Wednesday 5 April 2023

ECT: A Patient's Perspective

By Eric Russell

I want to begin by expressing my gratitude to Martin Baker for allowing me this opportunity to share my experience with electroconvulsive therapy (ECT). His book, High Tide, Low Tide, focuses on the intersection of mental health and relationships. So here I come down a side street to narrate my journey along the ECT path. I have bipolar disorder.

After all the medications I tried failed to calm the episodes and manage the symptoms my doctor asked if I were ready to discuss ECT. She explained that while medications have a success rate of 30-35%, ECT sees a roughly 80% efficacy rate in academic studies. However, at that moment I was too nervous to hear the favourable comparison. Although I was afraid of the unknown, my doctor convinced me to educate myself and make a fully informed decision. In the end I opted in.

As a part of the preparation my primary care physician had to sign off that I was physically healthy enough to undergo ECT. This involved both a regular physical and an EKG to get a sense of how the heart would respond. Another step in the process was to interview with two different psychiatrists. This is really for patient safety as the doctors must verify the patient has the capacity to give consent for the treatment. In my case it was my regular psychiatrist and the psychiatrist who would be administering the ECT. The double interview might seem a hassle, but governing bodies want to protect patient rights.

Although not required, I did the initial series inpatient. This was for two reasons. First, the initial series is three times a week for three or four weeks. Going inpatient meant my family didn’t have to sacrifice all those days driving back and forth. (I live two hours from the hospital.) Secondly, family was also spared taking that time off work. Consequently, I was introduced to the experience all on my own. Looking back on that time though, I can’t recall any of it other than what got written down in my journal.

It wasn’t long after getting home that I realised I had memory holes. At times I struggled to recall the names of individuals close to me, details of autobiographical events, and how to navigate once-familiar landscapes. While this can seem disconcerting, it reinforced my determination to live in the present and cherish the loved ones who surround me.

At the same time, I have learned that the memories are not actually gone. For example, one day on my way to the hospital for ECT as usual I passed the Civic Center and a flood of memories came rushing back to me. I was riding in a bicycle race which went under the Civic Center’s arches. I could see the road as it curved through a descent. I could hear the tires on the road, the shifting of gears. I could feel the breeze. The memory had come to life in my mind again, giving me a confident new attitude toward those memory holes. I can refill them.

It’s important to make clear though, ECT is not a cure-all. I still had to take medicine and continue with ECT. After the initial series my doctor scheduled me for treatments once a week. Before too long the interval was extended to every other week. Eventually, it was stretched to every fourth week, and there it stays.

On treatment days I arrive early at the ECT department’s Pre-Op staging area to make sure I don’t throw the schedule off. I’m taken to a private room to change into my pyjama bottoms and a hospital gown. We take my vitals then there’s usually a bit of a wait before a nurse comes in to start my IV so I wrap my arm in a warm blanket as this seems to make the stick easier when it’s time. That done, we go over health and health care as well as medications I’ll be given in preparation for the procedure and those I take on a regular basis. Then, after speaking with my doctor, I’m left by myself while the IV replenishes my fluids.

With the IV bag near empty the OR nurse comes to get me. After a quick visit to the lav I’m ready for the procedure. We go back and I settle in on the gurney. I meet the anaesthesiologist as staff attach all the monitor leads. As I’m filling my lungs with pure oxygen, my doctor attaches electrodes to each temple. (I get bilateral treatments. Unilateral electrode placement would be the temple and crown.) At about the same time, the anaesthesiologist lets me know the muscle relaxant and anaesthesia are flowing. From that moment when I fade into sleep it seems only seconds before the Recovery Room nurse calls my name.

It wasn’t as simple as waking up and walking away from the crushing depression, but through the dedication of my care team it did seem like an awakening in a way. I had been struggling for a long time and finally began to feel good. I did things with and for my family; I even returned to interests I’d had in the past. I had my life back.

In conclusion, as I look back over my years of electroconvulsive therapy although it is typically thought of as a treatment of last resort, I don’t feel it should be. I consider it all a small price to pay for the benefits I’ve gained and a reliable tool to keep in mind.


The image is a sketch I drew in 2015 while inpatient during the initial series.


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