The wondrous truth of Electroconvulsive Therapy.

July 23, 2019

The high pitched squeaking of the food trolleys wheels makes me aware that someone else has entered my room. I stay with my head under the doona for five more seconds, the classical music playing in the headphones bringing me a sense of calm. I haven't slept much, but also haven't gotten out of bed in 12 hours so it kind of feels like I have. The fact that my breakfast is being delivered means it must be 5:30am. I have until 6am to enjoy my cornflakes, milk, fruit juice and toast before I have to fast to prepare for today's ECT.

After eating, I re-enter my music induced daze for another hour before I am called to the interview room for a session with my psychiatrist. We discuss whether I can try taking melatonin to reset my sleep pattern, and I tell him I am scared and confused but also feeling different, in a good way. After only two ECT treatments, the heaviness I have been carrying around and confusion in my mind are already starting to dissipate. I can follow a conversation for longer, engage in the movies I watch, and exercise feels somewhat good again. I'm still not sure about my place on this earth and in moments my world is as dark as ever, but I have glimpses of something different. Something better.

After my psych session I go back to bed for a few more hours. At 10:30am I decide it's probably a good idea to get up and get a workout in before ECT, as that will be impossible after.

Sitting on the hospitals exercise bike with ER playing on my computer, I detach from the unit for a while. As my mind wanders off into thoughts I haven't explored in a long time, thoughts about a future with me in it, I marvel at just how bizarre my situation is. A week ago I was so clouded by pain and darkness that making it through the next 24 hours seemed impossible. Now, though all that pain and darkness is still there, there is also a tiny amount of hope. A tiny amount is all I need right now.

Finishing up on the bike I head to my room and shower, again marvelling at how a task that drained so much energy not long ago can so quickly become part of my normal routine again. At 12:30pm I head down the hall to the treatment room, ready to go in. Despite it being my third time now there is still a sense of anxiety about the process, the seeming seriousness of it all. For such an incredible treatment, the fact that they aren't even sure how it works induces both apprehension and wonder in me. I also start to worry about how much my memory will be affected this time, what I will forget next. Already I can't remember the names of anyone new I meet, and I find myself all too often walking into rooms and in the middle of doing things not knowing why. Still, I'll take that over how I used to feel.

The entire process is efficient and unintimidating here. I go in, have my blood pressure and heart rate taken, wrist bands put on and every list double checked. The procedure is re-explained as the anaesthetist places a needle in my arm. Then as the doctor and nurses calm me with jovial small talk I am wheeled into the treatment room. The final identification checks are done, electrodes are placed at various places on my head, and a mask and oxygen bag is placed over my mouth. One of the nurses pumps oxygen into me as I hear the anaesthetist tell me he is just going to give me something to relax me. Staring at the bright lights above me, I feel the warm and slightly painful sensation of the drugs entering my blood stream rise up my arm, but before I can even count to five the world disappears.

I groggily come around about 15 minutes later to the sound of monitors beeping and the feel of a blood pressure cuff inflating on my arm. The same nurse that was delivering oxygen starts cheerily talking to me, explaining where I am and that I just had ECT. I am wheeled out to the recovery room as the next patient is wheeled in. They keep an oxygen mask on me for the next 10 minutes or so, closely monitoring my heart rate and blood pressure. When I am able, I sit up in the bed and take stock f what is going on. My muscles hurt and I am extremely tired, but otherwise fine. The left side of my face and jaw feels like I got knocked recently, and with how my legs feel I would believe it if I was told I had just run a hard 10km. Everything around me is confusing and a little hazy, but overall I feel nowhere near as bad as after the very first treatment. It seems they get easier as it goes on.

Slowly, I begin to wake up a bit more. I am wheeled back to my bedroom in a wheelchair and given a drink and a sandwich. I lie in bed, unable to do much for the next couple of hours other than watch more ER and sip tea. At 4:00pm Mum comes and sits with me as we watch together, although I keep getting confused about the storyline. I can't remember the episodes I watched this morning or yesterday. I also have forgotten my nurses name, and mum tells me I have repeated the same question a few times now. It is frustrating, but I am told it will pass and I know by now I will wake up tomorrow feeling better, so it is worth it.

Mum has brought my dog Maya in to visit, so we go to the courtyard to play fetch and cuddle with her. After dinner together, mum tucks me into bed with the TV set to masterchef, then heads home.

As I sit watching, I am still. The characteristic movement and fidgeting that has been all I know for months is gone. The way I feel inside myself is new again; like I am lighter, and more present. It is scary for everything to feel so different so quickly, but this fear of the unknown is overridden by the relief. Relief that after everything we have tried maybe there is something out there that helps. Relief that although it hurts, it is nowhere near as bad as the daily pain of depression. Relief that maybe soon, after 48 days of living in this hospital, I can go home.

Waking up initially
Waking up after later treatments
Recovery Tea
The room where the magic happened

ECT and MST (Magnetic Seizure Therapy) were the real turning point in my recovery and saved my life. They involve inducing a therapeutic seizure via directing currents into the brain to alter the brain's activity. Unfortunately, ECT has gotten a bad reputation and stigma among society and patients alike, due to the barbaric depictions of it in the media. If you have seen One Flew Over the Cuckoo's Nest, you may be familiar with the frightening scene showing McMurphy surrounded by men holding him down to the bed as a shock is delivered while fully conscious, leaving him writhing in pain. I don't know if this is accurate at all for the way it was administered at the time, but it most certainly isn't how it is now.

Nowadays, ECT is proven to be the most effective antidepressant treatment for severe depression, with response rates of 70%. This is much higher than that of medications or psychotherapy. It can also sometimes be used for mania and psychosis. It is never given without consent, the treatment itself is not painful (only after effects which are mild), and it does not leave people brain damaged. The protocol and procedures around it are carefully thought out too. I had to go through rigorous screens for suitability, and was given lots of information and reassurance throughout the process. Yes it is still unknown exactly how it works, but when it does it is truly amazing. After years of searching for relief, it gave me another shot at life.

By no means is ECT a cure, and it does wear off over time, but it enabled me to engage in other therapies and live at home again. The main reasons it is not used more often are partially due to stigma, as well as that it is intrusive in that it involves a general anaesthetic. It is often done outpatient, and the main side effects are muscle pain and memory loss. This memory loss is usually short term and gets better with time, although not always. In my experience, I can now remember a lot more about the events surrounding ECT, but the memories are hazy and there are some gaps that may or may not come back.

My journey with ECT and seizure therapy was again, not your usual one. Usually you have three treatments a week for four weeks (so 12 total). However, I lasted only four treatments my first time round. After four treatments, I had already lived in hospital for 54 days and experienced enough benefit to make me want to refuse treatment and go home. Also, the short term memory loss paired with all the new feelings and continued benzodiazepine withdrawal symptoms was extremely overwhelming and scary at the time.

Because I only had the four treatments, the effects did not last long. Having had those four treatments in May, I began to experience a relapse of my depression in July. Rather than go straight back in for more ECT, I did some research and found a research study that the Monash Alfred Psychiatry Research Centre was doing into a newer form of seizure therapy, Magnetic Seizure Therapy. MST had shown promise in overseas studies, and is essentially the same as ECT with the exact same procedures, except the therapeutic seizure is induced with a magnetic current rather than electrical current. This has been shown to have all the mental health benefits without any of the scary memory loss side effects, which was indeed my experience. Thankfully, I was accepted into the study and over five weeks had 15 MST treatments in August/September 2015 as an outpatient. The relief this treatment gave me allowed me to start studying nursing at the start of 2016, come off all medications except a single low dose antidepressant, and kept me out of hospital for almost an entire year.

The MST did wear off around 10 months later, but by some miracle of the universe MAPRC had started another research trial that I was again accepted into in September/October 2016. This time, I went into it slightly better off. So although I found the treatment difficult, I was able to keep training for, and run, the Melbourne Marathon in week 4 of treatment. Not your usual marathon preparation and recovery, having a general anaesthetic and seizure two days before and on the morning after, but I'm hoping that shows just how incredible, life changing and not at all horrific these treatments can be.

I don't know all the ins and outs of the science, I just have personal experience to say if ECT is suggested for you or a loved one, don't be alarmed by the myths of the media. Do your research and go into it prepared for what it involves, but keep an open mind to the possibilities this treatment can unlock. Thousands, if not millions of people have benefited from this life-saving treatment since it was discovered in the 1930s. I quite possibly wouldn't be alive and certainly wouldn't be who I am today without it.

For more information go to:

For the results of the MST research I was part of, you can go to: https://www.beyondblue.org.au/docs/default-source/research-project-files/bw0352_magnetic-seizure-therapy-in-the-treatment-of-depression.pdf?sfvrsn=8f2f50ea_0
I am hoping (and have been told) they will be starting to offer this as a treatment to the public once all the necessary hoops and loops of the system have been navigated.

And lastly, for an accurate depiction and video of the ECT procedure, go to: https://www.youtube.com/watch?v=-T0mwzXHgvI.

Still We Rise.