Treatment Resistant Depression: My Experience with Countless Interventions

by Risa Sugarman

The Trigger

In 2009, my husband, Ken, and I had to endure fertility treatments to get pregnant. We ended up doing IVF which resulted in our daughter, “IL.” We also were able to freeze four other embryos for later. When we tried for a second child, we transferred one embryo at a time but none of them worked. I was devastated and felt I had failed.

I was first depressed as an adolescent and was officially diagnosed while in college. I began cutting myself and was hospitalized as a result in my junior year. I was then relatively stable for over a decade, but it was never easy.

Soon after the last failed embryo transfer, I became irritable, sad, and moody. I questioned my worth and believed I was a horrible wife and an even worse mother. What the fuck is wrong with me? I can’t even give my daughter a sibling? How will she grow without siblings? I started to cut myself again. I felt helpless and hopeless.

What I endured for months became like a routine: try a new medication to alleviate my depression and either feel horrible from the side effects, like nausea, fatigue, and uncontrolled movements of my legs, or feel absolutely nothing. One after another I experienced the same results. Meanwhile, my depression got worse. I was suicidal and I was tired… tired of needing to shut my office door or go to my car so I could cry for fifteen minutes. I was tired of feeling such pain… words could not describe the depth of the pain I felt.

ECT: Part One

In July of 2014 I was hospitalized for five days where I agreed to begin electroconvulsive therapy (ECT). The process of ECT consists of a doctor putting you into a deep sleep then inducing a seizure. While there is no certainty about how ECT works, in a sense, it “jump starts the brain.” It can cause short-term memory issues which I experienced intensely during each treatment series and since. You do not feel any improvements immediately, but rather each treatment builds on one another. There were many times I woke up and forgot I had already had the treatment, which can be common. I always felt relieved it was over and comforted when one of the nurses would give me water and graham crackers. She knew what I wanted before I even asked.

That first ECT treatment petrified me more than anything in my life had before: not major abdominal surgery, not having my daughter. I was frightened I would forget milestones in my life: my wedding, my daughter’s birth, her first steps, first words, etc. What kind of mother am I if I can’t remember these important times in my own daughter’s life? I openly sobbed for hours in the unit the night before that first treatment.

My terror lasted up to the point I was about to be given the anesthesia. I remember the anesthesiologist saying, “It’s okay, love. Don’t cry.”

I felt like an albatross to my husband, daughter, family and friends due to not feeling well, physically and mentally after each treatment. They were the ones who would drive me to and from my treatments. I am an affliction to those around me.

I completed this series of ECT and had short-term memory issues and word-finding difficulties which were frustrating and made me feel inadequate. Over time I have been able to recognize the difference in what is a “normal” forgetful moment versus one that resulted from having ECT.

ECT: Part Two

After only a few months of feeling well, I was thrown into another deep depression and after trying more medications that did not work, I had to return to the one treatment that we knew did work: ECT.

I was angry at myself for becoming ill again and was caught in feelings of self-hatred: you fucking stupid woman—you thought you were in the clear, that all was well. Now you really will destroy the people you love. I did experience more headaches, as well as more nausea and exhaustion with this series. As with the first round of ECT, my memory issues my word-finding problems increased. This was difficult, in general, and in terms of working, as well. I’d started working part-time in retail and had to learn designers’ and product names. I realized I simply could not be “superwoman” and conquer everything anymore. It was too overwhelming. I wrote notes for myself as reminders and would try to force myself to remember things. I would struggle having conversations where I could not think of words to connect together in order to get my point across.

Once again, I had several months of feeling better but quickly fell into a full blown severe depression. My cycle seemed to be this: become ill, have a course of ECT, be well for several months and then cycle back to a severe depression. I couldn’t imagine being a burden, again. That kept circling around in my head as did the usual guilt about how it affected Ken and our daughter. He has had enough of me and he and “IL” will be better off without me. These thoughts haunted me constantly. I was completely in my depression and sunk deeper and deeper.

I took leave from work and felt stuck in intense hopelessness and self-hatred. I did not want to have ECT again. Although it always alleviated my severe depression, the negative physical effects were too much for me to tolerate.

TMS

Instead, I had transcranial magnetic stimulation (TMS). TMS involves sitting in what looks like a chair you sit in at the dentist. A two-sided helmet-like apparatus is placed on your head where there is a tapping/knocking on the upper part of your left forehead for about ten seconds followed by a twenty-five-second break which cycles for forty minutes. As each treatment builds on one another, the intention is to lift the depressive symptoms over time. While I was anxious before that first treatment, I felt comforted knowing there was no anesthesia and I could go about my day driving and not feeling sedated.

TMS helped to dissipate my symptoms, particularly my low mood, suicidal thoughts and lack of thinking clearly, but only for four months. Then the depression returned. I was convinced that everyone in my life was better off without me as none of the treatments were holding me. I am poison to everyone around me. I started another series of TMS but my thoughts turned darker and my therapist was worried the treatments were making me worse. It was unclear why this happened, but I stopped the TMS completely and then moved on to the next attempt: ketamine infusions.

Ketamine

Ketamine is currently being used to aid patients with treatment resistant depression among other mental illnesses. I had looked into this treatment in an earlier depressive episode and met with the director of a study but due to being severely ill at that time, Ken and I were afraid I would be given the placebo which would not help at a time of urgency.

Ketamine is given intravenously through a saline bag with the intention of alleviating depressive symptoms over a course of treatments. Currently, while the short-term benefits of ketamine infusions are demonstrating very positive results, there are many questions regarding ongoing infusions and long-term effects. This is the focus of many studies presently. I walked in feeling hopeful, even though it was in the same room where I received my ECT treatments.

My first infusion felt strange but somewhat positive. I experienced a feeling of being outside of my body but was always aware of where I was and why I was there. I talked a lot during the treatment which felt good and was able to joke with the doctors and nurses. These are experiences that became foreign to me while ill. During the second infusion I began to cry as I looked at the clock and saw it was the time when I would wait with my daughter for the school bus. I cried harder. I felt trapped in the bed in the room as if this was my life now and my existence consisted of being outside of myself. I will always be a patient and everyone will leave me. I cried more. For me, each infusion consisted of 40 minutes of hell with all of my most negative and self-hating thoughts, all magnified. I continued with them though with the hope that something would “click” and my depressive symptoms would begin to decrease.

During my last infusion, I sobbed. I am a terrible wife, my beautiful daughter is losing out with a mother like me, I do not deserve to feel better. I already knew I would be taken upstairs to be admitted upon completing this infusion, yet I felt nothing—emptiness and sadness but also indifference to the magnitude of being hospitalized for the fourth time in four years.

At last, we decided to try the last class of medications that I had never tried: MAOIs (Monoamine Oxidase Inhibitors). This medication was recommended a few years before when I was first hospitalized but because of food and medication restrictions, needing to taper off of my Zoloft and then wait two full weeks before beginning the MAOI, I was not interested. I was so severely ill, there was no way I could wait that long for relief.

I had already begun my taper prior to being hospitalized and once hospitalized I reluctantly agreed to five ECT treatments to help carry me while going through the steps of switching medications. The particular MAOI medication I was prescribed was a transdermal patch which is changed every 24 hours. Luckily, this medication kicked in and began to lift me out of my painful depression in August of 2017. It is unclear why this particular medication has held me for so long. Any psychiatric treatment is a hit or miss situation. It is never known why one treatment works for one person and not another.

Here and Now

I have maintained remission since August and have been doing well. I try not to look back too much and not revert to feeling the guilt that goes along with having a chronic illness. I do think of everything I have been through—the therapy, medications and treatments I have tolerated. I don’t want to disregard my own experience and history for it is remarkable for one human being to endure so much within such a small period of time.

It amazes me that I have had countless medication trials, ongoing psychotherapy/psychoanalysis, five psychiatric hospitalizations, fifty ECT treatments, sixty-nine TMS treatments, and five ketamine infusions, and in the end, it appears it was one prescription combined with the rest of my medication regimen as well as therapy that has held my depression at bay.

Right now, my life is full between my family, friends, work, and treatment. The depression is a low hum in the background while my anxiety is a bit louder. This is my normal and I accept it. I am living in my life, able to give and receive an abundance of love and it is working for me.

EDITOR IN CHIEF: Gabriel Nathan | EDITOR: Evan Bowen-Gaddy | DESIGN: Leah Alexandra Goldstein | PUBLISHER: Bud Clayman

See Related Recovery Stories: Anxiety, Depression, Mental Health First Person Essays