SHE WAS SHOCKED Electroconvulsive therapy helped to treat her intractable, dangerous depression. But the author was surprised to find out how much of her memory was wiped out.

The Washington Post
Ann Lewis
06-06-2000

I've been asked over and over again whether undergoing electroconvulsive therapy -- also known as ECT or shock therapy -- was a good decision. And whether I would have ECT again under the same circumstances.

The only honest answer I can give is that I have no idea. To say whether ECT was the right treatment for me, I would have to compare my life before ECT to my life now. And I simply cannot remember life before ECT. In particular, I cannot remember much about the two years leading up to my ECT treatments. That period, along with much of the preceding years, is memory that I lost in exchange for the hoped-for benefits of ECT.

That loss was huge and painful and potentially crippling. And yet, when my therapist describes how I was just before ECT, I believe that ECT was probably the best option at the time. He says that I was spiraling down into a depression that wouldn't lift. He says that I was contemplating suicide. And I believe him. While I don't remember that particular depression, I remember others -- many paralyzing episodes of depression in my 37 years of living with mental illness.

My therapist also says that I was failing to respond to medications. And that I also believe. While I cannot remember specific experiences with the plethora of drugs I've tried over the years, I do know that I tried so many because I was constantly searching for one that would finally work.

I had 18 ECT treatments over a six-week period beginning in May 1999. Based on some vague recollections and on what I've been told, here's what happened: Three times a week I rose at dawn to be at the hospital first thing; I sat in a crowded waiting room until my name was called. Then I put on a hospital gown, lay down on a gurney and was wheeled into an operating room designated for ECT patients. Full anesthesia was administered intravenously, and the next thing I knew I'd be waking up in the recovery room, ready to be taken home, where I'd sleep for the rest of the day.

My boyfriend and my mother shared the burden of caring for me. On the days between treatments, she says, we sometimes went to museums, malls and restaurants. She says that I was a zombie, unable to make even the smallest decisions. My boyfriend says I asked the same questions over and over again, unaware that I was repeating myself.

Right after my last treatment--my mother made a note of this in her diary for July 8--I woke up. I can liken this only to what I expect a person coming out of a coma experiences. I felt like a newborn, seeing the world for the first time. But unlike the common notion of first sight as a thing of splendor and awe, for me it was complete frustration.

While I couldn't recall how I had felt before ECT, I couldn't imagine it was any worse than what I was experiencing now.

Every little thing told me that I had no memory. I couldn't remember who had given me the beautiful picture frames or the unique knickknacks that decorated my home. My clothes were unfamiliar, as were the jewelry and trinkets I had owned for years. I didn't know how long I had had my cat or who my neighbors were. I couldn't remember which foods I liked or what movies I had seen. I didn't remember people who greeted me on the street or others who called me on the telephone.

A former news junkie, I was especially frustrated to realize that I didn't even know who the president was or why someone named Monica Lewinsky was famous. I was floored when I found out about the impeachment hearings.

And I couldn't remember my boyfriend, although he practically lived with me. There was evidence all over the apartment that we loved each other, but I didn't know how or when we had met, what we liked to do together or even where we liked to sit while watching television. I didn't even remember how he liked to be hugged. Starting from scratch, I had to get to know him again while he had to accept the frustrating loss of what we once had together.

While continuing to battle my mental illness--ECT is no instant cure--I had to relearn how to live my life.

I didn't know my parents had moved. I had to be "reminded" about that great sub shop in Bethesda and about my favorite restaurant, the Lebanese Taverna. I spent 15 minutes in the cracker aisle in Safeway until I recognized the box of my favorite crackers, Stone Wheat Thins. I retrieved some clothes only by going to seven different cleaners to ask if they had an overdue order belonging to Lewis. Just yesterday I lost a contact lens: I've been wearing contacts for at least 10 years, but I have no idea who my eye doctor is, so replacing the lost one will be another tedious challenge.

Socializing was the hardest part of my recovery, since I had nothing to contribute to a conversation. While I had always been sharp-tongued, quick-witted and sarcastic, I now had no opinions: Opinions are based on experience and I couldn't recall my experiences. I relied on my friends to tell me what I liked, what I didn't like and what I'd done. Listening to them trying to reconnect me to my past was almost like hearing about someone who had passed away.

Before ECT I had been working for a legal concern in the District where the environment was exciting and the people were fun. That's what I've been told, anyway. Just before undergoing my treatment I informed my employer of my disability and requested time off. I estimated that I would need two weeks, unaware that the ECT would eventually stretch on for six weeks and that I would need months to recover.

As the weeks passed, I missed going to work, though I realized I had forgotten the names of major clients I had dealt with daily and even the names of the computer programs I had used routinely. And I couldn't recall the names--or the faces--of the people I had worked beside--people who had been to my house and with whom I had traveled frequently.

I didn't even know where my office building was located. But I was determined to get my life back on track, so I dug up all my work materials and began studying to catch up with my old life.

Too late: My therapist's request that the firm accommodate my extended absence failed. The company claimed that for business reasons it had been obliged to put someone else into my position and asked where my personal belongings should be sent.

I was devastated. I had no job, no income, no memory and, it seemed, no options. The thought of looking for a job scared me to death. I couldn't remember where I had saved my resume on my computer, much less what it actually said. Worst of all--and this is probably the most familiar feeling among those who suffer from depression--my self-esteem was at an all-time low. I felt completely incompetent and unable to handle the most minor of tasks. My resume--when I finally found it--described a person with enviable experiences and impressive accomplishments. But in my mind I was a nobody with nothing to hold onto and nothing to look forward to.

Perhaps due to these circumstances, perhaps due to my natural biological cycles, I fell back into depression.

Those first months after ECT were horrible. Having lost so much, I was facing another bout of depression--just what the treatments had been intended to correct. It wasn't fair and I didn't know what to do. Restoring my memory--or trying to accept its permanent loss--became the focus of my therapy sessions. I couldn't recall how badly I had felt before the treatment, but I knew now that I was desperate and completely demoralized.

At the edge of hopelessness, I somehow committed myself to hanging in there--not for me, but for the family members and friends who were working hard to make my life better. Daily thoughts of suicide were something I learned to ignore. Instead, I focused on making it through each day. I managed to get out of bed each morning and drive to the coffee shop, where I forced myself to read the entire newspaper, even if I couldn't remember much of what I had read. It was exhausting, but after a few weeks I was reading books and running errands. Soon I re-entered the world of computers and e-mail and the Web. Little by little, I was reconnecting to the world.

I also attended therapy religiously. The therapist's office was a safe place where I could admit just how bad I was feeling. Thoughts of suicide were a normal part of my life, but I felt it would be unfair to share those dark feelings with family and friends.

Through the Depression and Related Affective Disorders Association, I joined a support group, which became central to my recovery. There I realized that I was not alone in my plight and for once I had friends to whom I could talk honestly. Nobody was shocked to hear what the voice in my head was telling me.

And I began to run and exercise again. Before ECT I had been training for my first marathon. After, I couldn't run even a mile. But within a few months I was covering long distances, proud of my accomplishment and grateful for an outlet to deal with my stress.

In October I tried a new medication for depression, Celexa. Maybe it was this drug, maybe it was my natural cycle, but I began to feel better. I experienced days where death wasn't on my mind, and then I experienced days where I actually felt good. There was even a turning point when I began to feel hopeful, like something good could actually happen in my life.

The most poignant moment occurred a month after I changed medications. My therapist asked, "If you always felt the way you do today, would you want to live?" And I honestly felt that the answer was yes. It had been a long time since I had felt like living instead of dying.

It's close to a year now since I finished my ECT treatments. I am working full-time. I see my therapist only once every two to three weeks. I still attend DRADA meetings regularly. My memory is still poor. I cannot recall most of the two years before ECT, and memories prior to that time must be triggered and dug out of my mental archives. Remembering requires a great deal of effort, but my mind is sharp once again.

Friends and family say that I am less gloomy than I was, cheerful and less brash. They say I've softened a bit, though my basic personality has indeed returned. In part I attribute my gentler attitude to the truly humbling experience of having my self disappear. In part I attribute it to the loss of my well-honed vocabulary: I was reluctant to speak up when I couldn't find the right words. But in greatest part I attribute my change to a renewed desire for peace in my life. I am now dedicated to managing my depression and living a satisfying life day by day. I feel that if I can make the best of the moment, then the future will take care of itself.

As for my boyfriend, we're getting to know each other again. I'll be forever grateful for how he cared for the sudden stranger he met after my treatments.

Would I undergo ECT again? I have no idea. Where medication does not work, I believe the doctors' judgment that ECT is still the most effective treatment. For people who are sick enough to be considered for ECT--as I was--I believe the benefits justify the potential loss of memory. Losing my memory, my career, my connections to people and places may seem too much to bear, but I see all that as not a huge price to pay for getting better. What I lost was enormous, but if it is health I have gained, that is obviously far more valuable than what I lost.

While this year has been the hardest of my life, it has also provided me with a foundation for the next phase of my life. And I truly believe that this next phase will be better. Perhaps it will even be great. With a medication that seems to be working, a strong network of support and the ability to move forward, my life looks promising. I've learned to hang in there when it seemed impossible and to rebuild from a significant loss. Both are difficult. Both are painful. But both are possible. I am living proof.

Followup story by Washington Post