Secrets Revealed: ECT is benefitting more patients than ever before

“It is hidden in plain sight—many people are receiving this treatment and many people are benefiting from it,” says Brigham and Women’s Faulkner Hospital attending psychiatrist Dr. Benjamin Yudkoff of electroconvulsive therapy (ECT), which is now offered by the Department of Psychiatry on both an inpatient and outpatient level.

Depictions of ECT in popular culture have led many to believe the treatment is painful or a form of punishment. But Dr. Yudkoff says that simply isn’t true. “ECT is now done with anesthesia and muscle relaxants making the procedure very tolerable. People can experience discomfort related to the placement of an IV or the infusion of the anesthesia, but these are relatively minor discomforts. The ECT itself can result in headaches, which we either treat ahead of time with medicines similar to ibuprofen, or after the fact with ibuprofen or Tylenol. Discomfort is really minimal for the majority of people who are electing to receive ECT.”

ECT is a highly effective in treatment for a variety of different ailments, including major depressive disorder, bipolar disorder (both the manic and depressed phases), schizophrenia, obsessive compulsive disorder, neuroleptic malignant syndrome and catatonia. In fact, remission rates for depression and obsessive compulsive disorder are between 60 and 80 percent, and “It is the gold standard treatment for catatonia,” says Dr. Yudkoff. While the exact mechanism of ECT has not been identified, Dr. Yudkoff uses the analogy of exercise: “ECT is similar to going to the gym and working out. When you lift weights you apply a stress to the muscle and the muscle responds by releasing growth hormone and becoming more effective and efficient. With ECT, we’re using a low stimulus of electrical current to make brain cells become much more active. This stress results in changes in concentrations of all sorts of chemicals in the brain, including growth hormones, which results in the way the brain communicates with itself, ultimately leading to relief from psychiatric illness.”

At BWFH, all patients begin ECT on the 2 South inpatient psychiatric unit where they have a full psychiatric and medical evaluation prior to receiving ECT. “Depression is a symptom, not a disease. Hypomania or mania is a symptom, not a disease. We want to work with our patients to determine the correct diagnosis prior to starting any treatment, including ECT,” says Dr. Yudkoff. While some patients have the full course of treatment on the unit, most, when ready, leave the unit and continue as an outpatient. Some patients might have a one-off course of treatment (usually spanning two to three weeks) and then have it again. Others may elect to have an intensive two to three week treatment course (consisting of three treatments per week) and then taper the treatment slowly over weeks to months. Others still will receive “maintenance” ECT on a fixed schedule indefinitely. Patient preference, tolerance, comfort and treatment requirements dictate the schedule.

The decision to start ECT can be a difficult one for patients and their families to make. “When people tell me they are frightened by ECT, I talk with them about the reality, not the reputation. It’s extremely safe. The rates of complications are very low and the rates of success are very high,” says Dr. Yudkoff. “ECT is not just for people with the severest forms of depression, but, due to its safety and efficacy, it is available to anyone who has failed adequate treatment with antidepressants. It is becoming an increasingly popular option—it has even become more common than appendectomies in the United States. A lot of people are getting it, but very few people are speaking about it. We also take a lot of pride in the environment in which ECT is provided here at BWFH. The nurses are incredibly skilled, they understand what people go through and they really can help motivate people to get better. It is profound to see the speed at which people recover from mental illness when they incorporate ECT into their treatment regimen.”

Because it is both safe and effective, the Department of Psychiatry at BWFH hopes by 2018 to be able to offer ECT on the outpatient level without first admitting patients to 2 South.