Therapy: ECT (Electro-Convulsive Therapy)

FAQ 1: ECT (Electro-Convulsive Therapy)
FAQ 2: Bipolar & ECT Therapy: An interview

FAQ 1: ECT (Electro-Convulsive Therapy)

Q: Dear Frank, A survivor recently wrote that she was receiving ECT (electro-convulsive therapy) for Bipolar disorder. It is going very well. She wonders if you were aware of anyone using ECT for PTSD. Her concern with ECT is that it is a highly effective treatment that is being underutilized due to the stigma attached to it. I agree, and believe that people have the misconception that it is a radical and barbaric treatment. Although ECT is certainly not a treatment to enter into lightly, it might be extremely useful for some survivors. I was wondering if you could give me your thoughts on this.

A: Dear reader, I am aware that several survivors with depression and PTSD find ECT helpful. I thank you for writing and for inquiring about ECT for PTSD. First of all, ECT is clearly not barbaric nor radical. Decades ago, in the era of mental asylums that were likened to snake-pits, and the era when lobotomies were used for schizophrenia, ECT was barbaric. It was performed without adequate sedation and anesthesia and was used without informed consent and without consideration of less painful alternatives.

That era is over.

Now ECT is used selectively, electively, safely and effectively. Most people who choose ECT are well screened and well treated. It is indicated for depression that resists more conventional treatment with medication and “talking therapy.” That is true whether the diagnosis is Major Depressive Disorder or Bipolar disorder. The only absolute contraindication for ECT is a brain tumor, although other risks must be evaluated. The procedure is done under sedation and there is no generalized seizure as happened in the old days. There may be some short term memory loss. There may be minor cognitive impairment. The risks and benefits should be weighed carefully with an experienced ECT physician.

ECT causes a convulsion, a generalized seizure, as in epilepsy. Why this reduces depression is not known, although many theories exist.: Some authors suggest that ECT restores memory circuits that have been lost or suppressed or over-ridden by negative memories: This would explain why ECT appears to be useful when a person has a combination of PTSD and major depression. In some earlier studies of subjects with both depression and PTSD, ECT improved depression more than PTSD. But one recent study with a relatively small sample concluded that the PTSD was improved and that improvement was not simply due to relief of depression:

This suggests that persistent, disabling PTSD symptoms could be treated successfully with electro-convulsive therapy. We do not know exactly how and why the treatment works. We do know that it does work – for some.

For the first time, I referred a patient with depression and PTSD for ECT. She and I are hoping for a positive outcome. I’ll let you know as soon as I know how she does. It does take several treatments over a period of several weeks. I also know that one of our GFW correspondents had an excellent outcome with ECT and has written an extremely helpful article about her experience.

However, despite the evidence favoring ECT, most clinicians are still not comfortable arranging “shock treatment” for anyone, let alone for PTSD. ECT is not considered a “first line” treatment for PTSD. It may become an effective tool and may become more available and common-place through positive outcomes such as this GFW survivor reports.

FAQ 2: Bipolar & ECT Therapy: An Interview

This is an interview with someone who has undergone electroconvulsive therapy (ECT) for bipolar. Please note that it is one person’s experience. It is recommended that anyone considering this treatment do additional research to determine whether or not it is right for him or her.

What exactly is electroconvulsive therapy?

Electroconvulsive therapy (ECT) has also been known as “shock therapy.” During ECT, currents are passed through the brain intentionally triggering a brief seizure. It believed that it causes changes in the brain chemistry thereby reversing the symptoms of some mental illnesses.

Could you tell me why you went to get ECT?

I have been Bipolar all my life. I was diagnosed only 8 years ago and have tried countless medications achieving only minimal results. Most often, I had an external life that was functioning and appeared to be very fortunate. However, I have been secretly suicidal on and off for my entire life due to the instability of my internal world.

I never messed around with my medication. I was 100% compliant with it. It just didn’t seem to work. I couldn’t achieve true happiness and joy was typically fleeting. I used to describe it as living on a fine line between life and death. You can’t seem to die but you certainly aren’t truly living.

ECT was recommended 8 years ago and I instantly blew it off wondering how my psychiatrist could recommend something so barbaric. Eight years later when I had tried everything, I looked into it to find out it is not barbaric at all. It is a painless procedure with a great deal of research behind it.

What is the rate of success?

ECT is highly successful. Academic research suggests an 80%-90% success rate. The National Alliance on Mental Illness puts the success rate at 90 percent.

Who benefits from ECT?

ECT is useful for people suffering severe depression as well as bipolar. It can work quickly to relieve catatonic depression as well as mania. It is also useful for pregnant woman who may not be able to take medications. ECT has also been shown to be effective in treating the elderly with aggressive dementia.

Were you hesitant on getting ECT?

It was recommended to me when I was in a severe suicidal depression and I immediately rejected it. I thought it was just barbaric and ridiculous to even suggest. In hindsight and having the results I have had, I could have avoided a lot of heartache if I would have done it back then.

What misconceptions did you have?

ECT was developed in the late 1930’s before the benefits of modern anesthesia. Back then, the patients were restrained instead of put to sleep. I had seen the movie One Flew Over the Cuckoo’s Nest where Jack Nicholson was restrained while fully awake and given ECT. This was the image that came to mind when it was suggested to me. Of course, I immediately discounted such a painful experience.

I also thought it was a radical treatment reserved only for the really “insane” people. I thought that having this treatment would put me in a category as someone who would be disabled the rest of my life. Truth of the matter is that I have had a better life since.

What is the actual procedure like?

The actual procedure is quite simple. I couldn’t eat after midnight because I was undergoing anesthesia. They start it early in the morning although I am sure different places may do it at different times. I would show up at around 6:30 am and start to be prepared for the procedure.

The preparation started by inserting an IV so I can receive fluids as well as the anesthesia. Through the IV, the nurse gave me a mild, non-narcotic pain reliever and a muscle relaxer. The pain reliever was for the headache that typically accompanies treatment. The muscle relaxer is because your body will be going through an internal seizure.

Then I would be wheeled in my hospital bed over to where the procedure takes place. They would put some oxygen over my face and insert the anesthesia through my IV. The next thing that I experience is someone asking me how I am feeling. Without fail, my first thought is “when are you going to start the procedure?” Then I quickly realize that it is already over. The whole procedure from the time they put me asleep to the time they wake me up takes about 5 minutes. About 15 minutes later, my mom came to pick me up.

The treatments were 3x per week initially then went down to 1x per week and then every 2 weeks. I completed a total of 14 treatments. They said because I am young that I shouldn’t need maintenance. However, if I need another treatment I can go back for one.

What are some of the side effects you’ve experienced?

The day of the procedure, especially right after, my body is a bit sore and I have a mild headache. My jaw is a little tight as well. I have some memory loss of events that happened right before the ECT but it’s been fairly mild. I have noticed a few memory issues but they are not significant. I just write things down more. I am told they won’t last very long.

What positive changes have you seen in yourself since the treatment?

I did a total of 14 treatments. Initially, the antidepressant effect was so significant that I was sent into mania. However, after a couple more treatments, I noticed that life was drastically different. I am much calmer, I don’t obsess or ruminate about things as much as I used to, and I don’t have such a short fuse.

I feel like I am a normal human being for the first time. I am hopeful and feel like I have a chance now at life. My relationships are better with my family. Specifically, I always had a hard time with my brother and it has been so much better. I am now getting the relationship with him that I always wanted.

What support did you need?

Getting ECT is a big decision. The first 3 treatments were done while inpatient so I had to be financially prepared to be out of work for a while. I also took some time off although many people work during their treatment. I needed someone to drive me in the mornings and pick me up. I couldn’t drive on the day of treatment so I needed some help there too.

I needed understanding of some of the memory issues. It was helpful when people would realize that my memory would be slightly compromised and not to get frustrated with me. I needed compassion because this was a hard decision. It was useful for people to learn more about the treatment and how it is for people who have depression or bipolar that doesn’t respond well to meds and it’s not just for the “insane.”

Most of all what I needed was forgiveness for all the past behavior that I did as a result of my bipolar. I needed to be given a second chance. Although I have a lot of making up to do, I feel like I have a fighting chance and the mental stability to do it. My mental illness hurt some people but I feel like I have the stability now to make it up to them.

Are you glad you did it?

Absolutely. Being bipolar, you get often get false hope and because the good feeling you had was just you ramping up to mania. Then you have consequences to follow. I am glad that I can now have hope and know that I am feeling good not because I am on my way up, but because I am better.