ECT: Blowing up some myths – Part 2

Mental illness — To find the story behind this photo read to the end of the post

Where were we? That’s right. We’d left me in a state of catatonic depression. If you haven’t read Part 1 of this post, which dropped yesterday, I suggest doing so now.

The first time I slid into catatonic depression, my psychiatrist tried anti-depressant after anti-depressant while I was hospitalised. Nothing worked. I was still brand new to mental illness. Two months before, I’d suffered my first psychotic episode after the birth of my first child. My First Time

I had gone from mentally healthy for thirty-two years, to experiencing some of the worst psychiatric symptoms in existence. I felt as though I had entered a parallel universe. When ECT was recommended I had a sense of being at the end of the line. I didn’t know much about it.

I did know I had never been this sick in my entire life. I had no idea it was possible to get this sick. I also knew I couldn’t continue as I was, and that doing something was preferable to doing nothing. My husband and parents were thankfully open minded and intelligent enough to consider all treatment options. And we all trusted my psychiatrist.

I have mentioned how crucial trust is in the psychiatrist/patient relationship in Treatment. Never is this more the case than when ECT is being considered. No guarantees can be given with regards to the effectiveness of the treatment. My psychiatrist felt I was a good candidate for ECT, because of the severity of my illness. Very generally speaking, the worse the depression, the more responsive it seems to be to ECT. The most common side effects are some memory loss and confusion. In most cases this is temporary and only surrounding the treatment period. Headaches immediately after treatment are also common.

My psychiatrist explained that ECT treatments would be performed under a short general anaesthetic including a muscle relaxant. Electrodes would be attached to my scalp and a brief, carefully controlled current of electricity passed through them to elicit seizure activity in the brain, which would be monitored on an EEG. The muscle relaxant ensures the seizure activity would be limited to my brain, so my body would remain mostly still.

I was terrified the first time I had ECT. And it had nothing to do with the ECT itself. At that point I had a phobia of having needles or catheters inserted into the veins on the inside of my arm. However, by the end of a month of anaesthetics three times a week, my phobia had been cured by desensitisation. As for the ECT itself? It was no different to having a short anaesthetic for any other procedure. I sometimes woke with a headache, which was relieved with paracetamol.

After the first three to four treatments (in the first course), something shifted. Not every minute was agony anymore. Expression returned to my face. I began to see colour again. I began to take pleasure in my baby for the first time in three months. I still had to take a lot of medication, but at the end of that course of ECT I was well enough to go home.

The second time I needed ECT was nine years later. It was also to treat a rebound depression after a manic/psychotic episode. Just like the first time, the catatonic slide swept in quickly. This time neither my psychiatrist nor I were willing to waste time messing around with anti-depressant doses and changes. Again, the severity of my symptoms meant the decision to proceed with ECT was easy. This time my response was even more dramatic. Before the first treatment I could not get up off the floor of my room. I barely made it to the ECT suite. After that treatment I walked back into my room and smiled at my nurse. She had tears in her eyes when she looked back at me and said:

‘Oh my God. You’re smiling. I’ve never seen it work so quickly before.’

I needed a longer course to stabilise, the second time. I was also a lot more sensitive to the anaesthetic. I woke up intensely nauseous every time during the second course. Anti-emetics (Ondansetron and Maxolon) made no difference. I had some memory loss both times, but it was minor and only surrounding the time of treatment. Given how sick I was pre-treatment, for me, this was a small price to pay.

I sometimes think of ECT as a defibrillator for the brain. It metaphorically shocks it back into rhythm when it’s close to flat-lining. It is not a magic cure for everything. Of course the potential benefits must always be weighed against the potential risks. They will be different for every patient. And the use of ECT has to be viewed in the context of the severity of the patient’s illness. In the same way you wouldn’t use chemotherapy to treat a pimple, you wouldn’t use ECT to treat mild situational anxiety. And in reverse: Just as you wouldn’t use a topical antiseptic cream to treat a malignant cancer, it would be useless to attempt to treat severe clinical or catatonic depression with a herbal supplement.

Perhaps, before we condemn ECT as extreme and unacceptable because we don’t fully understand it, we must pause and remember that if it is used appropriately, it saves lives. It’s returned me to my life twice.

ECT: Blowing up some myths – Part 1

Radio Interview

The English Patient

This flea ridden, little guy brought back childhood memories of providing refuge for baby hedgehogs in our cellar over winter in Germany. If they were below a certain body-weight by the end of autumn, they wouldn’t survive a winter hibernation outside. So, if we found them at that time of year we took them in, kept them warm, fed them up, and released them back into our garden in spring.