Electroconvulsive Therapy, or ECT, is surrounded by controversy and unknowns.  Still widely practised, both clinicians and many who have experienced ECT see it as a rapid and effective treatment for severe and seemingly untreatable episodes of depression, schizophrenia and bipolar disorder.  But there are few first-hand accounts and, for many people, the idea of ECT is something which evokes fear, confusion or simply unanswered questions.  Commonly known as ‘electric shock treatment’, some view it as inhumane and worry that it leaves severe and permanent damage to cognitive abilities.  

Here is my account of undergoing ECT multiple times.  I hope that it will address some of the major concerns and bring some understanding of what the process involves and can achieve.

I was 20 when I first received ECT.  I had been very unwell for almost a year, experiencing what I now know was a ‘mixed episode’ of bipolar, but diagnosed then as ‘atypical depression’.   For me, the dominant symptom was, and has always been since, a racing mind – spinning so fast and so uncontrollably that it draws you in, separates you from the world and other people, feels overwhelming and intolerable and then, suddenly and briefly, switches into moments when the boundless energy brings you towards near-ecstatic exhilaration.   Sleeplessness, strange visions, ideas, voices and periods of unbearable physical and mental agitation gradually intensified.  But, strongest and most dangerous of all was an obsessive and irresistible torrent of suicidal thoughts.  Often these would present themselves as an escape from endless and unbearable internal speed, fear and unreality.  Sometimes, swinging towards exhilaration, instructions would lead me to see this as destiny, an indescribably beautiful moment of glorious enlightenment.   Either way, the situation was increasingly dangerous, and ideation came very close to fulfilment.

In and out of hospital, apart from sleeping pills and tranquilisers which brought short periods of relative relief, medication made no difference, and I was far past the point where psychological therapy could help.  Things worsened and there seemed no viable solution.   One day a different psychiatrist suggested ECT.  I didn’t really know anything about it and, when first suggested, it sounded alien and frightening.  The psychiatrist reassured me about the process and told me that, although nobody knows exactly how it works, for the most severe and seemingly untreatable depression, it was often the one successful treatment.   My brother was a psychiatrist – he also welcomed the suggestion and had seen ECT achieve remarkable results.  For me it really was a ‘miracle-cure’.  After 5 treatments, I woke to find the wall dividing myself from the world around me had lifted and the extremities of speed, fear and suicidality had lifted. 

The process itself was swift and painless.  The ECT team are extremely calming and approachable – ready to answer any concerns and explain everything.  A short general anaesthetic is given, along with muscle relaxants.  While asleep, small electric currents are passed through the brain inducing a brief seizure.  The muscle relaxant prevents any major bodily response.  Essentially, you drift off to sleep and, a few minutes later, you wake to find yourself in the recovery area, feeling slightly dazed and confused for a few minutes post-anaesthesia.   That day, you may well feel some fatigue and slightly off-colour from the effects of the anaesthetic, but this is usually short-lived.   

A course of ECT is usually about 6-8 treatments.  I have found relief from extreme symptoms typically comes suddenly around the 5th – 7th treatment.  After this, comes a period of recovery.  Mild symptoms generally remain, and it takes a while to restabilise mood and sleep, through a combination of self-management techniques, medication and psychological approaches, such as CBT.

Although I remained well for many years, there were multiple later episodes, sparked by miscarriages and pregnancies.  Despite receiving a firm bipolar diagnosis, gaining much more understanding of the condition and trying pretty much every mood-stabiliser and anti-psychotic available, my severe episodes have remained both resistant to medication and extremely dangerous. 

I have now had many successful courses of ECT and have also used monthly ‘maintenance’ ECT as a preventative measure.  I even had ECT which successfully treated a mixed and psychotic episode during the final trimester of pregnancy.  There was no effect on the pregnancy.  My baby was safely delivered a month later and is now a happy and healthy three-year-old, looking forward to starting school. 

Lasting side effects are usually minimal and vary between individuals.  I have experienced a small degree of lasting memory loss - generally elements of whole or partial amnesia surrounding the time when bi-weekly treatment took place.   However, ECT has had no long-term effects on my cognitive faculties or abilities to build new memory.  As an academic, these skills are central to my work and I have managed to continue successfully with my career.   Help from family, friends, photos and old emails etc. help me to manage gaps in my memory.  It can be a challenge – but has always seemed a small price to pay for a treatment which has, essentially, saved my life.  

Louise

 


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