How Shock Therapy Can Save Depressed Women's Lives

When I think of electroconvulsive therapy, I think of Angelina Jolie as Lisa in Girl Interrupted, the sociopathic scene stealer's eyes changed to dull after she's given the "shocks." Electroconvulsive therapy (ECT) induces seizures by applying short electrical bursts through electrodes placed on your brain. Your brain is thought to be "resetting" itself through this process, but its mechanisms are still fairly unknown. Early on, it was done at high doses without the muscle relaxant and anesthesia – so it was rather an unsettling, dangerous, and, as Hollywood knows, unsightly procedure. Today it's most often used to treat severe depression that has been unresponsive to other treatment, and some doctors place its success rate at 75 to 83 percent. It's still a highly controversial treatment, and one thing is certain: it can fuck up your memory.

About 70 percent of ECT patients are women. The treatment is still highly stigmatized; some women whose lives were improved by ECT think we should change that. "I know me and my husband felt so alone during that first hospitalization, and we felt like we couldn't talk about the ECT. We should talk about it. It saves lives," says Ann, a 40-year-old nurse practitioner. Wanting to hear first hand about what modern day electroshock therapy is like, I spoke to three women who have or are currently going through it. Along with Ann I called Jennifer, a 20-year-old from Ontario, and Christine, a 43-year-old from Raleigh.

Broadly: When did you you start ECT?
Jennifer: I think I started probably about a year ago. I've been in ECT for a while.

Are you currently in treatment?
Yes.

What is your diagnosis?
Borderline Personality Disorder, Major Depression, Generalized Anxiety. And eating disorder, non-specified.

Before ECT, what other therapies have you tried?
I tried CBT [cognitive behavioral therapy] and then DBT [dialectical behavioral therapy]. They both weren't working as well as hoped, so then I was getting ECT three times a week when I was in inpatient [therapy], and when I was discharged I went down to once a week. And then I went back to inpatient and did twice a week. I'm currently doing twice a week [outpatient].

What symptoms were they hoping to address with ECT?
The suicidal thoughts. ECT is mostly for depression. So I did find it helped with the depression, and is still currently helping. I was self-harming. I've had multiple suicide attempts, but clearly…. [they were non-successful].

What was your initial reaction when someone suggested this as a method of treatment?
Well, I really didn't care that much because I didn't care what happened to me. I know I was a little afraid, but when I found out they put you to sleep I was okay with it.

I don't think a lot of people understand what modern day ECT is like. Will you tell me about the actual procedure?
They put in an IV, and you wait because there's a room where they do the treatment, and then there's a room where people are waiting to get the treatment. You're in a hospital bed and when it's your turn they wheel you into the room. They put, I guess it's like a headband on, and then they give you the anesthetic so that you fall asleep and then do the treatment.

Are there any side effects?
It affects my memory; I know my memory is not as good as it used to be. I don't feel anything, and then when I wake up from the treatment I'm just really tired.

How has it helped with your suicidal thoughts and self-harm?
I still have the thoughts sometimes but I find that I'm able to resist them. I can have the thought; but then the urge isn't as strong as it used to be.

How do you like to spend your time - are you currently in school?
I'm hoping to start university in September. I'm interested in criminology and psychology and teaching.

Awesome – do you think you'd like to work with others who have struggled with mental health issues?
Yeah, probably!

Broadly: What were you in treatment for?
Christine: Depression, but honestly you can't just have one thing. I've got the trifecta of ADHD, depression, and anxiety.

When did you first seek mental health treatment?
When I got out of college in '94…somewhere around 1995 I finally went to someone. But it was an internist, and he pretty much just gave me 50mg of Zoloft and that was it. I've had no luck with regular clinical therapists or licensed social workers. They've been a total waste of money and time for me, honestly. I've had better luck converting to Buddhism and going to a Buddhism Center. It's worked better for my mind than any therapy I've ever had. I eventually [found] a shrink I've been with for a long time.

How did you get into ECT treatment?
Here's the thing…[my memory] is so foggy that my best friends and husband were probably the ones who noticed [how bad my depression had gotten]. I stayed in bed and slept a lot and I started saying more crazy things. I said things about suicide. I was never at the point where I would do it, because I'm chicken. I did climb out on the windowsill to see: "How high is this, would it really work?" It scared the crap out my husband. My memory is not very good; depression makes your memory go just from that. So I thought about [ECT] and decided to try it. My girlfriend drove me—it had to be at five in the morning, to Duke Hospital.

When was this?
Three or four years ago. I'm sorry, but my memory is bad. It did mess up my memory during that time and after. At first I was blaming the ECT [for memory loss] but my friend's mom says it's also an age thing – and I know it's an ADD thing. It's frustrating. Sometimes I forget what I'm saying again in the middle of a sentence. Also, because I don't have a job I don't have as many markers in my life. I know when I got my Bachelor's, I know when I got married, but everything else is so amorphic. But I'm getting therapy hoping that will work out, I'm just wondering if I'll be able to work again or if I'll get disability. Again, I really don't know if [ECT is to blame] for the memory loss.

How is the actual procedure different from famous media portrayals?
I was really angry…do you know the show Homeland?

Yeah.
Well there's one scene in a season finale and she was going in to get ECT, and apparently they made it out like, "Oh no, if she gets this done she'll forget everything and be brain dead!" That's what they implied. Now this show has done a very good job of showing what it is like to be bipolar. I thought that was incredible. I'm not bipolar, but I know enough about it. And they show her convulsing, as far as I know you don't really convulse. That's just not true anymore; they give you a muscle relaxant. Maybe your toes twitch. So I was really upset that they showed it like that.

Did it help your depression symptoms?
It did. I mean I was bad. Everyone says that I was extremely apathetic, pessimistic, hopeless, despairing, no hope…you know when you're in a really low [place]? Like, "Oh God…I'm not use in this world, nothing will ever get better, everything is just going to suck," I was at that level.

Broadly: Hey, will you tell me about yourself?
Ann: I'm from Connecticut. I'm a surgical nurse practitioner. I have two kids. I have a husband.

My current diagnosis is Bipolar I disorder, but I had ECT back before we knew that. I was being treated for pretty serious postpartum depression. I was in the hospital for about a month. I was depressed, the meds weren't working, I was suicidal. They [doctors] finally thought that, "She's severe enough that maybe we should try ECT." They brought my husband in—the consent is pretty impressive. They started doing the ECT right away after that. I was later moved to outpatient, I completed my course, and I haven't needed it since.

When was this?
This is back in 2012. And then I was diagnosed with Bipolar I in 2013. So I mean, it worked. It brought my back to life. It absolutely 100 percent saved my life. I got better. I was able to go back to work. I was compliant with my medication. I participated with my therapy; I was interactive with my children again.

Will you tell me about the actual treatment?
I didn't mind it so much because you're not really aware of the treatment. You go, you get a shot, it dries up of all of your secretions, takes away any risk of aspiration. Then the anesthesiologist is like, "Okay, count to ten" and you never ever make it to ten. Next thing I'm awake in a cozy little lounge and they're offering me water. Because of how I felt after, I refuse to believe it was as grotesque as it's been made to look [in popular media]. You're not biting on a bite stick, no one is strapping you down. The most I had was a blood pressure cuff on my arm.

What was it like after?
The day after the treatment I always called it my "ECT hangover" because I was just tired, fatigued, a little achy, because I mean, you're having a seizure while you're asleep. You're dry from the medication they gave you. But it was never awful. I think the most challenging thing for me was the memory loss, which they always tell you is a real possibility. There are still huge gaps that I can't fill in today. It was frustrating when I went back to work because I just felt so slow and fearful. Fearful I wouldn't remember something; I would go in hours early for my job to write down every single detail of my patients so it wouldn't ever appear I didn't know what was going on with them. My husband and I lived in Maryland for five years before we moved to Connecticut, and I don't remember Maryland at all. I know I lived there, I know I worked at John's Hopkins, and I know I really liked my job at John's Hopkins. We were just down there in November driving around, and he'd say "Oh this has changed so much!" and I was like… it has? And he's like, "Honey we've been here 100 times." It was like I was seeing everything for the first time, which is kind of sad in a lot of ways.

What else is important you think readers should understand about ECT?
I think people should know that the decision to recommend ECT for someone is always a last option. It's not a decision that providers make lightly. It was a group decision and we all arrived at it together – "You're not doing well on meds, and we need to get you back and we think this will do it."