The electrovulsive therapy did not go as expected.

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In August 2019, I never thought that I would be in this position. I sat in the small waiting room, with my dad next to me, for my first ECT appointment.

Diagnosed with severe bipolar disorder, I tried countless combinations of medications to treat the extreme ups and downs over a tumultuous seven years. Even with all the medications and bi-weekly therapy, she still suffered bouts of depression so unrelenting that she was constantly suicidal for weeks on end. (Studies have shown that the depression experienced by bipolar patients is, on average, much more intense than those with major depressive disorder).

After struggling and fighting, my symptoms were beyond my control and I finally attempted suicide. I spent time in a mental hospital to determine the best course of action for treatment. I was labeled “resistant to treatment”, which means that constant medication management, therapy and lifestyle changes did little to alleviate my bipolar symptoms. Two psychiatrists collaborated on what my next step in treatment should be, and both recommended that I try electroconvulsive therapy.

When the idea was first suggested to me, I wasn’t sure. It seemed extreme. the scene in one flew over the cuckoo’s nest in which Jack Nicholson’s character convulsing with wide eyes came to mind. However, I was at the point where I was willing to try anything to make my suicidal ideation go away, and since I was “treatment resistant”, ECT seemed like the “Hail Mary” I needed.

When I was called back to the treatment area, my body jerked. The nurse described the procedure to me before the psychiatrist checked in. I lay on a standard hospital bed with several heart monitor stickers on my torso and a pulse oximeter on my finger. Finally, I was wheeled into the procedure room where I was introduced to the anesthesiologist, a warm-hearted older gentleman whose soft voice calmed my nerves.

“Don’t worry, Sarah. She will be completely under anesthesia along with a muscle relaxant. You can do this,” she assured me. I gave a nervous laugh as the nurse appeared behind me with an oxygen mask.

“Okay, Sarah, let’s get started,” he told me softly. “Now I am putting you on the oxygen mask and the anesthesiologist is going to administer the anesthesia. You’re going to feel a pinch, but focus on taking a deep breath.”

I was too scared to respond when oxygen was placed over my nose and mouth. I felt the pinch, a rush of anxiety, and I was out.

Not even an hour later, I woke up in the recovery area to hear a distant voice.

“Hello, Miss Sarah, you’re done. Don’t try to get up yet. I’m going to get you some crackers and water. We need to monitor him for a while until he is cleared to go home.”

That was it?

After the nurse determined that I was free to go, she told my dad to drive the car to the front door. She wheeled me into my dad’s blue Hyundai. He was sleepy but conscious enough to tell her what had just happened. We drove home as I contemplated the difference between what I thought I knew about ECT and the treatment I had received.

Seizure therapy is one of the oldest treatment practices in the world of psychiatry and was officially “discovered” in the 1930s by Ladislao J. MedunaHungarian neuropathologist and neuropsychiatrist. Meduna got the idea after noticing that patients diagnosed with both epilepsy and psychosis suffered less frequent psychotic episodes when they experienced active epilepsy. (active epilepsy is when a patient has been diagnosed with epilepsy and is taking medication to control it and/or has had at least one seizure in the past year, according to the CDC.) having two or more unprovoked seizures.)

The first seizure therapies in 1934 were not induced by electric current but by drugs, namely camphor and metrazol, which were injected in the muscle to cause cerebral seizures. According to 2013 manual of clinical neurology“The procedure had some success, which was notable during that time when few treatment options were available.”

But these chemically induced seizures were difficult to control and painful for the patients. Seizures could last longer than necessary and cause unwanted results, such as fractures and memory loss.

Later, in the 1930s, the Italian neurologist Hugo Cerletti he discovered that an electrical current could be used instead of medication. Cerletti and his assistant lucio bini he built a crude machine that could be used in humans to control the amount of electricity given to a patient to cause a seizure, while also controlling how long it lasts. For his research and invention, both were nominated for the Nobel Prize in Physiology or Medicine. Beginning in the 1940s, ECT was used as a treatment for schizophrenia; it was quickly adopted to treat other chronic and serious mental illnesses.

My own paternal grandfather underwent ECT treatments. He was born in 1910 and developed symptoms of bipolar disorder, once called manic depression, in his early adulthood. (Bipolar disorder, like many serious mental illnesses, has a strong genetic component.) He went years without a proper diagnosis or any kind of treatment; this was before there were psychiatric medications to treat bipolar disorder in the US, including the gold standard mood stabilizer. , lithium. Instead, he self-medicated with alcohol. Even today, many bipolar patients self-medicate with drugs or alcohol at a higher rate than any other psychiatric illness.

In the late 1950s and early 1960s, he sought treatment for his mental illness, spending time in and out of mental hospitals. He went through many rounds of the early ECT practices, then known as electroshock therapy. Psychiatrists in the 1950s began using muscle relaxants and anesthesia to prevent convulsions associated with seizures that could injure the patient and make the procedure more comfortable overall. I don’t know if the hospital where my grandfather received ECT had already introduced such practices. I hope he was able to receive them.

However, ECT entered popular culture with the 1962 book one flew over the cuckoo’s nest and the 1975 film adaptation, both of which portrayed the treatment as punishment that left patients with the shells of what they were. In certain inpatient hospitals, this was somewhat true, and without anesthesia or muscle relaxants, the the treatment was absolutely more traumatic.

Although the treatment has changed significantly, the popular conception of ECT remains stuck in the past decades, as evidenced by my own reaction to the idea of ​​undergoing it. However, today about 100,000 people receive ECT per year in the United States. In addition to offering a more compassionate approach, the treatment itself has changed. As University of Michigan Article explains: “There are mainly two types of electrode placement that are used to deliver ECT. The differences between these two techniques include the area of ​​the brain stimulated, the timing of the response, and possible side effects.” Unilateral ECT, in which one electrode is placed on top of the head and the other on one side of the head, is used for less severe patients who only require one or two treatments. Meanwhile, bilateral ECT, in which an electrode is placed on each side of the head, is used for more severe patients who require several rounds of treatment to see results. Bilateral, which I received, can create a rapid improvement in symptoms.

But while much has changed in recent decades, the stigma against ECT continues (including, spoiler alert, in the recent movie do not worry honey). Unfortunately, this can lead patients to avoid receiving the treatment out of fear or embarrassment. According to Neera Ghaziuddinprofessor at the University of Michigan Medical School Department of Psychiatry, “ECT is still used because it is a highly effective and safe treatment. The stigma is due to lack of familiarity and overestimation of side effects. [Ultimately] it is safe, effective and acts quickly”.

A typical TEC course ranges from six to 12 treatments total, nine being the mean number of treatments. I received 10 treatments.

My treatment helped me get rid of depression. However, my results only lasted three months. I was disappointed. My new psychiatrist suggested that my ECT was not effective in the long term because I did not receive follow-up treatment such as cognitive behavioral therapy. Relapse can occur if no other treatment is used during and after ECT.

Although the ECT I received was not the “long-term miracle cure” I was looking for, it worked quickly to stop my suicidal thoughts and actions. If I had taken antidepressants, I would have taken four to eight weeks to receive the full benefit. Looking back, ECT did what it needed to do at the time, which was to prevent me from harming myself in any way, including attempting suicide.

Honestly, I am afraid of anesthesia, so being put in twice a week was difficult. But I weighed the risks and benefits and decided that I was willing to face my fears in order to receive treatment.

Fortunately, my insurance covered most of the procedure and I paid $20 per session. Most insurers will cover ECT if the doctor deems it medically necessary and if it is coded correctly when submitted to the insurance company. Now, I wish someone had suggested it to me sooner; It took me about six years to try different medications before my doctors suggested ECT. If I had realized it might work, maybe I could have applied earlier and saved myself a bit of heartache.

Today, I am taking the proper medications and am in therapy. Both are helping me immensely. The medication I take helps stabilize my mood, while cognitive behavioral therapy gives me the tools to combat suicidal thoughts. ECT didn’t cure me, but it did give me hope that my unrelenting depression could be overcome. I saw improvement within a week and found relief from my suicidal thoughts. For that, I remain grateful. The therapy I feared the most helped me avoid making a mistake that could have cost me my life. lifetime.

​​If you need to talk, or if you or someone you know is having suicidal thoughts, send a text to crisis text line at 741-741 or call or text 988 to reach the Crisis and Suicide Lifeline.

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