The Nuclear Option

For about four months now I have been slogging through a prolonged period of depression. It's actually not the worst I've ever had, in the sense that I have not been actively trying to destroy myself and I've been capable of doing routine work, but it's been bad. The phone rings, and I don't answer. In the mornings I count the hours until I get to go to bed again. I am detached and flat with my kids. My libido is--pffft! Worst of all, I cannot think of a reason why I should continue to be here, what possible interest there could be for me on this planet for another five years, let alone another 25. I have started and put down a dozen books; my concentration doesn't last past chapter two. And if reading is impossible, writing is even more so, which is why there haven't been many blog entries lately. My career as a writer seems over; every day, I feel a little bit deader.

A lot of things have led to this, none of them anybody's fault; it's just the way life is sometimes. My mother died just over a year ago, and I miss her acutely. I published a book I had poured the last three or four years of my life into, and--unlike my first book--the interest from the mainstream media was nonexistent. (Which is not to say that I regard it as a failure or not worth doing; whoever is reading this has probably run across my book; the fact that the mainstream media didn't pick up on it has nothing to do with the importance of the topic; and I know it's helped some people.) But still: the book was written against long odds, and I guess I had hopes that it would spark more of a public conversation than it did about the topic of depression and motherhood, so there's disappointment, to say the least. This year has also been a year of health issues, probably not coincidentally: surgery on my knee, an unusual number of colds and stomach bugs and fevers, arthritis in my neck and lower back. This was the year we established a health club membership and I was going to finally lose those 20 pounds (again). Didn't happen.

But mainly, it's just the fact that it's winter--February, to be exact--and this has always been my worst month. It comes every year without fail. This year it came early. And every day for the past three or four months, I have felt a little bit deader, a little bit less like ever coming back to life. I upped my meds, and that didn't help. I started in on the benzodiazepines again, even though they are addictive, for the same reason that you reach for morphine when you're having surgery: it blocks the pain of constant anxiety...even though there will be hell to pay later on.

Depression takes a toll, and not just on you. Repeated episodes of depression have been associated with decreased volume in the hippocampus, the area of the brain where emotion and memory are integrated. For people who think antidepressants are a crutch, here's some news: a lifetime of untreated depression can literally leave you brain damaged. And that's saying nothing of the damage to your family: the husband who gets a hologram for a wife, the children who beg, " Mommy, can you spend some time with me?" only to hear, "No, I can't, I'm sick." They get fooled, because the person they know as mommy is still making dinner and picking them up at school--she's not on life support in a hospital anywhere--but she's not really mommy. She's the person who is inhabiting mommy's body, and, increasingly, that person is a ghost. (Which is why I chose the title I did for my book,The Ghost in the House.)

All of which comes as background for my reason to take a step which may sound extreme: electroconvulsive therapy, or ECT. Yeah, I've seen One Flies Over the Cuckoo's Nest, and I know that what people think when they think of ECT is of a drooling Jack Nicholson at the hands of a punitive medical establishment, a shell of his former self. ECT began a bit that way, but even in the 1960s it was nowhere near as barbaric as Ken Kesey described. Today it's often done on an outpatient basis, and among its more famous consumers is Kitty Dukakis, wife of former Democratic Presidential candidate Michael Dukakis, who has written her own book (with co-author Larry Tye) entitled Shock: The Healing Power of Electroconvulsive Therapy. Mrs. Dukakis' experience is extremely atypical, in some ways: she gets "maintenance" ECT about once a year, since her experience with depression follows an extremely predictable pattern (which, come to think of it, mine does too). I also have two friends who have gone through ECT, one of them twice and one of those times back in the bad old days before they sedated patients or gave them muscle relaxants to mitigate the physical effects of the artificially induced seizure, and before techniques were developed the minimize the (usually temporary) memory loss associated with ECT. Even so, both of these people said it helped them.

How does it work? Doctors don't know. But then, they don't know much about how antidepressants work, either, just that they usually do. The brain is still very much a mystery to science, even though we know more about it than we ever used to, and it may well be, as a scientist at Eli Lilly once told me, "If the brain were simple enough for us to understand, we would be too simple to understand it." About all we know is that a low-voltage electrical current, when passed through a portion of the temporal lobe, will induce a temporary seizure, and that this in turn changes the levels of neurotransmitters in the brain (which is what antidepressants do, by a different mechanism). Still, it remains extremely controversial. My own psychiatrist was not thrilled with my idea; he calls the ECT doctors "shock jocks." But one of the things you learn when you have a chronic illness is that, in the end, it's not your doctor who will be living with the results of what you do or what you don't do. It's you....and your family. In the end, my psychiatrist wrote the referral, and said he could understand my decision even if he didn't agree with it.

I had my first treatment yesterday. It was like getting hit by a truck (and I can say that with some authority, having survived being hit by a car as a teenager while getting off a school bus). Today, I have some muscle aches. It also gave me the mother of all migraines, and for an hour or so I was extremely disoriented. But then things slipped back into place, and now I can even remember the anesthesiologist saying, "You're going to sleep now" as he pressed the syringe into my IV. I also know that last night I looked at the sunset with real appreciation, and that after I went to bed I cried for a long, long time. They were healing tears. I felt much better after I was through.

Am I doing the right thing? God only knows; I don't. All I know is I have two little girls that I love, and a husband I love, and things I want to do. And when I die, whenever that day comes, I don't want anybody to be able to say it was for lack of wanting to live.

Comments

[Her Bad Mother]

I just went through two months of depression, without consulting my my doctor. I wish that I had done so, because now, from this vantage point *beyond the fog*, I can see that even taken the steps to do something about it would have made a significant difference.

You go. And let us know how it goes.

[Jojo]

Tracey,

I thought your book The Ghost in the House was brilliant. It was very educational. Good on you for getting the ECT.
There is a good article in the Feb 2007 vol 23 No. 8 edition of The Harvard Mental Health Letter on Electroconvulsive therapy

[Doggy Mama]

I have been dealing with anxiety and depression for my entire adult life (they began in my teens) and it is always refreshing to see that there are bright, educated people out there who know what I go through. Thank you!

[Virginia]

Thank you for sharing this. About 14 years ago, I read an article you wrote for the Washington Post, when you were still a staff writer, on your depression. I later read your first book, and met you, and I have to tell you, you're part of why I believed I could get better. I'm also a writer (though not as well published as you, but I'm working on it) and your words, many times, have expressed what I have wished to say.

If ECT is what it takes, well, I can't imagine it's an easy road, but I think it will be worth it. Thank you for fighting on.

[rebel]

I hope this works well for you. I know its not an easy decision to make, and yet it helps so many people. When my epilepsy is not doing well but my depression it, we always wonder if it's the antidepressant meds making the difference, or the seizures.

And I'm sorry I took the book out of the library instead of buying it :-)

[Sandy D.]

Wow. I always learn so much from your posts.

And I agree with you about February!

[di]

Yea!!! I hope your ECT works as well for you as it did for me. I had a two week cycle of six treatments last June and it saved my life...or at least saved me from a life of being "the ghost in the house". Both of your books touched and helped me tremendously!

If I recall, the first session or two was done bilaterally which did have stronger side effects like those you describe. But the later sessions were unilateral and the effects were less painful.

One piece of advice I can give for the disorientation...write yourself a letter before you go in for the next session. My letter would detail why I was there, who would be in the waiting room when I came out, where my kids were and who was taking care of them, list who the people are who know what I am doing and who are part of my support system, etc. I would read this over and over again after I woke up and before they would release me...it helped.

Later I could go back and read e-mails from the time period of my ECT to remember stuff...but I honestly cannot bring myself to go back and read the e-mails from the very dark months that preceded my treatment. It's too raw and painful and I don't want to go back there, even just to remember.

Tracy, you are doing the right thing for you...and don't let ANYONE tell you that you aren't. You had the strength to pull your head above water long enough to reach for a lifeline...because you really don't want to go down...at least not with this pirate ship of depression!

[thordora]

I've thought of ECT in the past, when things got really bad, but I think what scared me from it was the fact that some of the experiences my therapist shared mentioned people losing memories, parts of themselves. That freaked me out.

I still think of it from time to time, when I hit the big depressed phases.

It will pass. You'll come through. I'm on a drug that makes it impossible to cry, and I miss those cries so badly. It's almost like make up sex those cries....

Feel better. I wish I had some magical words to make it all better aside from "Hot Fudge"

[jenn]

I just wanted to speak up and say that I'm one of those people who your book (The Ghost in the House) really helped. It gave me the courage to go to my doctor last fall, despite being 5 months pregnant, and say "I think I need meds." And because of that, and because of some great insights from your book and support that I've started to get, I'm a better mother to my 2-year-old son. And I'm actually excited about the baby I'm having in April, instead of just a ball of nerves curled up in the fetal position on the sofa for days at a time. I think you're a wonderful writer, mother, and person, and I hope that this new therapy makes you feel better. Hugs.

[madmommy]

There are so many things I'd like to say in response to this post, I'm not sure there's space here. Mostly, thank you for sharing with others what you're going through. Your book came out merely days after I found I was bipolar (rather than major depressive disorder) and I was looking to find other moms trying to survive, for proof I wasn't alone, and maybe for some answers on how to keep going. Thank you for giving me the courage, after reading this post, to speak up to my psychiatrist to get the best care I can; like you said, I'm the one who has to live with this everyday. I pray the ECT works for you in the end.

[J.lea]

Thank you so much for posting again, I love reading your blog because you are so much more eloquent about how it feels to be a mother, a wife, be living with depression, especially in the winter months, and trying to survive.
My favorite phrase is from your daughter's letter to santa, letting him know that you would like a pink robotic butt kicker.
If they had them at Target there are days when that is exactly what I need too.
Best Wishes,
Jodi