The name "electroconvulsive therapy" invokes thoughts of patients strapped to a bed, cruelly being administered shocks while they’re awake. Leaving them completely frazzled, lost, and in despair. The way it’s actually done, according to WebMD is, “During the process, an electric stimulation is delivered to the brain and causes a seizure.” It’s a painless procedure, as you’re under anesthesia the whole time. It’s much more civilized and they’ve stopped trying to treat patients with illnesses, like schizophrenia, that can’t be helped by the procedure. Medical professionals currently use it to treat conditions like bipolar and depression, in particular, symptoms of mania and suicidality.
The treatment is generally given two to three times a week for a total of six to twelve sessions. The process takes about an hour from treatment to recovery room. Some people do it inpatient, outpatient, or a mix of both. According to an an article on Psychiatric Times, “ECT is the most effective antidepressant treatment we have; response rates are typically in the 60% to 90% range.” It’s seldom given as the first option for treatment, though. Although it’s an effective treatment, it’s a last resort because it can have grave side effects. Many people come out the other side with minimal memory loss.
I had the facts, had done the research, and talked to my own psychiatrist, but I still grappled with the choice of whether or not to pursue ECT. It was suggested to me during my stay at McLean Hospital during my second hospitalization that year. At that point, I had been on literally dozens of medicine combinations over the years to no avail. My depression was so bad that I was constantly suicidal, rarely having a break from wanting to die. I would dream of ways to kill myself and think about how I was no longer needed on the planet. My mania had me wound up enough that I felt close to relapse with drinking and drugs after a four year period of being clean. The two were unmanageable. I was at the end of my rope.
Despite thinking it was the next best course of action, telling my family was hard. There was no shortage of them freaking out about “shock therapy” as it’s sometimes inappropriately called. This was my first run-in with the stigma surrounding ECT. I learned just how taboo it is and how people really did have those barbaric images in their minds. Some family members refused to even give it a chance. It was hard because I was in a psychiatric bubble where there was so much support for the procedure.
Regardless of how they felt, I did it anyway because I felt there were no more options available to me. I agreed to start a course of treatment and my doctor at McLean took me off my Lithium. I was frightened by this, as it was my stability for my bipolar, but he claimed the ECT treatment would temporarily replace the benefits Lithium gave me. I let go of the reigns and put my care into the hands of my providers.
The first session was scary. Since I was in inpatient care at the time, I was wheeled down from my unit in a wheelchair. Upon arrival, I sat and waited my turn. When my room was ready, the nurse got my IV in and prepared me for the procedure. She was very kind and reassuring. Despite having a gazillion tattoos, I’m terrified of needles, so that part was unpleasant. It wasn’t nearly as unpleasant as administering the anesthesia was going to be, though. When it was my turn to have ECT. my bed was wheeled into what looked like an operating room. I was told that they’re going to start giving me the anesthetic and I completely freaked out. I cried and shouted, “no, no, no.” I was terrified of going under, having the feeling that I might not ever wake up. I was more scared of the anesthesia than the ECT, and it ultimately turned out that my fear was justified.
I woke up, who knows how much time had passed. My awakening was a unique one. I came to consciousness only being able to talk, but unable to move the rest of my body. It was as if lead filled my bones, anchoring me to the bed. Doctors and nurses surrounded my bedside and the looks on their faces scared me the most. They looked puzzled and frightened, which was not at all assuring to me in my state. The paralysis lasted about 15 merciless minutes before I was able to slowly move my body parts again.
The doctors chalked it up to too much anesthesia and vowed to just lessen the dose next time. Well, the same thing happened again during my second treatment and this time I actually was awake and conscious briefly during the procedure. I then had the same effects upon awakening, my body had not caught up with my mind and I experienced the frightening paralysis.
At this point, there was a question that I may be allergic to a strand of the anesthesia as I was having a wildly abnormal reaction. After bloodwork, it turns out that I’m allergic to succinylcholine, which is part of the general anesthesia used. I was deemed to have a medical issue and could no longer be treated at McLean. They transferred me over to the medical psych unit at Mass General Hospital. There they were able to use a different kind of anesthetic and they were equipped for if anything went wrong. I had four treatments while inpatient and three outpatient, totaling seven treatments.
During the course of this time, I was experiencing some interesting side effects. My memory was completely obliterated during that time. I would have a conversation with someone, then have no memory of it at all the next day. I called these lapses “shockouts,” sort of like a drunken blackout. Things would happen and I was there for them, but they were blotted out the next day. This had freaky long-term effects.
When I was out of the hospital I started dating again. I have no memory of the dates I went on during this time. I later messaged a man on OkCupid starting a conversation with him and he said: “Um, this is awkward but we went on a date over the summer.” More awkward for me! I had no memory of it happening. I also was swiping through Tinder and I saw a man I recognized. I could have sworn something happened between us, but I had no memory of it at all. It was totally bizarre.
My memory loss extended further than the acute period during treatment. It’s absolutely heartbreaking. While not being able to remember the 6 week period I was getting ECT is scary, it’s much scarier that my permanent long and short-term memory have been affected. I struggle to retain names of people whereas in the past I had an impeccable memory around faces and names. I have difficulty with word recall, especially when under pressure, it’s challenging for me to find the words I’m looking for. I don’t remember details anymore, like what happened on a TV show I just watched, and I’ve lost a lot of my long-term memory details like how I felt during certain situations. I genuinely feel as if I’ve lost IQ points as a result of the ECT.
During this time I could not hold a job. The idea of working seemed totally impossible to me and thank goodness that was the case. Could you imagine having such severe memory loss while also trying to work? No thank you. I’m fortunate that my circumstances were such that I could go a long period without working.
I finished with those seven treatments, I didn’t have anymore. I ultimately stopped them because I was having such a traumatic reaction to the anesthesia even after they switched it. I completely freaked out when they were giving me the dose. I so feared the treatment that I was anxious about it all of the time, even when I wasn’t in the hospital. It was no longer worth it. The side effects were worse than what I’d be like without ECT.
Was the whole thing worth it? It’s hard to say. The memory loss is devastating, but ECT may have had a hand in saving my life. After treatment, I was on an upward climb out of the desperate depression and my mania had ceased. A few months after my last treatment I was hospitalized again (my 7th time that year), but that was my last. Since then I’ve stabilized and I’ve even reached a point of contentment. Life is level and pretty anticlimactic, as it should be. I experience real happiness. Was this all because of ECT? Was it med combinations, lots of therapy, and/or time? Who knows. I just know that I’m doing better.
It’s difficult for me to say whether or not I recommend it because it was both helpful and hurtful. I sometimes liken it to chemotherapy. It does the job, but it also has some horrendous side effects and kills off good things in the process.
While I’m not sure what my stance is on the matter, I do know that stigma needs to be broken. People need to know more about the treatment without the idea that it’s barbaric. It’s a legitimate option for many people and sometimes the only option. Kitty Dukakis, the wife of the former Massachusetts governor, Michael Dukakis, is doing tons of work to break the stigma. Her book, “Shock,” is a great resource if you’re interested in learning more about ECT.