Chapter 4 - The Joint and ECT - January Through February 2011

The joint, nut house, loony bin, the pen, centers for behavioural health...there are many names for a mental hospital, but my favorite is the joint. I have fortunately never been in prison, but a mental hospital has got be a close cousin. The one that I was admitted to had four wards - geriatric, drug addiction, psychiatric, and crisis stabilization. The ward that I was admitted to had almost every vacancy filled by a mixture of gender, age education level and social status. Some were depressed, some suffered from severe anxiety, some had already attempted suicide, and spill-over from the drug addiction ward because it was full.

Before entering the ward the staff confiscated everything and anything that could be used to hurt yourself or others. Shoe strings, belts, etc. Personal hygiene was pretty much limited to deodorant and toothpaste. Obviously, it was a safe environment. Each room, in the ward, had two beds, one shower, one sink and no doors. Privacy? Forget about it. It didn't matter if you wanted to be by yourself, you had a same sex roommate, and not one that was up to you to chose. Upon arrival and my bed assignment I considered myself very fortunate to have been assigned a roommate who was basically in my exact same situation. For whatever reason it made me feel better that I was not alone, and there was someone who I could talk to who knew exactly how I felt. To this day we are still in contact.

There is a schedule of events that everyone follows. Meal times, break times, therapy times, telephone times, shower times, medication times, lights out times. You get the picture - everything is pretty much structured and routine. Fun?...not at all. Safe...absolutely. The highlights were visiting hours 3 times a week. Even though the time was brief the feeling of being able to see your family and friends is not something I am capable of putting into words. The other highlight was smoke breaks. I don't smoke, but I dip snuff. This escape several times a day gave me something to look forward to and kept me going. Tobacco may rot my face off one day, but currently it is saving me.

You definitely meet people who are worse off than you though. There was a guy there who either lost or won a game of Russian roulette. There was another who had both wrists bandaged, Another with a nasty welt on his neck consistent with an attempt of hanging himself. One of my roommates tried cocaine, meth, pot, heroin and several other drugs all at the same time. Others their, sadly, just didn't have anywhere else to go. No home, no money, no family, nothing. It was sad to see them actually be kicked out of the hospital just to make room for others.

I think I saw my assigned psychiatrist (I will call him Duke Nukem) the following morning. Who, after taking the time to interview me, theorized that I was 1) very sensitive to medications, 2) Refractory (treatment resistant), and had 3) Hereditary Major Depressive Disorder. I was also told that because of all of this that I was exponentially at a greater risk of suicide than my father. Duke Nukem decided that I needed Trazadone for sleep and Welbutrin for everything else. Why Welbutrin? Because I have never tried it before, so let's give it a shot.

In addition, Duke recommended ECT (electroconvulsive therapy) because it is an alternative for both refractory depression and hereditary depression. You have to understand that in my current mental state that if someone told me that removing half of my brain would make me feel better then I would be looking for where to sign-up for the surgery.

Now my hopes were up! A possible cure via ECT! I was amped (pun intended). The ECT procedure is done in this particular mental hospital. Basically, you are anesthetized, given a very powerful barbiturate (muscle relaxer) that actually stops you from breathing and makes it necessary for the technicians to do it for you. The unipolar ECT procedure is when one electrode is placed on the side of your head (temple area) and one is placed on the top of your head, and anywhere from 200 to 450 volts are administered (depending on your particular threshold). "The main aim of Electroconvulsive Therapy is to cause a massive convulsion in the brain (a massive epileptic fit).  This is achieved by giving the brain an electric shock.  ECT machines are, basically, transformers which modify Mains Current so that it is transmitted to the patients skull in timed pulses." I guess this a way to rewire your brain. I am told that today's treatments are much more humane than of old, not what you see in the movies where the patient looks like they are being electrocuted and flailing all over the table.

The side effects of ECT that I experienced were severe cotton mouth a massive headache and memory loss. Short term memory loss is a reported side effect, and for that they do not want you driving a car as an example. Because you may forget which is the accelerator pedal and which is the brake pedal.  For me it was more than that. I still have trouble remembering most of 2010! I meet people who I think is for the first time and they look at me like I have pancakes on head and say "you don't remember me?" I read a book (The Lost Symbol) while I was in the waiting que for treatments. About a month after my last treatment I found the book and read it again...didn't remember a word of it from the first read.

I was in the joint for 2 weeks. Towards the end of the two weeks is when I began the ECT treatments. Duke Nukem decided to release me and continue the ECT treatments on an outpatient basis. My hopes were up!

It was a big relief to get to come home and at the same time very scary because you can't help but think that you are on a very shaky foundation. I was not fully recovered and my mind just constantly ruminated. One of the questions that they ask you every morning, in the joint, is "are you having thoughts of suicide?" Even if I wasn't just having this question asked kind of started the whole process over again. This question became a part of my own daily evaluation of myself. As time passed I began to realize a transition from suicide ideations to thinking of suicide just as subject matter. Never-the-less, at this point in time, the way I felt was generally not very good. I still did not have a very good sense of well being and I was no motivated or excited about anything other than getting better. I was counting on ECT being the silver bullet.

I did the outpatient ECT for a week and then was readmitted to the joint. I felt awful....again. Duke Nukem made some medication adjustments (Zoloft + Trazedone + Remeron) (later I read that Trazadone should not be administered in conjunction with ECT...hum) and I was told that the reason I wasn't recovering was because I neglected to schedule talk therapy. I thought electroconvulsive "therapy" + meds was enough. I ended-up spending another week in the joint before being released again.

By the end of February I had completed ECT for a total of 20 treatments, I kept my scheduled appointments with Duke Nukem (who also has an outside practice) and continued talk therapy with a therapist who was conveniently in the same office as Duke Nukem. On my final visit with the therapist she told me that my coping skills were really good. She also told me that I should perhaps be a therapist because she felt more than once that we should switch chairs.

I started to get suspicious of Duke Nukem when, at one of my appointments, he gave me some samples of a brand new med called Oleptro (extended release Trazadone) and told me to give it a shot. My suspicion was that I was dealing with yet another prescription pusher. My suspicion escalated when, at another appointment, he gave me some samples of Deplin which is basically a mega-dose of folic acid. Deplin is supposed to make SSRI's work better. So now Duke Nukem, who originally theorized that I was over sensitive to medications, has me on four different meds - Zoloft, Remeron, Trazadone and Deplin. Not to mention that Oleptro and Deplin are both $70 per prescription - after insurance. I concluded that the three antidepressants all target different chemicals in the brain (SSRI + SARI + a tetracyclic), and with the addition of ECT is why I tagged him Duke Nukem. It would appear as though if he unleashed enough different weapons on my brain that one of them was bound to work.

By the end of February I was beginning to feel better. Put that into perspective though. I am not at all feeling like I should, but I'm not in the joint and feel like the depression is beginning to be manageable. I went for my regular scheduled testosterone shot and one day after that I am crashing (bad) again. I call Duke Nukem. He sees me on an emergency basis and decides to cut in-half all of my med dosages. Within days I begin to feel better.

Now I am back to thinking about testosterone levels, and why something that should make me feel better is having the opposite effect. I have a conversation with a body builder friend, who is well versed in such matters. He is appalled that a my general doctor would prescribe a 1ML dose once a month. He says that this type of administration will cause my testosterone level to spike and then drop. He also says that my estrogen levels will increase along with the testosterone level. Basically putting me on a hormonal/emotional roller coaster. That's JUST what I need! I decide to get my testosterone level checked weekly to see what's going on.

Three days after the testosterone shot my level was at 1380 (that's massive). One week later the level is at 653 (still fairly high for a 44 year old), and three weeks later it was at 461 (fairly normal). During this time frame my depression progress was doing better. For now I think my theory that low testosterone is part of the problem is not valid.

This is also when I began thinking that why is it that when I put something into my body that helps most others (antidepressants, testosterone, B vitamins) actually makes me feel worse?