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Modern Day Application of Electroconvulsive Therapy (ECT)
Modern Electroconvulsive Therapy (ECT) is very safe and effective. It is a viable treatment option for patients whose medication or other treatments have failed to ease symptoms associated with some mental health issues. Today's ECT has evolved into a valuable treatment tool recognized by the National Institute of Mental Health, American Psychiatric Association, American Medical Association, and the U.S. Surgeon General. This episode will review the modern day application of Electroconvulsive Therapy (ECT) and address the benefits of the clinical intervention for Treatment Resistant Depression. Why would someone consider ECT?
Featured Speakers:
Learn more about Rene Compean, II MD
Rene Compean, II MD | Shahan Sibtain, MD
Rene Compean, II MD is a Bergen New Bridge Medical Center Psychiatry Resident.Learn more about Rene Compean, II MD
Shahan Sibtain, MD, serves as Chief Psychiatrist Ambulatory Services and Associate Residency Program Director at Bergen New Bridge Medical Center, Paramus.
Learn more about Shahan Sibtain, MD
Learn more about Shahan Sibtain, MD
Transcription:
Modern Day Application of Electroconvulsive Therapy (ECT)
Cheryl Martin: There are times that medication and therapy don't relieve the symptoms of severe depression or another mental health condition. But other options are available. One is modern electroconvulsive therapy or ECT. It's very safe and effective. And here to discuss this viable treatment and its benefits are Dr. Shahan Sibtain, the Chief of Ambulatory Psychiatry at Bergen New Bridge Medical Center, and Dr. Rene Compean, a third year psychiatry resident also at Bergen New Bridge.
This is Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm Cheryl Martin. Dr. Compean, let me begin with you. Talk about today's modern ECT, what it is and what it does.
Dr. Rene Compean: Sure. First of all, thank you for having me. So I will just start off with ECT stands for electroconvulsive therapy, as you mentioned. And this is a procedure that is done under general anesthesia where you have a small current that is passed through the brain. And at the end of it, you have a small brief seizure while the patient is asleep under anesthesia. And this helps change the way the brain communicates with each other. And it can help raise some hormones, for example, serotonin and dopamine, for example, with patients who have severe depression and can really be effective and quickly help the patients feel better. And it's important to know that the patients are not intubated and it is not invasive and they're under general anesthesia only for a few minutes.
Cheryl Martin: You mentioned some patients, but what are some other ideal patients for this treatment option? You mentioned those who are dealing with severe depression. What are others?
Dr. Rene Compean: Yeah, so severe depression, of course, is a very big one. We also have some patients who, you know, have what we call psychosis, some patients that hear voices who are very paranoid, it can also be effective in treating those symptoms. In addition, there are some patients who are severely depressed that do not want to eat or they're refusing to eat and we can also use ECT in these patients.
Cheryl Martin: You talked a little bit about the initial treatment, but how long are the treatments? Are they coming in for just one treatment? But what timeframe are we looking at? Dr. Sibtain, did you want to handle that one?
Dr. Shahan Sibtain: Yeah. Sure. Thank you again for having us, Cheryl. So as Dr. Compean just mentioned a few of the patients who are applicable to this treatment, not only actually involves just depression or psychosis, but in other cases catatonic patients and manic patients who are not responding to medication. Suicidality is a big one, which is used like usually the patients who are acutely suicidal or chronically suicidal. This treatment actually helps them for coming out of that.
As far as the treatment is concerned, the length of treatment, it varies usually somewhere from 10 to 12 sessions and it's recommended from various research done over a course of time that usually 12 sessions of treatment three times a week preferably shows benefits and resolution.
Cheryl Martin: You talked a little bit about the benefits of this clinical intervention. Talk also about compared to medicines, ECT works a lot more quickly?
Dr. Shahan Sibtain: That's very true, because usually the best treatment modalities which is recommended is pharmacotherapy along with psychotherapy. But that takes somewhere more than six to eight weeks to actually show some improvement. Whereas ECT, you start seeing improvement within days of treatment and that's why we emphasize that in treating depression or acute psychosis or acute suicidality. We get faster results with ECT, which is safer, and like the patient starts feeling the response themselves within few days to weeks.
Cheryl Martin: Can you provide even more statistics on the effectiveness of ECT?
Dr. Shahan Sibtain: So if you look at all the research trials which are done, we go back up until 1940s when the actual trial started. And now, the latest trial we had is from 2010 and '11, and we have seen at least 80% to 100% remission in patients who were given ECT treatment. Multiple studies have shown that these remission actually takes up to like two to three weeks to actually provide symptoms-free in these patients with ECT response. Resolution of suicidality is seen up to 50% to 60% of the cases where there's complete resolution of suicidality.
Cheryl Martin: Wow. Those statistics are very impressive, but would both of you say that ECT is underutilized? And if so, talk about the reasons for that and what needs to change in terms of getting the word out.
Dr. Shahan Sibtain: Definitely, I think this is an underutilized service, especially with the stigma around the society and how it has been portrayed over the course of time with whether it's cinematics or the notion the public has about ECT.
In the beginning era, of course, ECT was given as a shock treatment. The word shock treatment itself has a stigma attached to it. It was done not under anesthesia. A large amount of current was given to the patient. But now, with more research and improvement in the procedure, a very controlled seizure is delivered with a very small amount of current and in a very non-invasive way. So, again, I think with all these new developments, this is a modality we should utilize more often compared to how the perception is out there among the people and the society.
Cheryl Martin: Now, maybe Dr. Compean wants to answer this one. When a potential patient meets with you, what have you found to be some of the pressing questions that they have, the patient and/or the family?
Dr. Rene Compean: So one thing they usually will ask is I think, as we mentioned previously, some in the society, they see TV or movies where patients, they're being shocked and they're shaking uncontrollably and that's something that they believe is happening, you know, however, that's not the way it is. So that's one thing. That's usually one of the first questions. And of course after that, they like to know what the side effects are and how many procedures they will have to have and what exactly is ECT and how many times a week they would have to come, if they would have to stay in the hospital, can they come in the outpatient setting. Those are some of the bigger questions that we'll get asked.
Cheryl Martin: Please talk about the side effects.
Dr. Rene Compean: Sure. So some of the side effects, of course, you know, as you're under anesthesia, you might have a small headache and some nausea after the procedure. You might have some muscle aches and soreness as you have had a little bit of a shock treatment. Sometimes patients can have a little bit of confusion. However, compared to the past, the memory and confusion is very minimal. So sometimes people can forget a little bit before the ECT, of some memory loss. However, usually memories that were from a long time ago, usually those are not at risk of being lost. Sometimes, of course, people can have difficulty forming new memories. But it's been the new technology and the new treatment, it usually improves. And so far, I think of all the patients we've done, you know, memory has been a small issue.
Cheryl Martin: Are there any long-term negative effects, like memory troubles or dementia, Dr. Sibtain?
Dr. Shahan Sibtain: So, usually, the side effects of ECT, the bigger question, which comes to our like attention when the patients are there is memory because people keep on thinking and that this is going to affect the memory. Honestly, ECT does not impact memory in long-term. Usually, there is a very small transient loss of memory. But, as I said, it's a transient loss and it comes back. And that's commonly seen with bilateral ECT. With unilateral, we even see negligible or minimal amount of memory impaction or anything else. We don't see any dementia or severe consequences or see a sequelae of side effects with ECT in the long run.
Cheryl Martin: You mentioned the initial treatment and it could be maybe up to 12. But after that, how long is it before a patient has to come back. I assume that this one time initial treatment is not enough, those series of treatments.
Dr. Shahan Sibtain: Yes. So there are certain percentage of people who do really good with 12 sessions of treatment. And there is an remission of symptoms that they become symptoms free. But then, there is certain percentage of population who need a continuation or maintenance of ECT. So instead of giving treatment three times a week, we usually taper it down to preferably once a week and then probably once a month. And that's comprises of at least four to six treatments. After which, we see a complete remission or what we call symptoms-free period.
Cheryl Martin: And how long would that period last let's say on average?
Dr. Shahan Sibtain: So, if I have to look at the actual numbers, people can go up to six months or in some cases, a year symptoms-free, and be on a minimal dose of medication or in some cases without medication.
Cheryl Martin: Is this therapy available for children, Dr. Compean?
Dr. Rene Compean: Not that I am aware.
Dr. Shahan Sibtain: I would like to answer that.
Cheryl Martin: Sure. Go right ahead, Dr. Sibtain.
Dr. Shahan Sibtain: So, as for the children, FDA has not approved this treatment below the age of 18. It's only approved for adults for several reasons, as there has been no studies, any research trials. And of course, as we discuss about the stigma, it's not appropriate to even do any research or studies on children. So it's limited only to adults for now.
Cheryl Martin: And at Bergen New Bridge Medical, is ECT available for inpatient as well as outpatient?
Dr. Shahan Sibtain: Yes. We have inpatient and outpatient ECT treatment available for our patient population and the community. And I would like to draw some difference between inpatient and outpatient, just so that people can understand it better. Usually, for inpatient ECT, you have to get admitted in the hospital and get treatment three times a week. And of course, that also requires you to stay away from your family, be in a hospital setting. Now, with this modern technology and improvement in the medicine, it's possible to get this treatment in the outpatient setting. You come on the day of treatment, get the treatment and, a couple of hours later, you can go back home. Of course, this is an add-on to like the treatment, because you get to go home the same day, can resume your lighter activities and be a part of your family and you'll be in the same environment, which is more therapeutic once you are with your family and loved ones.
Cheryl Martin: That's great. Now does medical insurance typically cover ECT, or Medicare?
Dr. Shahan Sibtain: Usually, most of the insurance, including Medicare and private, they cover ECT. We have had no issues getting authorization through the insurance.
Cheryl Martin: Now, for your program, does a patient need a physician referral? How does that work?
Dr. Shahan Sibtain: Not necessarily. A patient can request evaluation themselves. We have a direct line for ECT requests. Of course, majority of our patients are coming through referral process because they are advised by their own psychiatrist who referred them for this service. But not necessarily that they need a service referral for.
Cheryl Martin: And this is a question that either one of you can answer or both, as you look at the work that you've done, is there one success story that really sticks out that you at the end of the day was just so happy when you looked at the results as well as the patient?
Dr. Shahan Sibtain: I honestly feel proud in the work I do because it's not just one but several stories. And it's their personal life, which is in front of my patients and they talk about it. And again, if I have to say, one person who actually came in was belligerently psychotic, and not even realizing what she is doing, and was actually given ECT treatment in the hospital. And after first treatment, she realized what a difference it has made and not only that she agreed for the further treatment, she completed the course. And the family was amazed at how she responded with the treatment and was completely turned around in the symptoms. Like it works. And sometimes I feel until you actually go through the treatment and see it for yourself, what a difference it can make in the quality of life and how it will improve not only your life, but people around you. It's something which the words cannot describe.
Dr. Rene Compean: Yes, I would like to add to that as well, as the same case. However, there is another, as Dr. Sibtain mentioned, not only the patient but also the family. So I had a patient who was very depressed and he was admitted to the hospital and he had only four sessions done. And when he went home, his wife, you know, said it was a new person and she could not believe how good he was doing. He had not been seen that good in many, many years, you know, and he was able to get back to his quality of life that, you know, he and she didn't think was possible. But you know, they put their trust in us and he had the ECT done and as Dr. Sibtain said, not only when you see the patients doing better, but the family, the children, you know, it's the greatest feeling as a psychiatrist that we can have.
Cheryl Martin: That's great. And what a wonderful way to wrap up our discussion about electroconvulsive therapy, ECT. Thanks so much to both of you for giving us an overview of modern ECT and its positive benefits, and for sharing those stories. Dr. Shahan Sibtain, the Chief of Ambulatory Psychiatry and Dr. Rene Compean, a third year psychiatry resident, both at Bergen New Bridge Medical Center.
To learn more about ECT, just visit newbridgehealth.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the podcast library for other topics of interest to you. Thanks for listening to this episode of Wellness Waves.
Modern Day Application of Electroconvulsive Therapy (ECT)
Cheryl Martin: There are times that medication and therapy don't relieve the symptoms of severe depression or another mental health condition. But other options are available. One is modern electroconvulsive therapy or ECT. It's very safe and effective. And here to discuss this viable treatment and its benefits are Dr. Shahan Sibtain, the Chief of Ambulatory Psychiatry at Bergen New Bridge Medical Center, and Dr. Rene Compean, a third year psychiatry resident also at Bergen New Bridge.
This is Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm Cheryl Martin. Dr. Compean, let me begin with you. Talk about today's modern ECT, what it is and what it does.
Dr. Rene Compean: Sure. First of all, thank you for having me. So I will just start off with ECT stands for electroconvulsive therapy, as you mentioned. And this is a procedure that is done under general anesthesia where you have a small current that is passed through the brain. And at the end of it, you have a small brief seizure while the patient is asleep under anesthesia. And this helps change the way the brain communicates with each other. And it can help raise some hormones, for example, serotonin and dopamine, for example, with patients who have severe depression and can really be effective and quickly help the patients feel better. And it's important to know that the patients are not intubated and it is not invasive and they're under general anesthesia only for a few minutes.
Cheryl Martin: You mentioned some patients, but what are some other ideal patients for this treatment option? You mentioned those who are dealing with severe depression. What are others?
Dr. Rene Compean: Yeah, so severe depression, of course, is a very big one. We also have some patients who, you know, have what we call psychosis, some patients that hear voices who are very paranoid, it can also be effective in treating those symptoms. In addition, there are some patients who are severely depressed that do not want to eat or they're refusing to eat and we can also use ECT in these patients.
Cheryl Martin: You talked a little bit about the initial treatment, but how long are the treatments? Are they coming in for just one treatment? But what timeframe are we looking at? Dr. Sibtain, did you want to handle that one?
Dr. Shahan Sibtain: Yeah. Sure. Thank you again for having us, Cheryl. So as Dr. Compean just mentioned a few of the patients who are applicable to this treatment, not only actually involves just depression or psychosis, but in other cases catatonic patients and manic patients who are not responding to medication. Suicidality is a big one, which is used like usually the patients who are acutely suicidal or chronically suicidal. This treatment actually helps them for coming out of that.
As far as the treatment is concerned, the length of treatment, it varies usually somewhere from 10 to 12 sessions and it's recommended from various research done over a course of time that usually 12 sessions of treatment three times a week preferably shows benefits and resolution.
Cheryl Martin: You talked a little bit about the benefits of this clinical intervention. Talk also about compared to medicines, ECT works a lot more quickly?
Dr. Shahan Sibtain: That's very true, because usually the best treatment modalities which is recommended is pharmacotherapy along with psychotherapy. But that takes somewhere more than six to eight weeks to actually show some improvement. Whereas ECT, you start seeing improvement within days of treatment and that's why we emphasize that in treating depression or acute psychosis or acute suicidality. We get faster results with ECT, which is safer, and like the patient starts feeling the response themselves within few days to weeks.
Cheryl Martin: Can you provide even more statistics on the effectiveness of ECT?
Dr. Shahan Sibtain: So if you look at all the research trials which are done, we go back up until 1940s when the actual trial started. And now, the latest trial we had is from 2010 and '11, and we have seen at least 80% to 100% remission in patients who were given ECT treatment. Multiple studies have shown that these remission actually takes up to like two to three weeks to actually provide symptoms-free in these patients with ECT response. Resolution of suicidality is seen up to 50% to 60% of the cases where there's complete resolution of suicidality.
Cheryl Martin: Wow. Those statistics are very impressive, but would both of you say that ECT is underutilized? And if so, talk about the reasons for that and what needs to change in terms of getting the word out.
Dr. Shahan Sibtain: Definitely, I think this is an underutilized service, especially with the stigma around the society and how it has been portrayed over the course of time with whether it's cinematics or the notion the public has about ECT.
In the beginning era, of course, ECT was given as a shock treatment. The word shock treatment itself has a stigma attached to it. It was done not under anesthesia. A large amount of current was given to the patient. But now, with more research and improvement in the procedure, a very controlled seizure is delivered with a very small amount of current and in a very non-invasive way. So, again, I think with all these new developments, this is a modality we should utilize more often compared to how the perception is out there among the people and the society.
Cheryl Martin: Now, maybe Dr. Compean wants to answer this one. When a potential patient meets with you, what have you found to be some of the pressing questions that they have, the patient and/or the family?
Dr. Rene Compean: So one thing they usually will ask is I think, as we mentioned previously, some in the society, they see TV or movies where patients, they're being shocked and they're shaking uncontrollably and that's something that they believe is happening, you know, however, that's not the way it is. So that's one thing. That's usually one of the first questions. And of course after that, they like to know what the side effects are and how many procedures they will have to have and what exactly is ECT and how many times a week they would have to come, if they would have to stay in the hospital, can they come in the outpatient setting. Those are some of the bigger questions that we'll get asked.
Cheryl Martin: Please talk about the side effects.
Dr. Rene Compean: Sure. So some of the side effects, of course, you know, as you're under anesthesia, you might have a small headache and some nausea after the procedure. You might have some muscle aches and soreness as you have had a little bit of a shock treatment. Sometimes patients can have a little bit of confusion. However, compared to the past, the memory and confusion is very minimal. So sometimes people can forget a little bit before the ECT, of some memory loss. However, usually memories that were from a long time ago, usually those are not at risk of being lost. Sometimes, of course, people can have difficulty forming new memories. But it's been the new technology and the new treatment, it usually improves. And so far, I think of all the patients we've done, you know, memory has been a small issue.
Cheryl Martin: Are there any long-term negative effects, like memory troubles or dementia, Dr. Sibtain?
Dr. Shahan Sibtain: So, usually, the side effects of ECT, the bigger question, which comes to our like attention when the patients are there is memory because people keep on thinking and that this is going to affect the memory. Honestly, ECT does not impact memory in long-term. Usually, there is a very small transient loss of memory. But, as I said, it's a transient loss and it comes back. And that's commonly seen with bilateral ECT. With unilateral, we even see negligible or minimal amount of memory impaction or anything else. We don't see any dementia or severe consequences or see a sequelae of side effects with ECT in the long run.
Cheryl Martin: You mentioned the initial treatment and it could be maybe up to 12. But after that, how long is it before a patient has to come back. I assume that this one time initial treatment is not enough, those series of treatments.
Dr. Shahan Sibtain: Yes. So there are certain percentage of people who do really good with 12 sessions of treatment. And there is an remission of symptoms that they become symptoms free. But then, there is certain percentage of population who need a continuation or maintenance of ECT. So instead of giving treatment three times a week, we usually taper it down to preferably once a week and then probably once a month. And that's comprises of at least four to six treatments. After which, we see a complete remission or what we call symptoms-free period.
Cheryl Martin: And how long would that period last let's say on average?
Dr. Shahan Sibtain: So, if I have to look at the actual numbers, people can go up to six months or in some cases, a year symptoms-free, and be on a minimal dose of medication or in some cases without medication.
Cheryl Martin: Is this therapy available for children, Dr. Compean?
Dr. Rene Compean: Not that I am aware.
Dr. Shahan Sibtain: I would like to answer that.
Cheryl Martin: Sure. Go right ahead, Dr. Sibtain.
Dr. Shahan Sibtain: So, as for the children, FDA has not approved this treatment below the age of 18. It's only approved for adults for several reasons, as there has been no studies, any research trials. And of course, as we discuss about the stigma, it's not appropriate to even do any research or studies on children. So it's limited only to adults for now.
Cheryl Martin: And at Bergen New Bridge Medical, is ECT available for inpatient as well as outpatient?
Dr. Shahan Sibtain: Yes. We have inpatient and outpatient ECT treatment available for our patient population and the community. And I would like to draw some difference between inpatient and outpatient, just so that people can understand it better. Usually, for inpatient ECT, you have to get admitted in the hospital and get treatment three times a week. And of course, that also requires you to stay away from your family, be in a hospital setting. Now, with this modern technology and improvement in the medicine, it's possible to get this treatment in the outpatient setting. You come on the day of treatment, get the treatment and, a couple of hours later, you can go back home. Of course, this is an add-on to like the treatment, because you get to go home the same day, can resume your lighter activities and be a part of your family and you'll be in the same environment, which is more therapeutic once you are with your family and loved ones.
Cheryl Martin: That's great. Now does medical insurance typically cover ECT, or Medicare?
Dr. Shahan Sibtain: Usually, most of the insurance, including Medicare and private, they cover ECT. We have had no issues getting authorization through the insurance.
Cheryl Martin: Now, for your program, does a patient need a physician referral? How does that work?
Dr. Shahan Sibtain: Not necessarily. A patient can request evaluation themselves. We have a direct line for ECT requests. Of course, majority of our patients are coming through referral process because they are advised by their own psychiatrist who referred them for this service. But not necessarily that they need a service referral for.
Cheryl Martin: And this is a question that either one of you can answer or both, as you look at the work that you've done, is there one success story that really sticks out that you at the end of the day was just so happy when you looked at the results as well as the patient?
Dr. Shahan Sibtain: I honestly feel proud in the work I do because it's not just one but several stories. And it's their personal life, which is in front of my patients and they talk about it. And again, if I have to say, one person who actually came in was belligerently psychotic, and not even realizing what she is doing, and was actually given ECT treatment in the hospital. And after first treatment, she realized what a difference it has made and not only that she agreed for the further treatment, she completed the course. And the family was amazed at how she responded with the treatment and was completely turned around in the symptoms. Like it works. And sometimes I feel until you actually go through the treatment and see it for yourself, what a difference it can make in the quality of life and how it will improve not only your life, but people around you. It's something which the words cannot describe.
Dr. Rene Compean: Yes, I would like to add to that as well, as the same case. However, there is another, as Dr. Sibtain mentioned, not only the patient but also the family. So I had a patient who was very depressed and he was admitted to the hospital and he had only four sessions done. And when he went home, his wife, you know, said it was a new person and she could not believe how good he was doing. He had not been seen that good in many, many years, you know, and he was able to get back to his quality of life that, you know, he and she didn't think was possible. But you know, they put their trust in us and he had the ECT done and as Dr. Sibtain said, not only when you see the patients doing better, but the family, the children, you know, it's the greatest feeling as a psychiatrist that we can have.
Cheryl Martin: That's great. And what a wonderful way to wrap up our discussion about electroconvulsive therapy, ECT. Thanks so much to both of you for giving us an overview of modern ECT and its positive benefits, and for sharing those stories. Dr. Shahan Sibtain, the Chief of Ambulatory Psychiatry and Dr. Rene Compean, a third year psychiatry resident, both at Bergen New Bridge Medical Center.
To learn more about ECT, just visit newbridgehealth.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the podcast library for other topics of interest to you. Thanks for listening to this episode of Wellness Waves.