ECT Not for Me

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"Maybe you need ECT", she said to me a little too casually. It was two years ago, at the age of 29 that a therapist suggested that Electroconvulsive Therapy (formerly known as Electroshock Therapy) might be beneficial in treating my depression. She said it in a tone that was as casual as a strolling walk.

I no longer have this therapist. Not because I didn't like her or the services she provided, but my employer switched insurances at the time and so I had to drop her.

I remembered leaving that session stunned. No, not shocked. But stunned. She had silenced me, she had worried me. Am I that bad off? My depression was crippling me and yes, things were bad. It was that year that I found a VERY good shrink and was prescribed meds that gave me room to sigh. I've had Dysthymia for years. Since childhood. The DSM-IV-TR defines Dysthymia as a low-grade chronic depression. Don't let the "low-grade" fool you. Dysthymia can often be more powerful than Major Depression. A person with MDD must experience at least one major depressive episode for at least two weeks in order to meet criteria. A person diagnosed with Dysthymia must carry depressive symptoms every day for at least two years to meet criteria.

Some therapists have diagnosed me with "Double Depression" which is not an official DSM diagnosis but is often used within psychology and psychiatry. It is considered Dysthymia but with bouts of Major Depressive episodes. Constant depression but with major dips that can last a couple of weeks. After those dips, a person returns to a baseline of Dysthymia. There is never a break from depressive symptoms.

Once upon a time I referred to the DSM as "the bible." Many folks in "the biz" called it that as it held the diagnostic criteria for all recognized disorders under the American Psychiatric Association. I no longer refer to it as "the bible" as I believe that is quite insulting. When I was a student I was infrequently reminded that the DSM is meant to be used as a "guide." But really, any mental health position is going to require an employee to go by the book, so to speak.

I am a psychiatric social worker. I entered graduate school in 2006 (graduated in 2008) so as to become a therapist and work with the "worried well." I shifted my sights during grad school and now I offer therapy, but for the "severe and persistently mentally ill." Mainly individuals who experience Schizophrenia, Bipolar Disorder. Individuals who are high functioning enough to undergo therapy.

For insurance purposes, clients must be given an immediate diagnosis. Drives me crazy. The diagnosis may not be accurate as it can be difficult to know a person's true diagnosis until a clinician is able to meet with a patient over a period of time. Schizophrenia Undifferentiated Type? Schizophrenia Disorganized Type? Schizophrenia Paranoid Type? Schizoaffective? Schizoaffective Bipolar Type? It takes time to figure it out.

I had been against the idea of medication until the age of 23. It was not just that I was depressed but my memory had deteriorated to the point where I couldn't retain anything. The journey was a long one but I am happy to say that I am stable on meds. "Stable" means different things to different people and in my case it certainly doesn't mean "cured." 

When I underwent an internship at a psychotic hospital I was exposed to some very sick people. I continued to work in hospitals and saw the sickest of the sickest. It always pained me when I would work with a patient who was so sick that the meds just wouldn't touch them.

During my internship I had a patient who was going to receive ECT. It was a last resort and rarely used. The patient never went through with the treatment as he eventually felt the effect of the medications he was prescribed. When the patient was initially going to receive the treatment I asked the attending psychiatrist if I could observe it.

He said that he would and explained to me that the process is not as dramatic as it once was. It's no Cuckoo's Next. The person is put to sleep and does not feel the shock. ECT causes a seizure in the brain, that reboots the emotional wiring.

Treatments are to be carried out a few times a week over the course of two weeks to a month.Electricity is administered to the head for about a fraction of a second and a seizure may last about as long. The body is mostly calm. A person's foot may wave back and forth a bit, but that is usually all. When a person comes out of it they might feel a little foggy but it subsides.

Although the treatment is supposedly very effective, there is a risk of memory loss. When a person is depressed, memory loss is a symptom. It certainly was for me. So, ECT would potentially worsen my memory if I had decided to go through with it.

Not only that, but ECT is not long lasting. A person would need to continue treatments in order to maintain relief. Some feel that ECT has changed their life for the better. I for one, am glad that I never went down that road.

I've got a couple of people in my life who are going through some pretty tough stuff. As a friend I continue to do my best in supporting them. I've recommended therapy to both of them and they are heeding that advice.  I've suggested medications and they are heeding that advice as well. It is their struggles that brought me to the memory of my former therapist and her suggestion.

Desperate times may call for desperate measures and sometimes we experiment and fail. But hopefully we learn from our failures and keep on keepin' on. I did and I'm glad I did.