ECT- Ten Years On by Annie Watkinson

(This article can be found in full, with references, in the journal Mental Health Practice

April 2007, Volume 10, Number 7)

In November 2005, my consultant suggested that I try a course of ECT for a particularly tough bout of depression. I was struggling to hold down my job (I was a mental health nurse) and she felt it would be the quickest, most efficient form of treatment.  I was assured that ECT was the treatment of choice for doctors suffering with severe depression, as it enabled them to get back to work quickly. So I agreed.

I am still puzzled as to why I accepted this, as I was used to researching treatment options, yet within days I was at the ECT clinic. Maybe it was the haste with which the treatment was commenced, and my very poor mental health at that time.

I was booked in for 12 sessions of bi-lateral ECT, with the understanding that I could stop at any time. According to my records, I received five treatments of bilateral ECT, and seven of unilateral. I am unsure of the reasoning behind this, but perhaps it was because I was presenting as rather confused and forgetful, but it may have been because my husband expressed his concern at my inability to undertake even the most trivial of tasks.

I was not to know at that point that I would suffer from severe retrograde amnesia that would wipe out several years of very autobiographical memory, as well as many major world events. Ten years on, the loss of memory is still very dense, and when family and friends recall occasions to me, it feels as if they are merely storytelling. I now have built those memories up with the help of photographs and videos and the like, but memory with emotions is simply history; learned, not felt.

It has been suggested that memory loss following ECT could be due to the severe depression, but this has never been the case in the many frequent and debilitating bouts I have suffered over a period of more than twenty years. Thankfully I have always kept a fairly comprehensive journal, and this, along with accounts from family and friends have helped to build up picture of my past. Without these two factors I would still be totally unaware of what I had missed. This appears to be a crucial point in looking at the whole picture of research into ECT and memory loss. It is of no value to conduct memory research shortly after the ECT has ceased, because it is frequently argued that memory loss may only be temporary, and will in all probability return in a few weeks.

There appear to be two schools of thought in terms of research. The first, made almost entirely by the medical profession, is that ECT is almost always successful, and rarely results in long-term memory loss. Yet this same research from the patients’ point of view shows that a third of patients felt that their memory had been permanently affected and two thirds had some problems with memory! This was put down to other factors, such as medication and depression.

The second school of thought comes from the ‘survivors’ of ECT, many of whom report very negative experiences, including severe memory loss, often spanning years of important autobiographical memory, and without the huge improvements in mood that is reported by many psychiatrists.

Ten years on, I have a much clearer picture of how much memory I lost, which spans about three years either side of the ECT treatment. Those ‘lost’ years contain some of the most important events a mother can have: both my daughter’s weddings, and the birth of my first granddaughter, at which, by all accounts, I was present. It is hard to believe that I have no sense of the incredible joy I must have felt being there. I have no recollection of the wedding receptions, where they were held, or who attended.

My son graduated from university with a first class masters’ degree, yet I haven’t the faintest recollection of being there, or of the pride I must have felt. My daughter miscarried her first ever viable pregnancy at the end of my ECT treatment, and had surgery. I must have been devastated, but I cannot capture the pain that we all must have felt as a family.

A couple of years after ECT I was horrified to be told by a friend that she had attended my granddaughter’s baptism- I didn’t know it had ever taken place. These gaps in memory can make one feel foolish and vague.

Now when discussing events, holidays, friends and so on, I have learned to act as though I know what people are talking about and let them fill in the gaps. Discussing trivia in social groups can be awkward, and sometimes I have to kick my husband under the table when he comes out with...’You remember Annie, that holiday in...or that event...’

The London bombings in 2005 coincided with my ‘lost’ time, and it is only through media coverage that I know they happened. I celebrated a milestone birthday, and was taken up to London to see a show, travelling in a limousine, complete with champagne and music. If it were not for the photos I have been shown, I feel I would insist they were making the whole thing up!

Since then I have sorted through files and wardrobes and found things I never knew I had. One small bonus was finding books on the bookshelf that I had obviously read before (the evidence being the dog eared corners) but cannot remember.

My husband recalls that time with utter horror, as he used to have to go to work, and leave instructions for me on how to answer the phone, and use the TV remote, etc. Looking through my journals, I have discovered strange entries such as....had a bath, but couldn’t remember where the flannel was! This  is getting so confusing...., ...I can’t remember how to make porridge..... got confused with time, stared making supper but it was only 4pm..... given up using computer, I can’t remember how to make it work!

These are all vaguely amusing looking back, but it must have been horrific for Mike to see. Even now, we will curl up for a film evening and watch a DVD that I will swear blind I have never seen, yet my family will tell me otherwise.

One of the strange side effects that I found quite distressing was an inability to perform mental maths. I used to work in a bank when I was younger, in the days when we added up columns by hand, and worked exchange rates out by looking in the Financial Times every day! So I have always prided myself on the speed of calculating in my head. Sadly, this still eludes me, so that if someone says they were born in a certain year, I find it very hard to work backwards and figure out how old they are. A very small problem, but I find it a frustrating legacy of the ECT.

ECT is supposed to be less barbaric than it was in the past, because they now use sedatives and muscle relaxants. However, the doses of electric shock that pass through the body are higher due to sedatives, which have the effect of raising the seizure threshold.

I have not done any current research, but I do believe that uni-lateral ECT is more commonly carried out, so I hope that memory loss is not quite so much of a problem, but I still find it strange that this aggressive method of treatment is carried out, sometimes even enforced, on patients that are not in a good place to either accept or reject ECT. I had hope that we would have progressed enough to make this a treatment a thing of the past. I do have to add that I am aware of some patients who will swear by ECT, and I do not wish to negate their experience.