Sentara and EVMS offer electroconvulsive therapy (ECT) for persistent depression
ECT is an option when antidepressants are not effective
Dolores Orrico, 71, has struggled with depression for decades. She counts seven major episodes since 1979, and at least seven different antidepressants prescribed by different doctors, none of which offered lasting relief.
“I was functioning,” she said. “I was cooking, cleaning, and socializing with our friends, but I was really very down. Depression runs in my family, and I was desperate.”
In 2023, Orrico had a particularly bad episode and spent 101 days in the psychiatric unit at Sentara Norfolk General Hospital. That’s where she met Dr. Shriti Patel, a psychiatrist with Eastern Virginia Medical School at Old Dominion University, who oversees the electroconvulsive therapy (ECT) program at the hospital, which has been offered there for more than 35 years. It is the only ECT program in Hampton Roads.
“ECT is an option for persistent depression when indicated medications are not effective,” said Dr. Patel. “Patients have often completed at least two courses of different antidepressants that don’t lift their depression before considering ECT.”
“They are usually referred to us by their psychiatrist, neurologist, or primary care provider,” Patel added. “When ECT is indicated, we do a complete medical workup to ensure the procedure is safe for the patient.”
In essence, ECT applies electrical current to the brain for up to ten seconds to induce seizure. It is conducted under anesthesia. Strong muscle relaxants, called paralytics, are also used to minimize muscle contractions.
During a recent treatment, a resident physician held small, round “stimulator” paddles to Orrico’s temples with his eyes locked on the device that delivers the current. “Green light!” he called out to the care team surrounding the patient. “Ready? Three, two, one.”
The paddles delivered three seconds of current to Orrico’s brain. She seized, almost imperceptibly, for 45 seconds. Then the treatment was over. She would soon wake up in recovery, and go to lunch with her husband, Bill.
While she was hospitalized, Orrico had ECT treatments three times a week and soon began to see results. After she went home, the outpatient schedule was twice a week.
Currently, she has ECT every six weeks for mood maintenance, in conjunction with an antidepressant and therapy.
“She’s doing beautifully,” said Bill. “I wish we’d found out about it sooner.”
The 1975 movie “One Flew Over the Cuckoo’s Nest” inaccurately depicted ECT as punitive, painful, and violent. Sentara’s ECT treatment is purely voluntary, with strict clinical guidelines, and full disclosure of risks and potential side effects before patients provide informed consent for the treatment. Side effects can include headaches immediately afterward, which fade, and short-term forgetfulness, which improves over time.
‘That is annoying,” Orrico said of the forgetfulness. “But it’s no big deal.”
ECT sessions are normally scheduled two to three times per week for active patients, for a total of 12 sessions, as recommended by the American Psychiatric Association.
There is an ECT procedure room at Sentara Norfolk General Hospital where Dr. Patel, other EVMS providers, and the Sentara clinical team conduct procedures on Mondays, Wednesdays, and Fridays. There is a waiting list to get onto the schedule.
“We know ECT improves depression,” said Dr. Patel. “Research shows evidence of neuromodulation and normalization of brain activity in depression and other psychiatric illnesses, although the exact mechanism of improvement is not clear.
“ECT is an FDA-approved therapy and widely accepted in the medical community,” Dr. Patel said. “The stigma from movies, television, and social media lingers, but the fact is, it works for most patients.”
There is, perhaps, no better advocate than Dolores Orrico, a patient who experienced it.
“ECT helped me,” she said.
“I was functioning,” she said. “I was cooking, cleaning, and socializing with our friends, but I was really very down. Depression runs in my family, and I was desperate.”
In 2023, Orrico had a particularly bad episode and spent 101 days in the psychiatric unit at Sentara Norfolk General Hospital. That’s where she met Dr. Shriti Patel, a psychiatrist with Eastern Virginia Medical School at Old Dominion University, who oversees the electroconvulsive therapy (ECT) program at the hospital, which has been offered there for more than 35 years. It is the only ECT program in Hampton Roads.
“ECT is an option for persistent depression when indicated medications are not effective,” said Dr. Patel. “Patients have often completed at least two courses of different antidepressants that don’t lift their depression before considering ECT.”
“They are usually referred to us by their psychiatrist, neurologist, or primary care provider,” Patel added. “When ECT is indicated, we do a complete medical workup to ensure the procedure is safe for the patient.”
In essence, ECT applies electrical current to the brain for up to ten seconds to induce seizure. It is conducted under anesthesia. Strong muscle relaxants, called paralytics, are also used to minimize muscle contractions.
During a recent treatment, a resident physician held small, round “stimulator” paddles to Orrico’s temples with his eyes locked on the device that delivers the current. “Green light!” he called out to the care team surrounding the patient. “Ready? Three, two, one.”
The paddles delivered three seconds of current to Orrico’s brain. She seized, almost imperceptibly, for 45 seconds. Then the treatment was over. She would soon wake up in recovery, and go to lunch with her husband, Bill.
While she was hospitalized, Orrico had ECT treatments three times a week and soon began to see results. After she went home, the outpatient schedule was twice a week.
Currently, she has ECT every six weeks for mood maintenance, in conjunction with an antidepressant and therapy.
“She’s doing beautifully,” said Bill. “I wish we’d found out about it sooner.”
A voluntary, effective treatment for depression
The 1975 movie “One Flew Over the Cuckoo’s Nest” inaccurately depicted ECT as punitive, painful, and violent. Sentara’s ECT treatment is purely voluntary, with strict clinical guidelines, and full disclosure of risks and potential side effects before patients provide informed consent for the treatment. Side effects can include headaches immediately afterward, which fade, and short-term forgetfulness, which improves over time.
‘That is annoying,” Orrico said of the forgetfulness. “But it’s no big deal.”
ECT sessions are normally scheduled two to three times per week for active patients, for a total of 12 sessions, as recommended by the American Psychiatric Association.
There is an ECT procedure room at Sentara Norfolk General Hospital where Dr. Patel, other EVMS providers, and the Sentara clinical team conduct procedures on Mondays, Wednesdays, and Fridays. There is a waiting list to get onto the schedule.
“We know ECT improves depression,” said Dr. Patel. “Research shows evidence of neuromodulation and normalization of brain activity in depression and other psychiatric illnesses, although the exact mechanism of improvement is not clear.
“ECT is an FDA-approved therapy and widely accepted in the medical community,” Dr. Patel said. “The stigma from movies, television, and social media lingers, but the fact is, it works for most patients.”
There is, perhaps, no better advocate than Dolores Orrico, a patient who experienced it.
“ECT helped me,” she said.
By: Dale Gauding