***Some content in this post may be disturbing or triggering. This post primarily focuses on a major depressive episode of Bipolar disorder type 1***
At the end of Part 3 of this post series, I had attended my eighth out of 10 hospitalizations for mania and/or mania with mixed features, and was again in an Intensive Outpatient Program (IOP). The remaining major depressive episode eased briefly. I had improved sufficiently enough to return back to work part-time and resume care under my private psychiatrist, Dr. Ripley.
Only two months later, the depressive episode worsened to severe, but there were no hints of mania involved. In addition to depression, I was having severe panic attacks at work, screaming and crying in my car, or hiding elsewhere away from my desk for most of the day. My mind and body wanted to sleep 14 hours a day and I couldn’t get myself to do anything. I called out sick from work so frequently that I grew concerned about my job. I also had occasional suicidal ideations, but never acted on them. Dr. Ripley recommended I return to the hospital. He strongly suggested I have electroconvulsive therapy (ECT). This was the second time a doctor recommended this to me. The first time, as you may recall, I refused quite fiercely. By this time I had grown terribly weary, and completely discouraged that no medications (or anything) could help. Since I admired Dr. Ripley, he had a stronger influence than past hospital psychiatrists, so I gave in.
Dr. Ripley arranged a meeting between my husband and I and the head psychiatrist at the ECT center. The ECT psychiatrist interviewed me and provided a medical evaluation. He provided lots of information on the treatment, and my husband did a lot of research. At first I thought to have the ECT outpatient. In fact, my very first treatment was outpatient, but I later felt it best to have the remainder while hospitalized. First, someone would have to be with me after the treatment for a total of 24 hours, because of the anesthesia. Hubby couldn’t take off work, and my father was unwilling. Second, something terribly scary happened during my first treatment.
The ECT treatment center consisted of a very large room with several beds in a row (perhaps eight or so), with curtains separating them. It also had a “recovery” room where patients who’ve awakened from the anesthesia get vital signs taken, and are observed. My husband waited in the waiting room outside the ECT treatment area.
If you are interested in the actual ECT treatment procedure, I recommend visiting the Mayo Clinic’s description of ECT. I had a total of seven unilateral treatments administered about every other week day M-W-F.
Every patient receiving ECT receives a general anesthetic and a muscle relaxant, through an IV. The first time I received ECT, the anesthesiologist must have miscalculated the dosage of the anesthesia medication for me. Though I strongly believe I had already received the ECT treatment, my anesthesia medication wore off before my muscle relaxant. I experienced the relatively rare “anesthesia awareness”. I woke up and not only couldn’t open my eyes, move any part of my body, or speak, but I also felt like I couldn’t breathe. I remember at that moment panicking. They must have realized my situation, because I was either given more anesthesia, or I passed out. I don’t know how I was breathing. Perhaps I was intubated or they reintubated me. All I know is that when I woke up again I was brought to the recovery room. I remembered my scare, so I told the nurse. The staff took it very seriously. The next day when I entered the hospital for my remaining treatments, I was interviewed by the anesthesiologist. She apologized profusely, and promised it would never happen again. Luckily, it never did.
I remember little of my time receiving ECT. It is very common because ECT can affect your memory. By my fifth or sixth ECT treatment my depression was apparently lifting, but my memory grew worse. When released, my poor husband witnessed the extent of my memory issues; I forgot how he took his coffee, how to get to the phlebotomist office, and even where he was driving me at times. I also forgot that I had stopped drinking, but hubby let me drink a beer anyway.
The ECT psychiatrist wanted me to have maintenance ECT treatments, but my husband and I decided not to because of my memory issues. They then put me on the same lousy medications I had been on before my ECT. They didn’t help. I ended up back in the psychiatric hospital for my 10th and final hospitalization, only about three weeks later at 38 years old. I still refused the extra ECT, and would from that point on. I don’t know, maybe I should’ve gotten more treatments. Perhaps someday, if necessary, I’ll consider ECT again.
It wasn’t until I was in an IOP again that a new IOP psychiatrist changed my medications. That new mix seemed to be slightly helpful, but not 100%. At that time, I had a very scared feeling that my employer would no longer hold my job. I was right. As I started my Social Security Disability Insurance (SSDI) application I received my job termination letter. It was about five months before I would receive approval for SSDI. I was lucky. It was my first application. Many people don’t have such luck during the first round.
The many months following were rough. I was moderately to severely depressed, but not to the point of being a danger to myself. I just sort of accepted the misery, hoping that at some point the depression would finally ease. I slept all of the time, hardly did anything around the house, rarely showered, and hardly ever ran an errand. I just lay in bed and wasted away, in a sense. Dr. Ripley made no medication adjustments at first; just hoping my situation would ease with time. But it didn’t, so he started to make minor changes. He tried an antidepressant, but that inevitably caused serious mood cycling. That was stopped immediately, and he gave up on antidepressants completely. I had a history of becoming unstable on them. Instead, he tried Lamictal again (a moodstabilizer), which had caused me mood elevation in the past. Little by little my Lamictal dose was raised. When I reached 100 mg only I had some hypomania arise, which was a welcome change. He stopped there and increased one of my antipsychotics to counter the effect. Things seemed good at that point, but I found myself on two mood stabilizers, three antipsychotics, and a benzodiazepine. A six medication cocktail is pretty large.
Since then, my moods have been far from stable, despite brief reprieves. Luckily, Dr. Ripley has managed to extinguish them. I’ve tried many times to progress back to long-term stability, but it has been difficult. When I think I’m almost there, I take steps back. It’s frustrating, and I’ve had to learn extreme patience. Not only have my bipolar moods been an issue for me, but several other weird brain quirks arose, as well. I wrote about them two months ago in my post Unraveling the mystery of my past brain quirks.
I am hopeful about the future. Yes, it’s been a very long rough ride for me, but I have learned so many great coping skills along the way. I think my current medication mix is the best of them all. Right now I’m using my blog as a place to practice writing. Every day I spend hours reading and writing to build up my endurance for brain work. I think this will help prepare me for an eventual new job (at first part-time) in the future. I’ll admit that I do need to get out of my house more. I’ve become a bit of a hermit. The trauma of bipolar episodes, extreme anxiety and other strange mental happenings can do that to some people.
Thank you for following this story!