Quick, when someone says electroshock, what’s the first thing you think of? Was it a horrible, traumatic, forced experience à la One Flew Over the Cuckoo’s Nest? If so, you seem to be amongst the majority of the population.
When I requested electroshock (also known as electroconvulsive therapy or ECT) from my psychiatrist, she was shocked that I was actually requesting it, and the idea of it being a “bad thing” was so pervasive that nearly every medical professional I spoke to on my ECT journey made a concerted effort to sing its praises and try to convince me to stick with it. I didn’t need convincing, and I am incredibly glad that I stuck with it.
ECT has helped me in ways that no other treatment has, lifting me out of a 15+ year fog of depression and making me much more capable of functioning like a “normal” adult.
I don’t remember when I first became depressed, but I do remember being suicidal for the first time at around age 10. It was probably a combination of genetics, circumstance, and my own unique brain chemistry, but I was a profoundly troubled child. I managed to keep good grades and extracurricular activities, however, so my depression flew under the radar, swept under the rug as adolescent hormones. It’s only when I moved away for college that it really caught up with me. I started falling behind and missing lots of class almost immediately, spending days in bed and having long, regular crying spells.
When, at age 18, I started engaging in some very self-destructive behaviors, I knew something was really wrong, and got my ass to Student Psychological Services. And so began my long career as a mental health services consumer.
In the 15+ years since, I’ve usually been in some form of therapy and on some form of antidepressant. While these resources have kept me from going over the edge, they have not been enough to help me thrive or even be able to function consistently. As a result, my ability to grow and succeed has been frustratingly stunted. For a long time I put the blame on myself for “not trying hard enough” or something. But when my 34th birthday came and I was miserable as ever, despite being on medication and in therapy at the time, I felt some validation and a need to pursue something more for treatment. I googled “treatment-resistant depression” to see what would come up, and that’s where ECT caught my eye.
I’d learned about ECT many years prior, but it had been framed as a last-resort option, and I’d wanted to explore more traditional treatments first. Now that I’d exhausted those options, I was desperate and felt like I was ready for the last-resort option. I was also encouraged by the statistics: ECT is proven to be something like 70-90% effective at improving depression symptoms, compared to the 30% efficacy rate of antidepressants. The biggest side effects are some confusion and temporary short-term memory loss, which didn’t seem like a big deal to me. I’ll take some memory loss over life-sucking depression — sign me the fuck up! So I made an appointment with my psychiatrist.
Not all psychiatrists keep up their ECT certification and mine hadn’t, so she referred me to someone nearby who did it regularly. They wanted me to be admitted overnight for my first treatment, so I made an appointment to check into the hospital on a Tuesday morning. I would be on the behavioral health ward with a bunch of people who were detoxing, which was fine with me.
The first day was very hectic because I had to be screened to see if I was okay for general anesthesia, as ECT is done under anesthesia. They took blood and tested it, and took me for an EKG. I also had talks with two psychiatrists and two psychiatric social workers. Apparently you need approval from THREE psychiatrists to get ECT, and they also wanted to make sure that I knew the risks. (Please note that I live in California, so the process to qualify for ECT may be different elsewhere.) The social workers were more concerned with establishing that I had a support system and someone to give me a ride home after the treatments. Once I’d talked to everyone I was supposed to, I was allowed to relax and wait for my first treatment the following morning.
Now that I’d exhausted those options, I was desperate and felt like I was ready for the last-resort option.
In short, ECT is a seizure induced by electricity while you’re under sedation. ECT is done early in the morning; they usually have me arrive between 6-8am. I’m not allowed to eat or drink anything after midnight the night before, to prevent aspiration. After filling out the informed consent papers, I’m led into a large recovery room with a few beds. They have me change into a hospital gown, letting me leave my socks and underwear on, hook me up to a blood pressure cuff, and put oxygen tubes in my nose. They also put electrodes on my chest to monitor my heart, and insert an IV into the top of my hand or the crook of my arm. The nurses are very attentive and make sure I’m comfortable and warm.
When it’s my turn, they wheel me into the operating room and start getting me set up. In the room there are one or two nurses, a psychiatrist, and an anesthesiologist. The nurse(s) hook me up to an EKG again and put a tourniquet below my right knee. The psychiatrist puts electro-conductive gel on the right side of my head and wraps a band around my head with an electrode placed on top of the gel. (There are two kinds of ECT: unilateral, on the right side of your brain only, and bilateral, both sides of your brain. So far I’ve only had unilateral ECT, which is known to have fewer potential side effects.)
The anesthesiologist starts pumping an NSAID painkiller through my IV to prevent a headache afterward. Then they put an oxygen mask over my mouth and tell me to take some deep breaths, because apparently ECT works best when you have a lot of oxygen in your system. During this time the anesthesiologist pumps muscle relaxer through my IV to prevent my body from convulsing so much; the tourniquet under my right knee is to prevent the muscle relaxer from getting to my right foot, so they can watch the course of my seizure there. During this time they’re usually saying soothing things, encouraging me to imagine myself in a forest or on a beach, and telling me they’re going to take good care of me. Then the anesthesiologist tells me she’s going to start giving me the ketamine for anesthesia. I feel the cold of it hit my brain and then lights out. At this point, they put a mouth guard in to protect my teeth during the seizure.
After I’m asleep, the psychiatrist zaps me with the electrode on my head on the lowest setting. This causes a seizure whose progress they watch in my foot. They’re also constantly watching my heart rate and breathing to make sure they don’t have to step in, in case something goes wrong. The seizure itself lasts a very short time (mine have been 50 seconds on average, apparently). After it has run its course, they wheel me back into the recovery room where I’ll wake up shortly thereafter. They only give me enough anesthesia to sleep for about 10-15 minutes, but oftentimes they let me sleep for longer afterward.
Once I’m awake again they give me some water or juice and a snack if I want it, and help me back into my clothes. It’s around this time that they’ll call my mom in, who’s there to pick me up, and she and the nurse will help me into a wheelchair. Then we make an appointment for my next treatment, and they take me in the wheelchair upstairs to my mom’s car. The wheelchair is necessary because even though I’m awake, I’m still coming out of anesthesia so I’m kind of walking like I’m drunk. I also woke up with a headache after my first two treatments, so the anesthesiologist had to adjust the medications I was getting and I haven’t gotten one since.
Officially, they want a responsible adult to stay with you for 24 hours after the treatment. They definitely won’t release you from the hospital if you don’t have a ride home; Uber and Lyft aren’t even acceptable. You’re not supposed to drive yourself at all on treatment days, and it’s strongly recommended that you not make any major plans or decisions on those days as well.
It’s like all that positivity and hopefulness I was trying to foster in years of therapy was hitting a wall before, but now that wall is gone and it’s all flooding in. I feel more confident, happier, content.
It’s generally recommended to do a full course of ECT, 10 or 12 sessions, 2-3 times per week. You can do fewer if you prefer, but my nurses said they tended to notice relapse amongst people who did fewer sessions. The hospital I go to does ECT on Mondays, Wednesdays, and Fridays, so I committed myself to doing that for a month. It’s also possible that in the future I’ll need “maintenance” ECT once a month or so, but I’m okay with that. I’m just shocked (pun intended 😜) at how much of a difference it’s already made. Even after just the first session, I felt… lighter. I don’t know how else to describe it. My automatic thoughts are different, my feelings are different. I can feel my brain making new connections. (Gotta love that neuroplasticity!) It’s like all that positivity and hopefulness I was trying to foster in years of therapy was hitting a wall before, but now that wall is gone and it’s all flooding in. I feel more confident, happier, content.
Plus, now I have an entire world of electricity-themed humor at my disposal. (Some people might be sensitive about it, which I understand, but I lean into it.) To be fair, I’m still on an antidepressant and I still see a therapist. Once I’ve completed my ECT I’ll check with my psychiatrist about maybe going off the medication, but if I need to stay on it it’s not the end of the world. And I’m NEVER gonna stop seeing a therapist, I love that shit. (I’m one of those people who thinks everyone should be in therapy.) But it feels like I’m starting from a higher point now.
I’m also lucky that I haven’t experienced any side effects, other than the couple initial headaches, and the grogginess when I wake up from anesthesia. But I haven’t noticed any memory loss or difficulty recalling things so far, and I’ve had seven treatments now. The only bad thing about this whole situation is that I didn’t do this MUCH sooner.
Side note: I did have the unfortunate experience of falling into a K-hole while under anesthesia for one of my treatments. That’s the dissociative state where you feel like you’re in a nightmare or dead or something; people who take ketamine recreationally have written lots about it. It’s a very bizarre and unpleasant feeling, so I told my doctors about it, and since then they’ve given me some anti-anxiety medication during my treatments to prevent that from happening again. But that’s not a risk for just ECT exclusively, it’s a risk anytime you undergo a procedure where they put you to sleep using ketamine.
So if you struggle with depression, be it chronic and long term or acute and situation-specific, and are hitting a wall in terms of treatment, consider getting your brain shocked. It’s not nearly as difficult as I envisioned it being, and it just might be the jump start you need (puns!) that can’t be provided by medication or talk therapy. Every doctor I’ve talked to about it has said that the only reason it’s not more common is because of the stigma attached to it, so if you can get past the idea in your head, you may get a real boost from it. I certainly did, and I’m extremely grateful for it.