Patient Story

Over the past year, Jolien’s condition has steadily declined. She now feels low all day and night. Sleeping is difficult. She has reported sick from work and the days crawl by as she sits on the couch, withdrawn in her own thoughts. Cooking, showering, grocery shopping—everything takes too much energy and exhausts her. Food no longer tastes good and she has lost 7 kg over the past few months. Her mind is constantly racing with thoughts that things will never get better and she feels guilty toward her partner and children. She tries to understand why she is depressed, but no clear reason emerges. That uncertainty makes her anxious and desperate. Her family is deeply concerned. At times, Jolien even wonders whether life is worth living if she has to feel like this. Eventually, she is admitted to the psychiatric ward.

During a conversation on the ward, her psychiatrist suggests that Jolien could try a treatment called ECT. “ECT stands for electroconvulsive therapy and is a treatment that stimulates the brain,” the psychiatrist explains. She says the treatment is very effective for people with severe depression.
 “It’s also a good alternative for those who can’t take medication or for whom medication hasn’t worked —just like you.”

“Like me?”  Jolien is startled when she hears ECT is being suggested. She immediately thinks of scary movie scenes. “Am I really this ill that I need to do this?”  These thoughts race through her mind and she decides to ask her psychiatrist.

“The treatment does not hurt and is not dangerous,” the psychiatrist reassures her. She says that ECT is a safe treatment that may seem frightening but can help many people. The images you’ve seen in films don’t match reality.

She goes on to explain: “With ECT, a controlled electrical current is passed through the brain via two electrodes. This triggers a short epileptic seizure.” All of this happens while Jolien is under general anaesthesia, so she feels and experiences nothing. She is closely monitored by a whole team. She also receives a muscle relaxant to prevent her body from convulsing.

“Usually, the only sign from the outside is a slight twitching of the muscles,” the psychiatrist adds. “After a few minutes, you’ll wake up feeling tired and perhaps a little confused —this is normal and passes quickly.”

Jolien finds it hard to take in all the information that is being discussed, especially since she feels so unwell. Luckily, her partner is there and she receives tips about websites and brochures where she can review the information. That evening at home, Jolien discusses the treatment with her partner and children. Her daughters say, “We miss you, Mom, so if this is something that can help you, give it a go.” Feeling supported, Jolien decides to go ahead with ECT.

Her psychiatrist refers her to a nearby hospital where ECT is performed. There, the team checks again to make sure ECT is suitable for her. “We need to confirm that you’re a good candidate and that there are no reasons you shouldn’t have anaesthesia or ECT,” the psychiatrist explains. This is done together with a team, including the anesthesiologist who administers the anaesthesia. “If necessary, we will do blood tests and other physical examinations.”

Jolien has no other medical conditions and, apart from her antidepressants, takes no other medications. Once she gives her consent, she can start ECT. At first, the treatment will take place in the hospital and if it goes well, she can begin outpatient sessions after two weeks. She will then have to come to the hospital twice a week on an empty stomach for treatment.

Everything that will happen today is explained step by step.  Jolien appreciates this —it helps calm her nerves, though it remains a tense moment. The nurse explains: “First, we will ask you to fill out some questionnaires and check how you are doing today. Then you can change clothes if necessary.”

Jolien then waits until it’s time for her ECT treatment. The nurses then take her to the room where the ECT will be performed. She lies down on the bed. The treatment team welcomes her. This team consists of the psychiatrist and ECT nurse, who are responsible for the treatment, as well as the anaesthesia nurse and anesthesiologist, who will administer the anaesthesia and monitor Jolien’s breathing, heart rate and blood pressure.

“We’ll place gel-coated electrodes on your head and some monitoring pads on your body,” the nurse explains. “This lets us track your heart rate, blood pressure and brain activity. The electrical current is only applied after you’re under anaesthesia.” Jolien also receives an IV for the anaesthesia medication.

After everyone in the room has checked everything with Jolien, she is given an oxygen mask over her mouth and nose. The anesthesiologist then administers the anaesthesia. Jolien drifts peacefully to sleep and feels nothing of the procedure that follows.

Slowly, Jolien wakes up. She had been told that right after the treatment, she might have a headache, muscle aches and temporary disorientation.  Fortunately, for Jolien, this is mild—she only feels a little nauseous. After half an hour, she is sitting upright in bed and chatting with the nurse. After an hour, she feels well enough to change clothes, get up and eat. She then returns to the ward with her partner to rest and recover. Here, she is closely monitored. “When you start doing ECT as an outpatient, you won’t be allowed to drive on treatment days,” the doctor had said. “Someone will need to accompany you.” She is also told that after any anaesthesia, it is standard for someone to stay with her for the first 24 hours.

After three weeks and six ECT sessions, Jolien notices she can and wants to go for walks with her children again. She is also sleeping much better. She’s even considering taking a bike ride soon—something she once loved. Her partner and family, in particular, notice that Jolien is more cheerful. They do see that Jolien sometimes forgets things that were said to her during treatment. The psychiatrist explained that this is a known side effect, but it usually improves after ECT treatment ends.
 With some tips from the ECT team, her family can manage this well. Jolien will continue treatment until the benefits level off.

“Even if ECT works well for you, you will still need to keep taking medication to prevent another depression,” the psychiatrist had said during their previous conversation. “Psychotherapy can also help with this.” Jolien is grateful she took the step to try ECT. She hopes that others can receive the treatment if it helps them, too.

The ECT treatment is now fully completed. Over the past few weeks, Jolien has gradually resumed more activities at home, such as that bike ride. Still, she often thinks back to the difficult period and her time in the hospital. Jolien is especially afraid that the depression might return. She wonders whether she could receive ECT again if she relapses.

“Yes, absolutely,” her psychiatrist reassures her. “I can’t promise with 100% certainty that it would work as well as it did this time, but because you’re now taking medication, the chance of another depression is smaller.”  Jolien very much holds on to that hope.