Content warning: This post includes discussion of self-harm and suicidal thoughts that may be distressing to some readers.
I'm fuzzy.
It's a few hours post-treatment, and I'm fuzzy.
The kind of short-term memory fuzzy that I've only ever experienced with electroconvulsive therapy (ECT).
Despite the barbaric picture that films such as One Flew Over the Cuckoo's Nest paint of ECT, it's actually a pretty straightforward, safe and regulated procedure. It's also very effective.
Used for the treatment of severe depressive, manic or psychotic episodes, ECT is employed when other treatments have failed (also known as treatment resistance) or when a situation is life-threatening. Under a general anaesthetic, an electric current is passed between electrodes that are positioned on your head until a short seizure is induced. You don't feel it, and you're given a muscle relaxant, so you also don't visibly convulse (the most you might see is the twitch of a toe or finger).
Watch: The truth about electroconvulsive therapy (ECT). Story continues after video.
Obviously, ECT is much more invasive than simply taking an antidepressant or antipsychotic, or mood stabiliser, but its efficacy is also much higher – so much higher.
When you're suicidal, this matters. If my psychology degree serves me correctly, around 50-60 per cent of people notice improvements with medication, whereas the success rate of ECT sits at around 70-90 per cent. Of course, in both instances, relapse is not uncommon. During an acute episode, however, improvements in mood can be, and are, seen more immediately with ECT than the usual four to six week period it often takes to reach a therapeutic dose with medications.
So, what's the fuzzy actually like? It's like, I ask my partner what the kids wore to kindy today, and he says, "Oh, you know that dark green dress and that plaid jumpsuit?" and I say, "Actually, no, I don't." Because I have no idea what dress or jumpsuit, he's referring to.
It's exactly like that.
As soon as I see them when they come home in the afternoon, I know exactly what dress and jumpsuit, but for now, that part of my memory is gone.
The memory loss used to be worse. I think it eases with the more treatments you have and the better able they are to 'titrate' the current that they administer. You can have unilateral (one side of the brain) or bilateral (both sides of the brain) ECT. The treatment I'm currently receiving is right unilateral, which means they placed the electrodes on the right side of my head. It's probably the most inconvenient part of it all. The gel that they need to attach the electrodes. I always forget about it afterwards because #memoryloss and I end up running my fingers through it or getting a shock (excuse the pun) when I look in the mirror and wonder why it looks as though a teenager from the 90s has taken to my locks with their bucket of gel.
If my jaw wasn't too sore, I'd laugh.
Jaw soreness/stiffness is pretty standard with the first few treatments, as is a headache. With time these side effects tend to settle – as does the fuzziness and the memory impacts.
Having said all this, what exactly does ECT involve?
You can access ECT as both an inpatient and an outpatient – I've done it both ways for different reasons, and both have their benefits and drawbacks.
The procedure is the same regardless of how you choose to access the therapy and a standard course is anywhere from six to 12 treatments, usually administered three times a week on a Monday, Wednesday and Friday. You fast from midnight the night before your treatment and usually have a physical in the lead up to check your heart, blood pressure, etc.
On the morning of the treatment, you'll be asked to arrive with clean hair (makes it easier to stick on the electrodes). You'll then lie on a kind of operating table where said electrodes will be attached to your head using said gel. The treating anaesthetist will then make a couple of jokes (if they're one of the good ones), before administering a short-acting general anaesthetic and muscle relaxant into your arm or the top of your hand. While that's taking effect, you'll usually be given some oxygen. I rarely remember what happens after that, as I'm usually fast asleep within a few seconds. The whole procedure only takes a few minutes, and when I wake, I'm in recovery.
Life-wise, what does it involve?
My kids are super young (two and a half, and 18 months) so it means a lot of juggling. My partner and I are fortunate enough to have the support of an extraordinary childcare centre that tweaks our enrolments to accommodate the kids five days a week whilst I'm having treatment.
It's a huge expense though.
During my last course of treatment, our fortnightly out-of-pocket payment was over $2000. Few people can afford that. Most can't. The rest of the juggling involves friends and family stepping in for pickups and drop-offs (I can't drive while I'm having treatment or be left alone with the kids for the 24 hours following).
We stock up the freezer in the lead-up and then we also, and perhaps most importantly, inform the kids. Usually a couple of days in advance and always in age-appropriate language. They're both super verbal so we encourage them to ask questions.
It is absolutely a disruption to their lives which manifests in many ways (separation anxiety, more frequent than usual night waking) but so too would be my permanent absence. At least with this scenario they know that mummy is going to the hospital and will be home in X amount of days. I leave notes and trinkets for them to open after kindy. They have a village of people visiting for play dates. It all helps.
Understandably, ECT is often viewed as quite an extreme treatment option – because it is.
Extreme should not be mistaken for dangerous though. My first ever ECT course was during a lengthy inpatient stay at a psychiatric hospital. I had attempted suicide several times, was on a cocktail of mood-altering medications and was under 24/7 surveillance in the hospital's ICU.
I couldn't read. I couldn't write.
My sole memory of that admission is watching food show after food show from the ICU couch whilst trying to find a way to die to escape the pain I was experiencing. Enter ECT. I don't remember what kind of ECT I administered, but I do remember two things from that time:
1. It worked.
2. It obliterated my memory.
I lost entire weeks of memories either side of the treatment. To this day, I'll swear black and blue that I've never watched the film Ted (ha!). Since this original course, I've had three more, including the course I'm currently undergoing.
It's always after being on a merry-go-round of medications; it's always because I'm suicidal; it always saves my life.
I used to feel ashamed that I needed ECT. That I couldn't just talk or medicate myself out of my depressive episodes like most other people can. It felt extreme. It felt wrong.
My disability is psychosocial. I don't need a medical procedure. A general anaesthetic. Electric currents passed through my brain.
Especially not three times a week.
The funny thing is that, actually, I do. It's exactly what I need to continue to live my life and work, make art, and care for my two toddlers.
It's still unclear just how ECT works; what the mechanism of action is. It's thought to serve as some kind of 'reset' but precisely what happens for the reset to occur remains a mystery.
And for me, that's okay.
As a treatment, it's not for everyone; just like different classes of medications aren't either, but it works for me.
It's not without its setbacks, and some people find the memory impacts intolerable. For me, although frustrating, they are the lesser of two evils. I much rather be in a position where I can't remember the conversation we had yesterday, but I don't spend each waking moment wanting to die, rather than have my memory completely intact but my brain waging war against me.
In no way is ECT a pleasant treatment or one to be entered lightly, but it also isn't the brutal and inhumane regime that TV and movies have primed us all to believe. As with any approach to mental illness, one size most definitely does not fit all, and it's useful – for me anyway – when in those darkest of dark moments, to know that I have options.
If you think you may be experiencing depression or another mental health problem, please contact your general practitioner. If you're based in Australia, 24-hour support is available through Lifeline on 13 11 14 or beyondblue on 1300 22 4636.
Feature Image: Supplied.
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