Depression Is Real – And It Hurts – Treatment Begins – Meds and ECTs – Part V

Over the past few weeks I’ve been sharing my experiences with mental illness and depression specifically. Today I will be talking about the treatment of my depression including electroconvulsive therapy (ECT) and medications. I am going to begin with the statement that some of the treatments I have agreed to try have been questioned by providers I consult for second and third opinions. Another thing that I am going to say is that the stigma attached to mental illness is unreal! More on that a bit later though. . .

When I began seeing my mental health provider at the University Hospital in 1987, I was uncertain what to expect. Although I had been seen briefly in the past by a psychiatrist, I was not medication compliant, I missed appointments more regularly than I attended them. I lied to my therapist and psychiatrist both so I would not end up in the hospital – which realistically looking back now, I needed to be!

One of the biggest mental health challenges in Iowa is that funding was gutted two years ago. This substantially reduced the number of providers at all levels as well as forced the closing of the state mental institutions. This budget cut dripped directly down to me. I placed my call to the University Adult Psychiatry Clinic to schedule my intake appointment on June 8, 2017; the appointment was scheduled for July 20, 2018 – over a year later. Anyone other than me see a problem with waiting over 365 days to see ANY doctor? Ughhhhhh!!!!!!!!!!!

Fast forward to the first appointment with Margaret. I entered the clinic alone because it was the one appointment I attend at the University alone. Following check-in and vitals, I met my new practitioner. I immediately felt at ease and trusted Margaret. I cannot explain it nor give any reason that I should have trusted her as a complete stranger, but that is my reality.

Margaret is a nurse practitioner with prescribing privileges. She is a kind spirit, so very kind. She allowed me to lead the conversation asking questions when she needed clarification or explanation. In the past therapists and psychiatrists had directed the conversations during our appointments. Margaret was a breath of fresh air. I asked her why she was a shrink. She s aid because she truly wanted to help people. I believed her then and I know she has helped me so much over the past 8 months too.

Meds are often the first line of treatment for mental health issues.

I was prescribed Adderal for the ADHD, Hydroxyzine for the anxiety, and Prazosin for the nightmares and PTSD symptoms, Duloxetine for depression, and Haloperidol to help with quieting the voices and noise in my head as well as assist with getting to sleep. From here I am going to fast forward to this inpatient stay.

Suffice it to say that the medications alone did not work. I became more depressed than I had ever been in my life. I attempted to take my own life because I was so depressed and hopeless. I begged for the physicians at Genesis and the University to both figure something out and fix me.

Those that follow this blog already know that I am writing this from the comfort of the University of Iowa Hospitals and Clinics. I was admitted via self-committal on March 1, 2019. I agreed to be admitted under the guise of getting my meds checked over more thoroughly and adjusted as needed.

The first few days were boring and I slept long and hard. The Tuesday after I was admitted the staff physician came with my resident physician and broached the subject of ECT treatments. Like many in the US, I thought that ECT (electro convulsive therapy) had been out lawed long long ago. Nope. I was wrong. They have, just like other areas of medicine, made great strides to make the ECT process pain free. The ECTs, I learned that fateful Tuesday afternoon, are conducted under general anesthesia. y’all KNOW how I love a good nap!

Needless to say, I agreed to undergo 8-12 ECT treatments at the University. So far the worst side effect that I have experienced is an upset stomach and a bit of a headache. Not bad at all.

Now I’m going to delve into what ECTs are and what they are not. ECTS are not electroshock therapy. LOL.

For some people with severe or hard-to-treat depression, electroconvulsive therapy (ECT) is the best treatment. This treatment, sometimes referred to as “electroshock therapy,” is often misunderstood and incorrectly portrayed by popular media as a harsh, cruel treatment. In reality, it is a painless medical procedure performed under general anesthesia that is considered one of the most effective treatments for severe depression. It can be lifesaving.

ECT works quickly, which is why it’s often the treatment of choice for people with highly severe, psychotic, or suicidal depression. For these people, waiting for antidepressants or therapy to work might be dangerous. However, the drawback is that the effects of ECT usually don’t last, and further treatments will likely be necessary.

No one is sure how ECT helps certain psychiatric disorders. It may promote changes in how brain cells communicate with each other at synapses and it may stimulate the development of new brain cells. ECT may flood the brain with neurotransmitters such as serotonin and dopamine, which are known to be involved in conditions like depression and schizophrenia.

What happens during an ECT procedure?

Before ECT, patients are asked not to eat or drink from midnight the night before treatment.     

During the procedure, the patient receives a short acting anesthetic agent which puts the patient to sleep for approximately 5-10 minutes. A muscle relaxant is also used during the procedure to stop the patient’s muscles from moving during the seizure. Cardiac monitoring pads are placed on the patient’s chest to check on the cardiac status during and after the procedure. Four electrodes are placed on specific areas of the patient’s head. Two electrodes of these electrodes are for monitoring the brain waves. The other two are for delivering a short, controlled set of electrical pulses for a few seconds. The electrical pulses must produce a generalized seizure to be effective. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor feel the current.

Patients awaken about 5 to 10 minutes after the end of the treatment. Patients are then moved to the recovery room and remain there until their blood pressure, pulse and breathing return to their pre-treatment levels. Usually this takes about 20 to 25 minutes.

Patients who are given ECT on an outpatient basis must have someone drive them home after the procedure and stay with them until they go to sleep at night. People should not drive in the 24 hours following ECT.

How long is an ECT procedure?

A single ECT session usually lasts one hour. This includes the time the patient will be in the treatment room (approximately 15-20 minutes) and the time spent in the recovery room (approximately 20-30 minutes).

Typically, ECT (whether inpatient or outpatient) is given two to three times a week for a total of six to twelve sessions. Some patients may need more or fewer treatments.

These sessions improve depression in 70 to 90 percent of patients, a response rate much higher than that of antidepressant drugs.

Although ECT is effective, its benefits are short-lived. For this reason, patients take antidepressant medication after ECT or may continue receiving ECT periodically to prevent relapse.

What are the side-effects of ECT?

The immediate side effects of the procedure which may last for about an hour include:

  • Headaches
  • Nausea
  • Muscle aches and soreness
  • Disorientation and confusion

Patients may also develop memory problems. Memories formed closer to the time of ECT are at greater risk of being lost while those formed long before ECT are at less risk of being lost. The ability to form new memories is also impaired after a course of ECT treatments but this ability usually makes a full recovery in the weeks and months following the last treatment.

The most common side effect of ECT is short-term memory loss. However, some people report that they have long-term memory loss, as well. ECT also causes a brief rise in heart rate and blood pressureduring the procedure, so it may not be recommended in people with unstable heart problems. A physical examination and basic laboratory tests including an electrocardiogram (ECG) are necessary before starting ECT to assure that no medical problems are present that could interfere with the safe administration of ECT.

ECT can often work quickly, but 50% or more of the people who receive this treatment will relapse within several months if there is no subsequent treatment (for example, medicines) to prevent relapse. Your doctor will typically advise a medication regimen including antidepressants, or possibly additional periodic (“maintenance”) ECT sessions to help prevent relapse.

Tomorrow is my fourth ECT. So far so good! I will update again soon! ❤

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