Note: This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.
Electroconvulsive Therapy (ECT) is a treatment method that comes with huge stigma, because of the way it was originally used and because of its dramatization in movies such as One Flew Over the Cuckoo’s Nest. The prospect of having ECT was very scary for me, but nothing else was working to decrease my deep depression and control my obsessive suicidal thoughts. I was ready to try just about anything.
My psychiatrist wanted to use ECT treatments as soon as he saw me during the Meltdown (first hospital stay) because I was so deeply depressed. I was too out of it to really make a decision, but that became a moot point when my insurance refused to cover the treatments. It was determined that therapy and medications should be tried instead. I was frightened when ECTs were revisited as the best option for treating my intractable depression during my third hospital stay. I had researched it on the internet to get a more reliable impression than what I knew was misleading on TV and in movies. I trusted Sharon and Dr. Greene, so I agreed to do ECT in April 2003.
I don’t remember every detail about having ECT, partly because I was in such a crazy place emotionally and partly because the most common side effect is short-term memory loss. I remember enough to give the highlights though. I was still in the hospital for my first treatment. Early in the morning a man came to my room to escort me to the ECT suite on the third floor. I remember he was in charge of the ECT process and he always wore Hawaiian print shirts. In the ECT suite I put on a hospital gown and signed a form (probably a consent for treatment. I don’t remember). While a nurse inserted an IV line into me another person asked me several questions. The only question I recall is whether or not I had any loose teeth, which seemed like a strange question (in hindsight it makes sense, since they were planning to induce a grand mal seizure).
Then, electrodes were put on my head. If you have unilateral ECT they are placed only on one side of your head; they are placed on both sides if you have bilateral ECT. I don’t know whether I had unilateral or bilateral, I just remember the electrode was cold. I was also hooked up to monitoring devices, which monitored heart activity (EKG) and brain activity (EEG), and measured the electrical discharges of the muscles. I was given muscle relaxants through the IV, and I was given anesthesia which quickly made me unconscious. I didn’t feel any of the seizure that was stimulated in my brain by the electrical current passing through it. Soon after the ECT was completed, I woke up in the recovery area and the nurse helped me change back into my clothes. I felt no pain, but I was a little fuzzy headed and disoriented afterward for a while. I was tired, whether from the ECT or the anesthesia I don’t know.
After the first treatment, the rest of the ECTs I had on an outpatient basis, and my dad transported me to them. At that time I was still not being very open with my parents about what was going on. I don’t think my dad knew what to say to me, and neither of my parents asked a lot of questions. I think taking me to my ECT appointments was my dad’s way of being helpful. He picked me up faithfully despite having to be there really early in the morning, like at five or six a.m. He sat around in the waiting room for the duration of the ECT procedure, and took me home afterward. I was grateful that my dad did this for me, as I would’ve had to do the ECT on an inpatient basis otherwise. None of my other friends or family would’ve been able to take this much time off from work.
I was given a sheet of Discharge Instructions after each outpatient ECT. It included things like “don’t drive until cleared by your doctor, avoid extremes of activity, refrain from making important decisions, and avoid emotional subjects in conversations or on TV.” My favorite instruction, though, was “avoid crowded public places, such as the grocery store or the mall. However, car rides with a family member, away from heavy traffic, are recommended as pleasurable relaxation.” This struck me as funny. Seriously, who does that? Car rides with family as “pleasurable relaxation?” The only pleasurable car rides I took back then were the ones I took while I was drinking and listening to depressing music, which I’m pretty sure they’d discourage.
During the first round of treatments, before I returned to work, I had a total of seven ECTs. I went every other day during the week for two weeks (Monday, Wednesday, Friday). After I lost my job, I had three more treatments. About a month later I had another one to reinforce the previous ones, for a total of eleven ECTs.
I suffered no ill effects from having ECT. It didn’t kill my brain cells, making me suddenly stupid. The only long term effects are the hazy memory I have of that time, which I might have experienced without ECT because it was such a freaked out time for me. It didn’t cause brain damage, or ongoing seizures, or any of the other things people fear when they hear the word ECT. There was no pain involved, other than a slight headache after each treatment for a couple of hours. The best part about ECT is that it worked. Not immediately, obviously, but I have no doubt that it sped up my recovery. It didn’t eliminate further hospitalizations, partly because I wasn’t on the right combination of medications yet. I think it shortened the length of my fourth hospitalization, though, and made it possible for me to get over the hump.
The fact that I had ECT is probably what I would’ve kept secret in my story, if that were possible, because of the enormous stigma about it. The image of ECT in the movies and on TV is very negative and misleading. Let’s face it, people believe something is SERIOUSLY wrong with you if you have to have ECTs, right? It is not used lightly. It’s often the treatment used when nothing else works. I’m hoping that by revealing that I’ve had ECT, I can help to normalize it a little bit. I don’t regret having this treatment. I believe that it played a large role in helping me get my life back. It’s not used casually, or to control behavior as some might think. It’s a safe, effective treatment modality for medication resistant depression like I had. I was not instantly cured, because it doesn’t work like that. However, without ECTs I may not have survived.
One of the hardest things when dealing with a chronic mental illness is the urge to give up. Giving up can mean many different things–it could mean stopping your medications, or starting to drink alcohol or use illicit drugs, or stopping therapy, etc. However, the most dangerous way one can give up is through suicide attempts.
For some people, for religious reasons or whatever, suicide never even becomes an option. They just don’t go there. Unfortunately, for too many people, killing themselves feels like the only option. It’s difficult to explain to someone who has never been suicidal how it feels to want to stop living in this world. It takes a great deal of desperation and pain to get to that point. I have also been suicidal when my depression was so bad that I felt total apathy regarding life.
As previously mentioned, I’ve suffered from depressive symptoms on and off since childhood. I’ve had suicidal thoughts for almost as long. When I was young, of course, I had no idea how I could kill myself and had little means to actually do it. It was mainly wishing I was dead at that young age. The first time I can remember feeling depression was in the fourth grade. We moved to a different school system half way through the year, and it was terrible for me. I had to face a new home with new neighborhood kids, as well as a new school with all that entails. My mom has said she thought I hated her at this time. I spent a lot of time alone in my room, crying and hating life. My brother adjusted well, making new friends easily. I remember looking out my bedroom window at him playing with the neighborhood kids, and feeling depressed. It took most of the rest of the school year for me to adjust to this change.
As I grew older, I ruminated about death but never had any real intention of trying suicide. I took a psychology class in high school, which gave me a better understanding of depression. I felt validated after this class, as it reinforced that there were others like me. Also, I read The Bell Jar by Sylvia Plath in high school and was further reassured that the way I sometimes felt was not uncommon. I have reread this novel countless times, as Sylvia Plath does an excellent job of describing how depression feels.
It was during my freshman year of college that suicidal thinking became an obsessive-compulsive issue for me. I think this is when my mixed bipolar symptoms really kicked in, and I started to self-medicate with alcohol. I started listening to depressing mix tapes, got really drunk and usually self-mutilated by cutting on my arms or hitting walls when things got especially bad. It was an out of control time for me, and thoughts of killing myself were rampant. I never consciously tried to kill myself, but it’s amazing that I never killed myself while drinking and driving. Over the years after college, suicidal ideation became a frequent companion to my depressive episodes, and there were several aborted suicide attempts.
I still struggle with suicidal thoughts when I become depressed, or worse, experience a mixed bipolar episode. Unfortunately I am very obsessive-compulsive, so my brain gets stuck on suicide when I’m depressed. At times I get to the point where I cannot possibly distract myself from these thoughts, no matter what I try to do. I ruminate about how, when, and by what method I would do it. I think about every detail. Even if I consciously know I don’t want to kill myself, my brain takes over and will not let me think about anything else. I can’t shift my thinking, my anxiety increases. I am completely unable to sleep and I feel so anxious I can’t even sit still. This makes suicide a real danger for me anytime I get very depressed. At times I will just pace around in my house, or sit and watch television with the sound off in an attempt to distract myself. Alcohol has been a coping skill in the past when I feel this way because all I want is to feel nothing.
Usually when I’m suicidal, there is something that keeps me from giving up. For a long time it was my cat, Epiphany. I knew that if I killed myself, Epiphany would have to go to the Humane Society where she’d probably live in a cage or be euthanized. It’s a sign of how my thinking was not normal that I didn’t worry about my family’s reaction if I killed myself. Many people who are depressed believe people would be better off if they were dead. I’ve actually never felt that way. Instead, I think if I kill myself at a certain time, or in a certain way, it will somehow minimize their grief. My distorted reasoning at those times is usually that, because they got through the death of my older brother to cancer, they’d get through my death okay too. The reality, which I know when I’m thinking clearly, is that they’d be devastated if I committed suicide. As I’ve gotten better and learned to manage my illness, I’ve become more able to let my family and friends help me when I’m having a hard time, so I don’t give up.