Dr. Oz and His "Controversial" ECT Show

At the beginning of this week, a few thoughtful people alerted me to the fact that, on Wednesday of this week, Dr. Oz was doing a show about Electroconvulsive Therapy (ECT). I was pretty excited, because Dr. Oz is about as mainstream as it gets, and to have ECT discussed on a mainstream show like that could be really helpful for a lot of people.

I think he did a pretty good job of talking about ECT in general; he had a couple of doctors (notably Dr. Keith Ablow, who used to have his own show, and is a fixture on "Fox and Friends"...hmmm), and also spoke to a few people who have had ECT. One, Julie Hersh (she writes about her experience with Dr. Oz here), is an author of the book Struck by Living: From Depression to Hope and also is a public advocate and speaker about mental health. The other patient Dr. Oz spoke to, Susan, was a "normal" person (i.e., no book, no speaking engagements, no websites -- just a woman who has had ECT treatments). He actually got her permission to film her having an ECT treatment, and showed it during the segment. You can get the videos of the segments from the show here, on Dr. Oz's website.

Dr. Oz started the show by saying it was one of the most "controversial" he'd ever done, but amusingly, there wasn't much controversial about it at all. In fact, it was kind of a glowing, enthusiastic commercial for ECT; I kind of wondered if he was getting a kickback from the ECT machine manufacturers (there was even a pretty obvious close-up of the machine in one clip). The doctors he talked to maintained that there were few, if any, side effects for most patients, that cost shouldn't be an issue for most patients because insurance usually pays for treatments, and that it was 80% effective in treating major depression, which was a much higher success rate than most antidepressants.

As he ended his discussion (which, I was disappointed to find out, only lasted half the show -- the other half was about being tired, or something), he said that he was just trying to "start a conversation" about this topic. He wanted to let people suffering from depression or other mental illnesses know that this option was available, and the treatment wasn't like what most people thought it was. I think he accomplished this.

However -- and it turns out that the National Coalition for Mental Health Recovery agrees -- I think the discussion was a little one-sided. While there was passing mention of memory loss as a potential side effect, it was pretty much glossed over as a mere annoyance. I know a lot of people have had significant memory loss as a side effect of ECT, and that side effect shouldn't be ignored. There's also the time commitment of the treatments themselves, which wasn't discussed, and the risks associated with general anesthesia that are always present. And then, of course, there's the risk of spending a ton of time and money on treatments and having them not work, or work only as well as medication does. In addition, in their response to the show, the National Mental Health Coalition said that the claims of 80% effectiveness were "'vastly exaggerated.'"

It's kind of an interesting coincidence that this show aired this week, because this is the first time in six weeks I have not had an ECT treatment. And you know what? I've kind of had a shitty week. I've been up and down, but it seems like mostly down. And I've been extremely irritable and prone to angry outbursts. Perhaps the most concerning change that I've noticed this week was that my urge to self-injure has returned. It was almost like magic when I started ECT that my desire to cut just disappeared, and it pretty much stayed gone...until I stopped treatment.

I don't know what this means. Does it mean that I have to have ECT treatments the rest of my life? I was under the impression that ECT helped on a more permanent basis; it wasn't just effective right around the time I would be having treatments. But maybe I was wrong, I don't know. I know it's concerning. And I also know that no matter what Dr. Oz says, or how safe and wonderful a treatment it's supposed to be, it still kind of terrifies me, and I don't really want to do any more treatments any time soon if I don't have to.

Did anyone else see the show? Any thoughts?

Goodbye, ECT, and Good Riddance

Wednesday was my tenth and last ECT (electroconvulsive therapy) appointment.  I am so very excited to be done with these treatments, I can barely contain myself.

Oh, the things I won't miss...not having to drive 45 minutes each way for every treatment...not having to wait in the inevitible backlogged queue for it to be my turn when I'm finally there and ready...not having that "lost time" feeling every time I wake up...not wanting to sleep for two entire days after the treatment.  (Well, if I'm honest, I'll still probably want to sleep, because that's just the way I work.  But at least it won't be a drug-induced, fall-into-bed-and-pass-out sleep.)

I also won't miss the random aches and pains I have after each treatment, especially in my right shoulder and back.  What is that about, anyway?  I think the pains are a result of my muscles clenching up during the seizure, but I get muscle relaxers, so that shouldn't be it. It's a mystery.

The only thing I'm concerned about is feeling worse.  For all the irritating parts of ECT, I really think it did help.  And I notice that the further I get from my last treatment, the more depressed and irritable I get.  This mood change could also be due to the fact that I have to stop taking my lithium 48 hours before each treatment.  For right now, I'm going to assume that the lack of lithium is the culprit, and not the lack of ECT.  I'm not sure what I'm going to do if it turns out I need ECT regularly to feel okay -- that would, frankly, suck.  I don't even know how or if that would work.  Hopefully I won't need to find out.

For now, I'm just going to bask in the glory of "graduating" from my treatments, and hope for the best.

ECT Update, and Why I Hate Seroquel

No, I haven't fallen off the face of the earth.  Like most people, I got distracted by Christmas and haven't updated in a little while.  Here's hoping you and yours had a lovely holiday and are getting some much needed rest and relaxation.

I am now in the "maintenance" phase of my ECT treatments.  I finished up my "acute" phase last week on Friday, with my sixth treatment.  Now I'm on to one treatment a week for a month, which is much less of a hassle, especially considering the treatment facility is 40 minutes away.  The bad news, though, is that while I was pretty sure the treatments were helping the first week or two, now I'm not so sure -- I seem to have slipped back into a funk and am generally intolerable to be around.  I'm trying to tell myself that maybe it's just the stress of the holiday (like I wrote last week, it's hard to determine what ups and downs are due to having bipolar disorder and what are due to general life stress).  I hate the thought that I may have to go back to 3 ECT treatments a week for another few weeks to try to stave off a heavier depression, but if I do, so be it.

I'm also tired -- very, very tired.  And I'm not sure if it's a side effect of the ECT, or the increased dosage of Seroquel I'm on.  When I was hospitalized in early December, the doctor increased my Seroquel and decreased my lithium in anticipation of starting ECT treatments, because lithium and ECT don't play well together.  I went from 50 - 75 mgs of Seroquel daily to 450+ mgs daily.  I think it does what it's supposed to do, which is even out my moods and make me a little less irritable and raw -- but it also makes me really sluggish.  Add the ECT treatments (and anesthesia) I'm undergoing, and I'm pretty worthless. 

It's so irritating to me that I have to make a choice between being an ugly-acting, depressed witch and being an exhausted, useless sloth.  I guess I should just be grateful that there are drugs that do help depression (more or less), and just look at the side effects as a small price to pay for the benefits they provide.  But it's still frustrating.  Ultimately, though, there's not much I can do about it -- just hope for a speedy end to the ECT treatments so I can get back up on a therapeutic level of lithium and leave the Seroquel behind.  Here's to hoping!

ECT Status Report

Since my life has been absorbed by ECT treatments the last week or so, that's pretty much all I have to write about.  I had my fourth treatment yesterday, which marks the mid-way point of this "batch."  Most people, according to my doctor, need an initial course of 6-12 treatments (at anywhere from $300-$800 per treatment) over two to four weeks. You then can have "maintenance" treatments once a week, once a month, every six weeks, or whatever your mood dictates (the American Psychiatric Association backs up this prescription).

Let me tell you flat out:  I'm not loving these treatments.  For one thing, the travel time is 45 minutes each way for each session, and tomorrow I have an appointment with my psychiatrist as well, so it's going to be an all-day affair.  But time is really just a minor inconvenience.  The whole process isn't all that fun, either.

Going under general anesthesia 3x a week can't be good for your body, not to mention, the whole fact that while you're out they zap you with enough electricity through the brain to cause a sizable seizure (read about ECT risks from the Mayo Clinic here).  Yesterday when I woke up from the anesthesia, I felt like I couldn't breathe, which was slightly alarming.  I almost always have some sort of headache afterwards, from mild to severe, and I have constant jaw, back, and shoulder pain.  During the first week, my calves were so sore it was difficult to walk immediately after sitting, until they loosened up. I think I mentioned some of these complaints in my last post.

But it is working?  In the greater scheme of things, jaw and calf pain is a small price to pay for a potentially large payoff.  The short answer:  I'm not sure.  I definitely feel like my brain is much quieter, with  less thoughts of self-harm, and suicide.  In my last post I said I felt "blunted," and I stand by that.  I kind of just want to sit in a chair and watch TV and zone out.

I even started a knitting project yesterday so I didn't feel like such a vegetable.  Someone was telling me about this cute knit headwarmer-wrap thing they got and how it would probalby be pretty easy to make, so I found a pattern for one here.  And I swear, it's a really simple pattern, but it took me forever to get the hang of it -- a lot longer than it should have.  I'd catch myself halfway done with a row, having knit every purl stitch and vice-versa.  It's like the instructions got scrambled in the translation from the page to my brain.  It's sort of how I used to feel with calculus.  And, man, I hated calculus.

In addition to having knitting problems, I seem to have problems remembering words, finding the right words, and holding a conversation.  These kinds of problems are the side effects most commonly associated with ECT treatments.  According to the APA, cognitive and memory problems are some of the more serious and worrisome risks associated with ECT, after problems with the actual procedure itself.  I found this cool website called the Experience Project, which collects personal stories on various topics, and one of the topics is ECT.  The biggest complaint that people had were significant memory issues; one person said their ability to do math was permanently impaired.  Another person said his memory was so impaired that he didn't even consider himself the same person that he had been before the treatment.

There are a couple of different places on the web to read personal stories, but if I read too much of them they'll drive me crazy.  It's like with anything else on the web; unusually people only get online and spend time talking about something if they really, really love it or really, really hate it -- whether it's a medical treatment or a refrigerator.  So I'll take all the online stuff with a grain of salt.

I do think my unusually-low irritation level is starting to rise back up, whether a result of medication or ECT, I don't know.  So that's a good thing.  I say this because yesterday, my favorite five-year-old dumped a yogurt smoothie on my computer keyboard, and nobody (and nothing) got hurt.  Two weeks ago, some innocent, inanimate object that was within my realm of reach would have been hurled across the room during a scene like that, but I managed to hold it together.

That's it for now.  This "status report" is sort of a misnomer, in that I really don't know what my status is at the moment.  But we'll just keep plugging away (plugging?  electricity?  get it??) and hoping for the best.

A Brief History of ECT

Yesterday morning, I found myself waiting on my third electroconvulsive therapy treatment.  The procedure center was backed up, so I waited for a while, and the longer I waited, the more I kept wondering, "What the hell am I doing here?"

I looked around at the other people waiting (though most of the people in the waiting room were family members who were there to transport their loved ones to and from their shock treatment), and tried to take comfort in the fact that if all these other people were having ECT, it can't be that crazy.  But then I started thinking about people who have lined up through the years for other treatments that promise to make them thinner, younger, happier, healthier, stronger.  And how most of those treatments didn't have nearly the negative stigma that "shock therapy" has ("shock therapy," as a name, is passe -- ECT is the politically correct name of choice).

It's no wonder that ECT has such a negative connotation and stigma, based on its origins.  According to Andy Behrman, aka "Electroboy," an advocate for people with depression and bipolar disorder, most doctors know that ECT was dreamed up in the early thirties by an Italian physician named Ugo Cerletti while watching pigs being electrocuted into unconsciousness before being led to slaughter to make them easier to work with.  Cerletti figured the same technique could be applied to mental patients to make them more malleable for their doctors (from electroboy.com).

The practice was introduced into the US the next year (1935) and was used to treat a whole host of mental "illnesses" -- from schizophrenia to homosexuality, from mania to truancy (truancy is a mental illness?  Sometimes I thank God I live in the era I do).  So, obviously, as most new, fabulous medical treatments are, it was grossly overused -- and grossly under-regulated.

According to the doctor administration my treatments, ECT began to be refined and specialized in the 1950s and 1960s, not incidentally along with the growth of the specialty field of anesthesiology (from SUNY Downstate Medical Center).  Concurrently with the improvement of ECT treatments, though, public opinion of the treatment began to plummet.  With the book One Flew Over the Cuckoo's Nest by Ken Kesey (released in 1962) depicting the treatment as barbaric and punishing, and the movie (released 1975) further solidifying that image, ECT all but faded into the background as a treatment of last resort for catatonic or extremely suicidal patients.  Sylvia Plath, the poet, didn't help much, either, with her poem "The Hanging Man":

By the roots of my hair some god got hold of me.   

I sizzled in his blue volts like a desert prophet.

The nights snapped out of sight like a lizard’s eyelid:   

A world of bald white days in a shadeless socket.

A vulturous boredom pinned me in this tree.   

If he were I, he would do what I did.

Written shortly before her death by suicide, Plath described what her ECT treatmenents were like to her.  And it didn't sound like anything anyone else really wanted to repeat.

With all the bad press and negative images in the media of ECT, it's not surprising that most people just assume that ECT is no longer practiced on a larger scale.  But since conditions in which the treatment is administered are more humane and streamlined now than it was 40 years ago, it is again becoming a legitiamite treatment.  According to the University Hospital in University, New Jersey, upwards of 100,000 adults receive ECT a year in the US alone.  

Even though the popularity of the treatment is increasing, there is still a fair amount of argument about whether ECT is more helpful than harmful.  I plan to look in to personal and doctors' accounts of the treatment and write more about that later.  The fact that doctors still don't really understand how it work -- though they can cite different brain imaging technicques to show that it does work -- is also a cause for concern.

But for now, I'm three treatments down and three to go.  Usually, the doctor prescribes 6-12 treatments upfront over a 2-4 week period.  I have to say, they're not really fun.  If nothing else, they're nerve-wracking and wearing on my psyche.  Buy physically, they take their toll as well -- muscle aches (especially the backs of my legs and my back and shoulders), jaw and facial pain, brutal headaches, and a general feeling of being "blunted."  Though maybe the "blunting" is the treatment working, I don't know.

Part of me wants to fight that "blunting."  Is it worth feeling dumber, duller, at the price of feeling less sucicidal and self-injuring?  I have to remind myself that it's not exactly like I'm Van Gogh, or Mozart, or even Plath - the world isn't losing anything if my intellect falls off a few notches.  But if I can spare my kids a mom who is in an out of the hospital, who cries less and plays more, who takes more of an interest in their doings, I guess it's worth it.

It's Shocking, but there's Even Something I'm Reluctant to Talk About: ECT

When I was in the hospital last week, I went in with three goals.  The first was to stay safe; the second was to get my meds regulated; the third was to have a consultation about Electroconvulsive Therapy (ECT).  The last time I was in an outpatient appointment with my psychiatrist, we talked about the possibility of ECT, and she scheduled a consultation with the doctor at the Lindner Center (where I was hospitalized) who does the ECT therapy.  She couldn't get me in to see him until the 27th of December, but if I was an inpatient, I knew I could see him much quicker.

In case you're wondering, yes, ECT is that treatment -- formerly known as Electroshock Therapy.   When people think of ECT, the first thing that usually comes to mind is that famous (and disturbing) scene from One Flew Over the Cuckoo's Nest where Jack Nicholson's character undergoes ECT as a form of punishment (link goes to YouTube clip).  In fact, that although ECT's popularity as a form of therapy was already on the wane by the time the movie was released in 1975, public opinion plummeted so because of the depiction that ECT became a therapy of last resort, indicated only for chronic, treatment-resistant depression and catatonic depression (from electroboy.com).

In the last 30+ years, however, ECT has gained more popularity as a safe, effective treatment for severe depression, bipolar depression and mania, and other forms of mental illness.  So here we are, and here I am.

Today I had my second ECT treatment; the first was on Monday.  Over the next week and a half, I'll have four more.  They're not particularly fun, and I'm left sore, a little groggy, and with a major headache, but the doctor says those side effects should get better the more I'll do. 

In the next week or two, I'm going to write more about the history of ECT, how it works, and personal testimonies.  Today, though, I just wanted to "break the ice," so to speak, and come out and say that I'm actually now undergoing ECT treatments.

And I feel weird, and a little embarrassed, saying it.

I guess because most people still think of ECT as a barbaric, radical treatment, something that only really "far-gone" people do, something that most people would never even consider, I feel like it's something I should hide -- or at least keep to myself as much as possible.  That I should only tell a certain few people who know me, whose opinions wouldn't be affected by my decision.

But what's the point of keeping a blog, of putting everything else out there, if I'm not going to talk about this, too?  I've spoken about being hospitalized, and I know people have certain stigmas about that.  I know that people I've known for a long time look at me a little differently since the first time I was hospitalized, so I may as well add one more log to the fire.

I decided to go ahead and go with ECT therapy because I'm so tired of feeling like crap, and of taking medication after medication and having none of them work, while their side effects diminish my quality of life even further.  I want my old self back, and from talking to the doctors and from my own research, I think ECT is at least worth a try. 

And, as always, I'll be keeping you in the loop.