In August 2019, I never thought I would be in this position. I sat in the small waiting room, my dad by my side, for my first electroconvulsive therapy appointment.
Diagnosed with severe bipolar disorder, I had tried countless combinations of medications to treat the extreme lows and highs for a tumultuous seven years. Even with all the medications and therapy every other week, I still suffered from bouts of depression so relentless that I was consistently suicidal for weeks at a time. (Studies have shown that the depression that bipolar patients experience is, on average, far more intense than those with major depressive disorder.)
After floundering and fighting, my symptoms went past the point of my control, and I eventually did attempt suicide. I spent time in a psychiatric hospital to sort out the best course of action for treatment. I was labeled “treatment-resistant,” which means that consistent medication management, therapy, and lifestyle changes did little to relieve my bipolar symptoms. Two psychiatrists collaborated on what my next treatment step should be, and both recommended I try electroconvulsive therapy.
When they first suggested the idea, I was unsure. It seemed extreme. The scene in One Flew Over the Cuckoo’s Nest in which Jack Nicholson’s character convulsed with eyes wide open came to mind. However, I was at the point where I was willing to try anything to make my suicidal ideation go away, and since I was “treatment-resistant,” electroconvulsive therapy seemed like the “Hail Mary” I needed.
When my name was called for me to go back into the treatment area, my body jerked. The nurse outlined the procedure to me before the psychiatrist checked in. I lay in a standard hospital bed with various heart monitor stickers on my torso and a pulse oximeter on my finger. Eventually, I was wheeled into the procedure room where I was introduced to the anesthesiologist, a kind-hearted older gentleman whose soft voice calmed my nerves.
“Don’t worry, Sarah. You will be completely under anesthesia along with a muscle relaxer. You can do this,” he reassured me. I let out a nervous laugh as the nurse appeared behind me with an oxygen mask.
“All right, Sarah, we’re going to begin,” she told me gently. “I’m now putting the oxygen mask on you, and the anesthesiologist is going to administer the anesthesia. You’re gonna feel a pinch, but focus on taking deep breaths.”
I was too scared to respond as the oxygen was placed over my nose and mouth. I felt the pinch, a rush of anxiety, and I was out.
Not even an hour later, I awoke in the recovery area and heard a distant voice.
“Hi, Miss Sarah, you’re all done. Don’t try to get up yet. I’m going to bring you some saltines and water. We need to monitor you for a while until you’re cleared to go home.”
That was it?
After the nurse determined I could leave, she told my dad to bring the car to the front door. She pushed me in a wheelchair to my dad’s blue Hyundai. I was drowsy but aware enough to tell him about what had just happened. We drove home as I contemplated the difference between what I thought I knew about ECT and the treatment I had received.
Convulsive therapy is one of the oldest treatment practices in the world of psychiatry and was officially “discovered” in the 1930s by Ladislas J. Meduna, a Hungarian neuropathologist and neuropsychiatrist. Meduna had the idea after noticing that patients who were diagnosed with both epilepsy and psychosis suffered from less frequent psychotic episodes when they were experiencing active epilepsy. (Active epilepsy is when a patient has been diagnosed with epilepsy and is taking medication to control it and/or has had at least one seizure in the past year, according to the CDC.) having two or more unprovoked seizures.)
The first convulsive therapies in 1934 were induced not by electrical current but by medications, namely camphor and metrazol, that were injected into the muscle to cause brain seizures. According to the 2013 Handbook of Clinical Neurology, “The procedure had some success, which was remarkable during that time when few treatment options were available.”
But these chemically induced seizures were difficult to control and painful for patients. The seizures could last longer than necessary and cause unwanted results including fractures and memory loss.
Later in the 1930s, Italian neurologist Ugo Cerletti discovered that an electrical current could be used in place of medication. Cerletti and his assistant Lucio Bini built a rudimentary machine that could be used on humans to control the amount of electricity given to a patient to evoke a seizure, while also controlling how long it lasted. Because of their research and invention, they were both nominated for the Nobel Prize in Physiology or Medicine. Starting in the 1940s, ECT was used as a treatment for schizophrenia; it was quickly adopted to treat other chronic and severe mental illnesses.
My own paternal grandfather underwent ECT treatments. He was born in 1910 and developed symptoms of bipolar, once called manic depression, in his early adulthood. (Bipolar disorder, like many severe mental illnesses, has a strong genetic component.) He spent years without a proper diagnosis or any kind of treatment—this was before psychiatric medications to treat bipolar disorder existed in the U.S., including the gold standard mood stabilizer, Lithium. Instead, he self-medicated with alcohol. Even today, many bipolar patients self-medicate with drugs or alcohol at a higher rate than any other psychiatric illness.
In the late 1950s and early 1960s, he did seek treatment for his mental illness and spent time in and out of psychiatric hospitals. He went through many rounds of early ECT practices, which were then known as electroshock therapy. Psychiatrists in the 1950s began using muscle relaxants and anesthesia to prevent the convulsions associated with seizures that could injure the patient and to make the procedure more comfortable overall. I don’t know whether the hospital where my grandfather received ECT had introduced those practices yet. I hope he was able to receive them.
However, ECT entered popular culture with the 1962 book One Flew Over the Cuckoo’s Nest and the 1975 movie adaptation, both of which depicted the treatment as a punishment that left patients shells of their former selves. In certain inpatient hospitals, this was somewhat true, and without anesthesia and muscle relaxers, the treatment was absolutely more traumatic.
Even though the treatment has changed significantly, the popular conception of ECT remains stuck in decades past, as evidenced by my own reaction to the idea of undergoing it. However, today approximately 100,000 people receive ECT per year in the United States. In addition to offering a more compassionate approach, the treatment itself has changed. As a University of Michigan article explains, “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.” Unilateral ECT, in which one electrode is placed on the top of the head and the other on one side of the head, is used for less severe patients who only require one or two treatments. Meanwhile, bilateral ECT, in which one electrode is placed on each side of the head, is used for more severe patients who require multiple rounds of treatment to see results. Bilateral, which I received, can create a rapid improvement of symptoms.
But while much has changed in the past several decades, the stigma against ECT continues (including—spoiler alert—in the recent movie Don’t Worry Darling). Unfortunately, that can lead patients to avoid getting the treatment out of fear or shame. According to Neera Ghaziuddin, a professor at the University of Michigan Medical School Department of Psychiatry, “ECT is still used because it is a highly effective and safe treatment. The stigma is due to a lack of familiarity and overestimating the side effects. [Ultimately] it’s safe, effective, and acts rapidly.”
A typical course of ECT ranges from six to 12 treatments total, with the average number of treatments being nine. I received 10 treatments.
My treatment did help rid me of depression. However, my results only lasted for three months. I was disappointed. My new psychiatrist suggested that my ECT was not effective long-term because I received no follow-up treatment such as cognitive behavioral therapy. Relapse can happen if no other treatment is used during and after ECT.
Although the ECT I received was not the “miracle long-term cure” I was seeking, it worked quickly to stop my suicidal ideation and actions. If I had taken antidepressants, it would have taken four to eight weeks to receive the full benefit. Looking back, the ECT did what it needed to do at that moment, which was to prevent me from hurting myself in any way, including attempting suicide.
Honestly, I am scared of anesthesia so being put under twice a week was difficult. But I weighed the risks and benefits and decided I was willing to face my fears to receive the treatment.
Luckily, my insurance covered most of the procedure, and I paid $20 per session. Most insurers will cover ECT if the doctor deems it medically necessary and it is coded properly when submitted to the insurance company. Now, I wish that someone had suggested it to me earlier—it took approximately six years of trying different medications before my doctors suggested ECT. Had I realized that it could work, perhaps I might have requested it earlier and saved myself some pain.
Today, I am on the proper medications and am in therapy. Both are helping me immensely. The medication I take helps stabilize my moods while cognitive behavioral therapy gives me the tools to combat suicidal thoughts. ECT did not cure me, but it did give me hope that my unrelenting depression could be lifted. I saw improvement within a week and found relief from my suicidal thoughts. For that, I remain thankful. The therapy I most feared helped save me from making a mistake that might have cost me my life.