Demystifying ECT: An Exploration of a Misunderstood Gold Standard Procedure
Electroconvulsive therapy, known as ECT for short, is an often misunderstood tool used to improve a variety of debilitating mental health conditions. Many people hear the acronym ECT and think about negative portrayals in media without realizing how misrepresented the actual treatment itself has been since its inception. The reality is that ECT has the ability to greatly improve the quality of life for people who struggle with certain conditions and has been proven in clinical trials over decades to be a gold standard treatment for some conditions that we see at Bridge House.
What exactly is ECT?
ECT is a psychiatric procedure that falls under the category of “neuromodulation” – a term that is defined by the use of technology to alter nerve activity for therapeutic purposes. Unlike its portrayal in mainstream media, ECT is not a painful procedure, nor is it akin to any kind of abuse or torture. Rather, it is a short (approximately fifteen-minute) process that takes place when a person is under general anesthesia.
While a patient is placed under general anesthesia, electrodes are affixed in strategic locations on the patient’s head. Under close supervision by multiple medical professionals, an electrical impulse is emitted through the electrodes, causing a brief, controlled seizure in specific areas of the brain. Although medical researchers still don’t know the exact mechanism by which the treatment improves symptoms, the leading theory is that the induced seizure causes a reset of neurotransmitters that can treat refractory psychiatric symptoms. The patient wakes up from the procedure with no pain, and the most common side effect afterwards is memory loss of the brief window before and after the procedure occurred. Patients can be released shortly after the procedure so long as the medical team finds it clinically indicated to do so.
What does ECT treat?
ECT can treat a variety of mental health conditions, including severe depression, catatonia, mania, and agitation and aggression in people diagnosed with dementia. Studies have shown that in many cases, ECT can be a more effective treatment for severe depression than medications alone. With regards to catatonia, ECT has become the gold standard for treatment; studies have shown that when a catatonic patient receives ECT quickly after the onset of symptoms, the likelihood of resolving those symptoms with fewer medications is much greater.
Who is a candidate, and will insurance cover ECT?
In order to receive ECT treatment, a person needs to meet with a medical professional to determine whether they are a good candidate based on their presenting symptoms as well as other factors within their medical background. Factors that indicate someone may not be a good fit for ECT include active substance abuse, mood symptoms that originate more from a personality disorder, and primary anxiety disorders. Insurance typically covers ECT treatments, and out-of-pocket payment is not recommended because each procedure can be quite expensive due to the use of anesthesia. The recommended frequency of ECT varies greatly and depends on the unique presentation of each individual and their response to the treatment itself. ECT can be done in an inpatient hospital or on an outpatient basis, depending on the needs of the individual.
When and how does Bridge House utilize ECT?
Bridge House has found great success utilizing ECT with certain resident profiles. When we see residents who struggle with catatonia, severe depression, or prolonged disorientation and confusion ECT can be an excellent reset for their neurological systems. Bridge House’s Psychiatrist and Medical Director can recognize when ECT is the best path forward for a resident. The option will be reviewed with prior care providers, the family of the resident, and involved referral sources prior to coordinating with local hospitals to create a treatment plan.
An ECT treatment plan for a Bridge House resident often (but not always) involves a short inpatient stay at the treating hospital for a period of time while the resident begins treatment. By utilizing an inpatient level of care, medical professionals can determine if the ECT treatments are working effectively and what frequency would be most beneficial based on the patient’s response. Bridge House stays in close contact with the resident and family while they are inpatient at the hospital. The Bridge House team will facilitate visits during visiting hours and coordination of care between all involved professionals. If an inpatient stay is required for an ECT patient, we follow this protocol and then bring the resident back to Bridge House once medically indicated. Doctors often recommend a maintenance treatment plan of one or more ECT sessions per week for a period of time after the initial treatment, which Bridge House can accommodate by transporting the resident back and forth to the hospital and accompanying the resident at the hospital. The frequency and duration of these visits will depend on the person, their specific diagnosis, and their response to treatment.
Closing Impressions
Unfortunately, ECT has developed a misleading reputation through media representations over the years- say, One Flew Over the Cuckoo’s Nest. Despite this, ECT is actually an incredibly helpful, evidence-based treatment for many conditions and can greatly improve the quality of life for those who receive it with very few side effects. Bridge House’s Medical Director, Dr. Kiera Schlansky, recommends watching “The Great Depresh” by Gary Gulman in order to hear a first-hand account of one person’s ECT journey.
The Bridge House Admissions and Medical teams are happy to answer any questions or clear up any misconceptions around the utilization of this treatment.
