March 8, 2023 • 19 mins
Electroconvulsive therapy (ECT) carries stigma thanks to negative portrayals in movies like "One Flew Over the Cuckoo's Nest." Such portrayals hide ECT's true value — and the truth about the treatment: ECT has a decades-long track record of safety, and it offers a fast-acting solution for difficult-to-treat severe depression. ECT is also effective for patients with suicidal ideation or depression with psychosis or catatonia, says Sohag Sanghani, MD. He joins Sandra Lindsay, RN, and Rob Hoell to dispel myths and misunderstandings around ECT. In Part 1 of this two-part episode, the director of the ECT service at Zucker Hillside Hospital — which was among the first few in the US to ever use ECT in 1941 — explains how ECT works, who benefits from the treatment and how it changes lives.
Chapters:
- 00:01 - Intro
- 01:33 - ECT patient perspective
- 03:36 - What is ECT?
- 04:49 - What happens during ECT?
- 06:10 - Evolution of ECT
- 07:11 - Who gets ECT?
- 08:26 - Is ECT more effective than medications?
- 10:20 - Continuation ECT
- 11:38 - ECT's impact on patients
- 12:34 - What makes ECT so effective?
- 14:48 - ECT side effects
- 17:56 - Life after ECT treatment
More from Northwell Health:
- Learn about ECT from the patient's perspective.
- The healing power of vagus nerve stimulation
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Rob (host) (00:05):
Welcome to 20-Minute Health Talk.
I'm Rob Hoell.
Sandra (host) (00:08):
And I'm Sandra Lindsay.
Rob (00:09):
Today we got a great show.
We're talking about ECT, which is electroconvulsive therapy.
It's been around for a long time.
It's got a little bit of stigma attached to it, but it's a highly
effective treatment for treating people with severe depression,
bipolar disorder, and schizophrenia.
Sandra (00:23):
That's correct
Rob.
I read these stats that just blew me away.
Over 100,000 patients get treated with ECT annually, and it's
effective in eight out of ten patients who suffer from major
depression.
They find relief in ECT, and as you mentioned, it's been around for
(00:44):
over 80 years.
Rob (00:45):
Yeah.
You talk to people, and a lot of people that you talk to say, I was
hesitant to get this because it sounds scary,
right?
Electro convulsive therapy.
But I'm so glad I did, because I was at the end of my rope.
I tried everything, and this really helped me to get my life back.
Sandra (01:04):
I listened to that interview you did, and the patient described it as
not scary at all.
When I listened to her story, it was heartbreaking and heartwarming at
the same time.
She had an amazing outcome.
Yeah.
Rob (01:19):
Her name is Katherine Gorleski.
And I was just so blown away by her interview because it basically
changed her life.
And talking to her, she knew exactly when she started ECT because it
was the last time she attempted to commit suicide.
Katherine (01:34):
I have so much more happiness in my life than before.
Not only happy to be alive, I want to be alive, and I want to be
happy.
Rob (01:48):
She suffers from bipolar disorder, and it really crippled her.
Where she couldn't hold a job, her relationships with people weren't
any good, and now she's doing this maintenance ECT, and she's got her
life back, and she's happy, and she became an advocate for ECT.
So I think it's really important to get the word out and let people
know about this, because there's not enough information out there
(02:09):
about it.
Sandra (02:11):
So your interview was so powerful, and just to hear or share a story I
remember that date.
I think it was February 2015.
Rob (02:19):
Yeah.
And that interview was so impactful to me.
I wanted to learn more and take a deeper dive into this.
So I reached out to Dr.
Sohag Sanghani, who is the director of Zucker Hillside Hospital's ECT
Service.
In part one of this two part interview, he breaks down how ECT works
and how it benefits patients like Catherine.
In part two, we get into the long history of ECT, addressing the
(02:42):
stigma surrounding this life saving treatment, and how Zucker Hillside
Hospital has been a leader in its evolution over the years.
Sandra (02:59):
Good afternoon,
Dr.
Sanghani, it's such a pleasure to meet you.
I've heard so much about you.
Dr. Sanghani (03:04):
Dr.
Lindsay, thank you so much for having me.
It's an honor. Please call me Sandra.
It's an honor to meet you.
I've heard a lot about you, and we have seen your videos and pictures,
and it's such an honor and pleasure to meet you in person.
Same here.
This is awesome.
This is going to be a great conversation because we're talking about
something that's highly effective, that's a fantastic treatment for
(03:27):
people with depression and bipolar, which is electroconvulsive
therapy.
But there's also a big stigma around it, and we're going to help kind
of break that down today.
Yeah.
So, for listeners, what is ECT?
Sure.
ECT stands for Electroconvulsive Therapy.
It is the most rapidly acting antidepressant treatment, and it's also
(03:52):
very effective in patients who have suicidal ideation or depression
with psychosis or catatonia.
We use electricity to stimulate the brain, and many people are
surprised to know that the actual time for which we stimulate the
brain is a couple of seconds.
And even within those couple of seconds, the actual time for which the
(04:15):
charge is being delivered is less than a second.
So think of it like this.
You take a charge which is less than a second, and then you spread it
into a few milliseconds and give it in small pulses, and that is
administered over a couple of seconds, and that induces a seizure,
which is very controlled, and it lasts for about a minute.
(04:38):
And then the patient wakes up in about five to ten minutes.
It takes them for another 20 minutes to get oriented to the
surrounding.
We give them some juice to drink to make sure they're able to tolerate
it okay.
And once they are fully awake, their vitals are stable.
If they are admitted on an inpatient unit, they would go back to the
inpatient unit.
(04:58):
If they're coming from home, they'd go back home.
So what you talked about before being simple.
I sat in on one of these procedures, and as a videographer, just to
record it, for awareness, to let people know what happens.
And it was kind of boring because not much happened in those few
minutes.
And the doctor told me this is one of the shortest procedures there is
in medicine.
(05:19):
And, Rob, it's funny that you say that, because we hear the same thing
from medical students.
They come in to observe a treatment, and they're coming in, expecting
a lot of drama, and then the treatment is over, and they say, that's
it.
I'm like, yeah, there's not much drama here at Zucker Hillside, family
members bring the patients for the treatment.
(05:39):
They come in their own clothes, they get an IV.
A nurse meets them, does a brief memory evaluation, and then a
psychiatrist comes in, meets the patient, puts the sticky pads on,
which are the stimulus electrodes.
Anesthesiologist comes in, we do a time out.
We make sure.
(06:00):
We are all on the same page and all the anesthesia is given through
IV.
We are giving anesthesia because we are giving muscle relaxant.
So ECT was invented in 1938.
Between 1938 and 1950, it was done without anesthesia and patients
(06:21):
used to come for subsequent treatments.
This was the most effective treatment.
And if it was painful or anything like that, no one would come back
for the second treatment.
But it's mainly during that period when we were doing it without
anesthesia.
The stimulus, those few seconds would produce an intense contraction.
(06:46):
So the body would go in a tonic contraction and those contractions
used to sometimes result in fractures.
So to prevent that, we have to give muscle relaxant.
And whenever you're giving someone a muscle relaxant, you have to give
them general anesthesia because their breathing is also going to stop
at that time.
So we give general anesthesia followed by muscle relaxant, and then we
(07:11):
do the stimulus.
So how do you make the decision to get to ECT?
How is it prescribed?
Is it after unsuccessful medical therapy or if somebody has suicidal
ideations, attempted suicide before, do you go immediately to ECT or
(07:32):
do you try medications first?
So it varies from patient to patient and it all depends on the urgency
of the situation.
So ECT is the treatment of choice when someone has severe depression
with suicidal ideation or psychotic features.
And the treating psychiatrist usually would make a decision as to how
(07:57):
urgent is the need.
If they can wait to try for medication, they would do that.
But if the patient is not eating, not drinking very catatonic, then
they would go for ECT, right?
They may try other medication and then immediately go for ECT.
(08:17):
There are conditions where sometimes they would wait for a couple of
weeks for medications to work.
But if they're not getting enough results, then they would go for ECT.
Now, once a patient starts ECT, do you have patients who are also on
medications or is it one or the other?
(08:38):
Most patients are on medications and we actually encourage patients to
stay on some of the medications now when they are getting ECT.
ECT's effect supersedes that of medication.
But being on medication helps, helps in the maintenance phase.
Think of it like a dose.
(09:00):
When the treatments are closed together.
That's where it is the strongest dose.
Once you are spacing it out, you are reducing the dose of ECT.
And that's where if there's a medication on board along with ECT, ECT
plus medication supersedes the effect of either alone.
So what's the treatment program then
(09:22):
for ECT? The goal is to have improvement in the symptoms.
The treatments have to be done close together, so one treatment itself
does not induce too much of a clinical change.
So we have to do the treatments close together two to three times per
(09:43):
week in order to reduce the memory side effects.
We try to do it alternate days, two to three times per week.
And at some point when the patient starts to show improvement, we
continue it as long as there is incremental improvement.
Typically what we have seen, especially for depression, is that you
(10:07):
start to see improvement somewhere between fourth and 6th treatment.
Then you start to see more and more improvement with each treatment.
And by eight or ten treatment, the patient improvement plateaus.
Once we have reached the point of maximum improvement, then we start
to space out the treatment.
And that phase is called continuation.
(10:28):
Now, 15% of patients, 1 5 percent of patients may reach that plateau
within four to six treatments.
And for them it works like a miracle.
And then there are some people who are late responders.
So usually if someone does for depression, if someone does not respond
(10:48):
by twelve treatments, then we say it's not working, let's stop.
Although recently there is some research that suggests that if the
patient is tolerating it okay, we can go even up to 18 treatments.
ECT is prescribed for depression.
It is also prescribed for treatment resistant schizophrenia and
(11:09):
sometimes treatment resistant mania.
And in treatment resistant schizophrenia we go up to even 20
treatments, and its efficacy varies between different disorders.
As far as describing clinical improvement, we look at the symptoms,
patients report, caregivers report, and our own evaluation.
(11:33):
So before each treatment we do evaluate the patient and then make a
decision.
Yeah, I actually interviewed a patient who told me that she was pretty
much at the end of her rope.
And she says since she started doing ECT, she is able to have a job,
she's able to maintain relationships.
She says she's more even keel.
She doesn't have those highs and those lows that she used to have in
(11:55):
suffer from depression anymore.
And she basically said it was a life changer.
Do you get
people like that.
We often hear those stories.
So patients are referred to us either because of severity of illness
or chronic treatment resistant nature of the illness.
We may get patients who are very severely ill and they need to get
(12:17):
better very quickly.
They don't have enough time where we can keep trying different
medications.
On the other hand, we also get patients who have tried so many
medication options and their episodes of depression keep coming and
then they come to us.
From what I understand how this procedure works, from what I was
(12:38):
getting, from talking to the doctor, it almost seems like a reboot.
I said is it like you're rebooting your computer?
And he said actually it is.
He's like the computer is fine, your brain is fine, it works.
But sometimes it has some bugs in it and it's like a deep debug.
You reboot the computer.
Is that how ECT works?
Now you're asking a million dollar question.
It's a great analogy about analogy about computer reboot.
(13:01):
But we get asked these questions a lot.
We know what it does in terms of what ECT does to the brain, it is
very hard to pinpoint.
Is there one particular mechanism that is responsible for the
therapeutic efficacy?
ECT can treat depression, it can also treat mania, which is opposite
(13:27):
of depression.
ECT can help with treatment resistance, schizophrenia or psychosis.
And even when patients with depression have psychotic features, ECT
works very well.
It is effective in both those conditions.
And currently the hypothesis is that because it does so many things at
(13:48):
the same time, it's multiple mechanisms working together.
And those mechanisms, what are they?
It affects different neurotransmitters.
It also affects the Hormonal axis, so it normalizes the hormonal axis,
(14:08):
it improves connections in the synapses.
So it's called neuroplasticity where the connection between the
neurons is improved.
It also proliferates neuronal growth and along with that, it also
affects some neuropeptides and expression of certain genes.
So because it is doing all of these things together, it works better
(14:30):
than other medications and that's why we are not able to pinpoint and
say this one particular mechanism is responsible for its role in this
disorder versus another mechanism for the another disorder and likely
it's multitude mechanism you mentioned earlier spacing out treatments
to reduce side effects.
(14:52):
Are there side effects to ECT?
When you mentioned the computer
analogy, that might also explain help me explain the memory side
effects.
The most common side effects are actually headache and nausea, which
can be easily treated with medications.
(15:12):
The memory side effects of ECT are entering grade and retrograde
amnesia, which means events immediately before and after the treatment
are likely to be forgotten.
Now, think of memory in general, right?
If you want to remember something, the first thing that needs to
happen is the event has to be registered in your brain.
(15:34):
Once you register the event, after some time, that memory gets stored
in different areas of the brain for long term storage.
That initial registration happens in an area called Hippocampus.
During ECT treatment, when you are doing the treatments close together
two to three times per week, that registration gets affected because
(15:58):
the Hippocampus is the one that gets stimulated the most.
And if the event is not registered properly, you won't be able to get
it back.
Hippocampus also works as a gateway.
So all the long term memories, even when you have to recall them, they
also come out through the Hippocampus pathway.
(16:21):
So when you talk about your computer analogy, if you are rebooting the
computer, if you did not save the file properly, you won't be able to
get it back.
But if the file is already saved properly, it is there.
Sometimes what happens is the pathway to access that file may get
(16:42):
corrupt and you may need some clues to remind you of the old memories
and then the old memory comes back.
So after the acute course of ECT, within ten days to couple of weeks,
most people's ability to register and recall new information is back
(17:02):
to normal.
As far as the long term memory, the retrospective memory or retrograde
amnesia, which is events ranging from days to weeks and sometimes
months before getting ECT, those memories gradually get better within
couple of months.
So some people may need some clues to trigger old memories.
(17:25):
Occasionally, some people continue to have some spotiness in the
memory where certain life events, what we call as autobiographical
memory, some of those memories, despite clues, don't come back.
But most people find those side effects to be insignificant.
And the benefits of treating their psychiatric illness, which is
(17:50):
severe depression or schizophrenia, much better compared to that race.
Yes.
So as a staff nurse, I worked at Lennox Hill.
And I remember recovering ECT patients in the ICU.
That was a long time ago.
The way that ECT has kind of evolved, they no longer need ICU care
(18:17):
post ECT.
That's correct.
The recovery from ECT is very smooth.
It's just like any other anesthesia, any other procedure in the
general anesthesia.
Many of the hospitals, they don't have dedicated space for ECT.
And that's the reason most of the times it used to be done.
(18:38):
Even still, in many hospitals, it is done in ICU,
Pacu, but Zucker hillside,
we have a dedicated ECT suite.
So patients get the treatment at Zucker Hillside Hospital, as
inpatient or outpatient.
When they come as outpatient, they don't even have to change their
clothes because it's a simple, brief procedure.
(19:02):
The patients who are admitted, they are not admitted for ECT, but it's
their condition that requires them to be in the hospital.
So if there is someone who is at risk of hurting themselves or other
or they are in a condition where they cannot take care of themselves,
(19:23):
that concludes part one of this conversation with Dr.
Sohank Sangani and part two, which will be available in the coming
weeks.
We address the stigma surrounding the life saving treatment, as well
as a look back on the origins of ECT and Zucker Hillside Hospital's
historic role in its use and development over the years.
Sandra
Lindsay,
I'm Rob Hoell,
have a great day and stay safe.
Welcome to 20-Minute Health Talk.
I'm Rob Hoell.
Sandra (host) (00:08):
And I'm Sandra Lindsay.
Rob (00:09):
Today we got a great show.
We're talking about ECT, which is electroconvulsive therapy.
It's been around for a long time.
It's got a little bit of stigma attached to it, but it's a highly
effective treatment for treating people with severe depression,
bipolar disorder, and schizophrenia.
Sandra (00:23):
That's correct
Rob.
I read these stats that just blew me away.
Over 100,000 patients get treated with ECT annually, and it's
effective in eight out of ten patients who suffer from major
depression.
They find relief in ECT, and as you mentioned, it's been around for
(00:44):
over 80 years.
Rob (00:45):
Yeah.
You talk to people, and a lot of people that you talk to say, I was
hesitant to get this because it sounds scary,
right?
Electro convulsive therapy.
But I'm so glad I did, because I was at the end of my rope.
I tried everything, and this really helped me to get my life back.
Sandra (01:04):
I listened to that interview you did, and the patient described it as
not scary at all.
When I listened to her story, it was heartbreaking and heartwarming at
the same time.
She had an amazing outcome.
Yeah.
Rob (01:19):
Her name is Katherine Gorleski.
And I was just so blown away by her interview because it basically
changed her life.
And talking to her, she knew exactly when she started ECT because it
was the last time she attempted to commit suicide.
Katherine (01:34):
I have so much more happiness in my life than before.
Not only happy to be alive, I want to be alive, and I want to be
happy.
Rob (01:48):
She suffers from bipolar disorder, and it really crippled her.
Where she couldn't hold a job, her relationships with people weren't
any good, and now she's doing this maintenance ECT, and she's got her
life back, and she's happy, and she became an advocate for ECT.
So I think it's really important to get the word out and let people
know about this, because there's not enough information out there
(02:09):
about it.
Sandra (02:11):
So your interview was so powerful, and just to hear or share a story I
remember that date.
I think it was February 2015.
Rob (02:19):
Yeah.
And that interview was so impactful to me.
I wanted to learn more and take a deeper dive into this.
So I reached out to Dr.
Sohag Sanghani, who is the director of Zucker Hillside Hospital's ECT
Service.
In part one of this two part interview, he breaks down how ECT works
and how it benefits patients like Catherine.
In part two, we get into the long history of ECT, addressing the
(02:42):
stigma surrounding this life saving treatment, and how Zucker Hillside
Hospital has been a leader in its evolution over the years.
Sandra (02:59):
Good afternoon,
Dr.
Sanghani, it's such a pleasure to meet you.
I've heard so much about you.
Dr. Sanghani (03:04):
Dr.
Lindsay, thank you so much for having me.
It's an honor. Please call me Sandra.
It's an honor to meet you.
I've heard a lot about you, and we have seen your videos and pictures,
and it's such an honor and pleasure to meet you in person.
Same here.
This is awesome.
This is going to be a great conversation because we're talking about
something that's highly effective, that's a fantastic treatment for
(03:27):
people with depression and bipolar, which is electroconvulsive
therapy.
But there's also a big stigma around it, and we're going to help kind
of break that down today.
Yeah.
So, for listeners, what is ECT?
Sure.
ECT stands for Electroconvulsive Therapy.
It is the most rapidly acting antidepressant treatment, and it's also
(03:52):
very effective in patients who have suicidal ideation or depression
with psychosis or catatonia.
We use electricity to stimulate the brain, and many people are
surprised to know that the actual time for which we stimulate the
brain is a couple of seconds.
And even within those couple of seconds, the actual time for which the
(04:15):
charge is being delivered is less than a second.
So think of it like this.
You take a charge which is less than a second, and then you spread it
into a few milliseconds and give it in small pulses, and that is
administered over a couple of seconds, and that induces a seizure,
which is very controlled, and it lasts for about a minute.
(04:38):
And then the patient wakes up in about five to ten minutes.
It takes them for another 20 minutes to get oriented to the
surrounding.
We give them some juice to drink to make sure they're able to tolerate
it okay.
And once they are fully awake, their vitals are stable.
If they are admitted on an inpatient unit, they would go back to the
inpatient unit.
(04:58):
If they're coming from home, they'd go back home.
So what you talked about before being simple.
I sat in on one of these procedures, and as a videographer, just to
record it, for awareness, to let people know what happens.
And it was kind of boring because not much happened in those few
minutes.
And the doctor told me this is one of the shortest procedures there is
in medicine.
(05:19):
And, Rob, it's funny that you say that, because we hear the same thing
from medical students.
They come in to observe a treatment, and they're coming in, expecting
a lot of drama, and then the treatment is over, and they say, that's
it.
I'm like, yeah, there's not much drama here at Zucker Hillside, family
members bring the patients for the treatment.
(05:39):
They come in their own clothes, they get an IV.
A nurse meets them, does a brief memory evaluation, and then a
psychiatrist comes in, meets the patient, puts the sticky pads on,
which are the stimulus electrodes.
Anesthesiologist comes in, we do a time out.
We make sure.
(06:00):
We are all on the same page and all the anesthesia is given through
IV.
We are giving anesthesia because we are giving muscle relaxant.
So ECT was invented in 1938.
Between 1938 and 1950, it was done without anesthesia and patients
(06:21):
used to come for subsequent treatments.
This was the most effective treatment.
And if it was painful or anything like that, no one would come back
for the second treatment.
But it's mainly during that period when we were doing it without
anesthesia.
The stimulus, those few seconds would produce an intense contraction.
(06:46):
So the body would go in a tonic contraction and those contractions
used to sometimes result in fractures.
So to prevent that, we have to give muscle relaxant.
And whenever you're giving someone a muscle relaxant, you have to give
them general anesthesia because their breathing is also going to stop
at that time.
So we give general anesthesia followed by muscle relaxant, and then we
(07:11):
do the stimulus.
So how do you make the decision to get to ECT?
How is it prescribed?
Is it after unsuccessful medical therapy or if somebody has suicidal
ideations, attempted suicide before, do you go immediately to ECT or
(07:32):
do you try medications first?
So it varies from patient to patient and it all depends on the urgency
of the situation.
So ECT is the treatment of choice when someone has severe depression
with suicidal ideation or psychotic features.
And the treating psychiatrist usually would make a decision as to how
(07:57):
urgent is the need.
If they can wait to try for medication, they would do that.
But if the patient is not eating, not drinking very catatonic, then
they would go for ECT, right?
They may try other medication and then immediately go for ECT.
(08:17):
There are conditions where sometimes they would wait for a couple of
weeks for medications to work.
But if they're not getting enough results, then they would go for ECT.
Now, once a patient starts ECT, do you have patients who are also on
medications or is it one or the other?
(08:38):
Most patients are on medications and we actually encourage patients to
stay on some of the medications now when they are getting ECT.
ECT's effect supersedes that of medication.
But being on medication helps, helps in the maintenance phase.
Think of it like a dose.
(09:00):
When the treatments are closed together.
That's where it is the strongest dose.
Once you are spacing it out, you are reducing the dose of ECT.
And that's where if there's a medication on board along with ECT, ECT
plus medication supersedes the effect of either alone.
So what's the treatment program then
(09:22):
for ECT? The goal is to have improvement in the symptoms.
The treatments have to be done close together, so one treatment itself
does not induce too much of a clinical change.
So we have to do the treatments close together two to three times per
(09:43):
week in order to reduce the memory side effects.
We try to do it alternate days, two to three times per week.
And at some point when the patient starts to show improvement, we
continue it as long as there is incremental improvement.
Typically what we have seen, especially for depression, is that you
(10:07):
start to see improvement somewhere between fourth and 6th treatment.
Then you start to see more and more improvement with each treatment.
And by eight or ten treatment, the patient improvement plateaus.
Once we have reached the point of maximum improvement, then we start
to space out the treatment.
And that phase is called continuation.
(10:28):
Now, 15% of patients, 1 5 percent of patients may reach that plateau
within four to six treatments.
And for them it works like a miracle.
And then there are some people who are late responders.
So usually if someone does for depression, if someone does not respond
(10:48):
by twelve treatments, then we say it's not working, let's stop.
Although recently there is some research that suggests that if the
patient is tolerating it okay, we can go even up to 18 treatments.
ECT is prescribed for depression.
It is also prescribed for treatment resistant schizophrenia and
(11:09):
sometimes treatment resistant mania.
And in treatment resistant schizophrenia we go up to even 20
treatments, and its efficacy varies between different disorders.
As far as describing clinical improvement, we look at the symptoms,
patients report, caregivers report, and our own evaluation.
(11:33):
So before each treatment we do evaluate the patient and then make a
decision.
Yeah, I actually interviewed a patient who told me that she was pretty
much at the end of her rope.
And she says since she started doing ECT, she is able to have a job,
she's able to maintain relationships.
She says she's more even keel.
She doesn't have those highs and those lows that she used to have in
(11:55):
suffer from depression anymore.
And she basically said it was a life changer.
Do you get
people like that.
We often hear those stories.
So patients are referred to us either because of severity of illness
or chronic treatment resistant nature of the illness.
We may get patients who are very severely ill and they need to get
(12:17):
better very quickly.
They don't have enough time where we can keep trying different
medications.
On the other hand, we also get patients who have tried so many
medication options and their episodes of depression keep coming and
then they come to us.
From what I understand how this procedure works, from what I was
(12:38):
getting, from talking to the doctor, it almost seems like a reboot.
I said is it like you're rebooting your computer?
And he said actually it is.
He's like the computer is fine, your brain is fine, it works.
But sometimes it has some bugs in it and it's like a deep debug.
You reboot the computer.
Is that how ECT works?
Now you're asking a million dollar question.
It's a great analogy about analogy about computer reboot.
(13:01):
But we get asked these questions a lot.
We know what it does in terms of what ECT does to the brain, it is
very hard to pinpoint.
Is there one particular mechanism that is responsible for the
therapeutic efficacy?
ECT can treat depression, it can also treat mania, which is opposite
(13:27):
of depression.
ECT can help with treatment resistance, schizophrenia or psychosis.
And even when patients with depression have psychotic features, ECT
works very well.
It is effective in both those conditions.
And currently the hypothesis is that because it does so many things at
(13:48):
the same time, it's multiple mechanisms working together.
And those mechanisms, what are they?
It affects different neurotransmitters.
It also affects the Hormonal axis, so it normalizes the hormonal axis,
(14:08):
it improves connections in the synapses.
So it's called neuroplasticity where the connection between the
neurons is improved.
It also proliferates neuronal growth and along with that, it also
affects some neuropeptides and expression of certain genes.
So because it is doing all of these things together, it works better
(14:30):
than other medications and that's why we are not able to pinpoint and
say this one particular mechanism is responsible for its role in this
disorder versus another mechanism for the another disorder and likely
it's multitude mechanism you mentioned earlier spacing out treatments
to reduce side effects.
(14:52):
Are there side effects to ECT?
When you mentioned the computer
analogy, that might also explain help me explain the memory side
effects.
The most common side effects are actually headache and nausea, which
can be easily treated with medications.
(15:12):
The memory side effects of ECT are entering grade and retrograde
amnesia, which means events immediately before and after the treatment
are likely to be forgotten.
Now, think of memory in general, right?
If you want to remember something, the first thing that needs to
happen is the event has to be registered in your brain.
(15:34):
Once you register the event, after some time, that memory gets stored
in different areas of the brain for long term storage.
That initial registration happens in an area called Hippocampus.
During ECT treatment, when you are doing the treatments close together
two to three times per week, that registration gets affected because
(15:58):
the Hippocampus is the one that gets stimulated the most.
And if the event is not registered properly, you won't be able to get
it back.
Hippocampus also works as a gateway.
So all the long term memories, even when you have to recall them, they
also come out through the Hippocampus pathway.
(16:21):
So when you talk about your computer analogy, if you are rebooting the
computer, if you did not save the file properly, you won't be able to
get it back.
But if the file is already saved properly, it is there.
Sometimes what happens is the pathway to access that file may get
(16:42):
corrupt and you may need some clues to remind you of the old memories
and then the old memory comes back.
So after the acute course of ECT, within ten days to couple of weeks,
most people's ability to register and recall new information is back
(17:02):
to normal.
As far as the long term memory, the retrospective memory or retrograde
amnesia, which is events ranging from days to weeks and sometimes
months before getting ECT, those memories gradually get better within
couple of months.
So some people may need some clues to trigger old memories.
(17:25):
Occasionally, some people continue to have some spotiness in the
memory where certain life events, what we call as autobiographical
memory, some of those memories, despite clues, don't come back.
But most people find those side effects to be insignificant.
And the benefits of treating their psychiatric illness, which is
(17:50):
severe depression or schizophrenia, much better compared to that race.
Yes.
So as a staff nurse, I worked at Lennox Hill.
And I remember recovering ECT patients in the ICU.
That was a long time ago.
The way that ECT has kind of evolved, they no longer need ICU care
(18:17):
post ECT.
That's correct.
The recovery from ECT is very smooth.
It's just like any other anesthesia, any other procedure in the
general anesthesia.
Many of the hospitals, they don't have dedicated space for ECT.
And that's the reason most of the times it used to be done.
(18:38):
Even still, in many hospitals, it is done in ICU,
Pacu, but Zucker hillside,
we have a dedicated ECT suite.
So patients get the treatment at Zucker Hillside Hospital, as
inpatient or outpatient.
When they come as outpatient, they don't even have to change their
clothes because it's a simple, brief procedure.
(19:02):
The patients who are admitted, they are not admitted for ECT, but it's
their condition that requires them to be in the hospital.
So if there is someone who is at risk of hurting themselves or other
or they are in a condition where they cannot take care of themselves,
(19:23):
that concludes part one of this conversation with Dr.
Sohank Sangani and part two, which will be available in the coming
weeks.
We address the stigma surrounding the life saving treatment, as well
as a look back on the origins of ECT and Zucker Hillside Hospital's
historic role in its use and development over the years.
Sandra
Lindsay,
I'm Rob Hoell,
have a great day and stay safe.
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