How Shocking That I Got Shocked! & The Amazing Dr. Nuland

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I’m still shocked that I had the guts to request ECT, also known as electroconvulsive therapy or electroshock. It was nothing other than pure desperation that drove me to try something so frightening and controversial.

It was January of 2009.  I was diagnosed with bipolar disorder two years earlier, and I was teetering on the edge of sanity.  Then my father died.  If you’ve read my post Stigma – Part Two you know that my relationship with my father (who also had bipolar disorder) was a close one, and I loved him unreservedly.  His health had been failing for several years before he passed away, but each time it seemed that when he reached his end, he’d make a miraculous recovery.  No matter how many remarkable recoveries Dad made, I knew that it was inevitable that I’d lose him forever.  I had been dreading his death every day since he became frail in his seventies.

Dad never liked to talk about death, unlike me. I was fascinated with discussing death with anyone up for it, and I was especially interested the afterlife.  I considered Elizabeth Kubler Ross, a pioneer in near-death studies (On Death and Dying) and Dr. Raymond Moody (Life After Life which has sold over 12 million copies to date) to be among my favorite authors.  Dad, an avid reader, wouldn’t allow me to discuss either of those books in his presence.

When I got the phone call that my Dad died exactly the way he feared: alone in a mediocre assisted living center, I became catatonic.  My depression plummeted to depths it never reached before.

A decade before I was diagnosed with bipolar disorder, I witnessed the death of another very close relative, my Granny. I fell into a deep depression after she died of lung cancer, but I was able to function more or less.  Not so with my father’s death.  After I received the news that he passed away, I asked to go to C.H.O.M.P., the Community Hospital of the Monterey Peninsula. C.H.O.M.P. had a locked-down mental health unit euphemistically called the “Garden Pavilion”.  When I was hospitalized there, my depression was so severe that I experienced suicidal ideations – I had no specific plan, but I felt utterly devoid of hope.

Prior to this hospitalization, I demonstrated that I was medication-resistant, meaning I tried a plethora of mood stabilizers, anti-psychotics, and anti-depressants and none of those medications helped lift my depression.

At C.H.O.M.P. I was given the option which psychiatrists offer to their medication-resistant patients: electroconvulsive treatments in which seizures are electrically induced in patients who are given anesthesia and a muscle relaxant.

My first association with E.C.T., along with many in our society, was a photo of Jack Nicholson’s character receiving it in the Academy Award-winning film “One Flew Over The Cuckoo’s Nest”.  I never read Ken Kesey’s book or saw Milos Forman’s movie, but I had a very negative impression from viewing that disturbing image of Nicholson’s grimace while undergoing E.C.T.

After my grandmother died, I found a beautifully written book titled Undercurrents in which the author, psychologist Dr. Martha Manning, fell into a depression so deep that she opted for E.C.T.  The treatments helped her enormously. While she struggled after the procedures with fatigue and short-term memory loss, she made it clear that it was the right, lifesaving choice for her.

I was affected profoundly by Undercurrents and when I began my freelance writing career, I contacted Dr. Manning for an interview.  I included her quote in a Fit magazine article “Shades of Gray” which examined the connection between depression, women and exercise.  It was an honor to interview Dr. Manning. I kept our topics to exercise and depression only, for at that point I never imagined I would need, let alone demand, E.C.T.

When E.C.T. was presented to me as a viable way to recover, I vaguely remembered Dr. Manning’s book. Without any hesitation I told the psychiatrist on duty, “Do it.”  

I didn’t care about its risks; I didn’t care about anything. To say I felt desperate was a massive understatement.  I was told by my psychiatrist Dr. C. that I would have unilateral rather than bilateral E.C.T., which meant that the electrodes used to stimulate my brain would be placed on one side of my head instead of both sides (bilateral).  This was the conservative approach (which is usually good when dealing with a brain!) and meant fewer side effects, most notably less memory loss.

The E.C.T. treatments started promptly at the grisly hour of 6:00 a.m. in the Short Stay Unit allocated for all outpatient procedures.  I was rolled up to the floor above the Garden Pavilion in a padded gurney by B., a compassionate longtime hospital aide.  If I had to be taken up to E.C.T. by anyone, B. had the perfect kind of personality for the job.

After B. dropped me off in a small, curtained room, I was prepped by a friendly nurse who immediately saw how down I was and she did her best to set me at ease.  She started the I.V. line that would be used to inject me with general anesthesia.  I’ve never had a problem with needles or injections, so that didn’t faze me one bit.  

I was looking forward to oblivion very much, thank you.

At 6:10 a.m. in walked Dr. C. holding a big coffee mug, accompanied by an extremely handsome anesthesiologist.  (Even though I was in a depression-induced stupor, I was able to notice physical beauty.)  Dr. C. gently placed several electrodes on my scalp and temple….it was no big deal.  A small, clear gas mask was placed over my nose and I remember finally being able to relax.

I wasn’t scared at that point; I felt like I was being taken care of and because I genuinely liked the staff surrounding me that went a long way in diminishing my anxiety.  

The anesthesiologist said “Okay, Dyane. I want you to count backwards from 10”, which I started to do and when I reached “5”, boom!  I was fast-asleep.  I didn’t feel a thing. There was no pain.  Not during, and not afterwards.

When I woke up within the hour, I was a little groggy, but then I was completely coherent within about ten minutes. That surprised me. I was fed a hot breakfast I had selected beforehand, and I had the appetite to eat most of it. My short-term memory loss was minimal. While I was still heartbroken over the loss of my father, I definitely felt better than I had before I went under, and with each treatment I felt a little better.  After my week at the hospital I had additional treatments as an outpatient.

I firmly believe that E.C.T. saved my life. I was lucky – I’ve heard the horror stories of those who had bad reactions, but I’d do it again in a heartbeat. I would also recommend it to others who feel suicidal, who have been medication-resistant, and who need to function as quickly as possible, i.e. a mother with young children or the breadwinner of the family.  My health insurance covered most of the procedures’ cost, and I was able to arrange an extended payment plan for the remaining balance.

Since I had the treatments in 2009, I learned about another procedure used to treat major depression called transcranial magnetic stimulation, or TMS. Wikipedia defines TMS as a “noninvasive method to cause depolarization in the neurons of the brain. TMS uses electromagnetic induction to induce weak electric currents” and no anesthesia is required.  I read an entire book about a woman named Martha Rhodes’ experience with TMS healing her depression. Rhodes made a suicide attempt and was hospitalized at the cushy Silver Hill, where Catherine Zeta Jones was hospitalized. Rhodes tried many medications to no avail and decided to pursue TMS. Her book is called 3000 Pulses Later and while I liked it very much, I disagreed with its one-sided depiction of E.C.T.

One important distinction between TMS and E.C.T. (which have comparable success rates) is that with TMS one must commit to almost daily procedures for up to six weeks.  The good news  is that the patient can drive back and forth to treatment unlike with E.C.T., in which a ride must be arranged due to the anesthesia  However, TMS doesn’t usually start working until midway through the four-to-six-week series.  E.C.T. can cause the depression to remit much sooner than that timeframe,  like it did with me.

Depending on one’s situation, it would be most worthwhile to closely examine both E.C.T. and TMS pros and cons before undertaking either treatment.  E.C.T. is an enormous commitment and it requires a major leap of faith.  It’s expensive, even with health insurance.  (TMS can be very costly as well.) Moreover, there are risks when undergoing any kind of anesthesia, or when subjecting oneself to potential memory loss.  

I can unequivocally state that doing E.C.T. was the best decision I ever made. 

October 21, 2015 Update: When I was undergoing E.C.T. treatments, I wish I saw the remarkable, inspiring TED talk given by the bestselling author/surgeon Dr. Sherwin Nuland about his E.C.T. experience. The following clip is brief and it’s considered by the TED content masterminds to be one of the best TED talks. It’s definitely worth the time to watch Dr. Nuland if you’re even remotely considering electroconvulsive treatment. He’ll make you laugh, he’ll make you think, and he’ll give you hope if you’re considering it.

Dyane’s memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder with a foreword by Dr. Walker Karraa (author of the acclaimed book Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth) will be published by Post Hill Press next year.

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Hell in Paradise – Part Two – Seeking The Real Aloha

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Our family in front of the Kona Inn Restaurant in Kailua-Kona at sunset, November 2013

To read the revised version of Part One please visit here

December, 2013

I know it sounds ridiculous to complain about being in Hawaii, but anyone who has experienced bipolar depression can empathize with this seemingly narcissistic attitude. No matter where you are, it doesn’t matter – being in such despair is a malady of the spirit that turns heaven into hell.

There were moments when I was able to acknowledge and appreciate my family’s joy during their various activities, but I was leaden and ashamed that I couldn’t be like them. 

We arrived at a gorgeous beach in Kua Bay that was perfect for boogie boarding. My girls and husband Craig made a beeline for the gentle aquamarine waves. I used to love to go boogie boarding when I was a teenager in the (much) colder waves in Santa Monica, California. In Hawaii I watched my family play in the waves from afar, unable to join them.  

I baked on the sand and people-watched instead, envious of the beach-goers glued to their books under umbrellas. I was so apathetic that I hadn’t even bothered to bring a good book with me. This was the complete opposite of how I behaved when I wasn’t depressed. Normally I’d never travel more than a couple feet without clutching a riveting book or my Kindle Fire.

Each day in Hawaii I desperately hoped for my unrelenting depression to lift so I would feel the Aloha spirit I heard so much about.  While the word “Aloha” is often used to mean “goodbye”, “hello” and “I love you”, there is a deeper meaning to the word.  The website http://www.huna.org explains:

Aloha is being a part of all, and all being a part of me. I will not willfully harm anyone or anything. The earth, the sky, the sea are mine to care for, to cherish and to protect. This is Hawaiian – this is Aloha!

I was full of anti-Aloha sentiment. That attitude felt all wrong in such a glorious setting.  In an attempt to feel better, I self-medicated with food and beverages.  On a humid, seventy-five degree day I inhaled a bag of “Donkey Balls”.  Yes, they were called Donkey Balls consisting of macadamia nuts covered with multiple layers of chocolate. The balls were a temporary sugar fix and they left me feeling nauseated and plumped up.

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My psychiatrist discouraged me from drinking caffeine due to the contraindications associated with the MAOI (monoamine oxidase inhibitor, a class) medication I recently starting taking with lithium. The  MAOI, called Parnate or tranylcypromine, was known to help treatment-resistant bipolar depression and like lithium, was old-school. MAOI’s were the first type of antidepressant developed, but Dr. D. didn’t think the Parnate would send me into mania as long as I took the mood stabilizer lithium.

My meds didn’t stop me from sucking down the famous Kona coffee of the region.  

High-quality Kona coffee often sells for at least $30.00 a pound.  Once I sipped some of it I understood why java addicts with cash to burn paid such an astronomical price for these beans. When we arrived at Al’s Kona Coffee Farm rental, Al left us a bag of his Kona blend.  I made a pot of it every day on his farm, and all that tasty coffee left me jittery and contributed to my insomnia.

Parnate’s dietary restrictions also prevented me from binging on certain comfort foods which I previously enjoyed such as aged cheeses and cured meats. MAOI’s require that patients relinquish eating anything high in the amino acid tyrine. I made up for that restriction by gobbling a large bowl of granola each night – it was a temporary sugar high.  Not to mention gross. Of course the sugary cereal also worsened my sleeplessness.

I was desperate to feel better, but since I felt so hopeless, I didn’t have much self-restraint.

To complicate matters, I obsessed about mortality.  We had brought my mother-in-law’s ashes and planned to scatter them in a spectacular location.  This type of ceremony was a fitting way to memorialize her because she loved the region. I knew she would have appreciated it.  But I was sickened by the macabre fact that her ashes were hidden a mere room away from where I slept every night.

We found the perfect place to disperse her ashes. It was a reef just off the Puuhonua o Honaunau National Park.  Also known as the Place of Refuge, this park was once the home of royal grounds and a place of refuge for ancient Hawaiian lawbreakers.  Kapu, or sacred laws, were tantamount to Hawaiian culture.  (If you’re thinking of that Brady Bunch Goes to Hawaii episode you’re not the only one!)

Seriously, the breaking of kapu could mean death. A kapu-breaker’s only chance for survival was to evade his pursuers and make it to a puuhonua, or a sacred place of refuge. Once there, a ceremony of absolution would take place and the law-breaker would be able to return to society.

On the surface, this park was a gorgeous, peaceful spot. As I learned a bit about its intense historical background, that distracted me a little bit from my depression   

Near the visitor center I walked by a huge plumeria bush and I surreptitiously picked a handful of the lovely, fragrant blooms.  Upon my return to the beach once again I was a passive observer rather than a participant.  I gave a few white and yellow plumeria blossoms to my husband and daughters and then I plopped down on my towel.  They walked out onto the reef together and tossed the plumerias into the ocean in remembrance of my mother-in-law.  (Craig decided to scatter her ashes alone.)

Less than ten days after we returned home, once again my bipolar depression lifted.  How did that happen?

A few days after our return my insomnia grew even worse and I experienced two completely sleepless nights.  Even one sleepless night could trigger mania and I could end up in the hospital, so I called Dr. D.  He prescribed Seroquel (generic name: quetiapine), a heavy-duty atypical antipsychotic.  It nipped my insomnia in the bud. As controversial as Seroquel is, I’ll always be deeply grateful to this medication for helping me in a crisis.

I noticed that my depression subsided a few days after I started taking the quetiapine.  It seemed to me that there could be a connection between my depression vanishing and starting the quetiapine, so I remained on it  despite the side effects  I had of daytime grogginess and some weight gain/nighttime hunger.

I was able to laugh again – not fake laughs, but the real deal. I had fun with my girls and Craig, and I felt hope trickle back into my brain. To my utter relief, I could write again. I stopped waking up every day wishing I could escape back into an agitated sleep. I knew that life would continue to be difficult, but I hoped with every cell in my being that I wouldn’t return to the hell of bipolar depression ever again.

10/9/15 Meds Update: I’ve been taking 900 mg of lithium/night, 30 mg of tranylcypromine/Parante a day ever since Hawaii. I slowly tapered off Seroquel, but I resumed taking it last August when I became hypomanic at the Catamaran Writers Conference. Today marks the second week I’ve been off Seroquel. So far, so good, but if I find myself becoming hypomanic I’ll take it again in a heartbeat! 

Dyane is completing her memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder with a foreword by Dr. Walker Karraa (author of the acclaimed book Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth).