Category Archives: Hospitals

Self Care – Hospital and ECT

I was in the hospital the first three weeks of April after my last post. I took care of myself by going in the hospital to be kept safe from my suicidal impulses and to start ECT again. As a common meme says, “It’s ok to ask for help. It’s ok to start again. It’s ok to say no. It’s ok to rest. It’s ok to let go. It’s ok not to be ok.” Going in the hospital and starting ECT again was telling myself it’s ok not to be ok, and it’s ok to rest and to start over again.¬†Having had success with ECT at the end of 2018, my psychiatrist recommended a course of it again including maintenance to hopefully prevent a mood crash again after only a couple months of stability.

Now I am out of the hospital, adjusting to life without suicidal thoughts, and have had 13 treatments. My mood is holding steady between treatments and suicidal thoughts are drastically reduced. I can’t say I’m feeling as good as I had been after the last course of ECT. But I did¬†just go from ECT 3x/week to ECT 2x/week. I’m staying the course by keeping up treatments even though I don’t really want to do ECT. Something about it just weirds me out. But I really want the experience of feeling good for an extended period of time, and ECT seems to be the main treatment that leads there.

I continue talking with my therapist over the phone on Fridays. And my mom is my companion for ECT, driving into the city and then keeping watch over me as I recover. I’m able to reach out to these thick branches of my support system, as well as some smaller limbs too, as I try to feel not alone. I wish I felt good and strong and happy again, but at this point I at least have hope that it will happen again as ECT continues.

Suicidal Ideation

A clawing, gnawing at the inside of my breastbone. Tears behind my eyes, but not released. Anxiety creases in the forehead. A fluttering heartbeat to my left, blankness and emptiness of the soul to the right. I see how I will do it in my head, over and over and over.

I’m noticing everything in this moment. This is what I experience in my body Every.Bloody.Time I have suicidal ideation. Which is minimally every couple hours, and right now intensely every other minute. It interrupts reading, watching tv, even doing algebra this afternoon, and while in conversations.

I watched youtube videos of Steven Hays giving ted talks about psychological flexibility and putting the mental brakes on thoughts. He is one of the founders of Acceptance and Commitment Therapy (ACT https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_therapy) which is the therapy that finally worked for me. I’ve been practicing it for years now. The reminders in the videos helped me a bit. Hours later I’m still using tips.

I tried something, and stopped because it hurt more than planned. I’m not going to do anything, yet I’m plagued by the sensations and thoughts I described. It’s miserable and horrible.

I don’t want to go to the hospital, nor do I think it would help. My mom, though not currently in a position to help, has hidden things I could use to hurt myself. This is as safe an environment as it could be, I guess.

I don’t think more ECT would help, though my mood feels like it dipped, and I find it easy to fall into old thought patterns besides the suicidal ideation. I had a long and emotional Friday and Saturday getting certified as a NAMI support group facilitator, something I’ve wanted to do for years! But it wore me out mentally and emotionally. Which could lead to a natural mood dip, which is why I think ECT would be overkill since the depression should lift after more rest (my hunch).

Several doctors and several therapists have come to independent ideas that I just have suicidal ideations as obsessive thoughts (OCD) and there isn’t anything that will stop them. If I didn’t have the anxiety of whether my life was threatened or the bodily sensations I described, it would be a little easier. How do I live with this terrible debate and these sensations with no way to rid myself of them, to fight them, to welcome or accept them?

No ECT!!!

I showed up for my scheduled ECT this morning. And in the pre-screen I talked about how well I’m doing, back to baseline on everything. Somehow the conversation twisted and the PA asked if I even wanted a treatment today. Um, NO!

I waited an agonizing 5+ minutes while she talked with the treating psychiatrist. They agreed I was doing well enough not to have a treatment! I’m to call in a week for a phone screen to see if I’m still doing well or if I need a treatment. If I’m doing fine, they will discharge me and I can get the port out of my chest (used to access a vein easily since IV’s are hard to get on me).

Hooray! I celebrated my unexpected free day and good prognosis with a ginormous mocha from the coffee shop in the hospital lobby.

I also saw my regular psychiatrist today to ask about the fine tremors I have developed in my hands. But, I got to gloat about how well I was feeling. And I was shocked to be doing so well that he wanted to see me next In Three Months(!).

Even as I’m feeling well, and stable, and Good, I’m worried about the bottom falling out and plunging into suicidal depression for the millionth time. My doctor encouraged me not to worry about what might happen, and even to make a video or add to my mirror post-its that Yes, I was doing well. Something to help remember if (when?) things get bad, that I had been healthy and it would happen again.

Why do I expect suicidal depression to come again? Just because it has been a companion I could count on? And I got as good as one could get at dealing with it healthily?

How about I have no freaking clue how to be in a good space? I’m worried that the increased energy I feel is mania, and that the only way I have to express how good I’m feeling is to talk too much or to spend money. Both of those are things I do when I’m manic, yet I’m not manic.

I just don’t know how to be healthy! What are behaviors You have when You are healthy?

Around the Cycle Goes

This week has been up and down and around as my mood, or more my thoughts, cycle through various mental phases.

I started the week with the ever popular Xmas delusion I get every year. Fortunately it lasted only several hours on Xmas Eve when I was in and out of touch with reality. My mood was still in the middle but dipping at times on Xmas Eve and Xmas Day.

Then December 26th, I was back! Mood perky and happy and optimistic. Mere fleeting thoughts of suicide (baseline for me to just have a few).

And then on the 27th, OCD thoughts kicked in and all I could tell myself was plans to kill me. All the time. And again I couldn’t talk about it or tell anyone until my NAMI support group meeting that night. Then I could articulate calling the ECT office to see if getting ECT earlier than scheduled might help. And I could note that I really needed to tell my mom about the OCD suicidal thoughts. And I was encouraged to contact my therapist, who did tell me to contact the ECT office and let them decide if I needed one.

You see, my mood was great! Stable, and in the middle. Not depressed. Not hypomanic. I just had obsessive, albeit dangerous, thoughts. I didn’t know if I would get to a point of having intent though.

When I called the ECT office today, the 28th, I thought the thoughts were less obsessive and therefore farther away from any intent. But later in the day they were just as obsessive and I worry about intent showing up. Or if obsession will finally give way to compulsion in OCD. It never has for me, but will there come a day that the pathology progresses?

My mood is still stable, happy, good, in the middle. It’s just my thoughts. I don’t want to kill myself, I just can’t stop holding it out as a possibility. Obsession. I suppose if I was worried enough, it would warrant a hospitalization. But, again, my mood is great! It’s just the obsessive thoughts.

Sigh.

I hate mental illness.

Suicidal Perspective

No, I’m not suicidal. At least I don’t think I am. I am scheduled for a 21st ECT tomorrow, but am authorized to call it off and schedule for Thursday instead if I don’t have any symptoms. Which means I’d be down to once a week – and I’d be allowed to drive again. So am I suicidal? Am I paranoid? Am I depressed?

The doctors think the irrational fear manifesting as paranoia is part of the cognitive side effects of ECT. So the presence of some paranoia is not cause for having a treatment tomorrow. I don’t think I’m depressed either; I have been highly motivated to do things and be social this weekend, and my mood is elevated. I don’t believe we’re in hypomania territory either.

Finally there is the ever-present suicidal ideation. They are just thoughts that pop into my head and are easily dismissed, even plans or the occasional desire for death. I’m not ruminating on death or desiring it as I think about it. The desire and intent to follow through just isn’t present. So, yes, I’m having suicidal thoughts – as is usual for me – but I’m not depressed, and the plan(s) are only theoretical, not action plans.

In fact I’m re-reading Night Falls Fast by Kay Redfield Jamison, about understanding suicide. This read through I’m not looking for ideas or plans or reassurance – or even a reason Not to kill myself. I don’t have a suicidal perspective. My mind is approaching the topic as a curiosity: why would someone think such thoughts or consider such actions? What psychopathology do I manifest when I’m thinking of suicide or taking actions toward it? And while I look with curiosity, thoughts of suicide do pop in and out and I wonder if I am thinking too seriously of suicide and need an ECT treatment tomorrow. My mind’s perspective is not suicidal though, even though I have energy and drive to follow through on plans. I don’t desire death. And, in fact, I wish to desire life. So sometimes I do desire life, and sometimes I wish I did in the midst of suicidal thoughts popping in and out.

But I don’t think I need a treatment tomorrow!

Lucky Number 13-ECT

Today I had my 13th ECT treatment. My depression continues to improve! I’ve had 3 ECT’s each week of the last several weeks. My brain is rewiring itself with the seizures, and symptoms are going away. Appetite and sleep are good now when they weren’t a couple weeks ago. Concentration is getting better, and psychomotor agitation and suicidal thoughts have dissipated. I still feel depressed or down every day, and have low energy. I think I’m about 90% better. And the gains are solid through non-ECT days too. Starting next week I’ll be having only 2 treatments each week and decreasing from there too.

Cognitively, the only side effect I’m having from ECT is some aphasia and some slowness putting thoughts together into sentences. My memory is not affected at all this time with ECT. The doctor has been careful to only do right unilateral ECT and not bilateral or bifrontal ECT which led to memory problems last time.

My family is surrounding me with help during this treatment. My brother drives my mom and I to and from the hospital downtown. My mom accompanies me through the several waiting rooms, and I’m discharged to her care. She prepares a sack-breakfast for me for after ECT. She cooks dinners too. My dad cleans up the dinner dishes and the kitchen counters for me.

My therapist asked me what I thought life would be like once these treatments are over. I don’t know if I’ll want to move, and if so, to where – back to CA for geography and culture, back to Chicago area for support system, to somewhere local to the family’s house to remain with their support. I do expect more independence: cooking, laundry, cleaning. But I am considering the benefits of staying with family, living in community.

ECT Update

I have now had 8 ECT treatments. My short-term memory is just starting to be affected, but with prompts I can remember things ok. My mood is slowly getting better, though. I’m not thinking about suicide and I don’t seem to be wallowing in depression. But I’m not enjoying activities yet. So I’ll continue with ECT three times a week for at least another week or two before we taper the treatments down to once a week or so.

I wake up at 5:15am on Mondays, Wednesdays and Fridays for ECT and get a ride with my brother to the hospital which is in downtown Dallas near his workplace. My mom goes with me as you need to be released into an adult’s care after ECT. We wait in the hospital’s lobby for a couple hours before ECT and then an hour or so afterwards too until my brother comes to pick us up. Then I relax for the rest of the day to let my body come down from the seizure. I’m grateful my family is supporting me through this treatment and I don’t have to go through this alone.

Today I was stuck 4 times to get an I.V. started. It’s the first time it took more than one stick. Ouch!! The only other problem I’m having with ECT is lightheadedness upon standing. Could be the ECT or the anesthesia. It started after the 4th ECT and isn’t getting better.