Mental Health Month: the truth about electroconvulsive therapy (ECT)

Approximately 1 in 5 adults (46.6 million) in the U.S. will have experienced a mental illness during their lifetime. Globally, an estimated 300 million people are affected by depression alone. Mental disorders are among the leading cause of disability worldwide, according to the World Health Organization. If those statistics aren’t staggering enough, try this one on for size: roughly two-thirds of people with a mental disorder never seek treatment.

The stigma associated with mental illness is still preventing people from getting the help they need. Compound that with movie depictions like “One Flew over the Cuckoo’s Nest” that, since its debut nearly 45 years ago, has negatively shaped public understanding of what has been known as one of the best treatments in psychiatry: electroconvulsive therapy (ECT).

“Electroconvulsive therapy was the gold standard decades ago,” said Marek Hirsch, MD, a psychiatrist at HCA Healthcare’s Memorial Hospital Jacksonville. “It was developed in the 1940s and commonly used to treat mental illness in the 1960s and 70s.”

“Then we all saw Jack Nicholson in ‘One Flew over the Cuckoo’s Nest’ when ECT was used as a punishment, not a treatment, and caused it to fall out of favor,” he explained. “But that couldn’t be farther from the truth. It has evolved tremendously since then. There is an 80-90 percent positive response rate for depression when using ECT.”

One of Dr. Hirsch’s patients seconds that description of ECT, saying: “All I knew is that I wasn’t stressing about so many things anymore,” she said. “I’m amazed. ECT should be called relief.”

Whether it’s embarrassment or ego, fear or misinformation, HCA Healthcare urges anyone suffering from depression or other mental health disorders to seek support and educate themselves on the many ways to cope or overcome the illness.

Let’s start today with expert information from Dr. Hirsch on ECT.

What is electroconvulsive therapy?

Electroconvulsive therapy, or ECT, is the safest and most effective way in psychiatry to treat behavioral health disorders, including:

• Treatment-resistant depression
• Bipolar disorders
• Schizophrenia
• Mania

Who would be a candidate for ECT?

Anyone who has sought treatment for depression, has tried at least two medications and has not received any benefit from those medications, would be a candidate for this treatment.

Patients of all ages, health conditions and presentations, from pregnant women to those with pacemakers, have had electroconvulsive therapy. It’s a safe, common, and well-tolerated procedure.

When should someone consider ECT?

Psychiatrists often try medications first, but if those aren’t effective and people aren’t getting any relief from their symptoms, another option is electroconvulsive therapy. ECT may also be recommended for an individual who is suicidal and may not have enough time for medication to take affect before potentially harming themselves.

How is electroconvulsive therapy performed?

A psychiatrist, anesthesiologist, registered nurses specially trained in ECT treatments and behavioral technicians will be involved in patient care the day of the procedure. The patient is put to sleep using general anesthesia. They also are given a muscle relaxant. Then we stimulate the brain, triggering a brief seizure. The anesthesia and muscle relaxant allow the patient to remain relaxed and unaware of the seizure, which typically lasts less than 60 seconds.

The procedure takes about 5-10 minutes, and the patient is then observed in recovery from 30-45 minutes. Total time in the hospital is about two hours. It can be performed as an inpatient or outpatient treatment.

What does this do to the brain?

The biological or scientific mechanism that causes people to feel better after ECT is unknown. However, the theory is that when people are depressed, hopeless, helpless, and anxious, parts of the brain becomes damaged or get smaller (atrophy). ECT releases in the brain what is known as growth factors, which are essentially proteins or food for neurons that help regenerate, replenish and nourish the brain cells. So, by flooding the brain with all of these really good proteins (growth factors), it tends to heal the parts of the brain that have been damaged by a prolonged depression.

Will patients feel better right away?

We recommend a course of three treatments each week for four weeks (12 treatments total). Usually, after a few treatments, people start to feel better, but they should continue with a full course of treatment so the benefits of ECT are sustained.

What happens after the recommended 12 treatments? Does one have to continue the treatments long-term?

It depends on the patient. Some people feel much better and will never need ECT again. They might stay on a light dose of an antidepressant, but some may discontinue medication completely. Others might come back in a year or so for “maintenance” treatments.

What are the potential side effects?

The side effects from medication are far greater than with ECT. Potential side effects from the procedure include confusion, headaches, muscle aches and short term memory loss. During the four-week treatment plan, patients may not remember an event that occurred the night before – what they had for dinner, for example – or have trouble recalling things that happened days or weeks prior to the procedure. The memory loss is temporary and cognition will return to normal after the individual stops treatment.

The risks are minimal, however, any complication associated with anesthesia is present.

What is the success rate of ECT?

It’s 80 to 90 percent effective at treating depression, compared to medications, which have about a 30 percent success rate.

“Frequently, people say, ‘why didn’t I do this sooner,’ or ‘why has this not been recommended to me sooner,’” said Dr. Hirsch in an educational video about ECT. “They’ve often tried many medications, been to many doctors over the course of many years, and have been frustrated to the point of feeling like nothing is going to work and they’re always going to feel this way.”

“Then they come in for ECT and have a true turnaround, and that’s obviously wonderful to see. That’s why we do what we do,” he added.

Electroconvulsive therapy is available at 25 HCA Healthcare facilities across the country, with the goal to expand to 40 by the end of 2019.

This May, Mental Health Awareness Month, we encourage you to help us break the stigma associated with mental illness by reaching out if you, or someone you know, needs help.

The National Alliance for Mental Illness (NAMI) is prepared to answer questions about mental illness.

• Call (800) 950-NAMI, Monday – Friday, 10AM – 6PM EST
• Text “NAMI” TO 741741

Mental Health Awareness Month has been observed in May in the United States since 1949, reaching millions of people in the United States through the media, local events, and screenings. Many rise together to fight stigma, provide support, educate the public about mental illness.