Category: Transcranial Magnetic Stimulation

I am getting Electroconvulsive Therapy (ECT)

I am being scheduled for ECT at the end of March or thereabouts. I am terrified but a little hopeful.

It might help friends, family and other readers to understand my choice to undertake ECT if I share my PROs and CONs list.

The CONs are very serious.

I’ll need to take six or seven weeks of sick leave from work. That’s because there will be about 20 treatments in total, three times a week; and then I’ll need about two weeks to recover from the whole series. There will also be a major disruption to our family life and to Anita’s work. The procedure has minor side effects like nausea and headaches. It has the major side effect of short-term memory loss during the entire length of the treatment regime. I likely won’t remember in the afternoon conversations that I had in the morning, that kind of thing. I might forget whole days. And ECT carries more serious risks such heart attack from the electric shock, broken bones or teeth if the anti-seizure drugs don’t entirely work and I go into major convulsions, and possibly death from the anesthetic. Also, occasionally patients have long term memory loss – if that happened, it would end my career. Speaking of anesthetic, I will be given an intravenous general every time. This for a person who has a phobia about needles: I’m genuinely as afraid of that as I am of the electric shocks.

Adding to the CONs, the specialist estimated only a 40-50% chance of a “clinically significant reduction in my symptoms”. This is a far cry from the 80% probability of remission that I had been led to expect from informal research. And the improvement, if it occurs, may be temporary.

The PROs are almost all “mights”. A significant improvement in my symptoms might get me back to working fully; able to travel; and interested again in things like food, novels, movies, etc. It might allow me to get off some of my medications, which in turn might take away various nasty side effects. As an example, my left hand sometimes shakes badly, to the point that I can only type with my right hand. I think the tremors are due to one of my meds. It might at the very least halt the continuing decline in my mental health. (Many times I’ve thought: “This can’t possibly get worse. What would worse be like?” Then it got worse, e.g., when agoraphobia struck.)

Maybe the most daunting CON of all is the potential for a total loss of hope going forward: ECT is basically my last resort, so that if it fails, I’m out of options. I have pretty much exhausted the possibilities for medications. I’ve been on 20 or so over the years. I’ve done lots of therapy, including Dialectical Behavioral Therapy, which has been the main topic of this blog. Yet my Bipolar continues to worsen. Being out of additional treatment options would be horrendous. I don’t see how I can continue in my career if I don’t improve. Nor go on fishing trips, nor function as a husband and father, nor…

Maybe the biggest PRO is that, if I do the procedure, I won’t wonder “What if?”

In short, the choice is between uncertainty and fear on the one hand and hope for the return of my most valued activities on the other. Scared as I am – and I have been literally shaking with fright today – I am choosing hope.

TMS and emotional vulnerabilities

I have just been scheduled for Transcranial Magnetic Stimulation (TMS). It’s a six-week long, non-invasive neurological treatment for severe depression. I’ll begin in mid-April at London’s Parkwood Institute.

For those who know nothing about it, here is a very brief but useful primer:

https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335

How might TMS help in the context of my psychotherapy? DBT identifies several elements in an episode of anxiety or depression: vulnerabilities; a prompting event or “trigger”; an emotion-infused reaction in the body (e.g., increased heartbeat, clenching of muscles); and an interpretation which the reasoning mind creates in light of all this.

The most relevant element here are the vulnerabilities. They can be short-term or long-term. The former pertain especially to i) reduced sleep, ii) unhealthy diet, and iii) insufficient exercise. Sleep in particular is a very strong predictor of emotional fragility in my case. Long-term vulnerabilities lie in iv) psychological history (e.g., an abusive childhood or a catastrophic loss) and v) biomedical diagnoses, such as my own Bipolar Disorder Type II.

I can and do work constantly at reducing those short-term vulnerabilities: I’ve learned lots about sleep hygiene and a mind-wise diet (think Mediterranean), and I run all the time.

I can’t do much about (iv): history is what it is. My pre-adolescence was a traumatic domestic nightmare. And, after a devastating five years of surgeries, radiation, and chemo, I lost my first wife to cancer. She was 29, I was 28.

TMS comes in with respect to that fifth vulnerability. It helps approximately 50-60% of people suffering treatment resistant clinical depression.

It’s very, very important that I focus on this fact, viz., that TMS might very well help with number (v), but cannot “fix me”. For, anticipating that 30 days of brain stimulation will itself excise all my sadness and fear sets me up for disillusion and despair. It is self-defeating.

So, wish me luck. And remind me to manage my expectations.