Yesterday I had a consultation with a local ECT specialist.
ECT (electroconvulsive therapy) is generally considered a last resort treatment for people in severe manic or depressive states whose symptoms have not responded to medication. The procedure works by producing a controlled seizure in an anesthetized patient by means of a low controlled electric current passed through the brain.
I can probably guess what you’re thinking at this point, and yes… it is a serious procedure. Though this form of treatment has undergone significant improvements since its early usage it is still highly stigmatized, even by many of those within the mental health community. At the same time, it is one of the few “proven” (i.e. studied) treatment options for people who experience severe symptoms that do not respond to medications (like mine).
I also feel inclined to note that I have not made any solid decisions regarding this form of treatment yet and I still consider myself to be in the investigative phase.
Thus the consultation.
Frankly, I am not sure why I was so nervous heading into my appointment. I knew I wasn’t headed toward receiving ECT yesterday and I have generally reached the point in my life where I don’t let doctors boss me around anymore. Still… I guess I was worried that, like most doctors, this one might try to shove his agenda down my throat without letting me make an important decision like this on my own.
Turns out I was completely off base, and the man I met with (a psychiatrist who I believe I may have encountered while hospitalized in 2011, though it is hard to remember) was extremely straightforward with me and seemed genuinely empathetic to my situation. Those two qualities are ones that I look for in particular from my healthcare providers, and after talking with him for 45 minutes to an hour I was convinced that if I were to receive ECT treatment he is someone who would genuinely do his best to help me. That was a breath of fresh air, let me tell you!
He told me the treatments would be 2-3 times a week for 6-12 treatments (depending on how I responded) and though the procedure only takes 20-30 minutes, the anesthesia would require me to spend about three and a half hours at the hospital. He performs the procedure in an outpatient setting, which is what I would prefer. My regular psychiatrist gave me the option of speaking to someone at a hospital much closer to where I live but they would require me to be inpatient during the entire course of the treatment which sounds, frankly, like a huge bummer to me.
I was surprised when he told me flat out;
“There will be nausea. There will be headaches. There will be body aches… but those are all things we can treat when they happen.”
No “might-be”s or “possibility of” side effects talk from him, which I also really appreciated. He has been doing this work for a long time, so he knows the routine and had no need to beat around the bush.
When the topic of memory loss came up, he said, somewhat forlorn, that that is not something that can be treated when it occurs and short term memory loss (being able to remember things from years ago but not what happened twenty minutes go) is pretty prevalent for people who have received ECT, but the memory loss he has seen has improved and dissipated within one month to six weeks after the treatment.
Obviously that is the big-scary when it comes to ECT (for me anyway) but again, I appreciated that he was up front about it.
One thing he told me that I didn’t know about previously was that ECT performed on bipolar patients for a depressive state can (rarely) trigger mania.
He said that for his depressed bipolar patients the procedure had a 70% success rate of reducing depression, however there is also a 40% relapse rate within 2-6 months after the procedure (which may require patients to undergo “maintenance” ECT sessions once a month or every few weeks).
Walking away from the appointment, my biggest concern was that he told me I could not be taking Lithium while having ECT (something I never heard before), and though the 1200 mg of lithium I am on is having no positive effects for me anyway, I am a little nervous about coming off of it because I had a hell of a time reaching my current dosage. With the prevalent side effects I experience, it isn’t uncommon for me to experience side effects when reducing or coming off a medication (in addition to going up or starting one).
After looking into the lithium/ECT issues when I got home it seems that research about mixing the two has not been completely straightforward (some studies have shown it works out fine, others have had big problems) but it appears that if lithium is something that even could cause a problem I certainly wouldn’t want to risk it.
Basically, my goal with this consultation was to speak with an ECT specialist and see if this is something he would recommend for me. Honestly when he heard I had already tried 14 medications with no luck (and some doctors refer for ECT after only 3 medications not working) he told me that while he considers me to be a good candidate for the procedure he wants to give me plenty of time and resources to help me think about it.
I told him flat out that even though I have been experiencing several months of worsening depression at this point, I consider ECT to be something of a last resort. It is important to me to learn what I can about it now, because if my depressive symptoms start getting worse (and trust me, they aren’t particularly hunky-dory now) I know I can enter into a place where I would trade my soul to the devil for one small moment of relief. There are definitely situations I can foresee where ECT will be on the table as an option, but I don’t want to leave that decision to a moment where my only deciding factors are based on desperation and not reason.
His response was not what I expected.
“Well, I really hope your depression lifts before then.”
As it stands now, he is scheduling three weeks out, which is a significantly shorter wait time than I expected honestly. That might increase once winter comes on, but knowing that I have ECT as an option with a relatively short wait time (at least, for mental health services in the Pacific Northwest) gives me a bit of solace.
Of course, I got home and had more questions… but he gave me his phone number and said I can (and should) call and ask him any more questions I can think of.
Despite the terror I felt walking in, I left the appointment feeling slightly optimistic. I am in no rush to make any decisions, and I am proud of myself for exploring this before the depression turns my brain into oatmeal.
Or, at least, overcooked oatmeal.