When Heather B. Armstrong agreed to an experimental therapy to treat her depression, she was already out of hope. She’d suffered for 18 months with a relentless bout of treatment-resistant depression that included ongoing suicidal ideation. Every day she fought through thoughts of “no longer wanting to be alive.”
The experimental therapy she agreed to participate in doesn’t sound real. For ten sessions over three weeks, Armstrong was to arrive at a clinic to willingly let her brain come as close to death as possible while still breathing. In her words, she was going to undergo “ten rounds of dying.”
She tells her story in the new book, The Valedictorian of Being Dead: The True Story of Dying Ten Times to Live, a memoir that recounts what led her to such an extreme, and her harrowing experience along the way.
The therapy involves an injection with a potent, short-acting anesthetic called Propofol to induce a near-brain-death coma for about 15 minutes. The objective is to alleviate symptoms of depression through something called “burst suppression” – quieting the brain’s electrical activity to a flatline and then bringing it back.
“Quieting is a polite way of saying ‘taking down to zero’,” Armstrong says in the book. Anesthesiologists refer to this induced coma as “the abyss.”
The treatment shares some similarities with Eltroconvulsive Therapy (ECT), in which electrical shocks are delivered to the brain while the patient is under anesthesia, triggering small seizures in hopes of resetting brain chemistry. But in this case no electrical shocks are used, just the anesthesia and a dose of the opioid fentanyl (yes, that one) to counteract severe headaches. (As it turns out, Armstrong was among the 4% or so of patients who hallucinate under influence of fentanyl, which added to what was already a surreal experience. “Heads and arms and torsos turned into jagged crayon cartoons…the room started melting,” she recounts from her first treatment.)
Before each treatment, Armstrong answered a series of questions aimed at assessing her level of depression – covering her self-perception, feelings of suicidal ideation and other areas. Her answers to the questions, and how they changed over the course of the study, convey a significant part of an ultimately positive story.
Somehow Armstrong manages to tell it all with humor. As a well-known “mommy blogger” and author with a popular website, she’s a skilled communicator who connects with the reader even when retelling tough situations. It’s a welcomed lightness amidst a lot of darkness.
The researchers from the University of Utah Neuropsychiatric Institute (UNI) that conducted the study also contribute a fair amount to the book, providing insights as to how this form of therapy may one day be a viable option for many more people who have otherwise run out of options. Of the ten people participating in the first study (of which Armstrong was one), the researchers said that six experienced positive outcomes. For now, however, the therapy remains experimental.
“This study…could be the beginning of something new,” Dr. Brian J. Mickey from UNI said in the book’s Afterword. “But the true benefits of Propofol for treatment-resistant depression remain unknown. Much work still needs to be done.”
Treatment-resistant depression affects an estimated 30% of depression sufferers. Without an effective means of managing the disorder, depression bouts can last a year or more, often with suicidal ideation. Too often, ideation becomes action.
Armstrong’s book offers hope not just because she willingly participated in an extreme experimental therapy and it worked, but because her story of wrestling with intense depression is many peoples’ story. She’s written a worthwhile contribution to better understanding and confronting a disorder that’s affecting more people every year.