Regarding mental health, the last year has not been easy. Hell, for me, the last two decades have not been easy. My brain has been a broken place, a world of contrast, elation and mess. And yet, its richness lies in its brokenness. As a bipolar one patient/sufferer/victim/convalescent/survivor, it’s been a harrowing and very polarising burden. True to the vignette of life, these seasons have ebbed and flowed (and by seasons, I mean epic fluctuations in mood and sanity). This year, however, I was designated a lifeline in the form of ECT.

Electroconvulsive therapy (ECT) is a well-established medical procedure used to treat certain mental health conditions, like bipolar. Although it can initially seem intimidating, understanding the basics of ECT can help clarify what it entails. The media and stories like One Flew Over the Cuckoo’s Nest have given it a bad rep (in the latter, Jack Nicholson’s character had a lobotomy, not ECT, but I digress). Although I did research before the treatment, nothing can quite prepare you – each patient and each experience is different. 

Beyond the facts I found on Google, there isn’t really a guide for how families and friends can understand the treatment. Hence I’m putting proverbial pen to proverbial paper. This beginner’s guide aims to provide an overview of what ECT entails, its purpose, the process involved, and what it actually means to go through it.

Procedure

ECT is performed under general anaesthesia, so you’re unconscious and unaware during the procedure. The psychiatrist delivers a carefully controlled electric current to the brain via electrodes placed on the scalp; the electrical stimulation triggers a brief seizure activity in the brain. The decision for me to undergo ECT was simple – nothing was working. I was on all the meds, doing all the things, and yet I was regularly having mixed episodes. It was extremely difficult to ‘keep up’ with my fluctuating reality. 

Mechanism of Action

The exact mechanism of how ECT works is not fully understood. It’s believed that the induced seizure activity may alter brain chemistry and communication among nerve cells, improving mood and alleviating symptoms. ECT may also stimulate the production of new brain cells. I was very fortunate only to need six sessions (the number of treatments varies depending on the individual’s response and the severity of their condition), but the results for me personally have been noteworthy. 

Effectiveness

ECT can be highly effective in certain cases, especially when other treatments have been unsuccessful. It’s considered when symptom relief is needed or when the patient cannot tolerate or respond to other forms of treatment, like medication. The result has significantly improved mood, cognition, and overall ability to function.

Side Effects

While ECT is generally safe, there can be side effects associated with the procedure. These are usually short-term and mostly include confusion, memory loss (particularly for events around the time of treatment), headache, muscle aches, and nausea. Modern ECT techniques aim to minimise these side effects through the use of anaesthesia and muscle relaxants. In my case, the three-to-four weeks after I was discharged from hospital were actually harder than the weeks in hospital. My reasoning for this is that I was in a safe space that didn’t demand much – the real world is complex and onerous. I also returned to work too soon and tried to do too much too quickly. My advice for anyone would be to give yourself significant time to heal. Memory loss is tremendously frustrating (for you and your loved ones), but it improves after about 1–2 months. 

Considerations

ECT is typically used when nothing else works. My decision to undergo the treatment was made in consolidation with my psychiatrist. It’s crucial to thoroughly discuss this with a qualified healthcare professional to assess whether this is an appropriate treatment option. I take my hat off to friends and family members supporting someone going through this.

I’ve chatted with my mom and closest friends and thought it easier to create a ‘podcast’ because they all wisely shared incredibly profound anecdotes. Before this post turns to rust, I’ve included a few favourites below because, let’s be honest, I’m never going to edit a podcast. 

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This was my first ECT experience, so I don’t know if it was a Lisa experience or an ECT experience. When it comes to your experience with bipolar, you deal with it in a very unique way. I don’t want to say you hide it, but you definitely mask it well, so from the outside, it’s hard to understand what you are going through because you’re so good at managing it. I don’t think I realised just how much you were going through. It’s a testament to your character because you are so strong.

Regarding advice for supporting a loved one going through ECT, I would definitely say patience. Concerning memory loss, specifically. You would ask me the same question many times. But I never told you that you’d repeatedly asked the same question. I didn’t want you to feel like you had forgotten or something was wrong with you.

Other advice is to ask questions. What is the best way I can support you? I didn’t want to make you seem like the problem child. I should’ve asked more questions.

You get paranoid about things, which was extremely heightened during your ECT recovery. You were constantly looking for reassurance. I think the reassurance needed came from the fact that you thought I was angry with you.

Realise that this person is going through quite a confusing stage; they don’t know if they’re Arthur or Martha because they forget so much. Everyone has a love language. Depending on that person’s love language would be giving it to them in that way – it will be super beneficial for that person. Yours is words of affirmation, so in that state, had I been like “Lis, I’m not pissed off with you, I’m not running away from you, I’m just leaving the house”.

You were super messy! You were suuuuper messy! I rationalised it in my head and said, “Claire, Lisa is going through so much. She’s had her brain shocked multiple times; dishes are the last thing on her mind.” I could tell how disorganised your brain was. You should not have returned to work; you were incapable in that mind frame.

Patience, affirmation and reassurance – or however that person responds to love – and trust that the process is short term. Ask more questions – do you need support? Am I coming across as condescending? You made it seem like you were so fine, so asking how you are did feel condescending. You needed to be vulnerable enough to let people know you weren’t ok. It was very hard to decode what you were feeling. There’s nothing I can relate to as part of this experience for you.

For me it would be, do your research. To understand. Patience and understanding; try to understand. It’s hard, it’s not easy because you’re seeing your friend go through something so tough and you don’t know what to do. It could be the wrong thing, it could be the right thing, you just don’t know.

I also think that a lot of people will say, I could’ve probably done more. But you just don’t know how.

It’s different for me when it comes to understanding your bipolar – there were questions that I asked and questions that helped me understand. But in this case, there was no sounding board. Or if I did you would have had the answer ‘I’m fine’. I would have loved to have experienced it with you and been in the room with you, just to understand better. You’re the only one now who really understands it. Like when you told me you had to have [the seizure] twice in one day because it didn’t work the first time, I would’ve wanted to ask questions and understand it. But maybe I’m more inquisitive in that way.

Writing this post is something you need to do, to be able to help others. Even something as simple as a little guide that you can share with people.