Inpatient care, ECT treatments can help depression when meds, therapy fall short

The stigma surrounding depression only grows with the level of treatment it takes to address it — when antidepressants and counseling aren’t enough, Geisinger’s Dr. Stephen Paolucci relayed that inpatient care and — in some cases — even electroconvulsive therapy (ECT) may be necessary.

“If a patient can address depressive issues in an outpatient environment at home, then that’s usually best, but sometimes, the depression can be so overwhelming that the person can’t cope in their home situation,” he said. “If there is a concern of safety, especially if there are concerns of suicide, an inpatient approach may be best.”

Paolucci admitted that staying at an inpatient mental health program comes with additional stigma, and that these types of treatments can be intimidating.

“There is no doubt it can be a very stressful unit. A lot of people there can be very ill and present some special challenges, but it also can provide an amazing opportunity to heal,” he said. “You can talk with others with similar issues and it helps to know you are not alone. If you are struggling with an illness, the staff can be right there to help. They specialize in this and can definitely get you through a variety of situations.”

The inpatient approach definitely worked for Elysburg/Danville native Sarah Sees a few years ago when she was struggling with depression as a military wife and mother of two young girls.

“I felt I had to be in a place where my kids were taken care of first before I could get myself help.

I got to a point where I couldn’t handle it,” she said. “My husband carries a gun for work. My depression got so bad that if I knew where his gun was, I likely would have shot myself. I knew at that point I needed help.”

After a few other treatment options failed, she went to a Centre County inpatient program.

“I checked myself into the Meadows (a 117-bed private behavioral health care facility near State College). I was there for 12 days,” said Sees. “They were definitely equipped to help me with my issues, and I greatly benefitted in a more specialized mental health facility.”

Electroconvulsive treatment

Patients that suffer from severe depression that doesn’t respond to antidepressants or other therapeutic stimuli may be best helped by ECT, according to Paolucci.

“It is one of the oldest treatments we have — it dates back to the early 1900s when doctors were studying neurology and decided that seizures were curative in some cases of schizophrenia,” he said. “The early use of this was pretty gruesome. They started with unmodified treatments, but surprisingly enough, it was helpful for some schizophrenic patients who later were determined to instead be suffering from severe depression.”

In the 100-plus years since, the ECT treatments have been significantly refined and improved and is surprisingly effective in many cases, according to Paolucci.

Unfortunately, misconceptions and stigma about the treatment can deter patients.

“So many television shows and movies paint a picture of the psych asylum being some sort of evil place and treatments like ECT are not represented in a positive fashion,” he said. “It doesn’t help that so many already see depression, mental illness and anxiety as some sort of personal failure when that couldn’t be further from the truth.”

Michelle Miller, of Miffflinburg, received nine ECT treatments in 2017 at Geisinger.

“ECT is three times a week usually Monday, Wednesday and Friday. You arrive at the hospital at 6 a.m. and are given an IV. There are typically three beds that are devoted to people getting ECT that day,” she said. “When it is your turn, they take you back to a small room and attach electrodes to your head on each side by your temples. You are given a bite guard to put in your mouth so when they induce the shock, you don’t bite your tongue. After that is in place, they give you a medicine through your IV and you’re given something to put you to sleep through a mask. You wake up in recovery and are sent home the same day.”

While the treatment regimen ultimately didn’t help Miller as she had hoped, Paolucci said the procedure is much more effective for most people than most people realize.

80-90 percent effective

“Specific medications can be helpful in 40 to 60 percent of people, and if you develop a medicine that consistently makes a difference in 60 percent of patients, you’re making $1 million,” he said. “When patients are selected properly for the ECT program, it is effective 80 to 90 percent of the time. And this isn’t the first line of treatment — these are typically people who didn’t respond to at the very least two to three different medication forms and various therapy attempts first, and ECT is still 80 to 90 percent effective.”

There are some cases in which ECT is not recommended, such as if the patient doesn’t do well with certain anesthetics, have a tumor in the head or other pre-screened conditions.

Paolucci said each treatment lasts approximately 30 seconds in which the electricity passed into the brain causes a seizure. The patient sleeps during the treatment and wakes up a few minutes later and is usually able to go home after that, if part of the outpatient treatment program. He said there are very few to no side effects for many people.

“You may not remember the events of that morning, and some people experience a headache afterward, but that typically can be treated with Tylenol or Motrin,” he said.

Others, including Miller, report some memory loss with the treatment.

Considering the severe situations these patients can be in, and how effective ECT treatments can be for some of these patients, Paolucci added that the process can be a real life-saver.

“We see patients that feel as though they’ve failed themselves, failed their families and failed at life in general. They consider themselves a bad spouse or parent or child and many times feel there is no reason to go on living or that people around them would be better off without them,” he said. “But there are options. There is a positive way out, but it isn’t always the same way out for each patient. If you are someone you care about are struggling, encourage them. Help them reach out and get the help they need.”