Treating depression with Electroconvulsive Therapy (ECT)

What is ECT

A patient receives electric shock
therapy in the UK in 2013
(BBC/Newsnight)

Electroconvulsive therapy (ECT) is an invasive type of brain stimulation that’s sometimes recommended for severe depression if all other treatment options have failed, or when the situation is thought to be life threatening, (NHS).

ECT, given to depressed patients under anaesthesia, sends electrical pulses to the brain through electrodes applied to the head. The electrical stimulation triggers a seizure, which seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. Repeated a few times a week for a short period, ECT eliminates depressive symptoms for an extended time in many patients, Brainwise, 2018.

“ECT is the most effective treatment available for severe and treatment-resistant depression, but it requires anaesthesia and can cause side effects like memory loss,” says Irving Michael Reti, M.B.B.S., M.D., director of the Brain Stimulation Program.

Who invented ECT

ECT causes change in the brain —
Medical Brain Health

There’s much written about the invention of ECT but I love and have used excerpts from this article written by Robyn Wilson for the Independent, 2017 — Once upon a time in April 1938, a team of Italian medical researchers got ready to do one of the most controversial things that medicine had ever seen. They’d attempt to heal a mentally ill patient by applying a jolt of electricity through his brain. They didn’t know if he’d live or die but it was a risk they were willing to take.

Leading the team was 61-year-old Ugo Cerletti, and his assistant, Lucio Bini who, together had been working on the intriguing new medical machine they were soon to put to use.

In a large, secluded room they shaved the patient’s head and stretched him out on a bed. They attached two electrodes to his temples, placed a rubber tube in his mouth as a bite-bloc and flicked the switch of Cerletti and Bini’s device.

The team braced themselves as the electrical current coursed through the man’s head. He let out a small spasm and then bizarrely burst into animated song. Interesting, amusing certainly, but it wasn’t a seizure.

They tried again, increasing the voltage, until finally the patient went into what was a rather dramatic convulsion; face purple, mouth clenched, fists balled, heart racing. The medical staff all nervously watched on, fearing his death. Until suddenly the man slumped back, still. His breathing was steady, regular.

Right then, they knew they had completed what they had set out to do. After two years of research, they had proven that an electrical current could be used to induce a seizure without it resulting in the patient’s death; a seizure that, as they had hoped, would go on to relieve the patient’s symptoms.

They had just given birth to electroshock therapy and psychiatric medicine would never be the same again.

Modern day ECT

Going from Mental Health Ward to a general hospital — Pixabay.com

Today’s ECT involves going to a general hospital, where the patient is given short-acting anaesthesia (including a muscle relaxant) before ECT is administered. The targeted (and very low-level) electric jolts, it’s said, stimulate the brain to address everything from depression to dementia-related outbursts of anger (something I haven’t seen it used for).

In my first post as a mental health nurse I’d developed a good therapeutic relationship with a lady who had bipolar disorder and during the depression phase she felt hopeless and suicidal — it was pitiful to see. Over the years she had been treated with several courses of ECT and this time, she requested more. When it was agreed she could have ECT she asked if I, as her nurse, would accompany her.

Jack Nicholson’s character Randle McMurphy received electroconvulsive therapy in the 1975 film ‘One Flew Over The Cuckoo’s Nest’ (Fantasy Films)
Independent 2017

I’d only ever seen Jack Nicholson in One Flew Over The Cuckoo’s Nest — and I cried watching that — so I wasn’t looking forward to observing Lyn having ECT. Oh my word, I thought I was going to have a panic attack as they pressed the button and she went into a seizure which lasted around 80 seconds. The ECT nurse must have noticed as she gave me a comforting shoulder rub and a smile that said she understood.

I waited for Lyn to come round in the recovery room with another nurse who took regular observations (obs) i.e. blood pressure, temperature and pulse to ensure Lyn wasn’t experiencing any unusual side effects. When she woke from the mild anaesthesia Lyn was drowsy but able to get into a waiting wheelchair with support from me and the other nurse.

Once back on the mental health ward I was to observe Lyn throughout my shift, taking hourly obs and asking her how she felt; documenting everything in her notes and on charts. She remained drowsy and confused for a few hours and her memory lapsed, she was unable to concentrate and complained of a headache, for which she was given paracetamol.

Shock and horror

ECT for treatment resistant depression — Image from
Youwillbearwitness.com

I was about 15 and terrified when my mum went into hospital — well, an asylum actually. I later learned she’d been suffering with clinical depression which was treatment resistant. When I became a mental health nurse, I was telling mum about ECT when she confessed that she’d been in an asylum once before, when I was about 4-5, and on both occasions, she’d had ECT.

I’m glad I had more awareness and insight into ECT when mum told me because I would have thought, like most people, it barbaric, inhumane. She said she didn’t remember too much about it all — long-term memory loss? Or perhaps she just shut it out for all those years? Still, it had relieved the depression and her mood had improved.

My conclusion on ECT

I’d accompanied Lyn on six more occasions and my anxiety lessened each time as I saw how much her mood improved — and I realised that ECT is actually more civilized than I’d been led to believe.

I’m not sure it would be my choice of treatment but then again, I’ve been lucky that medication and talking therapies were, and still are, beneficial to me — they’ve helped me out of a massive black hole — on more than one occasion.

Would you be able to explain what ECT is to other people now? What do you think of ECT? Is there anything I missed? I am happy to answer your questions. In the meantime, you might like to read more about depression here.

This article was first posted on the Blogger Community here – thanks to Saumya and Niki; authors on this blog. Why not drop in and say hi to some fellow-bloggers.

My journey through a psychotic depression – part I

The World Health Organisation recognises World Mental Health Day on 10 October every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. This year’s theme set by the World Federation for Mental Health is suicide prevention.

Today, in recognition of World Mental Health Day I’m going to tell you my story – publicly – for the very first time and already it’s unsettling me. I didn’t realise how difficult writing it all down and seeing it in print would be. However, I want to do this in the hope that it will help others to open up and raise awareness of how mental ill health can happen to any of us at any time.

My relationship breakdown

The first time I split up with my ex, after almost nine years, I was thirty and our sons were seven and five. I was absolutely devastated as I hadn’t seen it coming. I believed we were happy and everyone thought we were the perfect couple. However, one thing always came between us. He’d regularly smoked cannabis and by this time he was taking E’s (Ecstasy)* which I totally disagreed with and I didn’t like being out with him when he was under the influence. I also detested his ‘come down’ from the E’s which could last for days. It’s said that regular ecstasy use may lead to sleep problems, lack of energy and feeling depressed or anxious and along with these he was moody and angry.

We were with friends in a bar one night and I could see his mouth twitching, his jaw muscles tightening and moving and I told him I wasn’t happy that he’d taken E’s while out with me. He laughed and said “You need to take something Babes. Come on, lighten up a bit Darlin’. I was just saying to Maggie, we should go clubbing more.” Clubbing? More? We’d never been clubbing.

Oosh! It hit me like a physical blow to my guts! I was rooted to the spot as I remembered – he’d been on the phone (landline, before mobiles) a lot recently, female workmates had called him and he’d called them all darlin’ and he’d been out at least once a week (on lads nights) wearing suits I’d had cleaned for him, the shirts I’d ironed and the aftershave I’d given him for his birthday.

Walking from one bar to the next I said “You’re seeing someone?” and Tony replied “Eh? Sorry, what did you say?” giving himself time to form an answer. I knew then that he was cheating though he denied it. With my head spinning and my heart breaking we spent the rest of the evening with friends in our local, me all the while desperately hoping that it wasn’t true. When we got home I calmly said “You’d best pack cos you’re not staying here.” More to see what he would say or do. He laughed nervously and thought I was joking. “Where will I go? I can’t leave now.”

“It’s not my problem. Go to your mum’s,”

“Babes, look, we’ll talk in the morning. Come on let’s go to bed.”

Pft. I told him I wouldn’t be sleeping with him, “You might have caught something.” I’d sleep in the one of the boys’ rooms as they were at their grandparents round the corner. The effects of his drugs were wearing off because he started yelling “Your effin’ frigid you are.” and “I ain’t going nowhere you stroppy cow. You’re an effin’ nutter. Effin’ nuts just like your mother!” he spat.

Ouch! He really knew how to hurt. I’d told him some time ago that my mum had been in Stratheden (an old asylum in Scotland) many years ago and had Electroconvulsive therapy (ECT)** as she had severe depression. The nasty imbecile, trying to detract from the real issue here, just threw this confidence right back in my face. Stomping up the stairs and banging doors he eventually went to bed and within minutes I could hearing him snoring like the damn pig he was, not a bloody care in the world!

I sat awake on the sofa unable to sleep all night, crushed and sobbing uncontrollably, thinking about what to to do next and what to say to people. My mood swung wildly from sad to angry, anxious and confused, fear and denial as I drank one coffee after another and smoked too many cigarettes.

Tony was mostly a good guy

Tony wasn’t always a monster. He was actually a good guy (without the drugs). He made me laugh, he was affectionate, kind and generous, he was popular and had lots of long-term friends who adored him. He was a great dad; he did most of the night feeds and loved playing with the boys, taking them to all their activities and to the Arsenal games. He loved a clean house and enjoyed decorating our home, he’d often wash the windows and blinds without prompting. He came from a huge loving family (Indian and Spanish) who thankfully adored me and thought I was a good influence on Tony.

We’d often go out in the summer on huge family picnics where there’d be up to fifty of us all in Regents Park, Hyde Park, Kenwood Park, at Alexander Palace or at the beach. Friends who joined us couldn’t believe how many people were there and were amazed at the range of food; tortilla’s, croquetas, paella, Russian salad, whole chickens and hams, breads, cheeses, samosas, onion bhajis.

We’d be there until it got dark, playing swingball, cricket and football with the all kids. We regularly had Christmas dinner for around twenty people where Tony would keep everyone entertained and all the New Year parties were held at out house along with the boys’ birthday parties which went on way into the night.

“Cor, it stinks down here. You been up all night?” rasped Tony as he wearily descended the stairs in the morning, still with his stupid nervous smile. I almost felt sorry for him. He made us both coffee then slumped on one of the two sofas and reached for the television controls. Too slow. I grabbed it first and put it out of his reach, behind my back on the other sofa. “Have you nothing to say?”

“Aaww, this ain’t one of them ‘we have to talk’ thingy’s is it? Anyway what do you want to talk about?”

“Last night.”

“Last night. What was we saying? I can’t remember.” To be fair, he probably couldn’t remember too much after the fog of drugs and copious pints of beer. But I didn’t believe he could remember nothing and I knew he was just playing for time. “What’s her name?” I asked. He giggled anxiously and didn’t answer me – a sure sign he was cheating. “Ah, it’s one of those girls from the office.” I said. “Which one?”

He still refused to answer so I told him to start packing, still foolishly hoping he’d tell me it wasn’t true. The fact that he went upstairs to pack, so easily, with no arguing just confirmed it was. He packed some bits saying he’d come back for the rest, then he left and I watched from the kitchen window as he walked away without a backward glance. As he disappeared from view I locked the door. I turned, slid down and with my head in my hands I cried as I’ve never cried before, snot mingling with my salty tears.

When I eventually stopped crying my thoughts turned to the boys and off I went, howling again. How on earth was I going to tell them? I couldn’t bear to think of their gorgeous little faces, big brown eyes made even wider with disbelief as the life they knew would be turned upside down – just like that. That selfish b*stard, I hated him! What was worse, I knew he’d be down the pub laughing and joking with his pals.

Aaarrgghhh! I wanted to scream from the rooftops. Instead, I called his mum and dad to tell them the news and asked them to keep the boys for another night as I couldn’t face them right now. Not with my red-rimmed piggy eyes and blotchy face. I didn’t want them to see me so upset and I honestly hoped Tony would come back and tell me he’d made a mistake.

His mum and dad didn’t believe he’d leave and thought this would just blow over, bless them. Then I cried again. The thought of not seeing all my lovely family, missing out on weddings, picnics, celebrations and family gatherings. See it’s not just the couple involved in a breakup; think – when you throw a pebble into a lake and you see the water ripple outwards – it affects the bigger family and friends circle.

Ripple Effect

It makes no sense to consider
a life where we never met.
We met and that’s it.
Whatever pebbles we disturbed
started rolling down life’s mountain,
either missing other stones altogether
or eventually triggering landslides
where I always seemed to be standing.
But these avalanches of angst,
or anxiety, never touched you,
just the anger at all my dust
drifting by, obscuring your view
of what you found most important.
Your reflection may not look like
it once did in that mirror pool.
No, age didn’t cause the change.
It’s really the ripples
of concentric circles that your
fleet of pebbles set off now that
they’ve finally come to rest
upon what might’ve always mattered
to you most.

JOSEPH HESCH, FEBRUARY 20, 2019 / 

My story, Part II will follow shortly. You’ll learn about my hell during a Psychotic Depression; symptoms, effects and recovery.

You can read the next part here now.

*Ecstacy makes people feel very happy – hence the name, ‘loved up’ – users often feel love and affection for the people they’re with and the strangers around them, they feel energised and alert.

**ECT is an invasive type of brain stimulation that’s sometimes recommended for severe depression if all other treatment options have failed, or when the situation is thought to be life threatening. https://www.nhs.uk/conditions/clinical-depression/treatment/