Why electroconvulsive therapy was the closest thing to a magic bullet I’ve found for my depression


Guest post by Bonnie
Photo by Victorien Ameline

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.

  1. This was fascinating to read – thank you for sharing! I was in a serious car accident in college, resulting in multiple pelvis fractures. My physical therapy sessions during my recovery always ended with my being hooked up to a machine that pulsed electricity through my hips. It felt amazing, and I called it my electroshock therapy. (Clearly we have similar senses of humor.) I had no idea it was a real thing, with actual benefits.

    • Thank you for sharing your story. I think it's important to talk openly about mental health, and share sufferers' stories– by keeping silent, we'll never get rid of the stigma or shame so many people still attach to mental illness.

      I've had ECT too, starting last September. 3 times a week, and I wasn't allowed to be alone even on non-treatment days; fortunately my spouse can work from home. If he had to be somewhere, either I'd go with or he'd drop me off at my parents' house. He's said I was forgetful, vague, and semi-coherent, and likened it to dealing with someone with dementia. After a while the treatments spaced out and eventually I was able to be alone and later drive in between treatments, and I recently stopped treatments to see what happens.

      I have suffered from depression for nearly thirty years. Tried medication, therapy, distractions, location/situation changes; sometimes it worked, but I'd inevitably slide back into it again. I don't get sad so much as just stop caring about things, in either a good or bad way. It got so bad the last year or so that I didn't even care to get out of bed, eat, or dress unless someone prompted me to do it. I didn't even care enough to choose ECT; it was my spouse's idea, and I just went along with it because I didn't care enough to either agree or object.

      It's hard for me to feel the difference, but multiple other people have said that they've noticed one. I did lose about 6 years' worth of memories though, so everything I know about that time is reconstructed from photos or stories. I also have trouble forming new memories, which I used to be good at. Despite that, I still recommend it to other people with treatment-resistant depression, and would do it again it I needed to.

      • i'm a military veteran and my credit was so bad i couldn't get approved for a VA loan. I was so depressed. Imagine a veteran that can't get approved for a VA loan. I had to breach my principle and contacted a hacker by the name firewall breach expert. I saw his email, firewallbreachexpert atgmail dotcom on a blog about credit repair solutions and he is amazing, my first time working with a hacker and i was completely amazed, he cleared my debts and increased my credit scores to golden scores within just a few days. And this made me realize solutions only come to those who seek it and depression isn't one.

  2. I loved Sylvia Plath's description of proper ECT in The Bell Jar (there's also a harrowing description of poorly performed ECT), where she describes the bell jar lifting to let air into her life.

    Great article! Thanks for writing this.

  3. Thank you for this! I wish more people would come forward with positive experiences with ECT. It's been suggested to me, but I'm terrified of the possibility of memory loss, and I have to say, while I appreciated the detail you go into, I definitely got squeamish thinking about it! 🙂

  4. Thank you for sharing!

    You may enjoy going to one of comedian Gary Gullman’s new shows where he talks about getting ECT. He brought some levity to a very difficult situation. Let me know what you think of it! (IG @laurenlogi)

  5. Thank you for sharing your story. I had no idea ECT was still performed to this day. It immediately called up images of screaming people tied to the bed in the 1950s. I am glad to have heard your positive story.

    I have also had experience with depression and suicidal thoughts. Looking back I think I had also had a period of depression in puberty, but with me too that was written off as adolescent hormones. But in my early 20s, I got it really bad. I had been sick for 3 years, and it felt like forever. In the beginning, I only had cognitive behavioral therapy, which, as you described, helped me from tipping over the edge, but didn't really help me get better. Then my doctor suggested antidepressants. And at first, I was really afraid of it, because I had heard things like people not feeling like themselves and other side effects. And in films and series, I had seen people get really spacy after taking one little pill. But I talked it through with my doctor, and she explained really well how those drugs work. So I decided to try medication. And I can definitely say, it has saved my life! If I would have continued on without medication, one of my attempted suicides would probably have worked and I wouldn't be here today. And now I am happy and healthy, I have graduated from university, and started my own business.

    I also try to be open and talk a lot about my depression and my medication. because I feel that there is still a big stigma attached to it. And if I had heard people talk about it more before I was sick, I wouldn't have been so afraid to try medication. I am glad that in recent years, I have seen people be more open about mental health. It is such an important subject. And it is also important to know that there are multiple treatment options, and what works for some people, won't work for others. For me, medication was the big eye-opener and what really helped me, but for you it did nothing. I am so glad that you had the option and the courage to explore different treatment options, and have had success with it. I wish you all the best with the rest of your journey!

  6. I just recently finished a course of ECT,and it's been amazing. I did have some memory loss when they started doing bilateral stimulation instead of just unilateral, but it's been worth it. Most of my memory has come back, which is typical. Most people's memory loss is only around the time of treatment. But I'd been suicidal and depressed for fifteen years, and now I'm finally normal. I'm even a little bit bored, since so much of my life before was spent trying not to kill myself. Now I have so much more free time. But I did try everything else first-TMS, esketamine, years of therapy. I do recommend trying those first, simply because they're easier and they have fewer side effects.

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