Latest / 20-Minute Health Talk / The healing power of ECT

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The healing power of ECT · 20-Minute Health Talk

• 0:05
  Rob (host): Welcome to 20-Minute Health Talk.
• 0:07
  I'm Rob Hoell.
• 0:08
  Sandra (host): And I'm Sandra Lindsay.
• 0:09
  Rob: Today we got a great show.
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  We're talking about ECT, which is electroconvulsive therapy.
• 0:14
  It's been around for a long time.
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  It's got a little bit of stigma attached to it, but it's a highly
• 0:18
  effective treatment for treating people with severe depression,
• 0:21
  bipolar disorder, and schizophrenia.
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  Sandra: That's correct
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  Rob.
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  I read these stats that just blew me away.
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  Over 100,000 patients get treated with ECT annually, and it's
• 0:34
  effective in eight out of ten patients who suffer from major
• 0:38
  depression.
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  They find relief in ECT, and as you mentioned, it's been around for
• 0:44
  over 80 years.
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  Rob: Yeah.
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  You talk to people, and a lot of people that you talk to say, I was
• 0:49
  hesitant to get this because it sounds scary,
• 0:52
  right?
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  Electro convulsive therapy.
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  But I'm so glad I did, because I was at the end of my rope.
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  I tried everything, and this really helped me to get my life back.
• 1:04
  Sandra: I listened to that interview you did, and the patient described it as
• 1:09
  not scary at all.
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  When I listened to her story, it was heartbreaking and heartwarming at
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  the same time.
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  She had an amazing outcome.
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  Yeah.
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  Rob: Her name is Katherine Gorleski.
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  And I was just so blown away by her interview because it basically
• 1:25
  changed her life.
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  And talking to her, she knew exactly when she started ECT because it
• 1:30
  was the last time she attempted to commit suicide.
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  Katherine: I have so much more happiness in my life than before.
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  Not only happy to be alive, I want to be alive, and I want to be
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  happy.
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  Rob: She suffers from bipolar disorder, and it really crippled her.
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  Where she couldn't hold a job, her relationships with people weren't
• 1:55
  any good, and now she's doing this maintenance ECT, and she's got her
• 2:00
  life back, and she's happy, and she became an advocate for ECT.
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  So I think it's really important to get the word out and let people
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  know about this, because there's not enough information out there
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  about it.
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  Sandra: So your interview was so powerful, and just to hear or share a story I
• 2:16
  remember that date.
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  I think it was February 2015.
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  Rob: Yeah.
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  And that interview was so impactful to me.
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  I wanted to learn more and take a deeper dive into this.
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  So I reached out to Dr.
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  Sohag Sanghani, who is the director of Zucker Hillside Hospital's ECT
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  Service.
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  In part one of this two part interview, he breaks down how ECT works
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  and how it benefits patients like Catherine.
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  In part two, we get into the long history of ECT, addressing the
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  stigma surrounding this life saving treatment, and how Zucker Hillside
• 2:46
  Hospital has been a leader in its evolution over the years.
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  Sandra: Good afternoon,
• 3:00
  Dr.
• 3:00
  Sanghani, it's such a pleasure to meet you.
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  I've heard so much about you.
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  Dr. Sanghani: Dr.
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  Lindsay, thank you so much for having me.
• 3:07
  It's an honor. Please call me Sandra.
• 3:09
  It's an honor to meet you.
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  I've heard a lot about you, and we have seen your videos and pictures,
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  and it's such an honor and pleasure to meet you in person.
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  Same here.
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  This is awesome.
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  This is going to be a great conversation because we're talking about
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  something that's highly effective, that's a fantastic treatment for
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  people with depression and bipolar, which is electroconvulsive
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  therapy.
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  But there's also a big stigma around it, and we're going to help kind
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  of break that down today.
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  Yeah.
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  So, for listeners, what is ECT?
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  Sure.
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  ECT stands for Electroconvulsive Therapy.
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  It is the most rapidly acting antidepressant treatment, and it's also
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  very effective in patients who have suicidal ideation or depression
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  with psychosis or catatonia.
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  We use electricity to stimulate the brain, and many people are
• 4:03
  surprised to know that the actual time for which we stimulate the
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  brain is a couple of seconds.
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  And even within those couple of seconds, the actual time for which the
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  charge is being delivered is less than a second.
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  So think of it like this.
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  You take a charge which is less than a second, and then you spread it
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  into a few milliseconds and give it in small pulses, and that is
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  administered over a couple of seconds, and that induces a seizure,
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  which is very controlled, and it lasts for about a minute.
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  And then the patient wakes up in about five to ten minutes.
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  It takes them for another 20 minutes to get oriented to the
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  surrounding.
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  We give them some juice to drink to make sure they're able to tolerate
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  it okay.
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  And once they are fully awake, their vitals are stable.
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  If they are admitted on an inpatient unit, they would go back to the
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  inpatient unit.
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  If they're coming from home, they'd go back home.
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  So what you talked about before being simple.
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  I sat in on one of these procedures, and as a videographer, just to
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  record it, for awareness, to let people know what happens.
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  And it was kind of boring because not much happened in those few
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  minutes.
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  And the doctor told me this is one of the shortest procedures there is
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  in medicine.
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  And, Rob, it's funny that you say that, because we hear the same thing
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  from medical students.
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  They come in to observe a treatment, and they're coming in, expecting
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  a lot of drama, and then the treatment is over, and they say, that's
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  it.
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  I'm like, yeah, there's not much drama here at Zucker Hillside, family
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  members bring the patients for the treatment.
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  They come in their own clothes, they get an IV.
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  A nurse meets them, does a brief memory evaluation, and then a
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  psychiatrist comes in, meets the patient, puts the sticky pads on,
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  which are the stimulus electrodes.
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  Anesthesiologist comes in, we do a time out.
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  We make sure.
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  We are all on the same page and all the anesthesia is given through
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  IV.
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  We are giving anesthesia because we are giving muscle relaxant.
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  So ECT was invented in 1938.
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  Between 1938 and 1950, it was done without anesthesia and patients
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  used to come for subsequent treatments.
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  This was the most effective treatment.
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  And if it was painful or anything like that, no one would come back
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  for the second treatment.
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  But it's mainly during that period when we were doing it without
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  anesthesia.
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  The stimulus, those few seconds would produce an intense contraction.
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  So the body would go in a tonic contraction and those contractions
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  used to sometimes result in fractures.
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  So to prevent that, we have to give muscle relaxant.
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  And whenever you're giving someone a muscle relaxant, you have to give
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  them general anesthesia because their breathing is also going to stop
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  at that time.
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  So we give general anesthesia followed by muscle relaxant, and then we
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  do the stimulus.
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  So how do you make the decision to get to ECT?
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  How is it prescribed?
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  Is it after unsuccessful medical therapy or if somebody has suicidal
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  ideations, attempted suicide before, do you go immediately to ECT or
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  do you try medications first?
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  So it varies from patient to patient and it all depends on the urgency
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  of the situation.
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  So ECT is the treatment of choice when someone has severe depression
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  with suicidal ideation or psychotic features.
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  And the treating psychiatrist usually would make a decision as to how
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  urgent is the need.
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  If they can wait to try for medication, they would do that.
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  But if the patient is not eating, not drinking very catatonic, then
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  they would go for ECT, right?
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  They may try other medication and then immediately go for ECT.
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  There are conditions where sometimes they would wait for a couple of
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  weeks for medications to work.
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  But if they're not getting enough results, then they would go for ECT.
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  Now, once a patient starts ECT, do you have patients who are also on
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  medications or is it one or the other?
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  Most patients are on medications and we actually encourage patients to
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  stay on some of the medications now when they are getting ECT.
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  ECT's effect supersedes that of medication.
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  But being on medication helps, helps in the maintenance phase.
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  Think of it like a dose.
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  When the treatments are closed together.
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  That's where it is the strongest dose.
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  Once you are spacing it out, you are reducing the dose of ECT.
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  And that's where if there's a medication on board along with ECT, ECT
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  plus medication supersedes the effect of either alone.
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  So what's the treatment program then
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  for ECT? The goal is to have improvement in the symptoms.
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  The treatments have to be done close together, so one treatment itself
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  does not induce too much of a clinical change.
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  So we have to do the treatments close together two to three times per
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  week in order to reduce the memory side effects.
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  We try to do it alternate days, two to three times per week.
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  And at some point when the patient starts to show improvement, we
• 9:59
  continue it as long as there is incremental improvement.
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  Typically what we have seen, especially for depression, is that you
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  start to see improvement somewhere between fourth and 6th treatment.
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  Then you start to see more and more improvement with each treatment.
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  And by eight or ten treatment, the patient improvement plateaus.
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  Once we have reached the point of maximum improvement, then we start
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  to space out the treatment.
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  And that phase is called continuation.
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  Now, 15% of patients, 1 5 percent of patients may reach that plateau
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  within four to six treatments.
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  And for them it works like a miracle.
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  And then there are some people who are late responders.
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  So usually if someone does for depression, if someone does not respond
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  by twelve treatments, then we say it's not working, let's stop.
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  Although recently there is some research that suggests that if the
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  patient is tolerating it okay, we can go even up to 18 treatments.
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  ECT is prescribed for depression.
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  It is also prescribed for treatment resistant schizophrenia and
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  sometimes treatment resistant mania.
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  And in treatment resistant schizophrenia we go up to even 20
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  treatments, and its efficacy varies between different disorders.
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  As far as describing clinical improvement, we look at the symptoms,
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  patients report, caregivers report, and our own evaluation.
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  So before each treatment we do evaluate the patient and then make a
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  decision.
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  Yeah, I actually interviewed a patient who told me that she was pretty
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  much at the end of her rope.
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  And she says since she started doing ECT, she is able to have a job,
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  she's able to maintain relationships.
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  She says she's more even keel.
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  She doesn't have those highs and those lows that she used to have in
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  suffer from depression anymore.
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  And she basically said it was a life changer.
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  Do you get
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  people like that.
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  We often hear those stories.
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  So patients are referred to us either because of severity of illness
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  or chronic treatment resistant nature of the illness.
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  We may get patients who are very severely ill and they need to get
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  better very quickly.
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  They don't have enough time where we can keep trying different
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  medications.
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  On the other hand, we also get patients who have tried so many
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  medication options and their episodes of depression keep coming and
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  then they come to us.
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  From what I understand how this procedure works, from what I was
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  getting, from talking to the doctor, it almost seems like a reboot.
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  I said is it like you're rebooting your computer?
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  And he said actually it is.
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  He's like the computer is fine, your brain is fine, it works.
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  But sometimes it has some bugs in it and it's like a deep debug.
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  You reboot the computer.
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  Is that how ECT works?
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  Now you're asking a million dollar question.
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  It's a great analogy about analogy about computer reboot.
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  But we get asked these questions a lot.
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  We know what it does in terms of what ECT does to the brain, it is
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  very hard to pinpoint.
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  Is there one particular mechanism that is responsible for the
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  therapeutic efficacy?
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  ECT can treat depression, it can also treat mania, which is opposite
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  of depression.
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  ECT can help with treatment resistance, schizophrenia or psychosis.
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  And even when patients with depression have psychotic features, ECT
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  works very well.
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  It is effective in both those conditions.
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  And currently the hypothesis is that because it does so many things at
• 13:48
  the same time, it's multiple mechanisms working together.
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  And those mechanisms, what are they?
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  It affects different neurotransmitters.
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  It also affects the Hormonal axis, so it normalizes the hormonal axis,
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  it improves connections in the synapses.
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  So it's called neuroplasticity where the connection between the
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  neurons is improved.
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  It also proliferates neuronal growth and along with that, it also
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  affects some neuropeptides and expression of certain genes.
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  So because it is doing all of these things together, it works better
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  than other medications and that's why we are not able to pinpoint and
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  say this one particular mechanism is responsible for its role in this
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  disorder versus another mechanism for the another disorder and likely
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  it's multitude mechanism you mentioned earlier spacing out treatments
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  to reduce side effects.
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  Are there side effects to ECT?
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  When you mentioned the computer
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  analogy, that might also explain help me explain the memory side
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  effects.
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  The most common side effects are actually headache and nausea, which
• 15:10
  can be easily treated with medications.
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  The memory side effects of ECT are entering grade and retrograde
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  amnesia, which means events immediately before and after the treatment
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  are likely to be forgotten.
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  Now, think of memory in general, right?
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  If you want to remember something, the first thing that needs to
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  happen is the event has to be registered in your brain.
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  Once you register the event, after some time, that memory gets stored
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  in different areas of the brain for long term storage.
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  That initial registration happens in an area called Hippocampus.
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  During ECT treatment, when you are doing the treatments close together
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  two to three times per week, that registration gets affected because
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  the Hippocampus is the one that gets stimulated the most.
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  And if the event is not registered properly, you won't be able to get
• 16:08
  it back.
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  Hippocampus also works as a gateway.
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  So all the long term memories, even when you have to recall them, they
• 16:17
  also come out through the Hippocampus pathway.
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  So when you talk about your computer analogy, if you are rebooting the
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  computer, if you did not save the file properly, you won't be able to
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  get it back.
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  But if the file is already saved properly, it is there.
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  Sometimes what happens is the pathway to access that file may get
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  corrupt and you may need some clues to remind you of the old memories
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  and then the old memory comes back.
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  So after the acute course of ECT, within ten days to couple of weeks,
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  most people's ability to register and recall new information is back
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  to normal.
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  As far as the long term memory, the retrospective memory or retrograde
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  amnesia, which is events ranging from days to weeks and sometimes
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  months before getting ECT, those memories gradually get better within
• 17:19
  couple of months.
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  So some people may need some clues to trigger old memories.
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  Occasionally, some people continue to have some spotiness in the
• 17:29
  memory where certain life events, what we call as autobiographical
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  memory, some of those memories, despite clues, don't come back.
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  But most people find those side effects to be insignificant.
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  And the benefits of treating their psychiatric illness, which is
• 17:50
  severe depression or schizophrenia, much better compared to that race.
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  Yes.
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  So as a staff nurse, I worked at Lennox Hill.
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  And I remember recovering ECT patients in the ICU.
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  That was a long time ago.
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  The way that ECT has kind of evolved, they no longer need ICU care
• 18:17
  post ECT.
• 18:19
  That's correct.
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  The recovery from ECT is very smooth.
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  It's just like any other anesthesia, any other procedure in the
• 18:26
  general anesthesia.
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  Many of the hospitals, they don't have dedicated space for ECT.
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  And that's the reason most of the times it used to be done.
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  Even still, in many hospitals, it is done in ICU,
• 18:42
  Pacu, but Zucker hillside,
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  we have a dedicated ECT suite.
• 18:47
  So patients get the treatment at Zucker Hillside Hospital, as
• 18:52
  inpatient or outpatient.
• 18:54
  When they come as outpatient, they don't even have to change their
• 18:56
  clothes because it's a simple, brief procedure.
• 19:02
  The patients who are admitted, they are not admitted for ECT, but it's
• 19:07
  their condition that requires them to be in the hospital.
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  So if there is someone who is at risk of hurting themselves or other
• 19:16
  or they are in a condition where they cannot take care of themselves,
• 19:23
  that concludes part one of this conversation with Dr.
• 19:25
  Sohank Sangani and part two, which will be available in the coming
• 19:28
  weeks.
• 19:29
  We address the stigma surrounding the life saving treatment, as well
• 19:32
  as a look back on the origins of ECT and Zucker Hillside Hospital's
• 19:37
  historic role in its use and development over the years.
• 19:40
  Sandra
• 19:41
  Lindsay,
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  I'm Rob Hoell,
• 19:42
  have a great day and stay safe.