At Eternities Gate

"At Eternities Gate" painting - Vincent van Gogh

I have repeatedly asked my psychiatrist for ECT (Electro Convulsive Therapy) and been regularly refused. He has said my clinical depression is not severe enough. What do I have to do so that it is severe enough?; I have been treated now for over 3 years by drugs (Anti-depressants and anti-psychotics) and psycho-therapies with little evidence of improvement in the long term. I have had short term recoveries but inevitably these end up with me relapsing and back on a downward trajectory (mood wise) with no obvious outside cause. I have made a number of suicide attempts and been classified as at high risk of self harm by my Community Psychiatric Nurse (CPN).

ECT was frowned upon for quite a few years during the 80s and 90s but has more recently made a comeback as techniques for its application have been refined (so my son tells me and he is a qualified Consultant Psychiatrist). ECT for those who are not aware, is “a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe major depression which has not responded to other treatment [1]”. ECT used to be called, rather cruelly, ‘electric shock treatment’ and in years gone by it was highly stigmatized by society.

What are the symptoms of my own clinical depression? Perhaps then you can judge for yourself the seriousness and life inhibiting consequences of my condition.

One of my most common experiences when I am feeling low is what my Community Psychiatric Nurse has called ‘depersonalization’ together with loss of body image. During such a period, I feel like I am an observer detached from and looking at the surrounding scene, but not part of it, maybe even invisible. At the worst visual hallucinations, can occur, emotions can rapidly change from ecstasy to despair, often triggered by sensory clues (for example , sights, sounds and smells). Thoughts and memories flow incessantly, often breaking the boundaries of repression so that I am subject to sudden outbursts which often make no sense to the observer. This can be quite disconcerting for those nearest and dearest to me. To them it seems I am no longer the person whom they have known for all or part of their lives. Sometimes peace is obtained when I can turn inward to transcendental or contemplative thoughts. The downside of this is that I then perceive myself as communicating in great philosophical depth, while in reality I am living in a world of my own illusory imagination.

Another adverse effect is the panic attack as I am told a chemical imbalance in the brain associated with clinical depression interferes with the ability to filter and integrate sensory input. This leads to a sense of being overwhelmed and bombarded by stimuli. It tends to occur in crowded places such as busy shopping streets and supermarkets. At this time I tend to lose control and the usual reference points to reality become confused. I am overwhelmed with the fear of impending insanity accompanied by severe anxiety. It is during such a panic attack that a depressive can do the most harm to himself and possibly others. There is always a danger for instance that during a panic attack an individual may jump from a building in an attempt to escape the threatening situation. Panic attacks usually last less than 24 hr, but they can degenerate into prolonged psychotic states. I have been told that such a toxic psychosis can last from days to months but luckily I have not yet experienced this although this is one of the reasons why I’m asking for ECT treatment before my condition worsens. Prolonged psychosis resulting from clinical depression is in fact very rare but to me the fear is very real when I feel I am unstable and out of control and I will never actually regain control again.

Prolonged psychosis is a psychotic condition that may also be accelerated or exacerbated by self-medication and may include thought disorders, hallucinations, depression, regression, or depersonalizations. Self medication is a medical term meaning “the use of drugs, alcohol, or self-soothing forms of behavior, to treat a perceived or real malady. Self-medication is often referred to in the context of a person self-medicating, in order to alleviate their own distress or pain.” (Wikipedia). I don’t know whether it’s possible to convey to another person the intense craving for a substance (any substance) to relieve prolonged and severe emotional or mental distress in a sufferer. I do know however that any relief which is obtained is merely temporary and the chances are the condition will inevitably recur in an even more severe and less treatable form.

I can’t really say any more about how I am except that for the moment it helps me to write this down, the really scary thing being that at a future time my condition may not allow me to write anything down at all. Whoever reads this rather dismal BLOG, I thank you for your patience and forbearance.

After Note: A testimonial to ECT from a depression patient:

I know this may be not a smart question, but I don’t understand why ECT is the most controversial thing in psychiatry. I was told that in many foreign countries it is the first choice of treatment while in the US and UK it is the last resort. I tried everything else for a good three years before my doc recommended ECT. After receiving it, I realize the fear and such that follows the recovery period, but when you weigh the options of losing a few short term memories compared to getting your life back, is there even a comparison? I went through many emotions as I had ECT, even quit because I became scared. I returned a month later to finish and had to work through much fear then…but, ECT worked for me. For the first time in years I am not at all depressed. It’s a beautiful thing and I want people to know that side of ECT. How can we get the good stories out there to the mass media?