How To Stop A Relapse Before It Starts

Australian garden orb weaver spider, after hav...

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Baby I have been here before
I know this room, I’ve walked this floor
I used to live alone before I knew you.
I’ve seen your flag on the marble arch
Love is not a victory march
It’s a cold and it’s a broken Hallelujah…

– Leonard Cohen

Relapsing in brain illness is the pits.  The prodrome, as it starts creeping into our awareness, is worse than knowing we are about to walk into a spider web with the spider and his dinner still in it.  It’s so horrible that even before the prodrome hits, imagining a relapse can trigger foreboding and anticipatory anxiety.

What will I do if I…?  

Dear God no…

Recently we did a brief series on ECT and discussed how ECT can improve brain health, signal neurogenesis and trigger healing.  This brought many of us to wonder about what causes brain damage.  It became apparent that many of us had forgotten that brain illness, in fact, damages the brain.  We still have a hard time, despite all our progressive activism and awareness, believing to the core that the brain is human, that emotions and behaviors come from the brain and that a diseased brain is what generates disease symptoms as seen in emotions and behaviors.  We still have a hard time believing that the brain responds to medication, much like the liver does.

What?!  Depression causes brain damage?

What?  

Now compound that with the spider’s cousin, Medication-For-Life, and you’ll see us doing a funny walk-hop-dance in the dark to avoid what we wish we weren’t getting into.

The wonderful bit about all this is that staying on medications, even for life, is the best way to dodge the worst of it.  Sure, even with medications, as prescribed, compliant and all that fluffy five-star behavior, we still relapse.  “Depression should be considered as a continuous rather than an episodic process,” as stated so well by French biomedical expert, Vidailhet P.   But, (this is really good news,) when we relapse, we do not drop as fast, we do not fall as low and we do not hit as hard when medication compliant.  Staying on medication is prophylactic against those miseries.  Staying on medication is protective against progressive brain disease and it’s deteriorating effects.  Staying on medication is friendly.

…Hallelujah, Hallelujah
Hallelujah, Hallelujah

Leonard Cohen

Question:  What have you noticed that staying on your medication has done for you?  How do you manage to stay on it even when you don’t want to?  

When you’ve come off of it and relapsed, how was it different from when you relapsed while still maintaining your medication therapies?  Please tell us your story.

Self-Care Tip – Stay on your medication.

Be Friendly Enough With Yourself To Acknowledge the Gift In Your Suffering

Strange Lady

Image by bending light via Flickr

Pain. There are so many of us suffering from pain that sometimes it is as if nobody escapes. Even so, in the contorting agony that pain brings, we have a very hard time thinking outside of ourselves at all. We are preoccupied with ourselves. We do not think about the others hurting or others in general at all. Pain does that – emotional and/or physical.

Penelope was preoccupied too. She had suffered and was suffering still. Peeling her thoughts away from survival during those times when, with teeth and muscles clenched, her body felt like a universe unto itself. Everyone outside of her were aliens she was able to visit occasionally. Watching her and hearing her describe how it molded her current person, I remembered the book by Paul Brand, Pain: the Gift Nobody Wants. (We mentioned this book before in our blog-post, “Emotions: The Physical Gift We Can Name.”)

When we are sick with Pain Syndrome, with symptoms seen in our emotions, behaviors and nerve language, it is hard to perceive what good can come out of bad. Saying, when we are in that ditch, that the sun is happily shining overhead is rude and boring. Especially when it is rhetoric. Change that rhetoric to insight, well that would then be worth friendly and interesting. That would be hope. There comes a degree of knowledge that hasn’t reached our sensory selves yet but sits in our intellect. We have a glimpse of the ark of the covenant, a promise, nearly prophesy in fact – we have a knowing that something good can come out of this.

This is why I thought of the work of Paul Brand, M.D. with the lepers. I thought that Penelope might want to know that there is something good that could come out of her bad if she were healthy in other ways, enough to receive it. If her senses could perceive it, her emotions, sight, hearing, touch, taste and smell could take in that information and deliver enough of it uninterrupted, what was promised to her would come true; past the pain that distracts and preoccupies.

It is as if this good that comes out of bad were like a runner in a war zone. Bombs are exploding. It is noisy even though hearing was taken out after the last gun fire. Dirt and sweat drip over eyes and into mouths and no one believes they will survive. And then the runner trips into our shelter and collapses still alive; still holding the message in his hand. Something good made it across a land in havoc and war and we know about it now.

I thought of Paul Brand, M.D., telling Penelope that her pain is her gift at that point of knowing, with that timing. Better than I could. She wouldn’t laugh angrily and give him a bad review on-line. She would hear him. “Something good is coming your way. You have hope.” In my imagination, Penelope would not hear Dr. Brand moralizing her experience – “You are good if you perceive your gift and you are bad if you don’t.” In my fantasy, Penelope would understand that this offering wasn’t intended to make her feel guilty for hurting. It was an offering of hope.

Not so easy to do, as it turns out, in real life. I am a very human psychiatrist without

much magic about me very often. But if I did…

Question: How do you give yourself hope when your senses don’t perceive it? How are you your own friend when you are preoccupied and distracted from that which is friendly? Please tell us your story.

Self-Care Tip – Be friendly enough with yourself to believe that there is something good that will come out of your bad. There is hope.

Generic Patient Information on ECT

What is ECT? Electroconvulsive therapy (ECT) is a treatment for severe episodes of psychiatric disorders, especially major depression, mania, and some types of schizophrenia. It involves use of a brief, controlled electrical current to produce a seizure within the brain. This seizure activity is believed to bring about certain biochemical changes which may cause your symptoms to diminish or to even disappear. A series of ECT treatments, generally 6 to 12, given at a rate of 3 per week, is required to produce such a therapeutic effect; although sometimes a smaller or larger number may be necessary.

How is ECT administered? ECT is usually given three times a week, on Monday, Wednesday, and Friday mornings. It can be provided on either an inpatient or outpatient basis. You will not eat or drink after midnight the night before each treatment. Your ECT doctor will tell you what medications to take that morning. Before the treatment, a small needle is placed in a vein so that medications to put you to sleep and relax your muscles can later be given. The treatment itself is given in a special ECT Treatment Suite, where it is administered by a team of doctors and nurses with specialized training and experience. You will be brought into the Treatment Room and asked to lie down on a comfortable stretcher, after which blood pressure cuffs will be placed on your arm and ankle and a number of electrodes will be placed on your scalp, chest, and finger, so that brain waves (EEG), heart waves (ECG), and body oxygen levels can be monitored and so that the electrical stimulus can later be given after you are asleep. You will also be provided oxygen to breath by mask, and any pre-ECT medications, if indicated, will be given, followed by the anesthetic medication itself, which will put you to sleep.

Within a minute after the injection of the anesthetic medication, you will be asleep, and the medication to relax your muscles will be given. Within one to three minutes, your muscles will be relaxed. A controlled electrical stimulus, lasting a fraction of a second to eight seconds, will then be applied across the two stimulus electrodes, which will typically be placed either on both temples (bilateral ECT) or on the right temple and top of the head (unilateral ECT). As will be described later, unilateral ECT has less effect on memory than bilateral ECT. However, some reports suggest that it may not be as effective or rapid in all patients. The electrical stimulus triggers a seizure within the brain, which typically lasts around a minute. Because of the muscle relaxant drug given prior to the stimulation, very little body movement usually occurs.

Within a few minutes after the seizure, when you are breathing well on your own, you will be moved to a nearby room, where you will wake up within 5 to 10 minutes. Because of the anesthetic drug and the effects of having had the seizure, you will temporarily feel somewhat groggy. Usually within 20-30 minutes after leaving the treatment room, you will be brought back to your room (if you are an inpatient), or, if you are an outpatient, you will go to another area of the Treatment Suite, where you will wait till you are ready to leave the hospital (typically about an hour or more).

Is ECT effective? Although there have been many advances in the treatment of mental disorders in recent years, ECT remains the most effective, fastest and/or safest treatment for some individuals, particularly when alternative treatments, usually medications, are either not effective or not safe. Your doctor will discuss with you why ECT is being recommended in your case and what alternative treatments may be available. ECT is most effective in severe clinical depression (major depressive disorder), where it has a strong beneficial effect in 50-90% of patients, depending on the case. Still, there is no guarantee that ECT, or, for that matter, any treatment will be effective. In addition, while a series of ECT (or an alternative treatment) may bring an episode of illness to an end, it will not in itself prevent another episode from occurring weeks, months, or years later. Because of this situation, you and your doctor will need to consider additional treatment to follow any ECT that your receive. Such treatment generally consists of medication, psychotherapy, and/or additional ECT (given as an outpatient at a much less frequent rate and called “maintenance ECT”).

Is ECT safe? All treatments have risks and side effects, even no treatment at all. Prior to ECT you will undergo a medical, psychiatric, and laboratory evaluation to make sure that the treatments can be administered in the safest, most effective manner possible. Your medications may also be adjusted to minimize the risk and maximize the effectiveness of the treatments. For most patients, the side effects of ECT are relatively minor. The risk of death is very rare, about 1 per 10,000 patients for typical cases, but higher in those with some types of major pre-existing medical problems. Serious complications, which are also quite rare, include temporary or permanent heart abnormalities, reactions to the medication used at the times of the treatment, injuries to muscle, bones, or other parts of the body, and greatly prolonged seizures or seizures occurring after the treatment. More common side effects involve headache, muscle soreness, nausea, confusion, and memory difficulties. Headache, muscle soreness, and nausea are usually mild and can be prevented or at least diminished by medications.

Memory problems often build up over a course of ECT, but diminish as soon as the treatments have stopped. However, because of the harmful effects that mental disorders themselves often have on memory function, some patients successfully treated with ECT actually report an improvement in memory. When memory problems occur, they vary considerably from patient to patient, but are usually greater for larger numbers of treatments or when both sides of the head are stimulated (bilateral ECT). Because of the possibility of memory loss, it is recommended that important life decisions be postponed until any major negative effects of ECT on memory have worn off (usually within a week or two following completion of the treatment course).

ECT-related memory problems can be of two types: a difficulty remembering new information, and a loss of some memories from the past, particularly the recent past, e.g., during and just prior to receiving ECT. In this regard, the ability to learn and remember new information returns to one’s usual level over a period of days to weeks after ECT. The ability to remember material from the past, i.e. prior to ECT, likewise tends to return to normal over a similar time period, except that in this case, some memories from the recent past, mainly days to months prior to the treatments, may be delayed in recovery or even permanently lost. Some patients have reported longer gaps in memory. However, patient surveys have indicated that most patients receiving ECT are not greatly disturbed by memory effects and would have ECT again if it was felt to be indicated.

Other information on ECT: Please feel free to ask your doctors or nursing staff any questions you have about ECT. A variety of types of information are available concerning this type of treatment, including videotape material. You should understand that ECT is a treatment for which you (or your representative, if applicable) must consent on a voluntary basis, and that consent for future treatments can be withdrawn at your (or your representative’s) request at any time.

Take Care of Yourself And You Will Be Taking Care of Others – “Care-Givers”

Caregiver is a name that many of us own.  From basic parenting scenarios to families complicated with end-of-life, spinal cord injuries, congenital diseases or employees of group homes – care-givers is the generically applied term.

Is it difficult to ID care-givers that “did it right.”  Seeing them is a muscle that operates better by practicing the magical and material skills of empathy, doing rather than saying, so to speak.

By the way, I’m on hold right now with the service provider for our currently nonfunctioning internet.  The hold-music is so bad that I had to put the phone in a closed drawer to muffle it.  #selfcare.  Much better.

There are many people who have cared for me and do care for me.  You for starters have cared for and do care for me in your reading, your time, your thoughts, and comments, you are my givers of care.

I am cared for, and you know I get all fluttery when I start talking about you so I’ll stop before you throw-up.  Unless it’s too late.

There are others who gave and give care, obvious names like parents, spouse and friends. And there are many less obvious names – my dogs talking to me when I get home, the lady who came up to me in the 99-cent store and handed me $20.00 to buy treats for my kids, my psychotherapist who told me to “grow up.”  All these and more have and do care for me.

But do we call these people, (or other living creatures,) caregivers?  Is that a name for what you do for me? Not traditionally but it really is.

The differences are found between those who believe they take care of others when they don’t take care of themselves and the inverse – those who take care of themselves, and as part of that effort to be their own friend see caring for others as a natural maturation of their own needs(Remember, agendas again.) In any other design, taking care of others when we don’t take care of ourselves is not sustainable nor congruent with our intentions.  We become the hare who lost the race to the turtle, angry and confused by our results.

Care for the Caregiver Day
Image by Christiana Care via Flickr

I agree that this attempt to share space with the angels who so lovingly nurture and give to those who can’t give to themselves can be perceived as arrogant, ignorant and other names – creep, idiota, a– h—, pompous, fools, bigots, oblivious, uninformed, (this is fun), benighted, blind, old gum under the picnic table jerks.

Be that as it may, please believe that we speak of caregivers without malice.  And if we are ignorant, please let our flaws inspire you to grow us as empathically as you would like us to grow you.  I know it takes a lot of love to deal with someone like us and it is much easier to walk away.

Questions:  Where do you find yourself in the care you give to others?  What helps you remember your intentions to love yourself when stigma or guilt bang you upside the head?  How do you see that caring for yourself is consistent with your goals to serve others?  Please tell us your story.

Self-Care Tip – Care for yourself and you will see yourself giving care to others.

Related articles

AfterShocks (…Smile) From our ECT Series

Reference cat

I am hoping to get a running stream of references for those interested in finding out more about ECT.  To start, some are:

  1. As relayed in our last blog post, check out Mayo Clinic
  2. Kitty Dukakis: Shock Therapy Saved My Life – ABC News on abcnews.go.com
  3. Kitty Dukakis And ECT – CBS News Video
  4. Kitty Dukakis And ECT video – CNET TV
  5. Katherine Kitty Dukakis on ECT | Psych Central
  6. Kitty Dukakis & Shock Therapy | World of Psychology
  7. Shock: The Healing Power of Electroconvulsive Therapy – Amazon …
  8. Kitty Dukakis Backs ECT for Depression : NPR
  9. Scientific Articles on Neurogenisis From ECT as described on PubMed
  10. Mortality Rate From ECT
  11. University of Maryland describes their understanding of ECT as a treatment option for Bipolar Mood Disorder and Depression
  12. Currently under research at Duke University, “Not-So-Deep Brain Stimulation:  Transcranial Magnetic Stimulation (TMS)
  13. I also really love the 1st hand words from    Here is one of her excellent statements – “No one really knows how ECT works. For the longest time everyone just said it “rebooted” the brain. Hardly scientific. What we now know is that ECT creates neurogenesis, in other words, neuron growth. And this is needed because long term depression kills brain cells and shrinks the brain. (Antidepressants also induce neurogenesis, FYI.) So ECT is able to make connections in the brain that weren’t previously there, and it makes them very, very quickly compared to any other method.”  She has done her research.
  14. Also, enjoy reading The Bipolar Badger who is going to be writing more on his experience with ECT this week (he’s promised).  The Badger says, “there is very little positive or objective is more like it out there on the interwebs. While I do not expect every post out there to be positive as not everyone has a great experience with ECT. It as important to mention positive outcomes as well.”
If you know of more, please tell us!
Be a friend to yourself.  🙂

 

 

 

 

The Non-Dramatic Ending To Our ECT Series

Bert the Turtle

Image via Wikipedia

Not much traffic over here since drifting into electroconvulsive therapy (ECT) territory.  That’s alright.  Everything in its own time.  We got some feedback from some who didn’t find ECT helpful, some who would never be interested in ECT but not much from anyone who has found ECT helpful – and I know you are out there.  Healthy and quiet about it.  I know because I know from my patients and from the studies and statistics available.  You are there.  And you are not alone.

I was corresponding with my trusted mentor on this subject, Richard Weiner M.D., from Duke University, who has treated patients with ECT for 40+ years.  He referred us here at FriendtoYourself.com to the clean presentation by Mayo Clinic.  If you are interested in further introduction into ECT, check it out.  They have a lovely video, outline and inquiry resources.

On a slightly shifted topic, I’d like to introduce you to my friend, B.D.Erline.  This guy’s really rocking the friendship thing to yourself these days.  He’s writing and spending himself on his new, “Act-Like-You-Wanna-Live” series.  It’s brilliant.  Say hello if you’d like.

That’s all for tonight my friends.  I thank you for coming along even when topics interest you less than other days.  Keep on.