Letter to Aidan – My Psych wants me to start ECT Aidan, please reassure me

Dear Aidan,

I have tried so many medications, Lithium numerous times at various dosages, I cannot continue like this. I am booked to start ECT, ironically on April 1. I have all manner of thoughts. Can you reassure me.? My psychiatrist will not tell me anything. I am very scared. It is either a wise decision or the worse move of my life How does it work? Will I have memory loss? .I am advised I will feel ill after treatment Can you shed some light? Pease help. I am worried re my energy levels. Will I be a zombie?

K, Ireland

Hi K and thanks for writing

ECT or Electroconvulsive Therapy is a treatment for Mental Health problems namely Bipolar / Manic Depression. A lot of people think of “One Flew over the Cuckoo’s Nest” or they think very negative thoughts or they believe that we have left ECT in the past and have moved on with modern anti-depressants and psychology, The reality is ECT is an entirely acceptable course of action if your psychiatrist determines so. I have a colleague, a medic and he says; “it is the best treatment the medical world has for depression”. That said, the stigma around it really makes it difficult to make that known.

You ask how it will work. To the best of my knowledge -The anaesthetist will give you an anesthetic through a needle in your hand. Once you are asleep, they will give a muscle relaxant through the same needle. While you are going off to sleep, the anaesthetist will also give you oxygen to breathe.

Once you are asleep and fully relaxed, a doctor will give the ECT treatment. You will have a fit. Your fit will last between around 20 to 50 seconds. The muscle relaxant wears off quickly (within a couple of minutes) and, as soon as the anaesthetist is happy that you are waking up, you will be taken through to a recovery area where an experienced nurse will monitor you until you are fully awake.

When you wake up, you will almost definitely be in a recovery type room with a nurse. He or she will take your blood pressure and ask you simple questions to check how awake you are. There will be a small monitor on your finger to measure the oxygen in your blood, and you may wake up with an oxygen mask. You will probably take a while to wake up and may not quite know where you are at first, so do not panic. You may feel a bit sick. After half an hour or so, these effects should have worn off.

I have studied ECT as part of my psych, I’ll go a bit further into detail, as I be believe knowledge is power and may relay your fears too.

There are primarily two types of electrode placements used for the delivery of ECT. Your Psychiatrist will determine which is best for you.

To generate a seizure with a right unilateral treatment, one electrode is placed on the crown of the head and the other on the right temple. Patients who do not respond to right unilateral treatments may require a switch to bilateral placement.

Bilateral ECT treatment involves placing the electrodes on both temples. Bilateral ECT is indicated for severe mental illnesses including depression with psychosis, manic episodes of bipolar disorder, psychosis related to schizophrenia and catatonia.

With regard to energy levels, that is a complicated question, as we are all-different and react differently. Many patients do not feel the effect of the treatments after a short period, the treatments allow the patient to get back on their feet and move forward with life very quick with full energy levels.. I have to be honest and say that for some, in the short to medium term, energy levels are not comparable to what they were pre ECT, but they can catch up and be equal after a period of times passes by.

With regard to how you will feel after ECT, you will have been administered general anesthesia, so you may feel nauseous, but that will pass and your medical team may advise re anti-nausea medication for the very short term. There is also the possibility of some muscle aches and/or headaches, as essentially you will have a seizure. Again, these aches and pain will pass and your doctor/nurse can advise.

In terms of frequency, it all varies, but it is not uncommon to go to the hospital two or three time a week, for example, Monday, Wednesday, Friday. Some patients are in-patient while this occurs (the decision to undergo ECT may have been taken while their condition remained unchanged in hospital or patients are brought in-patient for the duration of ECT) Often the Consultant Psychiatrist will evaluate after eight to twelve sessions how the patient is responding initially. That said, the patient would (of course) be spoken to after the sessions.

You ask why have you been sent down the ECT route and I can’t answer that, but in general terms, the reasons are – the side-effects of antidepressants are too severe for you, you have found ECT helpful in the past (not in your case) and/or you are seriously considering suicide and/or you are persistently low in mood.

Again, there is a fear regarding memory loss. It is important to say there is a difference in the extent of memory in terms of where the electrodes are placed. My understanding and speaking to my medic colleague is that – yes, there is short-term memory loss, but that for most, the memory will (mostly) return.

Right Unilateral Treatment- -Those receiving the right unilateral treatments may respond somewhat more slowly than those who receive bilateral treatments. Right unilateral treatment is typically associated with less memory loss

Bilateral Treatment -This treatment may be associated with more acute memory side effects than right unilateral treatments

I cite professor Declan Mc Laughlin in St Patrick’s University Hospital, Dublin (who I have studied) and who says paradoxically, the worse the depression, the better ECT will help. Those who are acutely ill or psychotic “have about an 80-90 per cent chance of recovery with ECT”.”

This is hugely encouraging.

I will wrap up by saying ECT has been found to increase levels of nerve growth factors that trigger the birth of new brain cells and revitalize damaged connections in an area of the brain known as the hippocampus.

It is not for me to say Yes or no to ECT for you, but if I were in a position of decision for myself to say yes or no, I personally would say “Yes”. I trust my medic colleague. I trust what I read. I would trust my doctors. I personally believe it should be a third or fourth line treatment after some meds, rather than let the patient suffer. I would advocate for the patient to be in hospital for safety, mind you.

Thanks for writing, very best of luck with your ECT and thank you for being my second question in this new web space!