After ECT Number 6, And Don’t Forget To Give Blood!

It’s official-the nurses and staff of the hospital where I get ECT treatments think I’m the most loony of patients they’ve had. And considering you have to be a little crazy to get ECT in the first place, that’s saying a lot!

Why do they think I’m loony? Because I asked if I could take this home:

It’s the LMA-Larygeal mask airway, which has given me so much trouble when waking from the anaesthesia following the ECT treatments.

This is, by FAR, the worst part of the treatments for me, as I’ve mentioned before. But it’s not a common problem for patients, so if you’re reading this while contemplating ECT, please don’t think you’re going to have issues with it like I have. Nor will you necessarily have to use it-there are other options, which just didn’t work for me so I’m stuck with the LMA.

From Wikipedia, here’s how it’s used:

Laryngeal mask airways come in a variety of sizes. The cuff of the mask is deflated before insertion and lubricated. The patient is anaesthetized if conscious, and their neck is extended and their mouth opened widely. The apex of the mask, with its open end pointing downwards toward the tongue, is pushed backwards towards the uvula. It follows the natural bend of the oropharynx and comes to rest over the pyriform fossa. Once placed, the cuff around the mask is inflated with air to create a tight seal. Air entry is confirmed by listening for air entry into the lungs with a stethoscope, or by presence of end tidal carbon dioxide.

I just thought it was interesting enough to include in the blog.

At any rate, I’ve finished treatment number 6.  I feel like it might be helping, but my issues with panic have been flaring up badly, so it’s hard to tell. My family thinks they can se the difference, so that’s something that’s not insignificant, in my mind. I would do the treatments if I never saw a change, but my family found me easier to handle.

In other matters, I donated blood on Thursday, so it’s time for my six-times a year reminder that giving blood is relatively pain free (although I gotta say,  between ECT and donating blood, I’m a little weary of needles!) and can save the lives of three people. Do it! Now!

ECT, treatment number four.

Today I had treatment number four. I’m assuming I’ll have around 8, so it’s kind of nice to know we’re halfway there.

Nothing too terribly exciting about today’s experience, but I do have a bit of a headache, which I’d not gotten to this point. But it’s not unexpected-it’s one of the common side effects.

A couple of questions to answer…

Can you tell me how you are getting on now? Has ECT helped or is it helping you?

I’m getting on okay. I’m still having some trouble, but I think I can tell that the ECT is helping. In fact, my husband says I’m more animated that I used to be-and believe me, animated was NOT something I have been in the last couple of years.

Treating depression is a giant, miserable, hell-hole of a waiting game. ECT, as many medications, takes a little time to feel like there’s any progress. Fortunately, with ECT, it’s a matter of a week or two, as opposed to thee three  or four weeks you can get with some medications. I’m hopeful that I will start feeling better very soon.

One thing the ECT is not doing, and I don’t expect it to, is help the panic disorder, which is robbing me of any kind of enjoyment of life. I am hoping, though, with a base of a reduced depression, that the panic will become easier to handle.

Taking a minute to answer a few questions.

I want to thank everyone who has visited my blog over the last few days to read about my experiences with ECT. There are a couple of questions I wanted to address that were left in the comments sections…

Didn’t they show you the procedure on dvd or photos? How did they inform you about the procedure?

Yes, actually, they showed us two older videos on ECT while I was getting some inpatient treatment. I actually elected to undergo the procedure on my own after talking to a therapist in my psychiatrist’s office.

I’ve tried to locate the videos we watched somewhere online, but I’m not succeeding. One was a general video and the other was, I suspect, from a 20/20 episode several many years ago.

At any rate, I suspect my confusion about being intubated, and I think that was your question, might have been a bit of residual memory stuff that’s going on that I completely expected. If it is, it’s important to note that this is the ONLY memory problem I’m having.

I don’t know if this is typical or not. I know that memory loss is a great concern for most patients-and it was for me as well. And as I’ve mentioned before, most people-myself included-have memory loss with depression anyway, so it’s tough to say if the memory problems predate the treatments.

To me, in weighing the options, facing even losing six months of memory (which I am told is about the worst case scenario and is very rare) was a gamble I was willing to take for some relief.

Back to how I prepared myself for the treatments, though. A friend shared this article in Slate magazine online which I found very useful. Also, I took the time to ask a number of people about their experiences-mostly nurses but also my psychiatrist (who administers the therapy.)

NONE of those people-and I must have talked to at least 10-have really ever seen any significant problems with ECT and patient recovery. This was HUGE for me.

It is worth mentioning here the my hospital uses a lower current or voltage or whatever the right word is than some other hospitals. In the upcoming days, I’ll see if I can get them to tell me what that is versus what is used in other hospitals so I can pass that along here.

ECT, Treatment number two.

I learned something today that I got wrong in my initial description of the procedure. They didn’t do intubation. I was confused because they mentioned doing something to help me breathe and that something had to come out of my throat-which turned out was the thing that holds your tongue in place and keeps you from smacking your teeth together.

And it was equally confusing that my throat is sore. I am going to edit my initial post to reflect what I learned today.

The second treatment was somewhat easier than the first. We arrived at the hospital at 5:30 AM, which meant we were up at 4 AM to get here-which, for me will be the biggest pain in the keister about the whole business.

But knowing what was going to happen made the procedure much easier to handle, even though I had some anxiety immediately before they administered the anaesthesia. It is always kind of scary to go under uncontrollably, so that wasn’t a surprise for me.

Also, I meant to add that the procedure does not last very long-10 minutes at most. I think I might have been unaware of the time for about 20 minutes or so-I tried to keep track of the time but kind of forgot there towards the part where they administered the anaesthesia.

So, it’s two down, six or so more to go!

What electroconvulsive therapy is like.

I recently made the decision to try and battle a lifelong struggle with depression with ECT, or electroconvulsive therapy. Because it’s such a hot-button issue in the field of psychiatry and there are many conflicting reports out there on the internet, I thought I would write, from the patient’s point of view, what getting an ECT treatment is all about.

In the interest of full disclosure, I would like to mention that I’ve only received one treatment so far. I’m hoping to use this blog to talk about my experiences as I go through them in the next few weeks while I’m getting the remainder of the treatments.

For a full description of ECT and information on if ECT is for you, this is an excellent article.

In preparing for the treatments, you will go through a number of medical tests to ensure that you are healthy enough to undergo treatment. This included, for me, an EKG (a procedure that’s incredibly easy-little round pads are placed on various parts of your body and are hooked up to a machine so that the may record your heart rate on a strip of paper which a Cardiologist then reads) and a series of x-rays of the spine and chest area.

Additionally, they did a blood test to screen for various issues and a urinalysis and an STD blood test. I’m actually not sure why they needed to do some of these screenings.

The night before the treatments, you will be asked to drink or eat nothing after midnight. This is because of the anesthesia and to ensure you won’t aspirate during the treatment and is a standard practice when undergoing many medical tests and procedures.

The morning of the treatments, I was asked to put on a hospital gown and was taken to the area of the hospital where they do preparation for surgery. This, in this particular hospital, is where the treatments take place, and I wasn’t moved from there until after the treatment was done.

Preparation takes a little while. Your vitals will be monitored constantly with a blood pressure cuff and a monitor that will tell them your blood oxygen levels that slips over your finger. An IV will be started-really the only uncomfortable part of the treatments. Technicians will place pads on several parts of your body-for me it was on my chest, head and one leg. These will be wired to a machine that will monitor you during the ECT.

I told everyone that I saw that this was my first treatment and that I was really quite scared, and the staff was sensitive to that. If you are also scared, don’t be afraid to speak up.

Two bigger pads were placed on my temples. This is where the treatments are administered. There are two types of ECT-bilateral and unilateral. I’m going to let a section from the article I mentioned above detail the differences:

There are primarily two types of electrode placements used for the delivery of ECT. Differences between these two techniques include the area of the brain stimulated, timing of response and potential side effects.

Right Unilateral Placement

To generate a seizure with a right unilateral treatment, one electrode is placed on the crown of the head and the other on the right temple. Those receiving the right unilateral treatments may respond somewhat more slowly than those who receive bilateral treatments. This difference is usually no greater than 1 to 2 treatments. Right unilateral treatment is typically associated with less memory side effects. Patients who do not respond to right unilateral treatments may require a switch to bilateral placement.

Bilateral Placement

Bilateral ECT treatment involves placing the electrodes on both temples. This treatment may be associated with more acute memory side effects than right unilateral treatments. Bilateral ECT is indicated for severe mental illnesses including depression with psychosis, manic episodes of bipolar disorder, psychosis related to schizophrenia and catatonia.

The hospital I was in uses bilateral ECT. It’s at this point that I was given some oxygen-and the anesthesiologist actually helped me relax a bit by giving it to me earlier than they normally would and by talking me through thinking of something pleasant.

Then, the medication was given that made me go to sleep. This is given in the IV and is painless minus a slight burning. It takes only a few seconds for it to work. I wasn’t even really able to panic about it, it happened so quickly.

As I understand it, this is when a muscle relaxant is given to prevent muscles from twitching severely. They helped me to breathe by inserting something in my mouth and throat-which I think is also used to help keep the teeth from clenching.

It’s at this point that the ECT treatment is given, under the supervision of a psychiatrist who monitors the machines that will determine if a seizure has occurred.

And then you wake up. I had a little issue with the thing they put in my mouth, which I’m guessing is not something most people go through. Honestly, it’s a little scary to wake up with something going down your throat, and this was, by far, the only really troubling part of the whole thing for me, and in the upcoming treatments they are planning on using a different thing, which hopefully won’t bother me as much as the first one did.

One of the things that’s most scary for people about the treatments is the memory loss. I experienced no memory loss with the first treatment whatsoever. But it isn’t unusual for some to lose memory of the hours before the treatments. It IS unusual, but not unheard of, for someone to lose more significant amounts of memory-up to six months prior to the treatments. But it is very, very rare for that to happen.

Additionally, the short-term memory of some is affected, but it’s not common. This would mean it’d be a little hard to remember small things like phone numbers. But frankly, with the memory loss that comes along with depression I have problems with that anyway, so I considered it an acceptable risk, particularly given that it’s a somewhat rare phenomenon.

And that’s it. They took out the IV and monitored my blood pressure for a little while and I was done.

It’s the day after my first treatment, and the only side effects I’m having are sore muscles (which is common). I had a bit of a headache yesterday but it is now gone. I’m also a little hoarse and sore in my throat from the intubation.

It isn’t uncommon for some people to be really tired following the treatments, and I can say I was pretty groggy. Be sure to schedule the treatments when you can get some rest afterwards.

It will take several treatments, as I understand it, to feel much relief. So don’t expect to come out of the first one feeling markedly better. I’m not sure if I feel much better yet…I’ve also started some new medications recently so any improvement I’m feeling may be a result of that. I am hopeful, though, that I will be feeling improvement soon.

If you are reading this and are curious about treatment, considering treatment and have questions or are nervous about it, feel free to leave a comment for me and I’ll answer your questions as best I can. I did a lot of research before doing this, and on top of the depression I suffer from terrible panic, so really no matter what you might be feeling about going in for treatment I’ve probably also felt it and have thought about it.