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myectjourney · 6 years

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ECT Evaluation & current my medication list (2/28/2018)

This post will go over the questions asked during my evaluation and parts of the discussion.

Duration of appointment: 1 hour 30 minutes (hour and a half)

*** TW suicide/self harm mention/questions regarding suicide/self harm. TW for detailed medical procdures and sezuires***

Current Medication List:

Lithium (For depression. 2nd time around with no results. After this evaluation, I quit.)

Clonazepam (For anxiety and panic attacks)

Propranolol (For anxiety)

Zolpidem (For insomnia)

Evaluation (first appointment):

Doctor introduces herself.

We go over my intake form (which I filled out 2 weeks before my appointment. It included an extensive questionnaire.)

I was upfront about my diagnoses and that I was interested in ECT not TMS because ECT has a history of being more effective despite of there being more side effects. She did listen to this and didn’t bring up TMS at all during the evaluation.

She asked about my prior history with therapy. How long have I been in therapy and what for?

“Tell me about your life. How do you spend your days?”

I talked about how my illnesses have been getting progressively worse and how different drugs I’ve taken have effected this because of bad reactions.

I explained that I have had a lot of breakdowns. I classify them as “psychotic breakdowns” not panic attacks because I felt they were different from when I have panic attacks. She asked me to clarify my word choices, just so she could get a better understanding of what I meant by that.

She asked “How often are these kinds of breakdowns are happening?”, “How long do they last?”, “Explain what your episodes are like.”, “What causes these episodes?”.

Talked about personality disorders. We talked about how I am suicidal and how long I’ve been this way.

Talked about how many times I’ve tried to commit suicide. “How did you try to commit suicide?”

Talked about past history with self harm. “When you cut yourself, were you intending to harm yourself for some relief or to bleed out and die?”, “What stopped you from dying?” I explained that people came to my aid or there were times where I stopped myself because of my own fear of death. Even though I longed for it, I also fear it. “How many times have you stopped yourself versus someone stopping you?”. Some point between asking about suicide and self harm, I was asked “Have you ever been hospitalized?”.

“How often do you have panic attacks?”, “What does a panic attack look like?”

“Have you ever heard voices that weren’t there or seen things that aren’t there?”

“How often do you see your therapist?”, “How long are your therapy sessions?” “In your current situation you are having disregulation episodes which you are calling ‘psychotic breaks’ that are happening sometimes daily, or at least one a week in which you are pulling your hair, screaming, being disassociate and during these episodes are you trying to kill yourself or saying you want to kill yourself?”

To my partner who was in the room with me (my request): “How often does she talk about suicide?”

“How many of your suicidal attempts or gestures are caused by social stressers or fear of rejection?”

“Do you get into conflicts often in your relationships with people?”

“Do you have a bit of a temper?”, “Do you lash out at people you love?”, “How often do you find yourself making suicidal statements to others?”

She asked about a situation that my therapist wrote in her notes regarding a past experience that set me off.

“Have you done additional therapy for your agoraphobia?” I explained that my therapist and I have tried to get me into DBT but my insurance won’t cover it so it was no dice. We talked about how my social anxiety has gotten worse and the agoraphobia has been more of a recent development with the progression of my social anxiety and traumatic experiences. I also talked about how I think I have Selective Mutism which is brought on primarily through PTSD attacks (when I am triggered) or under immense amounts of stress.

“How is your thinking and memory?”

“Have you held a job at any point?”

Talked about my family and abuse I suffered through them and my lack of contact with them.

Asked about my medical diagnosis. I informed her I was diagnosed with Fibromyalgia.

“Have you ever had a head injury, concussion, or seizure of any kind?” Nope.

“Any retinal detachments or metal implants in your face?” Nope.

“Any brain aneurysm, vascular clips in your head or neck, metal in your eyes, or pacemaker?” Nope.

“Any heart problems?” Not that I know of.

Confirmed where I was born and raised and who raised me (all questions answered on the intake form).

“Do you have any siblings?”

“How did you do in school?”, “What led to me not continuing my education?”

“Any religion?”, “Any military service?”, “Any legal problems?”

“How would you describe your mood today?”

We went over the meds I am currently on and my dosages. I told her that I won’t be on Lithium by the time we do the procedure. She said the lithium is less of a problem, I just need to be sure I don’t take it 2 days before we start the procedure. She was mostly concerned about the fact that almost all the meds I’m currently on are considered anti-seizure meds and a lot of them are highly addictive, especially the clonazepam and zolpidem. This is important because basically what ECT does is they induce seizures in the brain. This helps basically rewire your brain.

She informed me that LUCKILY they can reverse the effects of those 2 drugs with an antidote (pretty nifty) so they can get around that but she expressed concern that I might be “a little doped up”. I told her I was on a very low dose.

Talked about family history with mental illness. “Any one in your family commit suicide?” No. At least not that I’m aware of.

This is when we finally talked about diagnosis and treatment.

She said “Your diagnosis is relevant here because certain diagnosies respond better to ECT as compared to others. Based on your history, it seems like you have an expanding list of diagnosies and that can happen in psychiatry because they are checklist based and can be presented differently at different times. I think the over all picture is best captured by a personality disorder based on what you are telling me and that doesn’t mean you cant have ECT by any means but it does mean that there is a little more risk for you in a couple of ways. So people with a history with disassociation and a history of trauma, which very much goes with a personality disorder, have a harder time being put under repeatedly and hopelessness of ECT. It can be kind of re-traumatizing.”

She goes on to explain that there are cognitive side effects for people who have personality disorders (specifically similar to my symptoms), which can include something she called “Soap Opera” Amnesia where a patient will complete forget everything for a few days. It only has happened one in her experience but it was very scary for the person going through it and that patient did end up going to the hospital at some point. This wasn’t caused by the ECT though. Seizures do not cause this. This was basically psychosomatic; something this person developed as a result of the panic of being put under and having to go through that over and over again, hence why she disclosed this to me as someone with a personality disorder specifically issues with disassociation.

She also explain that statistically, the effectiveness of ECT is a little lower for people with personality disorders versus those with just depression. It’s around 55% likely to be effective for people with personality disorders and around 87% likely to be effective for people who just have depression.

She said about a 3rd of people with just major depressive disorder that get ECT feel almost completely cured by it but with people with personality disorders, they might feel less suicidal and may be able to function better in day to day life but its way less likely to feel “cured” to that intensity.

We also talked about how she thinks I fit the description for BPD very much and that it looks different for different people. My favorite thing she said is that it doesn’t always look like “Girl Interrupted”. Luckily I already knew that and agreed with her on this matter. She talked about the stigma around it. Honestly, she was very understanding and knowledgeable (I mean, of course) but it was really nice to talk to someone who wasn’t bias about personality disorders.

Then we talked about the upsides and down sides of ECT in the most specific way we could.

Downsides being cognitive side effects, even if they are just doing the right side of my brain with pulses being as small as you can get and the dose being as low as possible, you can have cognitive slowing, feeling a little more spacey, attention is not “up to snuff”, and also short term memory problems. The most recent memories put in your brain are usually the ones that are effected first.

This can include the past couple week or months before the procedure.

During the course of ECT, 7-15 sometime 18 treatments, when youre having it 3-4 times a week, you might have trouble forming new memories. It’s not that you won’t form any, just a little fuzzy.

All of things add up to a DRIVING RESTRICTION. They will not let you drive during the course of treatment. She said it doesn’t matter how you GET to the appointment but afterwards they will not allow you to take a cab/taxi, uber, lyft or by bus and you cannot drive yourself. You absolutely NEED SOMEONE TRUSTED/CLOSE TO YOU TO DRIVE YOU HOME.

ALSO, if you have a history of any heart problems, you are at risk of sudden death because when they induce the seizures, your blood pressure and heart rates goes up. For young healthy people, there is almost no risk of this happening.

There are the normal/common risk of anesthesia (Like waking up). They usually give you Brevital (which puts you to sleep) and Succinylcholine (to relax your muscles before the procedure). The muscle relaxant will stop your breathing but she said it’s nothing to worry about since they will be pumping air into your lungs manually via bag mask and will be closely monitoring you which luckily means no invasive breathing tube.Then they deliver the stimulus, which induces the seizure and then you slowly wake up after that. If the timing is wrong or the dosing is wrong, there is a SMALL but serious risk that you can wake up but still feel paralyzed. They monitor your heart rate and they try to make sure you are completely out beforehand but it’s still a risk.

The worst symptoms after the procedure is headaches and nausea, which they will usually give you medication for and usually is the worst after the first treatment.

You will have an IV in your hand, before you go in, the nurse will make sure you have not eaten or drank anything in 8 hours.

They will talk to you for a few minutes to make sure you are okay and know whats going on. During this time they will put the IV in and inform you if there is any changes they need to make with anesthesia, then they administer the anesthesia. They will then induce the seizure (they usually start with a right unilateral which means they just do the right side of your brain and can change it to a bilateral procedure which is both sides of the brain later in treatment if needed) and the way they tell if you have seizured is by:

1.) putting EEG leads on your head so they can see your brain waves and

2.) They use a blood pressure cuff as a tourniquet around your ankle to stop the muscle relaxant from going into your foot so they can see that foot have a seizure.

Afterwards, they roll you out to the recovery room where you come down from the anesthesia which takes about 20 minutes.

The medical work-up and requirements before you schedule the procedure is a signed document from your PCP (Primary Care Physician) which they fax over, bloodwork, pregnancy test, and an EKG test (they will need a physical copy of the EKG tracings).

-END OF APPOINTMENT-

I hope this is useful info for someone out there!

If anyone has any questions, feel free to ask.

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