The Bipolar Cage Part 3: Relapse and My SECOND ECT SERIES
“Writing in Convulsive Therapy, Cohen and colleagues reviewed the medical records of 21 children aged between 13 and 19 who had been given bilateral electroshock from 1984 to 1995. They found a 40 per cent relapse rate after a year.”
A Critical A-Z of Electroshock by Craig Newnes
I was admitted for another inpatient ECT series a year later. Again, there was no diagnostic or health history review to ensure ECT was truly my only option.
Maintenance
After my second series, I began maintenance ECT. Each treatment was followed by weeks of 20+ hour narcotic naps. After I recovered from ECT, I would relapse and need another treatment to bring me back up.
Growing terror before ECT
Over time, I began to experience intense fear before each ECT treatment. This was partly due to the withdrawal symptoms caused by rapid pre-treatment tapers. On one occasion, I was so scared, my skin was crawling, and it felt like I was dying. Despite being on drugs for over a decade, no one had informed me about these withdrawal symptoms. The other reason I experienced so much terror is that my body knew something dangerous was being done to me that the anesthesia couldn’t hide.
The threat
When I told my ECT doctor that I wanted to skip that day’s treatment, he informed me that he would have to stop treating me, which stunned me. In a flash, his kind, grandfatherly demeanor was replaced with a cold edge. He told me I could go home but would stop treating me if I did.
I was terrified at the prospect of losing access to what I believed was a life-saving treatment. I quickly changed my tune and agreed to be shocked.
At that moment, I realized that expressing anxiety could endanger my access to this “life-saving” treatment. This doctor was the nearest ECT provider at 6 hour’s drive round trip. He was my only access to the treatment at this time. So, I did my best to keep my anxiety to myself and push through. After this, I avoided questioning my doctors in ways that might cause them to anger them or threaten my treatment options.
It never occurred to me that he might have been upset because his clinic would lose money if I didn’t get my push of the button that day.
Real flatliners
In a sense, I was a different person after each ECT. Each coma left me a little less me than I was before. After so many treatments, my past felt like it happened to someone else. It was like I became an echo of who I was, growing fainter after each treatment. I would find clues as to why, in early 2020, the brain temporarily goes silent from ECT. My pre-treatment anxiety was actually my self-preserving instincts screaming at me that I was in danger. Unfortunately, I had been conditioned for so long to ignore my instincts after taking drugs that made me sick and following the guidance of trusted doctors.
I had unwittingly become a Flatliner, like in the 1990 movie where a group of medical students intentionally trigger near-death experiences by flatlining each other with powerful drugs, then reviving the Flatliners before their bodies die completely. In their case, they wanted to see what was after death; I was unknowingly being flatlined to cure my depression.
Flatlined, my brain no longer knew how to tell my lungs to breathe. Modern ECT is said to be safer because of pure oxygen supplementation and more comfortable because of the “muscle relaxant” that is used. However, this muscle relaxant is actually a paralytic, which has its own dangers, like making spontaneous respiration impossible until it wears off.
The pure oxygen flowing through my cannula was useless to me without mechanical ventilation to force the air into my paralyzed lungs during the postictal suppression phase.
Interestingly, ECT machines are designed to stop recording data after a seizure, and doctors are not required to document how long postictal suppression lasts. I likely would have benefited from capnography, a tool considered the gold standard for monitoring Co2 levels to prevent anoxic brain injury while under anesthesia, which is not used in ECT.
Without this data, there’s no way to know how long I was unable to breathe spontaneously or what damage this caused my brain. I know being overweight didn’t do me any favors.
Starving but overweight
You may be wondering how I could gain weight by eating so little. It’s easy with hypoglycemia. Just eat simple carbs and avoid exercise, and you will gain weight. Insulin is a fat-storage hormone, so if you are spiking your blood sugars several times a day and not exercising, you will eventually gain weight. If this goes on long enough, you may become prediabetic. Add psychiatric drugs that impact metabolism, and you have multiple causes for gaining weight.
The cruelest part of this was that the only food I could eat with gastroparesis triggered the worst blood sugar spikes and crashes. I would have to sit through the rage, terror, and tremors as I got blasted with stress hormones after each high-carb meal.
ONE FAILED SOLUTION AFTER ANOTHER
Remember that med change I mentioned? The benefits didn’t last, likely partly due to electrical injury altering how my ion channels function and, in turn, my body’s reaction to medications, foods, and the environment.
The medications I was switched to caused more severe side effects. The gastroparesis was so painful it left me bedridden and starving for over two years. I ate a spoonful of rice to take my pain meds. Standing long enough to warm my food was unbearable, so I ate it straight from the fridge before returning to bed to ride out the hours of pain that would happen after eating.
Yet another taper
First, we tried swapping the “problem meds” with new ones without a washout period. Each change-up was more disastrous than the last, triggering everything from crippling migraines to shrieking suicidal akathisia.
Meanwhile, my kidneys were shutting down from being on the mood stabilizer Lithium I’d been on for nearly a decade. At one point, I inflated like a balloon from the fluid retention. I looked seven months pregnant, feet too fat to fit in closed shoes.
I’d already suffered through humiliating appearance changes throughout my teens from weight gain, angry red stretch marks, and hair loss. I was mortified at the latest freakish change in my haggard, already 70-pound overweight figure. Changes my psychiatrist would document with unflattering detail in my notes.
THE ECT MINI SERIES
Because of the urgency created by the gastroparesis, I underwent a mini-series of treatments to “speed up the withdrawal process” so I could eat again.
ECT’s waning benefits
Gains from treatment became less while side effects got worse. I could barely sleep from pain and withdrawal symptoms (I averaged about 3 hours on a good night). These symptoms spiked dangerously by quitting all anticonvulsant meds days before ECT. After resuming my normal dose, I would never fully rebound from these sudden tapers.
Drowning in Fentanyl
Fifteen years later, I would learn a reason why I crashed so hard after each ECT treatment: Fentanyl. I was given multiple doses of this powerful narcotic before and during ECT, followed by hydrocodone for post-ECT headaches and gastroparesis pain.
I had been on Vicodin for a year for gastrointestinal pain. I had become dependent on opioids within the first few months. Any peaceful, euphoric feelings from these drugs were followed by a crushing emotional pain equal to the death of a loved one I would suffer through several times a day.
Being pumped full of fentanyl likely gave me a tiny boost, seen as an improvement from ECT, and the crash that came after was seen as my pesky “treatment-resistant mental illness” returning. We better increase ECT!
My last ECT treatment
I didn’t feel right after one of my treatments. My doctor was unconcerned and told me to come for the next treatment. Dazed and in full withdrawal from my last ECT taper, I did what he said.
When I regained consciousness, something was wrong. It felt like my brain had been taken apart and put back together wrong. My vision was distorted, I struggled to hold on to words long enough to speak them, I lost all sense of time, and I would forget things within seconds.
Part 4: My Life After ECT
