Electroconvulsive therapy provides effective treatment, not ghastly punishment depicted in movies.
Remember the movie “One Flew Over the Cuckoo’s Nest” when the character played by Jack Nicholson undergoes horrifying electroshock therapy as a punishment for misbehaving in a psychiatric hospital?
Well, mental health professionals and patients wish you would forget that scene, because it’s one of the many myths surrounding this safe, effective treatment. Even the term “electroshock” is outdated.
Referred for years now as the more-accurately named Electroconvulsive Therapy, or ECT, the treatment is a proven crucial form of medical care and is a lifeline for many severely depressed patients, including those in the Kansas City area. Two hospitals — Shawnee Mission Medical Center and Research Psychiatric Center on the campus of Research Medical Center — have prominent and busy programs that administer ECT in what typically takes a mere 10 to 15 minutes from start to finish.
“I am so sorry that movie has such an impact on society in such a negative way,” regarding ECT, says Lisa, 65, of Leawood, who asked that her last name not be used. “You basically go in, and they put you out for just a couple of minutes, and you wake up, and you really don’t realize you had it.”
And patients feel so much better.
Lisa, who has bipolar disorder that leaves her with lots of lows and very little highs, has been receiving ECT treatments for 20 years after once attempting suicide by overdosing on pills. She goes in for one maintenance treatment at Shawnee Mission Medical Center every five to six weeks because if she didn’t go, she would become severely depressed.
“I’m so much calmer, so much brighter,” after the treatments, she says. “I just feel so much more full of life, and the people at Shawnee Mission really make that happen. They know us. When we come in, they call us by our first names. They don’t treat us like we’re down. They know this just happens to us. It was probably something we were born with.”
Steven Combs, 69, of Olathe, received his first ECT treatments about a year ago at Shawnee Mission Medical Center and now receives a maintenance treatment every four weeks. Serving two tours in Vietnam and retiring as a master sergeant after 22 years in the U.S. Marine Corps, Combs has post-traumatic stress disorder, which leads to severe depression.
“I had had depression for a long time,” he says. “It just got to the point where I couldn’t handle it anymore.”
He had contemplated suicide a couple of times and, like Lisa, was hospitalized. Antidepressant medications and psychotherapy alone didn’t do the trick. Both he and Lisa continue with medication and therapy while undergoing their ECT maintenance.
Both patients say ECT saved their lives.
“I don’t know where I would be without it,” Lisa says.
Dr. Lolitta E. Aznaurova is a psychiatrist at Shawnee Mission Medical Center who is one of two physicians who administers ECT to 14 patients a day, three times a week. It’s very rare when they don’t have a full schedule.
In addition to severe depression and bipolar disorder, ECT patients include those with schizophrenia, psychoses and severe mania for which traditional medications and therapy have not worked. Even some Parkinson’s disease and certain migraine patients have benefitted from ECT. For more than 30,000 U.S. patients each year, ECT is the most effective treatment for these biological conditions, which are unlike situational depression that stems from, for example, the death of a loved one that may require grief counseling. ECT patients come from all professions, walks of life, economic levels, and degrees of intelligence and character. Between 80 to 90 percent of patients find ECT exceptionally beneficial, and many are able to resume working and leading full, productive lives.
They may even be your next-door neighbor.
“The important factor to remember is that ECT is not a curative treatment,” Aznaurova stresses. “That’s the first thing I tell my patients when they come to me, especially with an external referral. They come sometimes with the misconception that if they have ECT they are going to be cured for life. ECT takes care of the end result of depression or end result of mania or a psychotic episode, but typically our patients stay on medications or continue therapy.”
They initially come in for nine to 12 ECT treatments. After that, they are reassessed for further treatment. The effects of one series of ECT treatments can be long-lasting.
“In many cases, we do recommend maintenance, which is basically once a week, once in two weeks, once a month,” Aznaurova says. “We have several patients who come once in two months. Ten percent of patients need it for a lifetime, depending on the diagnosis and what exactly we are treating.”
The treatments at Shawnee Mission Medical Center are administrated from 6 to 8 a.m. weekdays. Patients are hooked up to monitors that watch their heart and brain activity. An IV is started. Anesthesia is given and then a muscle relaxant. Now asleep, the patients have electrodes placed on their temple or temples depending on their condition, and a controlled current of electricity is passed through the electrodes for mere seconds. This stimulates the brain and produces a mild seizure that usually lasts about 30 to 60 seconds. The ECT machine monitors brain activity. When it is over, the patient is taken to a recovery area and observed by trained staff, usually about 20 minutes. Once awake, the patient does not remember the procedure.
“Think of it as rebooting your computer,” Aznaurova says, who suggests that those wanting more information should research the topic from reliable sources, such as the Mayo Clinic or Johns Hopkins.
When a patient first awakens after ECT, they may experience confusion, headache, stomachache or nausea, increased heart rate, a rise in blood pressure or fatigue. Symptoms usually go away in a few hours. The ability to remember new information may be affected for a short time. Severe memory loss, long-lasting side effects and death from ECT are rare. Pregnant women are able to undergo ECT. Patients do not drive for 48 hours or use any type of machinery, like power tools, up to 24 hours.
“It is safer than medications, that’s how safe the treatment is,” Aznaurova says, noting that the hospital does everything it possibly can to dispel myths surrounding ECT. “I like to say we’re happy people, and we’re here to keep everybody happy. It’s not like a scary, gloomy environment. We joke. It’s a very cheerful environment. To me, it’s a very positive start of the day.”
And to see vast improvements in her patients makes it all worthwhile. She remembers a college professor who was so paranoid that he thought the police were after him for removing a mattress tag. It felt so real to him. His rational mind was trying to find a reason why he felt so horrible. ECT treatments did wonders for him.
“Depression takes away your personality,” Aznaurova says. “It takes away a lot from you. The bottom line is that this is a biological illness and is a result of chemical imbalance in the brain. It’s fascinating work.”
Combs says the treatments have not only been healthful to him but to his relationship with his wife. Lisa, a retired pastor, says the same is true regarding her husband.
“I was suicidal, and I got so bad that I just really wasn’t there anymore,” she says. “I was in the hospital for a long time in the mental-health unit. They started doing the ECT every couple of days, and finally my husband walked in one day and said, ‘You’re going to be happy.’ And I smiled at him. It was working.”
MYTHS about ECT
● It’s used to punish patients.
● It causes permanent memory loss.
● It causes brain damage.
● It is painful.
● Once you start, you can’t stop.
● During ECT, the patient’s body goes into hard convulsions.
FACTS about ECT
● It helps patients.
● It causes chemical changes in the brain.
● It can be very effective.
● It can provide faster relief than antidepressant medications and psychotherapy.
● It has few risks.
● It can be the best treatment option for many people.