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