ECT

There are a variety of treatments when it comes to depression. Usually, medication and therapy are the go to treatments. Most people respond well when using these two treatments conjunctively together. However, there are a percentage of people who don't respond to multiple trials of medication. This is known as treatment resistant depression. One of the most common treatments for treatment resistant depression is electroconvulsive therapy or ECT.

ECT has been given a bad rap due to how it was done in the past and how it is portrayed in movies like "One Flew Over the Cuckoo's Nest". It is seen as something violent and painful and something people are forced to do. This is completely opposite of what ECT is actually like now.

What ECT actually is is an electrically induced seizure in the brain. It is a short seizure that is controlled with medication and specifically designed to help people with severe depression. There is no real evidence as to why ECT helps but it is shown to be an effective therapy for people with treatment resistant depression. There are 3 types of ECT: bilateral, unilateral and bi-frontal. All of these relate to the placement of the leads. In bilateral, the leads are planted on both sides of the head. This type generally is seen with more memory loss. Unilateral is just one side of the head and is seen to have less effect on memory. Bi-frontal is where both are placed in the front of the head. All three types of ECT can be used to help someone and it is up to the treating physician to determine which one would be the best fit. 

When ECT is first considered as an option, the psychiatrist and the patient usually talk about whether they think it would be an effective treatment. Then the referral is made to the ECT psychiatrist. From there, the psychiatrist sees the patient and asks multiple questions to determine if the patient is a candidate for ECT. They also will usually explain how ECT works and give the patient a run down of how the process will go or have them watch a video to make sure they feel comfortable going through it. If the psychiatrist thinks the patient could be a candidate then a series of tests are performed including an EKG and a chest x-ray. Consents are signed and then the first ECT is scheduled.

The night before the first ECT appointment, you can't eat or drink after midnight. The next morning you get up early and they take you to the ECT area of the hospital. Some hospitals require that you sign a consent form for each treatment so you would come in and sign that form first. They have you change into a gown and put all your personal belongings in a bag. Then they start an IV, put a blood pressure cuff on your arm and put the EKG stickers on to monitor your heart From there, they take your vitals. After that, it can differ depending on where the ECT is done. In some places, they will give medication ahead of time to prevent headache and nausea, other places will not. So part of the preparation process would include getting that medication. 

Once you are completely prepped, then you wait for your turn. This was probably one of the most anxiety bringing parts because you watched people before you go in the room looking like you and coming out of the room asleep from the anesthesia so that could be draw up some anxiety. Once it gets to your turn, they come and talk with you about your symptoms and how you have been doing. They ask if you think it has been having any effect on you. Based on that conversation will determine if that session will be your last session or if they will continue doing sessions.

From there, you are wheeled into a small room and are surrounded by medical professionals. There is the ECT doctor, the ECT nurse, the anesthesiologist and the nurse anesthetist and sometimes some med students. I think this is what made me feel the most anxious was laying on my back and being surrounded by people. Once you enter the room, they do the preparation for the ECT. They put the blood pressure cuff around your ankle. They clean places on your head where they will place the pieces that administer the shock (this varies based on what type of ECT you are having) and then the put a mask over your face and tell you to take deep breaths while they put a short acting anesthetic in your IV, which usually burns your hand as it goes in. Sometimes they warn you about that, sometimes they don't. When I had ECT and was preparing to go under, that was what I focused on, the burning sensation in my hand. 

Once you are under, they put a bite guard in your mouth, inflate the blood pressure cuff around your ankle, give you a paralytic so you don't actively seize and then give the electroshock. The whole process takes no more than 5-10 minutes. The seizure itself lasts no more than a minute and then is stopped. Once the process is over with, you're wheeled back out to the preparation/recovery room with the nurses who wake you up and ask if you are in any pain or need anything. They check your vitals to make sure they are stable and make sure that you come out of anesthesia okay. From there, you are set up to leave the hospital if you are doing it outpatient and wheeled out to your ride home. 

ECT is usually done on a schedule of three times a week for 2-4 weeks and then if it is seen to be effective, it is tampered down to once a week, then once every other week and then to once a month which becomes maintenance treatments. If it is effective for someone, they can maintain treatments for lengthy periods of time by just keeping up with maintenance treatments. 

There are a couple downsides to ECT. One is that it can affect your memory. That was my experience with my first trial of ECT, I had significant memory loss which scared me. Memory loss varies person to person and varies from the different types of ECT. Another downside to ECT is that it can make people who are bipolar manic. It is used to treat depression and if there is hidden bipolar disorder there, then ECT treatment can lead to that person entering mania which has it's own set of challenges. Both of these things have to be taken into consideration when looking at doing ECT. 

Overall, ECT is not like it's shown in the movies. It's well controlled with medicine and you are under anesthesia the entire time. It can be a very effective treatment for people with treatment resistant depression that medication didn't work for.  

Triggers

I've lived with mental illness for most of my life. You would think I'd have everything figured out by now, right? Unfortunately not. Mental illness is one of those things where you can learn a lot about it and about yourself during treatment and make all these strides and progress and think everything is fine. Until that one thing happens. That right set of circumstances comes together that brings everything back. We call this a trigger. 

Triggers are the things that spark our symptoms of our mental illness. For some people it is the time of the year. This is true for people with Seasonal Affective Disorder, which means that they struggle with more intense depression during the winter months. Other people the time of the year can include things like anniversaries or holidays. Triggers can also be related to specific people. Sometimes there is a specific person in someone's life that triggers symptoms of mental illness. Places are another thing that can be a trigger for people. When I think of places being triggers, I think of bars to alcoholics. Bars are triggering places to alcoholics because it makes them want to drink no matter how long they have been sober. Words and actions of other people can be triggers for some people. Specific situations can be triggers for people. Objects can be triggers. There are so many things that can be triggers for people. But every person has their own set of triggers based on their specific experiences with mental illness. 

One of the first things that someone has to do when they are diagnosed with a mental illness is identify their triggers. This is done through self-evaluation and sometimes through the help of a therapist or psychiatrist about what kinds of things bring symptoms on. The first thing that is evaluated is why a person is seeking help or treatment in the first place. What symptoms are bothersome and what causes those symptoms? Once these are identified, figuring out triggers is much easier. 

Let me clarify something here. Trigger is not a catch-all word that a person can use for everything that may upset them. Just because something upsets you doesn't mean it is a trigger. A trigger must spark symptoms of mental illness. This is something that not everyone understands. 

Once triggers are identified, the general next step is to identify thoughts and feelings that follow those triggers. This is crucial to being able to understand and overcome a trigger. Knowing where the trigger leads can guide the therapeutic process. It shows what thoughts and feelings need to be addressed. For example, if being in a crowd is a trigger examining the thoughts and feelings it leads to can help address the trigger. So the thoughts that could come with being in a crowd would be like "I can't escape" or "I'm in danger" and then the feelings that would go along with that are anxious, vulnerable, and frantic. Using these can help identify that a person may struggle with being in a crowd because they feel like they always need to have an escape plan. Having this knowledge ultimately can lead a therapist to helping someone identify what is driving those thoughts and feelings and thus driving that trigger. Addressing the core issue behind the trigger can ultimately lead to it not becoming a trigger any more. 

Triggers are something though that can catch you when you least expect them, especially when you have PTSD. Triggers play a big role in PTSD because a variety of things can trigger the past trauma. And sometimes, you don't know what your triggers are until they happen. So part of the struggle with PTSD is discovering triggers and also dealing with the traumas in a way that makes them less debilitating so that when a trigger does happen, it's not as major of a reaction. 

One of the biggest treatments for PTSD that can help with specific triggers is EMDR or eye movement desensitization and reprocessing therapy. In this therapy, eye movement or sensations back and forth using something like vibrating paddles are used to help work through the memory and desensitize the brain to it while also reprocess it. Essentially what it's doing is bringing down the intensity of the triggers and filing the trauma into a different part of the brain. It is very effective for PTSD. 

Now, if I relate this to myself personally, I have done a lot of trauma work and have decreased my triggers a lot but there are still some there. One of my biggest triggers still is the sight of a paint stick especially in relation to any situation that I would find threatening. We've been working on this in therapy and it's gotten better but it's still there. I also have just recently learned of a couple triggers that I discovered through an argument that I had with a friend. When they waved their finger in my face, that was a huge trigger for me and brought a lot back because that is what my father did to me so many times. My PTSD is generally well controlled so to get overthrown with memories and feelings like that is overwhelming. So it's going to be important for me to process the trigger and work through the results of that trigger in therapy and keep moving forward in my recovery. 

Living with mental illness is a journey and like my blog title says, a never ending battle. But it is one I determine to see myself succeed in. 

The Hardest Year Part 2: MIP

2015 was the hardest year of my life and this is part 2 of that story. 

When I was discharged from CCBH, I was still severely suicidal and had multiple plans on how to end it. Once my friends learned that I had lied to them to get out of the hospital, things blew up in my face. Those two friends who were one of the very few people I had in my support system, decided that they were done with me. As I was someone who had Borderline Personality Disorder, I had been abandoned, again. So I freaked out. I called a friend and ended up in an ER again. I spent 3 days in the ER on a psychiatric hold as they tried to place me in a psychiatric hospital. CCBH refused to take me back. This was the first time a hospital refused to offer me care. On the third day, I decided to call another hospital in the area to see if I could get in and they said I could. So I made the plan to get out of the ER after the 72 hours were up and then go make an appointment with assessment at a hospital called Marshall I Pickens hospital or MIP for short. This was at the beginning of February. 

So I was discharged from the ER and made my appointment with assessment. I was accepted pretty easily and admitted onto the unit. I had been to MIP one time before, back when I had had my first suicide attempt in 2013 but only stayed for 4 days. I walked in to the hospitalization feeling like a total wreck. I was reeling from the abandonment and it ruled my mind. The rejection from CCBH also weighed heavily on my mind. The first two weeks I spent in MIP was just trying to do medication changes and trying to weigh the decision of whether or not to try ECT or electroconvulsive therapy. I talked it over with the psychiatrist I was working with, watched an educational video on it and talked with both the ECT doctor and the doctor's assistant. Eventually we made the decision to move forward. After the first two ECT treatments went okay, I was discharged from the hospital to continue ECT on an outpatient basis. By the time the fourth ECT treatment came along, I was feeling somewhat better from it but started experiencing major memory loss, which scared the crap out of me. So I decided to call it off. 

Not too long after I discontinued ECT did my life fall apart again and I ended up back in MIP. This was towards the end of February. When I came back for the second time, I wasn't sure with what to do with myself. I didn't feel right from the ECT and then all my feelings came back as a gigantic wave and I was back in the depths again. I ended up self-harming in the hospital. Staff's reaction to that was to move me to the more intensive unit which was known as the "way back". They had the people who needed more intense help and more supervision. This didn't help things at all. This just made me feel more frustrated and out of control and led me to want to self-harm more. And that's exactly what I did. However, I never told them about it. Instead, I argued my case about not being back there and after a couple nights, they moved me back. The next few days I continued to struggle with consistent severe suicidal thoughts and extreme hopelessness. I self-harmed again but didn't tell the staff. 

February 28th, 2015 NAMI entered my life. The National Alliance on Mental Illness. There was a presentation done in the hospital called In Our Own Voice and I really connected with it. I asked the speaker the question "If there was one thing you could say to someone who was really struggling or feeling hopeless, what would it be?" and I remember that his answer encouraged me, a little. 

Then I went back to being hopeless again. I really struggled throughout these hospitalizations the loss and abandonment of the two friends and couldn't understand why they would leave me and I also couldn't understand the rejection from CCBH and both of those fueled my suicidal thinking. At one point, I even drew a picture in my journal of me trying to hang myself and didn't exactly hide it either. I was inpatient through the first week of March, when I was eventually discharged only upon the agreement that I would do their Partial Hospitalization Program or PHP. 

One thing I did once I started PHP was start going to NAMI support groups. I found these support groups helpful and encouraging and really enjoyed going to them. It was a place I found support for the intense issues that I was dealing with. After a couple weeks attending NAMI, they announced that they had an educational class starting called Peer-to-Peer and I quickly enrolled. This led to me having support two nights a week. 

I did the PHP program for approximately two weeks. I went to most groups and they had a relaxation room for if you felt overwhelmed and needed a break from the groups. I continued to struggle with self-harm though and after the third day of self-harm, they decided that I needed to be re-hospitalized, which I didn't agree with, but I didn't have a choice in the matter. So I was readmitted. 

When I was readmitted, I was assigned to a different doctor than the one that I had been working with in my previous hospitalizations. I was not a fan of his and he really wasn't a fan of me. We agreed really quickly that I should be switched back to the doctor that I was with from the previous stays. He additionally also granted me to have my pillowcase while I was there. However, I was still angry that I was there because I didn't want to be. I pitched a fit in my room and kicked things around. I vented angrily to other patients about not wanting to be there. I eventually decided I wanted to sign myself out. They told me that if I signed myself out I wouldn't be able to go back to PHP. I said okay and signed myself out. This marked the end of my experiences with MIP for that year. 

Poems/Songs - Feb/Beg of March 2015

Song written on 2/1/2015

My plans never work out

My wishes never granted

My coins never meant much

When thrown for good luck

Why is God punishing me?
Why can't I get a break?
What did I do to deserve this?

How many times will my life fall apart?
How many days will I wake up and be dark?

How many ways can a person lose everything?

How many people will get up and leave?
How many will give up on me?
How many times?
How many times will my dreams be forced to change? 

God, how many times?

My heart is hurting

Full of despair

Crying and screaming

Is there anyone there?

Everyone tells me

Life if worth it

But I can't see it

How many times will my life fall apart?
How many days will I wake up and be dark?

How many ways can a person lose everything?

How many people will get up and leave?
How many will give up on me?
How many times?
How many times will my dreams be forced to change? 

God, how many times?

Life doesn't seem worth it

The pain too much to bear

But God is with me

He is always there

How many times will my life fall apart?
How many days will I wake up and be dark?

How many ways can a person lose everything?

How many people will get up and leave?
How many will give up on me?
How many times?
How many times will my dreams be forced to change? 

God, how many times?

Oh, God how many times? 

2/10/2015 Poem

Trapping in a corner

Wanting to die

Sits a little girl

Starting to cry

All have left her

In a world of pain

With no one to care

Or help with the strain

Trapped in a corner

Sits a little girl

Trapped in her mind

In her own little world

Wishing for peace

Love and care too
Wishing for others

To show her love too

Trapped in a corner

Wanting to die

Sits a big girl 

Ending her life

Peace has arrived

Love and care too

Peace in her death

And faith in heaven too

2/28/15 Song

Why keep trying?
When the pain won't subside?
Why keep lying?

And acting everything's alright?

Why keep hiding

The pain that's too much to bear?

When there's peace in Heaven

An end in dying

No need to hide the pain?
Nothing's broken

All's wide open

No more life to live

Why keep trying?

Why keep trying?

Why keep going

When all seems hopeless?
Why keep showing

When it seems endless?

Why keep knowing

That there's no end in sight?

When there's peace in Heaven

An end in dying

No need to hide the pain?
Nothing's broken

All's wide open

No more life to live

Why keep trying?

When the paint's to hard to bear

The future's all a scare

No one to show you care

No one to show you care

When there's peace in Heaven

An end in dying

No need to hide the pain?
Nothing's broken

All's wide open

No more life to live

Why keep trying?

Ooooo..... why keep trying?
Why keep trying?

3/1/2015 Poem

The tears won't come

The pain too deep

The scars don't fade

The end in sight

The pain never ending

The scars multiplying

The tears always hiding

There's peace in dying

That's how it feels

To be stuck in darkness

To not see the light

Or even the tunnel

The tears keep running

The scars keep showing

The pain keeps growing

Where's the end in sight?

The blood keeps running

The cuts keep burning

The scars keep growing

There's no end in sight

Death is freeing

Pain is ending

Tears are flowing

Scars are glowing

Death is freeing

The peace is starting

The freedom everlasting

The pain forever gone

The Reality of Psychiatric Hospitals Part 3

This is part 3 of a series of what a psychiatric hospital is really like. This section we will focus on the daily schedule and the therapeutic aspects of being in a hospital.

The daily schedule of the hospital also varied by the hospital but most had the same framework. First thing in the morning was vitals. Vitals were taken every morning, usually 6am in most places. Some places you had to get up to get your vitals taken and others were done in your room where you could lay in bed. From there came breakfast. Some places you were given a mandatory wake up call for breakfast, others you weren't. Food quality ranged depending on the hospital. Some hospitals food was good, others it was pretty bad. How it was served also varied. Some hospitals you were given individual trays and others you got to pick what you wanted. Some places you were allowed seconds and others you weren't. Some places had vending machines where you could buy food, candy and drinks and other places didn't. It just depended on the place. 

After breakfast, it was medication time. This usually meant a long line where you had to stand to wait to get your medication. One place made you go to your rooms and they came around with a cart, but most places there was a med station and you waited in line to get your medications.
Groups began after medication. Usually this started with either a goals group or a morning meeting or a combination of the two. This group would go over the rules of the unit and review what the unit was having issues with. For the goals portion, they would go around the room and everyone would give a personal goal for the day for something they could work on themselves. This varied from person to person but included things like going to every group, talking to the doctor, getting discharged, working towards discharge, talking to the social worker, a wide variety of things. 

After morning meeting or goals group, the first main therapeutic group. In some hospitals, this was a process group where you were able to talk about and process why you were there. In other hospitals, these were topic based groups that focused on a specific issue. Sometimes groups were a combination of the two. Topics of groups could include things like boundaries, coping skills, and self-esteem. They were all designed to help address issues that led you into the hospital. 

Some hospitals had more groups than others. Some hospitals gave you a schedule of what groups you were going to be going to and some you just went to assigned groups. Groups for the day could vary from 1 to 4 or 5. 

During this point in time, you would also see the doctor. The doctor would call you out of group and bring you into an office. They would check in with you about your symptoms and how you were feeling. This would lead them to decide whether or not to make a medication change and when they think they should discharge you. They would ask about things like suicidal thoughts, anxiety and sleep. They would ask you about side effects from the medications. From this conversation, they would determine how long you needed to stay. If you were committed, you had to stay at least three days and then they could remove the commitment if they felt that you were safe enough to leave. If you were not safe to leave or they felt that you would try to leave if they removed it, they could extend it. Some doctors would have conversations with you about your discharge date and some would just make executive decisions about your discharge date and set it up for you. It just depended on the doctor. 
One of the groups of the day was recreational therapy. This therapy focused on a variety of concepts including art, music, writing, poetry, and many other things. Generally, recreation therapy was an enjoyable time away from the unit and included a variety of activities. 

Lunch happened between groups and varied based on the facility. Some places you could have seconds on your meal and some places gave you a tray to eat and that's all the food you were given. Some places there were choices, others there were not. It all depended on what the facility was set up like. 

Dinner was the same set up as lunch. 

After dinner, there was free time. This allowed the different patients to interact with each other and do things like play games such as card games or apples to apples or other things like color. Many times just being in a group and sitting around telling stories was just helpful because it made you laugh and gave you a bit of a break from all the intensities of the hospital. Some of the best parts of being in the hospital were the friendships you made with people during these times. Sometimes visitation would be during these times and you would get to use the phone. 

At the end of the day, there would sometimes be a closing group going over if you met your goal for the day or not. Some hospitals would have a group on the weekends where an organization like the National Alliance on Mental Illness would come in and do a presentation. 

Around 9pm at most hospitals, medication time would start for nighttime medications. This would generally include a long line to try to get your medications for the evening. It ran the same way that your morning medications did. 

At the end of the day, you would return to your room to sleep. At most hospitals, they had people who checked on you every 15 minutes to make sure you were okay. This annoyed some people because it included flashing a light to make sure that you were still breathing. It was a hospital requirement so eventually, one just got used to it. 

That is the summary of a day in the life of a psychiatric hospital. Hopefully this 3 part series has given you a more realistic look into how psychiatric hospitals are run. 

Making The Choice

One of the hardest choices I have ever made in my entire life was to choose to go to residential treatment. This is something that I fought for multiple years as I struggled to accept the severity of my illness and my need for a program like that as well as the feasibility of it. But when I made the leap, it made all the difference. So let's look at residential and short-term hospitalization, the benefits of both and what each has to offer and why residential treatment is sometimes necessary.

Residential treatment vs short-term hospitalization:

First, we will take a look at short-term hospitalization.

• Short-term hospitalization is usually for crisis stabilization. What this means is that this is what handles short-term major issues like suicide attempts, suicidal thoughts, and severe mania. Hospitalization is for people who pose a risk to themselves or to another person or who are extremely unstable. 
• Short-term hospitalization is just that, short term. People usually stay in the hospital for 5-10 days. 
• Short-term hospitalization is used to do things like make medication changes and provide group therapy and coping skills. 

Next, we will look at residential treatment. 

• Residential treatment is generally for a longer period of time, from 6 weeks to 6 months+. 
• Residential treatment looks at both core issues as well as coping skills.
• Residential treatment can be focused on one specific type of issue, like addiction or trauma. 
• Residential treatment is generally more personalized in nature. There are things like individual therapists, individual treatment goals, and personalized program tracks. 
• Residential treatment can include crisis stabilization and medication management, but some residential treatment centers require that patients be at some level of safety before entering their program. 

For me personally, I have had over 20 short term hospitalizations, most of them occurring over a three year period. The amount of hospitalizations that I had and the fact that they were over a short period of time indicated that I needed more intense treatment than just the short term hospitalization. 

For many people, the amount of hospitalizations, the severity of symptoms, and the frequency of symptoms can all lead to a decision of whether or not to consider residential treatment. Residential treatment offers many extra services and benefits that are not offered in short term stabilization hospitalizations. 

Part of the choice would also be insurance. There are some residential treatment locations that take different insurances and there are many that are self-pay only. It is all dependent on the specific treatment center and the specific insurance a person has. For me personally, I was able to attend a residential treatment center through my insurance. 

Another aspect of the choice would be whether or not the person is ready mentally for residential treatment. Many locations require some level of safety before admission (e.g. can be suicidal, but not actively). It is also important to look at the person's individual recovery and see if it is the right time for them. Are they willing to accept treatment? Are they going to put the work into it? Are they ready for the challenge that residential treatment presents? All of these questions have to be taken into consideration when making the choice for residential treatment. 

Overall, residential treatment centers can make a dramatic difference in someone's life. They can change a person's course of life and the direction that they are going. They are built for intense treatment to make differences in a person's mental health. Personally, I think if it's possible to go to one, then it's something to consider. It made all the difference for me.