, if I come to a place in my life again where therapy and medications aren’t cutting it and I am suicidal, I will be looking for a doctor to provide the ECT I know I need. I’m even putting that in writing in the form of a mental health advance directive, in case somewhere down the line I’m not able to express my wishes. My hope is that with more education and open communication about ECT, the stigma and fear surrounding this potentially lifesaving treatment will decrease.
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