Obstructive Sleep Apnea and Not Watering the Plant


Ownership of plants is an exercise. For some, their bread won’t ever rise. (Um, me.) Others, apply maschera like a windshield wiper. (Those people. Um, me.) Me, these are true, along with the exercise of owning plants, which is essentially expensive composting. They never live long.

These are different in my book than trees. I’ve got some duplicity here, I realize. Yes trees are plants but I think of them differently. More human. I classify leafy potted things as “plants.” If there were “Plant Protective Services,” (PPS), some social worker somewhere would have thick files on me. I’d never make it out of court.

But even I, plant abuser that I am, know that if you don’t water a plant it will “wilt”. Yup. Bookmark this post. Words of wisdom.

Marvelous as that pearl is, being a brain doctor and all, I can’t help but parallel that the brain will wilt without oxygen.

There is a disease called Obstructive Sleep Apnea which describes this very misery. What generally happens is the tube through which air goes from your mouth to your lungs, called the pharynx, collapses for any number of seconds, over and over throughout your sleep. Over time, the brain cells change, and diseases develop, secondary to “anoxia.”

The story goes something like this. The brain senses that there isn’t enough oxygen. As oxygen is carried on red blood cells to the brain, just like it is to any and every cell in your body, the brain interprets this as not getting enough red blood cells. As red blood cells are pumped to your brain from the heart, the brain tells your heart to “Get working! Pump harder! Pump more oxygen-carrying red blood cells. We’re wilting over here!” The heart dutifully pumps, like a champion.

What is the heart? Mostly muscle. What happens to a muscle when it gets worked is, …It gets sexy! Right? Venice-Muscle-beach type of sexy. Ding! …Um, or just muscly.

Every cell in the body, requires oxygen to live. Even muscle. Even heart muscle. So heart muscle has it’s own arteries that bring oxygen-carrying red blood cells to it’s muscle cells to live. The oxygen “perfuses” the muscle and the muscle is healthy, not like my potted plants. But when that heart muscle gets extra work-outs, like any body builder, the muscle wall of the heart grows thicker. The heart wall however was given arteries to perfuse a wall thickness less robust than that and eventually the heart wall gets too thick for it to get its own oxygen. Compost. You got it. After time enough, the heart wall will die. That thickened muscle won’t get enough oxygen, and it will die. Obstructive Sleep Apnea is a leading cause of early heart attack.

And, oh yes! there’s more! If this isn’t bad enough, boys can’t keep their erections. Wilted.

Related problems are happening everywhere in this body. Brain cells are dying. Any variety of brain diseases develop, including early dementia, depression, anxiety, and more. Day time sleepiness happens, and Boom! You’re falling asleep while driving. And you’re eating more. Yup. Good news after more good news.

When we don’t get enough oxygen at night, we don’t get enough sleep. During the day, therefore, our brain is falling asleep on and off throughout the day. Our eyes may be open, but we are actually in there early stages of sleep. Then, our subconscious tell us to eat. No respect! We can’t catch a break! That’s because food and eating release stimulating hormones and we wake up a bit more. But,… we also get more fat. The fat then pushes down harder on our poor suffering airway at night and our disease, obstructive sleep apnea, worsens! Round and round like that lovely Krispy Cream Doughnut, we go. Eating, obesity, obstructive sleep apnea, eating, more obesity, and more apnea. Burp.

Now why would the pharynx collapse? What is it’s problem, anyway?! Generally it’s because it just can’t stay open under all that weight. We’re too fat and heavy. Those poor oxygen molecules are out of luck spelunking through that tunnel.

The brain, is super tired after all this. All night, it’s been rudely and repeatedly awakened, gasping sounds like fog horns through the night herald the body’s cry for oxygen. Nobody can get any sleep around here, not even you. All night your brain is waking you up, even if you don’t know it, to get a deeper breath of air. You’re constantly being pulled out of a deeper sleep into a state where your pharyngeal muscles can take over again, push open, and allow yourself to breath.

Because you aren’t fully conscious when this is happening, the best way to discover this is to get a sleep study, called a polysomnogram. During this study, you have a type of electroencephalogram, where specialists study your brain activity, as well as your different levels of oxygenation, and more.

After this lovely post, it may surprise you that bucket loads of people avoid getting a sleep study, but they do. There are many barriers to getting treatment in obstructive sleep apnea, that on paper, seem tiny. Today, let’s breathily say, they’re there, they’re real, and we acknowledge them. We are just trying to understand some of the, “why?,” your psychiatrist keeps saying you need oxygen to have a healthy brain. Go figure.

Self-care tip: Everyone deserves a sleep study. Please consider.

Question: What are your barriers to getting a sleep study? What are your barrier toward getting other medical studies? Please tell us your stories. We know the barriers are real. We know the barriers are common. Please speak out!

Keep on!

“Daylight Savings Time – Oooops”

Photo post by @dagostino07.

Source: “Daylight Savings Time – Oooops”

Start Over


Muscled and gorgeous, he came in, like dessert, main course, and appetizer. Some people just carry themselves that way. It doesn’t work if they dress low, chest hair accentuated by opened buttons and glimmering chains. It doesn’t work if it’s their agenda, checking to see if you noticed, a finger hovering over the acoustic applause button. No. Attire must be intact, normal, not baptized in cologne. In fact, attire must be worn as if it is completely a non-issue. Attitude of a jack-rabbit, who never thought about his muscled legs. Those legs just hop because that’s what they do. That is the kind of attitude-ingredient to this kind of presence-recipe.

How would a mother name such a son? How could she know he would turn out this way? Greg is an essential name for this elixir to work, as essential as “Fabio” is to its destruction. Everything else may have been in place, developed over years, like a bonsai tree groomed under the tender ministration of Father Time, and caboom! “Fabio.” The bonsai becomes a paint-can-frosted Christmas tree. Greg’s mother named him ‘Greg’, in fact, because it was the dullest name she could think of, not wanting him to grow up to be anything like the sort of philandering infidel his good-for-nothing pig father “Fabio” was. Greg told me this. I didn’t come up with it. He knew it because his once beautiful mother, who worked seventy hour weeks, told him whenever he messed up, “I named you Greg! This is not supposed to happen!”

In came Greg, after three years of absentia. And it was like I had just seen him yesterday. His mother couldn’t believe that the name Greg would hold such a man, an addict. Yep. Greg hadn’t seen me for three years for a reason. There I was. Chirpy as ever.

Greg! Where you been?

Whenever a patient comes to see me, I believe in him or her. I believe. In part, because I believe in Me. I believe in my value. Wink. But I also believe in them because I believe in Love, and because I’m simply wired to. There are more reasons why we behave and feel the way we do, more than colors in your crayon box. It’s not just a moral issue, biology, or an adjustment to our human condition. Heck. His name may have even had something to do with it. “Greg,” is quite a name. But I did believe, more than I disbelieved, that he hadn’t been in to see me for reasons other than relapse. Maybe his primary doctor was filling his meds, and he was so stable he didn’t need psychiatry anymore! Yah! That’s it!

(This is inside information folks. You can’t tell anyone. My patients can’t know this about me. It could ruin my career! I don’t want them to be any more afraid of disappointing me than they already are. It’s hard enough to be honest in these places, and I do my darndest not to project my Pollyanna-agenda’s on them. They don’t deserve that. They deserve the hard-earned poker-face I screw into place when my heart gets broken. I purchased it with ten-years of my life from some magic spiders I quested in a cliff off distant shores. Bargain.)

Greg! (I said,) It’s great to see you!

Every patient wants to please their doctor. And every doctor wants to please their patient. And we all get our hearts broken at some point.

I was really glad to see Greg, after all. And he was looking good. But then I noticed he had more weather in his face, some clouds, lines, and gutters. And I noticed he wasn’t as glad. He had an aura of melancholy and self-loathing rolling off of him.

His little boy was with him, too, (Fabio. …J/K! Gotcha! Good ‘ol “cycle.”)

Greg sat there, thunder in his sorrow shaking his frame, and we reviewed his story. You may know Greg’s story. Greg may be your friend too. Or brother, husband, dad, or You. And you know the high from this addiction feels better than everything, until it doesn’t.

The best line ever spoken in this context is, “Relapse is part of Recovery.” That is from the God of Hope. That is what makes sense in every illness, like Charles Dickens is to literature, timeless and universal content, man. When Bob reaches for that doughnut, when Harriet rolls the dice at Pechenga, when Fabio uses porn rather than intimacy in a meaningful relationship, when Myrtle has to pull over on the freeway in a panic attack, this is when we ask, “Why am I alive?” and demand to start over for that answer.

I’ve asked that question fifty-plus times a week for fourteen-some years, and every time I ask it, I listen for an answer. I’m curious too. We all are, right?! It’s a marvelous question. Every time I ask, I wonder about the magic that keeps this beautiful creation in our community. I listen, because every answer is something that crescendos into the room, the words explosive, the best part of the atom.

I have a daughter. She needs me.

My dogs. Nobody loves me more than my dogs.

I want to know what it is to live without this.

I’m too scared to die.


I just don’t know why.

Oops! Wait. “I just don’t know why,” isn’t good enough. Figure it. Finger it. Cradle it, and answer. What do you want to stay alive for? Because this thing! This thing is part of your recovery. Another day will come.

Greg left our appointment with options for treatment and a commitment to treatment. I’ll see him again and he’s one of the reasons I love life. Can’t wait.

Questions: Why are you alive? Please give us your answer. It will explode into the universe and someone out there needs to hear it.

Self-care Tip: Answer the question and start over. 

Responding to Inquiries – The Sabbath, ECT, and The Rabbit Test

rabit tes

Hello Friends.

Today is my Sabbath. If you wonder, I’ll briefly explain. If you don’t, skip this :). I get the Sabbath from the Bible. The validity of the Bible as a mostly unchanged book from the original writers isn’t what I’ll comment on. But as all things, I keep the Sabbath because it has shown my selfish short lived self, (call me Blip,) that it is kind to Me. What the Sabbath is about is still my pursuit to know. My understanding influences my activities, and as my learning is plastic, my activities change over the blinking tinsy trail through space and time I traverse.

Because today is Sabbath, it is the day I choose to reengage in writing. Writing about self-care is something I unwrap with many emotions. The gift brings me here today to respond to a person who reached out a few weeks ago. I felt some inner conflict with the question from the Curious, which may have contributed to why I’ve waited to speak.

Here is an abbreviated bit of the person’s points of interest regarding electroconvulsive therapy (ECT):

  1. I’m concerned about the suicide epidemic in the military and veterans.  I don’t understand why we are not going to ECT in many of these cases (from a scientific standpoint – I understand stigma and pharma lead to meds first).    
  2. Are we in the military and VA missing opportunities to help people by putting ECT as the last resort?

This is how our nurse-ECT specialist responded – (Again I took liberties abbreviating, etc.):

My first exposure to ECT came during my psych rotation in nursing school at the VA in San Diego. I worked with some incredible men struggling  with depression and PTSD and I witnessed some positive results during their treatments. I did notice that ECT was not widely used, and of course had much stigma attached even within the confines of the mental health unit.

A big part of my job here at our center is patient and family education… trying to break down walls, or barriers, that keep people from exploring this treatment as a valuable option. I’ve even visited local psychiatrist’s office to discuss and collaborate – many medical clinicians underutilize it as well… a last resort option for those with “treatment resistant depression/illness.”

I also handle all the insurance authorizations for patients starting ECT, and one of the biggest barriers I come across is the insurance companies asking:

‘How many medications trials has the patient done?’

There have been times that insurances will not authorize the treatments because the patient has not tried ‘enough’ medications or sought out alternate therapies. This is so very frustrating to hear. My response, ‘The patient doesn’t have the luxury of waiting another 2-3 months to try another medication…and suffer any possible side effects!’

What many people don’t understand is that depression and other affective illness is progressive, and it can happen so quickly.

The quicker a patient can have a full treatment response the better… and the success rates lie with ECT as the gold standard… 80-90% success rate.This holds true here at our center.

Patients have come out of some pretty dark places in our small corner of the world with ECT treatment. It is rewarding to watch, to help them, and their families, get their life back.

There’s a study I remember, but can’t quote without looking it up, that unless personal experience is gained in some aspect with ECT, we all will have negative beliefs about it, physicians, medical students, nurses, et al. So, knowing that psychiatry residencies don’t require ECT experience is disheartening. Who do we look to for expert opinions about psychiatric medical treatments, after all? Eventually, those psychiatry residents will become psychiatrists, in a world of underserved mental health care workers. They will become, we might suppose, prejudiced (negative beliefs not based on reason or experience,) and they will act on those beliefs (discrimination.)

One might exhale under the load of it all and reroute. Why do we stay though, dig, and try to grow this poor “fig tree” with water, song, and verse? BECAUSE brain illness is a human condition that kills and destroys and denudes the beloved construct we call, Me. We continue, despite being misunderstood, because each one of us, individually and as a whole, are Loved, valued, and in the end of course, because it serves our selfish desires. Motivation to speak toward the truth about ECT treatment is as complicated as the construction of motivation in any context.

The person who started this dialogue is motivated by “the suicide epidemic in the military and veterans.”

The Curious asked why we wait so long to offer ECT, “from a scientific standpoint,” stating, “I understand stigma and pharma lead to meds first.” Let’s pull on this thread.

  • Is there a “scientific standpoint,” or has the alleged algorithm of treating a certain number of medications first before treating with ECT been scientifically studied and/or proven? No and no.

Some years ago during the Q&A of an expensive international well-attended ECT lecture, by those who have much more experience than I, my wobbly legs took my own curious self to the mike. I felt the years, like a bag of gold on a scale, hanging in a plate. And where I stood, my purse felt too light. But I did ask them why we continue to say this? I did even challenge, like a barking puppy, “We need to stop saying this. We need to support our community of practitioners who do offer ECT to anyone (that needs it) who wants it, at any point in their treatment. We need to stop perpetuating this tradition, that has no scientific support, to treat last.” Ruff. Ruff.

Tradition? Yes, tradition.

In medical practice, it is our standard to weigh the benefits of one treatment against the risks of that treatment. And likewise, against the available treatments otherwise known for any illness. For example, many medications may cause dry mouth. Dry mouth, leads to dry gums. Bad breath is there, sure. But do we think of root canals? When we speak about medical treatments, we consider the possible side effect’s along with the hoped for benefits.

  • Are the risks of the disease remaining unchecked, untreated, progressing over time, burning and pillaging along the way, etc. more dangerous than the risks of treatment?
  • Are the benefits of leaving the disease untreated, more than the potential benefits of the medical treatment?

The standard of one medical practice over time leads to traditions of medical practice. We would like to think that those traditions are based on science. But when they are not, well, here we are.

When I was a kid, I was fortunate to live in the community of FOB’s, (fresh off the boat’ers.) Our boats came from Lebanon. Among the many benefits, like belly dancing, tabouli as a staple, and high volume multi-voiced conversation, I also had to sift through noisy “traditions” not based on science.

Sana, sleep on your back so you don’t get wrinkles in your face.

Sana, pinch your nails so your fingers and nail-beds grow out thin and not flat.

Sana, drink a lot of milk because milk is good for you.

The misconception about when to offer ECT is a tradition that came from a time when many medical treatments were primitive compared to now. For context, imagine that you wanted to know if you were pregnant. You would pee into a cup, (so far so good), and your pee would be injected into a rabbit. (Wait! What!?) In 1935, Portuguese neurologist António Egas Moniz introduced lobotomies. In 1949, he was awarded the Nobel Prize for Medicine. (Clearing throat sounds rattling the air.) This is the company ECT kept.

Have you ever heard the wagging term, “Time will tell”? And it has. We can now leave rabbits perfectly unharmed in our pregnancy tests, and keep drills and saws out of the treatment options for panic attacks. But here, some 80’ish years later, we are still using electricity, a natural process in cell communication, to bring about healing. Why is it still around?

Why is it our tradition to offer ECT so late in the disease? Back in the day of the rabbit test, lobotomy, and when ECT was born, we didn’t have much control in the treatment. It was a wild foal.

  • We had ether-gas, or nothing, for anesthesia, rather than the easily tolerated and highly effective intravenously dosed medications we now use to allow our patients not to feel or remember any of the treatment experience.
  • We had a sign wave of electricity, comparable to a tsunami dosing; rather than the finely tuned small amount of electrical current we now effectively use.
  • We directed the stimulation haphazardly, like a four-year-old playing t-ball as compared to professional baseball. We now place the stimulation more specifically, with deliberation, in areas that are most effective.

The benefits not only stayed through the years, but they have improved. The risks have diminished. Dramatically. This changed the risk-to-benefit ratio, which you remember is our standard to consider in the practice of medicine. But 80-years is a long time. And since anesthesia really wasn’t developed until the 1960’s, fluoxetine was launched in the 1980’s revolutionizing the practice of psychiatry, and the recent changes in the style of practice with ECT have been made now over the last twenty-some years – our traditions have been what traditions are, practices of the old cultures.

This ends my Sabbath writing. Thank you for sharing it with me.

What is the self-care tip? To keep the Sabbath? To get ECT? To change one’s traditions? Laughing. You tell me.

Keep on!

The Perfect Doctor – Healthy With Disease


One of the difficulties we have in talking to psych patients is realized with the dawning truth that we are not curing anyone.  Working in those conditions of not curing, you both, patient and psychiatrist, have to come to terms with each others’ agendas.  The physician says, “(‘I’m a failure.’)  I can’t cure anything.”  Now eye contact is even tough.

“If I don’t look them in the eye, some other emotion will surface and they’ll stop crying.”

Rachel was crying and crying hot and hard in the emergency room.  She was unable to stop the lava flow.  It was bewildering to her.  The people around her shifted their gazes.  Those who didn’t, looked angry instead, as if to say, “Pull yourself together, Woman!”

Psychiatrists have the advantage perhaps to these others in the lobby and receiving rooms and gurney shelves. Supposedly psychiatrists can grip and tug at the corner of the large sweater that is human behavior and say, “Emotions and behaviors come from the brain.”  They can imagine, if not entirely believing at a visceral to cognitive level, that the person they observe is responding to symptoms of what is happening biologically, at a cellular level. When they are tempted to avert their eyes, or look back impatient with the messy emotions, they can say, “This is medical.”  Impatience with emotional chaos from psychiatrist to patient, is equivalent to the ER doc saying to the trauma patient, “How dare you bleed in a public area?”

When someone cries on the medical unit, you may hear, “Nurse! Call the psychiatrist! There’s an emotion on the ward!” Later when things are calm, I walk out and they say, “Doctor!  You’re amazing!  What did you do?”

“Well, I bit off the head of chicken and sacrificed a goat on the patient’s chest.  Then I said, take this pill and everything will be as it should.”

Luckily I have several chins now, and when I gesticulate, their quiver contributes to me looking very capable. As if I could cure something.  I don’t know much about art history but, The Thinker, a bronze sculpture by Auguste Rodin, is probably what that Frenchman’s psychiatrist looked like when they both came to terms with the fact that psychiatrists don’t cure anything. (Heresy.) At least he got to get nude while he did it.

Talking to psychiatric patients can be that difficult.

There are studies on patient satisfaction that demonstrate that patients don’t like us when they think we give them bad news.

You see the predicament here, don’t you? So, some of the difficulty the world at large may be having with talking to psychiatric patients is that we have distorted perceptions of good and bad news. We may have difficulty with our own humanity, frailty, infirmity, and seeing it out there “without a scarf on” for decency, is a hard reminder.

We will never be cured of so many things. All of us. And the best we can hope for…

What is the best we can hope for?

(We are all gluttons and all hope for many unpublishable things but please! Just humor me.)

Say: “I hope to be healthy with disease.” There. Now we will all speak better to each other. It all starts and ends with Me.

Questions: Have you ever had difficulty talking to a psychiatric patient? Have others had difficulty speaking with you? Why do you think that is? What could help? Please tell us your story.

Self-Care Tip: Hope to be healthy with disease. 

(I bet Carl D’Agostino could make an excellent cartoon with this rich irony to work with! That’s right Carl! You heard me! Maybe a blue ribbon with a hole in it?… Ah heck. I’m sticking with practicing psychiatry and leaving the toons to you!)

Making our way through the questions on ECT – Top 3 Reasons for Being an Advocate

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?


Ooh La La!

So much fun to play dress up! When I was a scrub, a solid big boned unkempt of the Cleveland National Forest bordered lemon groves, when I walked barefoot, disappeared for the entire day in the rattlesnake infested chaparral, when I followed my brothers around like a desperate child, I still liked to play dress-up. I would sneak into my mother’s long closet, a dressing room really, with folding doors. I could hide behind her dresses, or climb up onto her shelves and be nothing more than luggage. But mostly I remember staring at her clothes and shoes. I remember one of her all time best outfits – a blue knit bell-bottomed jumper. A wide white belt with a hand-made gold buckle was an excellent accent. Yes, it would drag down below, but all the better to cover my brown feet.

When I think of my top three reasons for being an advocate for ECT, I think of dress-up. There are so many great options to put on, and I can and do exchange them with aplomb, as Fancy Nancy would say. That’s a French word for poise. It’s fancy. If you catch sight of my brown feet here and there, well, you can’t take the hills out of the psychiatrist I guess.

For today, Reason Numero Uno, (Fancy for #1, in honor of the second language I wanna-be speak):

  • It works most consistently, and most quickly of any treatment available. One must pick her fights after all, mustn’t she?

Reason Ithnān, (Arabic for two, in honor of my fancy mother):

  • It doesn’t touch “the body,” i.e. metabolics. Clean.

Reason Trois, pronounced I think like, twa, (Fancy Nancy’s favorite language. Need anyone explain? “French is fancy”):

For example, just by requiring someone to help with transportation, it’s built in. That thereby inherently increases community awareness of mental illness, something we rarely speak of with each other.

Then there is the medical staff. Our nurses are every patient’s advocate. Our masseuse increases oxytocin and other healing neurotransmitters when the patient’s get their massage waiting for treatment and then when in recovery. Our anesthesiologists are knowledgable, see the patient in their “whole person,” often picking up other issues that then will get the patient to receive treatment and improve the patient’s quality of life (QOL); such as hypertension, obstructive sleep apnea, etc…

There’s more, but basically in ECT, none of our patient’s are alone. That stands.

Question: What are the top three reasons you prefer the treatments you engage in? 

Self-care Tip: It is always helpful to write out why you are doing what you are doing, when it comes to medical treatments.

Making our way through the questions of ECT – Memory Loss

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?

memory loss

1. Cognitive and memory impairments:

There is no brain damage done with ECT. One way to understand the memory loss is with our own not so fond memory of carbon paper and credit card receipts. It’s not too ago that we made manual credit card receipts. We used, what was essentially, a machine that held the card in place, while we rolled over a two-part receipt, including one surfaced with ink. When rolling over the card, the ink pressed into adjacent paper the outline of the card face.

Inevitably, whenever I had one such interaction, the carbon paper was used up. There would be little patches of ink left on it, but in all the wrong places. People would try to move the carbon paper around to maximize its usefulness. And we’d roll over it multiple times, using repetition to get a good enough copy, when the carbon-paper had gone almost white. Roll. Roll. Put your weight into it. Roll.

The machine hasn’t changed. The machine isn’t broken or damaged. There just isn’t enough ink on that paper.

This is a rough analogy of what happens in our cells.

When we get new experiences, our cells try to “imprint” those memories into another area of our brain for storage and later use.  We use the intracellular “ink” to do this. However, a seizure dumps that ink, the neurotransmitters, chemical messengers, hormones, ions, and all those good ingredients needed to lay down new memories. It squirts the intracellular ink nearly completely out when we are stimulated, like squeezing a bag.

ECT is a stimulation treatment. It uses electricity to stimulate, toward the effort of healing. There are other stimulation therapies that we have discussed already – magnetic and chemical. Not all stimulation therapies result in a seizure. We don’t know why a seizure is needed for such a dramatic benefit, but so far, in our 80+ years of experience with ECT, it is needed for this magnitude of healing. The seizure is the event that “tips the ink-well.”

Our cells will naturally refill if left alone, after being “tipped over” and emptied. What brings about the memory loss is that in the beginning, in the ECT index trial, we don’t. The proximity of the treatments to each other is more frequent than what will allow for the cells to refill adequately for new memories. We stimulate, Monday, then just as they start to refill, we stimulated again Wednesday. And then again Friday. Then we do it again the next Monday, and so forth.

This is only in the index trial though, the first part of ECT that we do in order to get healing. Once the first 2-4 weeks, approximately, are done, treatment response is achieved, and we progress to a maintenance program of ECT to keep those benefits. Just as with medication therapy, if we stop treatment, if we stop the pills, if we stop the stimulation therapy, often, we will relapse and become ill again.

In maintenance ECT, we treat as infrequently as once a week to once a month or more. By allowing our cells to refill with “ink” between stimulus events, the difficulty imprinting new memories goes away. Those memories of events that happened during the index treatment, (the 2-4 weeks when we first start ECT,) may never come back. But we wouldn’t expect them to, necessarily, because there wasn’t enough ink to imprint them at the time. Like a carbon copy paper without ink on it, no matter how many times we roll over it, mechanically, we don’t have the ability, the ink, the ingredients, or whatever you want to call that stuff needed to save the memory of an experience permanently.

I’m not going to go into the obvious juxtaposition of this with what happens cognitively with brain disease untreated, or with other treatment options toward brain health. I hope you do though. Because there’s so much there and it’s fun, liberating, and increases our personal freedom to choose.  Keep on.

Questions: What do you think about not being able to keep the memories of your life for a brief time? What is the cost benefit ratio to you, when you think about this? Please tell us your story.

Self-care tip: Be as careful as you can in your accounting, book-keeping, of your risk-to-benefit ratio of treatment.