New Walrus... ECT... What's That
I had my first appointment with my psychiatrist. The "Walrus" is my code word for him so the wife and I can talk about it without anyone knowing what we are talking about. We came up this because my first PDoc looked like a big walrus waiting for some fish to be dangled in front of him. The new PDoc is a bit young but gave me info that I did not know nearly immediately. The way I was taking Latuda was giving me no benefit because I was taking it completely wrong. The first PDoc did not know how to treat someone with Bipolar. Makes sense, bipolar was never treated in the military. But back to the new walrus, I think I like him.
The PDoc recommended ECT. I kinda know what that is - I know what I have seen in movies and TV. What is it like? What do you go through when you have a treatment (detailed). My first surgery was not what I expected, and it was rather scaring due to how I was treated. What happens afterward? Do I stay overnight? Do I lose part of my memory? How long does this last, how long is the treatment? I need to get back to work afterward. Is a long term cure or not? So I am a little freaked out and surprised the doc whats to electrocute me... I've only known him for five minutes. The wife will be extremely against this.
Replies
I've talked to you about this some. I don't know many others on this Board who've had ECT. And ECT is different for every person, like just about every other treatment for BiPolar.
The length of time you receive ECT Treatments to how often per week, etc. its different for each person. I would ask why your Pdoc recommended it. ECT is normally a "last ditch" treatment for people who are med-resistant and do not respond to any other type of treatment and are either "terminally suicidal" or Psychotic or Catatonic. The reason for this mainly is that you can't do ECT and do the rest of your life, you have to take a time-out from life and focus on your treatment only, and most people who do ECT are at the point where they aren't really capable of living or participating in life anyways.
I did ECT because my BiPolar after 21 years was complete medication and treatment resistant, I was "Terminally Suicidal." I had no will to live and no will no participate in life. I was at a point where someone staid with me 24/7 to make sure I didn't chose to end my life.
At the asking of my then 18 yr. old son to try 1 more time, I chose to admit myself to my Hospital Psych Ward and see what magic my Pdoc could try. The only thing left was ECT. We had reservations...many.
ECT is a procedure where small amounts of electric current are passed through the brain, intentionally triggering a somewhat controlled seizure. The effect being that ECT seems to cause changes in brain chemistry that can everse symptoms of serious Mood Disorders like Suicidal Depression, more quickly than trying multiple medication changes. Or when Medications no longer are effective. The Procedure is done under General Anesthesia. Generally a normal course of Treatment would be 2 - 3 ECT treatments per week for 3 to 4 weeks, somewhere between 6 to 12 Treatments total, depending on the severity of the patients symptoms. A Pdoc can make a somewhat educated guess based on his history of treatment of the Patient and the status of the Patient when they begin, but all in all you don't know exactly how many treatments it takes until you get into them and see how you react and how you progress or don't. Everyone is different.
There are Risks involved. Loss of long-term and short-term memory are possible. Loss of cognitive ability is possible, similar to what happens to a Seizure patient, feelings of confusion/not understanding. Headaches, muscle aches, jaw pain, nausea. You'll be having General Anesthesia, so heart and blood pressure complications.
There's all the general doom and gloom.
I and my Pdoc had reservations because I have a Seizure Disorder already and the Grand Mal Seizure I already have, hadn't cured me. I have Cluster Migraines that can last up to 13 days at a time, and was concerned about them being made worse. I had a couple of other Neurological issues that were to be considered. I have a Lung Disease and blood disease that had to be considered when dealing with General Anesthesia. I spent 2 weeks in the Psych ward sitting in my room weighing my choices, with a gastric tube down my nose, because the ability to put food in my mouth had stopped weeks prior.
Here's the sheer greed/selfish/stupid part. I have a high IQ, an Eidetic Memory, I read at a rate of around 800 wpm, I have an Associates Degree in Computer Science, a Bachelors Degree in Accounting and a Ph.D in Clinical Psychology, and I earned those 3 Degrees over a 12 year period all while being BiPolar and Mentally Ill and damaged. I had absolutely no desire to lose any of that, if ECT worked and I regained some will to live life again. I didn't want to live it as anyone other than Me! That was my Moral Conflict. I'd already had 27 surgeries at that point, too many procedures to count, the medical stuff did not bother me. My mind, intellect, my identity...losing that terrified me.
Options weighed, daily talks with my Pdoc, who'd been my Pdoc for 8 years, many medical tests to make sure I could actually medically survive all of the procedures...medically cleared, and on the 17th day I decided okay, I will do this, I signed on the dotted line. It was estimated that I would need ECT 3 times per week, every M, W, F for minimum 8 weeks. I actually ended up having it 3 times a week for 3 months.
I spent the next week mentally preparing. Writing down everything I could possibly want to remember about my past, present and future life. My children's lives, lists of where all of my academic material was, where all my computer data was stored...anything I might possibly forget, I wrote down. Memories can be forgotten, but they can also be re-learned.
I started ECT in-patient on a Monday morning, wheeled down to Surgical Pre-care like any other In-Patient Procedure. They had there own 6 bed bay in the Pre-Op Floor, the Hospital I use has a very large, advanced, up-to-date Psych Program. Very cheery atmosphere, nobody treated you like a Psych Patient, just another patient going in for a procedure. You got your IV, your pulse ox, your heart monitors, and a lil happy juice if you were too anxious. Generally within 30 min. you were wheeled into the operating room, the only difference between that and other procedures I recalled was I didn't have to "scooch" onto an uncomfortable table, I got to stay in the bed I was in. Dr. came in, was very pleasant, reassuring, nurses started hooking all the cords and gadgets up, at some point the lovely white juice came through the IV and you just stopped caring so much about all the activity. You know people are talking to you, you know they're asking you questions and your answering....but it doesn't really seem to matter. Then someone puts a mask on your nose/mouth and asks you to count backwards from 100. I'm one of those weird competitive people, (go figure), who always tried to see how far I could count...it was a game...that I never seemed to win....
And then I'd wake up in Post-Op, with a O2 mask on, which I hate, very groggy, with a killer headache, without a clue what the hell I was doing there, and feeling kind of like a Mac Truck had hit me, actually kind of like a normal, "I had a seizure" feeling. With each Treatment the "Side Effects" got less. The headaches were the worst for me, I'd generally have a nagging headache and be nauseous, most of the day. I did have memory issues, mostly Short Term, centered around what was going on during the week, during the Treatments. On the weekends I got a break, spent time with my sons, got to re-charge and that helped. It took about 3 weeks before we saw really good "this was worth it" improvement, but my Pdoc was expecting that. He hadn't told me that, but that's why he's good at what he does. He kept his Optimism on High. At 4 weeks I started wanting to go out of the ward on the weekends with the boys, to eat or walk in the gardens, I didn't mind being around people....life seemed interesting again. At 6 weeks I was spending evenings with the boys for dinner/board games/homework with my youngest son, there was a marked improvement in my condition. At 8 weeks I kind of stalled, and we started re-introducing psych meds. At 9 weeks I got to go home with my oldest son, and continue my treatments on an Out-Patient basis. He took me back to the Hospital every Mon, Wed, Fri. morning at 8:00a.m and by noon we were back home. I finished ECT at 13 weeks, was completely stable on an Anti-Seizure med, low dose Anti-Depressant, Sleep Med/Anti-Anxiety Combo. I have been stable for 9 years since. Although Depression appears now and again, I've not been Suicidal or had the type of Suicidal Ideation that used to be a daily life for me. I don't have the monthly bouts of severe Depression that used to be the norm for me.
I changed Careers, Semi-Retired and was back at work, with a total of 1 year off. My Eidetic Memory was fractured in the process, my IQ went down 5 points and I now read around 680 wpm. So, yes there was damage done, but I had 39 ECT Treatments compared to the average 12....hell I'm impressed I can still form a complete thought. I do actively complete daily Cognitive, and Memory Brain exercises to keep my Brain Cells healthy and functioning at their highest capacity. I do, after all, still have a Seizure Disorder and lose Brain Cells with every Seizure I have.
Was it worth it? Would I do it again? Did I trust my Pdoc to do the right thing? Yes. ECT gave me my life back, maybe not the exact "Me" or life that I had, but I don't think that's particularly a bad thing. My personality changed, more, than anything. I'm less easily stressed, less needing to constantly prove something, less worried about perfection, and less competitive. Consequently all the traits that equivocally relate to suicidal tendencies....
Dr. Kyle was my Pdoc for 2 more years, he's been a Peer for many years, and has since become a very good friend. He saved my life, more than once, and I am very fortunate that he was placed in my life when he was.
There are no guarantees with ECT, no Pdoc can tell you that this is a long term cure, if they do they'll be lying to your face. I've know patients that have to do this every few years, I've know some who do it and it has no effect whatsoever. I know some who had it many years longer than me and for shorter treatments and are still stable. The brain is a wonderfully unknown mystery and everyone's is different. Personally if I was not at a point where my Depression was not treatable, and I did not have the backing of a Pdoc I had history with and whom I trusted, I don't think I'd jump into ECT.
Its a very difficult thing to do, it takes a commitment to begin, to undertake and to keep doing, while your going through it, it takes a support group, including your Pdoc, to be there with you through it. There is also TMS to consider, which would be a less invasive step before ECT, why did he not mention or consider that? I might just want to get to know the Pdoc more and make sure that his treatment style, his style of care and commitment were going to be what I needed to go through such a large Treatment Step.
Sorry this was so long, I tried to be as candid as possible. Civilian Mental Healthcare is very different than what you're used to from the military. It does sound like this Pdoc is at least "caring" about you being better.
OlderCPer - thanks for the information. The PDoc went through the records that I brought and was impressed that I had a lot of self-reflection about my condition. Useful in some ways, and very dangerous in others as I will sit there an analyze something for hours. Each iteration yielded a bleaker or blacker result. He complimented me, but I told it is my mind that gets me into trouble. So anyway, I talked with the intake nurse for like 90 min and then the PDoc for about 60. He used my interview with him to train the nurse. I think I like him, but it will be a while until I can trust him. The military burned me so many times on privacy.
ECT scares me a great deal, and I would have to give up my new job. The procedure is just like cardioversion. I want to get out of this constant depressive rut and stop thinking about suicide when I see an opportunity (think long ladder well with concrete at the bottom). Sooner or later, I will act impulsively. ECT might be what I need. I will do it when I wind up in a psych hospital again. My job will be shot by then, and I will probably lose the wife this time around. ECT, yes, but not now.
Maybe as you learn that you can trust the civil Pdoc system, and if he's a good enough Pdoc that he leads you on a path of Trust, Understanding and Support, you may find your way out of the Depression and not need ECT in the future....that's the hope. Maybe you'll find that your ready to go on a different Career Path before the current job drives you to the pysch hospital....
I'll keep up the good thoughts for you and the hope.
Kat
Thanks Kat. Hospitalization feels inevitable but there is hope.