It makes sense to ask.

Why do you think you’re back in the hospital? Why have your symptoms increased in intensity lately? Are you under any significant stress that you can think of?

All these questions and their variants were asked of me by members of my treatment team. They’re also common questions from my family and friends. So far as we know, most things have a cause and if we can determine a cause then we can work to mitigate future issues that could arise. Trying to answer that question however, is a trap.

Don’t misunderstand me and think that finding first causes is not important, they’re just not the most important things when it comes to walking up out of a depressive spiral. Time spent on anything other than recovery is wasted time, and too often we get obsessed with determining how a person we loved fell into a depression as if that knowledge will carry the person out of it. There will be plenty of time to play detective later, for now we must rally around the individual.

I’m coming out of my depression; my first serious foray into that terrain in over two years, and I have a rough theory as to what happened. We still don’t know how Electroconvulsive Therapy (ECT) works. The most that can be said is:

“That many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses. That's why ECT is most effective in people who receive a full course of multiple treatments” (Mayo Clinic).

The short answer is that my brain chemistry changed. Exactly what changed and how remains a mystery. Some observations have the hippocampus increasing in size for those that complete a full course of treatment, but despite study after study we are no closer to determining why ECT works at all, let alone why it works in some people and not others.

I’m a fan of the theory that says there is a buildup of neurotransmitters in my synapses which then contribute to a depressed mood. General observation gets me to this conclusion because I felt nearly normal after one treatment of ECT. I could argue that my brain had been stockpiling various chemicals until the collection reached a point where depressive symptoms began. A few controlled seizures later and those neurotransmitters got wiped away and my brain can get to feeling like my own again.

I like this idea because it takes me off the hook. Every past depressive turn has been because I stopped my meds or lessened my therapeutic work, but that wasn’t the case this time. As far as I can tell this is just my depression getting a vote. It sucks, but it can be worked around. With clear evidence that ECT can get me back to my usual self I’m keeping it as part of my overall treatment protocol because there is no sense in having to constantly fight the thoughts my mind throws at me.