Monday, April 27, 2015
In less than 12 hours, an anesthesiologist will place me under IV sedation. A doctor will attach an electrode near my temple. He will turn the dial on a machine and intentionally flood my head with enough electrical current to raise my brain above its seizure level. I will be allowed to seize for about 30 seconds. The electrodes will be detached, I’ll recover from the anesthesia, and leave.
I’ll do this twelve times over the next four weeks.
It’s called electroconvulsive therapy or ECT. You might know it better as electroshock treatment.
I’ve been depressed, anxious, or bipolar for as long as I can remember. My first encounter with the mental health system came in junior high, when my parents brought me to a local therapist to help with my anxiety. He prescribed the self-help book The Assertive Woman. I was twelve.
Since then I’ve tried talk therapy, cognitive behavioral therapy, dialectical behavioral therapy, and EMDR. I spent ten years misdiagnosed with major depression until a prescription for Paxil threw me into a rapid cycling bipolar state. I’ve struggled to find the magic combination of drug and talk therapy that can keep me at or near the mood levels normal people apparently experience without woe. In this quest, I have been on the following psych meds, alone or in various cocktails:
For most of the 2000s, I was relatively stable. But bipolar women often find that during perimenopause their hormonal changes suddenly render their carefully crafted medical cocktails ineffective. This has been my struggle since late 2013. After a nervous breakdown last fall and mounting interventions since, I failed a structured outpatient program last winter. I say “failed” because the program confirmed what I’ve long suspected: My bipolar disorder is treatment-resistant. There are no drugs left to try.
So what’s left? ECT and other brain stimulation techniques – the scary stuff – turn out not to be so scary when the alternative is to live with the pain. [Or not. The suicide rate for people with bipolar disorder is as high as 20%.]
Electroconvulsive therapy, they tell me, is not the electroshock treatment of old – the Jack Nicholson “One Flew Over the Cuckoo’s Nest” cultural touchstone that strikes fear into the very patients who could most benefit from it. Psychiatry tried to pretty up the name, but I’m not sure whether focusing on what my body will be doing (convulsing) versus what the doctor will be doing to me (shocking) makes it any more palatable. With anesthesia and muscle relaxants, there are no broken bones, no emotional trauma. You sleep. Maybe your foot twitches, or you grimace. It’s not Academy Award-worthy.
And so I’ve gone from being terrified of ECT, to being resigned to it, to being hopeful. ECT is now considered a first line treatment for bipolar depression and is particularly useful for the bipolar “mixed state” – a combination of manic symptoms like extreme anxiety and agitation together with major depression – that I suffer from. Memory loss, ECT’s primary side effect, is much less severe now than it had been with older, cruder forms of the treatment. Its efficacy rate of 70-90% is as or more impressive than talk and drug therapy. Side effects include confusion, headaches, fatigue, and nausea, as much from the anesthesia as the ECT.
Nice statistics aren’t much comfort tonight, though, as I flop sweat my way through the final hours before treatment. But I’ll take healthy nervousness over empty hopelessness.
See, I’m clinging to hope. A hope that years from now I’ll look back and see a dividing line. A time before, when I had to keep telling my kids “Mom is having a hard morning.” A time before, when the days clattered and collapsed around me, the world all elbows and angles. A time before, when the road contained more bumps than pavement, and I stalled out.
And a time after, when the days’ edges softened and, at last, I could glide.