Several years ago, during a long and especially severe depressive episode, I took a medical leave from work for the purpose of receiving ECT. People are often curious about what this treatment is like and I really wish I could tell them. But the fact is that I remember very little about it. As I’ll describe here, I was rarely alert during the weeks that I received the treatment, and had difficulties forming new memories for about two months after the treatment. One thing to keep in mind, though, is that depression and extreme sleep deprivation had so severely compromised my concentration and memory that I also have trouble recalling events from the year prior to the ECT — and I don’t think this was an effect of the treatment, but of the illness itself.
Anyway, I had seven bilateral treatment sessions. Each one was first thing in the morning, on a MWF schedule. Prior to starting the treatment there were days of blood tests, chest X-rays, and other precautionary things. I had the first treatment session while hospitalized on an inpatient psych unit, but continued the series as an outpatient.
I remember that each time we got to the hospital I changed into a hospital gown, and someone put an IV connection into my hand. One of my socks was removed for monitoring the seizure in my foot. The team would gather around the bed, and start the anesthesia, which caused a sharp burning pain in my hand and arm for a few seconds. The blood-pressure cuff designed to keep the drugs from reaching my exposed foot would start to feel frighteningly tight. But after that, I recall nothing at all until changing back into my clothes, and dozing off in the car on the way home. Since I couldn’t eat the night before the treatment I’d be quite hungry, but immediately after breakfast I was ready to go back to bed. In all, I did little but sleep for those weeks.
At each session, the doctor would ask if I was feeling any better, and I really didn’t know what to say. I mean, I was just sleepy or asleep all the time. How could I tell how I was feeling? After the seventh treatment the doctor decided we should stop, because from his perspective the treatment didn’t seem to be effective, and I certainly didn’t have a clear opinion about it one way or the other.
Over the next 6-8 weeks, since I was still on medical leave my husband and I took this opportunity to go to the movies a few times. But after leaving the theater, I’d realize I had no recollection of what I had just seen. I’ve watched some of those movies again since then and it was as if I was seeing them for the first time. Needless to say I know almost nothing about those two months.
When it was time to return to work, things seemed to go reasonably well and most of my debilitating symptoms were gone despite being on little to no medication. So I came to realize that evidently the ECT had worked. The benefits were powerful for about six months. Then I resumed taking various medications, and continued to function sufficiently well (i.e., with only moderate depression and anxiety) for another year. When my symptoms got worse again after that, I considered ECT a possible option, provided that I could schedule the period of cognitive impairment to be over the summer when there are no classes. (As I’ve mentioned before, I ended up starting ketamine infusions instead, and since these do not interfere with my memory/cognition at all I can go right back to work the next day. But if I ever needed to, I’d go for ECT again without any hesitation.)
At least for me, it seems nearly impossible to be able to tell how I’m feeling while totally disconnected from real-life activities. I mean, testing my ability to function requires at least trying to function. In retrospect it seems obvious that someone who sleeps all the time and has no recollection for waking moments would have trouble estimating whether or not their mood and functioning had improved. Yet I think there is a tendency for doctors to rely on such estimates and to promote what I see as a false expectation that if ECT is working one will clearly know it by a certain point. My own experience is that it is possible for ECT to be working without there being obvious signs of improvement in what little exists of the patient’s daily life while undergoing the treatment.
The video clip posted below (from This Emotional Life, 2009) shows an ECT session that is very close to what I remember experiencing. Moreover, it illustrates what can be problematic about telling patients that they should expect to feel better after a certain number of sessions. According to an update on the PBS website, the patient in this video apparently went on to get ECT booster treatments, so I imagine that like me, she probably decided that the treatment had helped her after all (even if it hadn’t been clear at the time).
ECT video (from This Emotional Life, 2009): https://www.youtube.com/watch?v=jgWVyIzGyf0