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December 28, 2009

I Had Shock Therapy... And I'd Do It Again

Last year, an estimated 100,000 people treated their severe depression or bipolar disorder with powerful bolts of electricity to the brain. Here, one woman describes her experience undergoing the radical procedure.

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Let me establish from the outset that I am not crazy. Most people think that anyone who has shock treatment — it's called electroconvulsive therapy (ECT) these days — must be mentally disturbed. That's just not true. ECT was my last resort.

For most of my life, I had normal ups and downs. Sometimes I'd fall into a funk and obsessively diet and exercise. During rough patches, I'd take Zoloft and distract myself with work — I'm a publicist for a Seattle nonprofit. But in the spring of 2008, my life seemed to tailspin out of control. I was 38 and had just gone through a bad breakup, which triggered dark thoughts that I just couldn't shake. Barely able to drag myself out of bed, I took a six-week disability leave from my job, and even checked myself in to a hospital for a week. Did I contemplate suicide? I wasn't planning anything, but I thought to myself, It would be OK if I didn't wake up tomorrow.

I was scared to death and desperate for help. So I started to do research on depression. That's how I came across Shock, Kitty Dukakis' memoir about undergoing ECT in 2001. She explained how much the treatment had evolved since it originated in the 1930s, when it was often administered to mental patients without their consent, to keep them in line. Back then it was downright barbaric, with doctors sometimes forgoing anesthesia, which resulted in broken bones, even death. When One Flew Over the Cuckoo's Nest hit theaters, with its brutal shock-therapy scenes, that was the nail in the coffin for the procedure, which ultimately fell out of practice.

Over the past 20 years, ECT has become much more sophisticated and humane. Patients get general anesthesia, so they don't feel anything. It's conducted as an outpatient procedure at major medical hospitals like the Mayo Clinic and Johns Hopkins. I had mine at a Seattle hospital called Swedish Medical Center. I met Dr. Ken Melman, head of the hospital's ECT program, in May of 2008. He told me that merely having depression isn't enough to warrant a treatment as radical as ECT. It's basically the last line of defense when all else has failed. Dr. Melman consulted my psychiatrist and general practitioner to confirm that, in fact, antidepressants hadn't yielded any lasting results and that I was a potential danger to myself. They all agreed that ECT was my best shot at a normal life. That vetting process made me feel much more comfortable with everything.

My first treatment was scheduled the following day. I was terrified — someone was about to tamper with my brain! Dr. Melman warned me about some of the potential side effects — lingering headaches, short-term memory loss — but said most patients feel perfectly fine afterward. Still, I'd read online accounts of people who said their memories were never the same. I worried that ECT would wipe out the good parts of my brain along with the bad. Yet there were many other patients who said that the downsides were minor. I was so despondent that I was willing to take the risk.

It's pretty much like any other outpatient procedure — I didn't even have to change into a hospital gown. After I was given anesthesia (I was asleep for the entire treatment), Dr. Melman injected me with a muscle relaxer that would prevent my limbs from jerking while the ECT was being conducted. He then used electrodes on my forehead and right temple to transmit pulses of electricity to my brain — the left side of the brain controls speech, so to reduce potential side effects, doctors avoid stimulating it directly. Those bursts of electricity induced a short, controlled seizure. Despite the muscle relaxer, Dr. Melman said my toes tapped as though I were listening to music. All told, I was shocked for 90 seconds. And then it was over, just like that. It's not like getting struck by a lightning bolt or sticking your finger in a socket. If you put your hand next to the electrodes, you might feel a slight tingle.

After my seizure subsided, I was wheeled to a recovery room, where I came to about an hour later. I woke up with a mild headache, kind of like the ones I get when I have PMS. It disappeared after I took some Tylenol. To be honest, I felt a change right away. When my parents drove me home from the hospital that afternoon, I asked them if I had time to get my hair colored. That's how we knew something had shifted. For so long, I could barely muster the energy to eat, let alone book a salon appointment. It was a hopeful sign that things were looking up.

There was some memory loss, nothing major. I call it the "where did I put my keys" phenomenon — you forget little things like phone numbers or what channel CNN is on. But after a day or two, it all comes back. I do remember driving to the library a month after my first treatment and suddenly forgetting how to get there. I had to pull over and think hard about it for a few minutes before I remembered. That was alarming, but represented the worst of it.

It's not entirely clear how electroshock helps alleviate depression. One theory says it's a bit like rebooting the brain, though no one can say for sure. But ECT has a proven track record as an effective treatment for those, like me, suffering from extreme depression. I received ECT twice a week that first month, then tapered off to about once a month. (Each session costs upward of $1000, most of which was covered by my insurance.) All in all, I had about 20 shock treatments over the course of a year. That's pretty standard. Overall, I feel good these days, and am able to cope with the everyday drama. It's like I found perspective again. I'm told there's a chance the depression could come back. Without antidepressants, relapse rates can be as high as 84 percent. (I'm currently taking Pristiq, which cuts the chances of relapse by more than half.) But if I needed to, I'd absolutely undergo more shock treatments.

I haven't told many people about the procedure, aside from my family, a colleague, and the man I'm seeing. We'd been going out for a couple of months when I was referred to Dr. Melman, and I thought for sure he'd flee when I told him. To my surprise, he was very understanding. We're still together. Let's face it — there's a major stigma attached to shock therapy. And I know there are so many women out there suffering longer than they need to because they won't consider ECT as an option. For the first time in a long time, I'm looking ahead. I'm working again, in a healthy relationship, taking good care of myself. When I think back to where I was, that's nothing short of miraculous.


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