If you have any questions about electroconvulsive therapy treatments, here are the answers or at least some of them anyway…
Many people are frightened by the idea of electroconvulsive therapy treatments, but ECTs should not be feared. They are nothing to be afraid of and are far from the barbaric treatment depicted in the movie One Flew Over the Cuckoo’s Nest.
ECTs are still a viable and effective treatment option for many people suffering from severe depression and/or bipolar disorder that are not responding well to other medication or treatment options.
Think about it this way. When a heart stops beating, doctors shock the heart to make it start beating again and bring the patient back to life. That is similar to what ECT, electroconvulsive therapy treatments do. When severe depression or bipolar disorder become very severe, the brain stops functioning optimally to the point that a patient cannot function and they feel like they are not living. The ECT treatment shocks the brain so it will function and work again bringing the patient back to life to live a better, productive, good and happy life.
Twenty-six years ago, I was diagnosed with bipolar disorder 1 with rapid cycling and mixed episodes, which made it very difficult to treat effectively. I was also diagnosed with postpartum depression, PTSD, generalized anxiety disorder (GAD) and borderline personality disorder (BPD).
Most psychotropic medications gave me severe side effects and adverse reactions. I was super sensitive to the medications and I seemed to be medication resistant as well.
My illness and the medications made me become very ill. I could not cope. I overdosed on my medications too many times to count. I didn’t understand back then that I was physically addicted and dependent on my benzodiazepine, Klonopin. Unbeknownst to me, that was the reason I kept taking more and more of the medication. My body was craving more of it every day I took it.
Klonopin put me in a state of almost continuous withdrawal syndrome for two decades. The doctors and I were unaware of this at the time. Regardless of the reasons, I was overdosing repeatedly, two times being near fatal overdoses, but I was saved by the grace of God. Too ease my pain, I was also repeatedly cutting myself in dangerous ways requiring stitches a few times. Because of my repeated overdoses and dangerous cutting behaviors I was hospitalized too many times to count over a twenty year period.
My depressions were becoming too severe and dangerous and were occurring too frequently. The only treatment that seemed to help me for a while was electroconvulsive therapy treatments (ECTs). ECT is a safe, reliable and effective treatment for many people. I had over one hundred ECTs over a 20 year time period. ECTs helped me survive and get through some very severe depressive and manic episodes and times of my life.
However, when I think about it now, I find my mental health history and treatment to be rather ironic. I was given a Benzodiazepine called Klonopin, for twenty years. Benzos were originally made to treat and stop seizure activity in the brain. I took Klonopin that stopped seizures while receiving ECTs to promote seizures.
ECTs cause seizure activity in the brain to occur, but I was given a medication (Benzodiazepine) to stop seizure activity. Why didn’t they stop giving me Klonopin first? If they want to cause a seizure it makes perfect sense to stop the medication that prevents seizure like activity.
I still believe ECTs are an effective treatment, but not recommended while taking any Benzodiazepines used to stop seizures or seizure like activities. Please stop taking Benzodiazepines before having ECT treatments…
and stop taking all Benzodiazepines anyway. They are dangerous and addictive medications.
Electro-convulsive Therapy (ECT)
Electro-convulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.
ECT is much safer today than it was years ago. Although ECT still causes some side effects, it now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks and side effects.
Why it’s done
Electro-convulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of several mental health conditions. ECT is used to treat:
- Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.
- Treatment-resistant depression, a severe depression that doesn’t improve with medications or other treatments.
- Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision-making, impulsive or risky behavior, substance abuse, and psychosis.
- Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It’s associated with schizophrenia and certain other psychiatric disorders. In some cases, catatonia is caused by a medical illness.
- Agitation and aggression in people with dementia, which can be difficult to treat and negatively affect quality of life.
Although ECT is generally safe, risks and side effects may include:
- Confusion. Immediately after treatment, you may experience confusion, which can last from a few minutes to several hours. You may not know where you are or why you’re there. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.
- Memory loss. Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years. This condition is called retrograde amnesia. You may also have trouble recalling events that occurred during the weeks of your treatment. For most people, these memory problems usually improve within a couple of months after treatment ends.
- Physical side effects. On the days of an ECT treatment, some people experience nausea, headache, jaw pain or muscle ache. These generally can be treated with medications.
- Medical complications. As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky.
Initially I was confused upon waking up from anesthesia and I had a lot of memory loss.
Some of my memory loss was short-term, but a lot of it was long-term permanent memory loss that I will never get back. Most of the long-term memory loss were memories made around the time I received my many ECTs.
I did get some headaches, jaw pain and occasional muscle pain. The pain never lasted more than a day or two and mild pain medications helped with the pain.
I never had any severe complications from my ECT treatments and like I said I had so many I can’t even count them. I would guess I had at least 100 ECT treatments over 20 years.
How you prepare
Before having your first ECT treatment, you’ll need a full evaluation, which usually includes:
- A medical history
- A complete physical exam
- A psychiatric assessment
- Basic blood tests
- An electrocardiogram (ECG) to check your heart health
- Anesthesiologist review to go over the risks of anesthesia
- These exams help make sure that ECT is safe for you.
I always had the same above listed exams prior to my ECTs and passed with flying colors so I could receive the many ECT treatments I had for years throughout my struggles and journey.
What you can expect
- The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery.
- ECT can be done while you’re hospitalized or as an outpatient procedure.
I had ECT treatments while I was hospitalized and as an outpatient as well.
Before the ECT procedure
To get ready for the ECT procedure:
- You’ll have general anesthesia. So you can expect dietary restrictions before the procedure. Typically, this means no food or water after midnight and only a sip of water to take any morning medications. Your health care team will give you specific instructions before your procedure.
- You may have a brief physical exam. This is basically to check your heart and lungs.
- You’ll have an intravenous (IV) line inserted. Your nurse or other team member inserts an IV tube into your arm or hand through which medications or fluids can be given.
- Your nurse places electrode pads on your head. Each pad is about the size of a silver dollar. ECT can be unilateral, in which electric currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electric currents.
I was given mostly bilateral ECTs throughout my treatments, but towards the end of my treatments my Psychiatrist chose to give me unilateral ECTS to reduce the amount of memory loss I had. Unilateral ECTS cause less memory loss.
Because I had so many ECT treatments I lost a lot of memory and my recall started to become effected negatively. Since I have not had an ECT for about 5 years, my recall is getting better now. For me, memory loss was and is the only negative side effect for ECT treatments.
Medications cause many side effects making life difficult for me. ECTs have less side effects than psychiatric medications do for me.
Anesthesia and Medications
These medications will be put through your IV:
- An anesthetic to make you unconscious and unaware of the procedure.
- A muscle relaxant to help minimize the seizure and prevent injury.
- You may receive other medications, depending on any health conditions you have or your previous reactions to ECT.
During the procedure:
- A blood pressure cuff placed around your ankle stops the muscle relaxant medication from entering the foot and affecting the muscles there. When the procedure begins, your doctor can monitor seizure activity by watching for movement in that foot.
- Monitors check your brain, heart, blood pressure and oxygen use.
- You may be given oxygen through an oxygen mask.
- You may also be given a mouth guard to help protect your teeth and tongue from injury.
I put my own mouth guard in very carefully as I was always paranoid of damaging my teeth and hurting my jaw as I had bilateral TMJ (Temporal Mandibular Jaw) surgery years ago.
When I first started having ECT treatments my headaches were horrific. During my last treatments I didn’t even get headaches anymore. My Psychiatrist gave me a mild form of a preventative pain-killer prior to my procedure to help so I wouldn’t have any pain or headaches like I used to get.
Like I said before, my ECTs were a piece of cake for me. Nothing to them. Maybe I just got used to them but….
ECT TREATMENTS SAVED MY LIFE!
Inducing a seizure
- When you’re asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electric current to pass through the electrodes to your brain, producing a seizure that usually lasts less than 60 seconds.
- Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you’re having a seizure may be a rhythmic movement of your foot if there’s a blood pressure cuff around your ankle.
- Internally, activity in your brain increases dramatically. A test called an electroencephalogram (EEG) records the electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.
- A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You’re taken to a recovery area, where you’re monitored for problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.
The procedure of my ECTs was just like the above described procedure. It was very strange because it seemed like I was under anesthesia for hours, but I was only under anesthesia and asleep for only a few minutes.
Series of treatments
- In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments.
- Some doctors are using a newer technique called right unilateral ultra brief pulse electro-convulsive therapy that is done daily on weekdays.
- The number and type of treatments you’ll need depends on the severity of your symptoms and how rapidly they improve.
- Some people may be advised not to return to work or drive until one to two weeks after the last ECT in a series or for at least 24 hours after the last treatment.
- Many people begin to notice an improvement in their symptoms after about six treatments with electro-convulsive therapy. Full improvement may take longer. Response to antidepressant medications, in comparison, can take several weeks or more.
- No one knows for certain how ECT helps treat severe depression and other mental illnesses.
- What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses.
- That’s why ECT is most effective in people who receive a full course of multiple treatments.
- Even after your symptoms improve, you’ll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, or psychological counseling.
People need to learn and understand that ECTs are not controversial. ECTs are a very safe and successful treatment that help many people with a many different and severe forms of mental illness.
Many people are given ECTs for treatment and they would not continue to have them if they were not effective for them.
It is not the 1950s and people cannot be forced to have ECT treatments anymore. Patients must sign about a bazillion forms to give their consent prior to having any ECT treatments. People have a series of these treatments and continue to receive more because of the facts that it they help improve their health and lives in many ways.
I hope people start to realize that it is not the same treatment that was used as punishment or treatment back in the 1950’s as depicted in the classic move “One Flew Over the Cuckoos Nest” starring Jack Nicholson,
Carrie Fisher is one of my heroes as she was a great voice and advocate for Bipolar disorder and did not just fight the stigma of Bipolar Disorder, but also described in her memoir “Shockaholic” that she voluntarily used electro-convulsive therapy and that ECTs were a very effective and successful treatment for her bipolar disorder and…
ECTS were a very effective and successful treatment for my bipolar disorder, PTSD, GAD and BPD at the time. They got me through some very severe episodes when nothing else seemed to work.
ECT TREATMENTS SAVED MY LIFE!
References Sept. 19, 2015
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