DSM IV 296.43: Bipolar I Disorder, Most Recent Episode Manic, Severe Without Psychotic Features.

Somewhere in the course of nine ECT treatments in the summer of 2006, I forgot how to play Sudoku. Memory loss is a known side effect of electroconvulsive therapy and despite the fact that I'd played this number game daily for several months, I guess those neurons were in the wrong place at the wrong time. I lost other memories as well, most notably entire days. I was in the hospital for close to three weeks but don't remember much of it and for that I am profoundly grateful.

My first stay in a psychiatric ward was just a year before, in August 2005. Earlier that year my psychiatrist had diagnosed me with bipolar disorder, and that summer I was severely depressed. One day I revealed my suicide plan to Dr. L. and he immediately arranged for my hospitalization. I stayed there a week during which time they started me on lithium and kept me safe from myself. I left considerably better, stayed home for two more days, then went back to work. In comparison and in retrospect the experience was a piece of cake.

All was not sunshine and roses the next year and Dr. L. adjusted my meds several times in an effort to control the cycling that is bipolar illness. I was not severely ill, but had many days where I could not function normally. Dr. L. blamed the antidepressant which had served me well for twenty years. Antidepressants are generally contraindicated in bipolar illness and he recommended that I go off it. The schedule began with a nine day taper followed by a two week washout, after which I could start on a third mood stabilizer (I was already on two). My husband Phillip thought I should take some sick time from work; Dr. L. mentioned short term disability. I couldn't believe it would be that bad.

Unfortunately, Dr. L.'s prescience was right on the mark. What started as irritabilty progressed into anger then culminated as rage. Anything set me off into a tantrum of screaming, swearing, throwing and breaking things. My dog was so scared that he tried to climb into the shower with Phillip one day. Since I could not be left alone we asked friends and family to stay with me. My sister flew out from Oregon, a dear friend drove (twice) from Massachusetts, and another friend telecommuted from our dining room table to her office in Philadelphia. During this time I tried two different medications, one of which made me so nauseous that I stopped eating.

Neither drug helped and my mania worsened. Dr. L.'s arsenal of medications was just about depleted and there was no time to wait for another one to work. He had broached the topic of ECT a few days earlier and now he recommended it as my best option. ECT could significantly decrease my symptoms after just a few treatments. Phillip agreed with this plan of action and presumably I did too though I don't remember. Despite my vocal protest against hospitalization it was a done deal. What I do remember is Dr. L.'s concern that if Phillip drove me to the hospital alone I might try to make a break for it at a stop sign or red light. So Dr. L. rescheduled his last patient of the day and drove us the twenty miles to the hospital. For this too I am profoundly grateful.

After a long wait in the ER, they admitted me onto the locked ward (no surprise there). Monday, Wednesday and Friday were ECT days and the routine was predictable. A nurse escorted me out of the ward shortly after 6:00am and I joined my fellow patients for a quick trip in the van across the street. We changed into hospital gowns and were assigned to one of six gurneys. They always put me on the gurney at the end of the room (no surprise there either). A nurse started an I.V. and placed electrodes on various parts of my body. The psychiatrist, Dr. K. was a quiet man with a calming voice and French accent, placed an electrode on the right side of my head. He always asked how I felt and once I told him that I thought I was being prepared for execution by lethal injection. He assured that this was not the case but I remained skeptical. An anesthesiologist offered a brief hello then had me count backwards from ten while he injected something into the I.V. I barely reached eight after which I was rendered unconscious and a few hundred volts of electricity were delivered to my brain. Bzzzzzzt!

ECT bears no resemblance to the images from "One Flew Over the Cukoo's Nest." There is no thrashing around thanks to a muscle relaxant; in fact, only your foot moves. Anesthesia prevents any memories of the procedure and there is little or no pain involved. The only discomfort I experienced was an aching jaw, perhaps from clenching my teeth. I couldn't seem to escape my torment however, and usually woke up crying or otherwise carrying on. We remained on the gurneys until we fully woke up, then were allowed to change back into our clothes, have a cup of tea, and get back in the van for the ride across the street. Getting into and out of that van were the only times I was outside in sixteen days.

Many mood stabilizers are anti-seizure drugs and because I was on two of them when I was hospitalized the first four ECT treatments were essentially a bust, as they failed to induce a seizure of adequate length (30 seconds). I was at my sickest and though I had no idea, my poor husband was in despair. Phillip has since told me that during this time he repeatedly asked both Dr. L. and Dr. K. if I would recover. They assured him that I would, but he said it was hard for him to accept this given my condition. I remember only bits and pieces from this time and have relied on Phillip to fill in the details. I screamed and swore and was convinced that the ECT wouldn't work, furious at both Dr. L. and Dr. K. for continuing it. Though I was never violent towards anyone (just objects), I spent some time in the "quiet room", where I was anything but. And I was delusional. I believed there was a camera inside the smoke detector over my bed, and that a small spiral bound notebook I had was radioactive. I was totally convinced that dark-haired Erica, a nurse's aide, was in fact Monica Lewinsky. Eating was still a problem for me and all I wanted was ginger ale, which they could or would not provide. Visitors could not bring in food, but Phillip poured a can of ginger ale into a freezer bag, ice into another, then stowed them in his pockets and smuggled them in for me. My hero.

My fifth ECT treatment marked the beginning of my turnaround. The anti-seizure medications were out of my body and I finally had what is called a "good seizure." After I woke up and started to carry on as usual, one of the nurses scolded me for disturbing the other patients. Finally something registered in my manic mind. For the first time in weeks I was able to calm myself. When I returned to the ward after the treatment I tried to call Phillip but the single pay phone on the ward was turned off. I stomped over to the nurses' desk and demanded to use their phone. The head nurse said that I could, but only if I didn't swear. She hated to hear me swear at my husband. For the second time that morning I had a glimpse of my atrocious behavior and made an effort to control it. These were small but significant steps in my recovery.

I had two more ECT treatments before I was released. Once they took hold, my recovery proceeded quickly. I didn't suffer from any significant memory loss and this is probably due to the fact that I had unilateral ECT, not bilateral. The current had been applied only to the right side of my brain, not both. Before my seventh treatment I told Dr. K. that I was ready to go home. We had two long talks during which I explained to him that I was myself again. I went home on Thursday, the day after my seventh treatment with instructions to return as an outpatient for ECT the next morning. Phillip took that Friday and the next week off to be with me. I had my ninth and last treatment the following Monday. Then all hell broke loose.

In addition to memory loss, confusion is a side effect of ECT. My confusion after the final two treatments was so severe that I could not tell the difference between reality and dreams. I was in a constant nightmare for days and I can't summon the words to describe what I was thinking or how I felt. The memories are purely emotional. The panic and anxiety was so horrifying that I swore I would never have ECT again. Now, with the nightmares fading, I don't know what I would do. Hopefully I will not have to make that decision.

I continued to stay home after Phillip returned to work. He gave me tasks to do but I found myself stuck in anxious daydreams for most of the day. It was a recipe for relapse and that is exactly what happened. My symptoms returned and after throwing and breaking my cell phone against the wall in Dr. L.'s office, he arranged for another admission. This time his secretary drove. We stopped at our house so Phillip could pick up some clothes for me. He wanted me to stay in the car but I was so desperate to go inside that I tried to kick out the window of the car. Later, when we arrived at the ER, two burly police officers were assigned to stand outside my room so I couldn't escape. I weighed 120 pounds. Go figure. Thankfully, I was only in the hospital for three days. They adjusted the dosage of my new medication and kept me safe from myself. I had no ECT this time but improved quickly. I spent the next several weeks in an outpatient program where we had intensive group therapy (plus arts and crafts!) for five hours per day. I didn't enjoy it, but in the end, it helped.

I hate thinking of myself as being bipolar, and I hate that others might see me through the filter of mental illness. I hate thinking of myself as someone who had ECT because of the stigma attached to it. I hate that I have been hospitalized twice in two years. But I'm incredibly grateful and fortunate to have such a supportive husband and I am so sorry for the despair he went through. And I'm grateful to Dr. L. and Dr. K. for their genuine concern and for guiding me back from my manic hell.

Something went terribly wrong that summer. I became someone else, someone I hope never to be again. But now I'm back and getting better every day.

email (remove spaces) p s y c h @ l a u r i e k r a m e r . c o m

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