Dr. Ivan Mazzorana holds the paddles used to deliver electric shock during ECT treatments at Park Royal Hospital. (Jack Hardman/news-press.com)
Fort Myers, Florida (News-Press) -- The patients are rolled on gurneys into a small screened-off area at
Park Royal Hospital every 15 minutes with assembly line regularity.
is a woman in her 60s, who, like the others, gets a momentary jolt of
electricity sent through her head, causing a brain seizure and her body
to tense for several seconds. The hope: That this treatment - the
electroconvulsive, or "electro-shock," therapy - will ease the symptoms
of her bipolar disorder that has so far not responded well to drugs.
procedure, one of thousands performed at Park Royal since the 76-bed
hospital opened last year, has worked on the woman in the past, says Dr.
Ivan Mazzorana, who performs all of them on patients here. And, he
said, it's likely to do so again.
These days, the treatment goes by its more clinical-sounding acronym, "ECT."
you bring it up, most people say, 'Oh my God! Not ECT, that's something
from the past,'" Mazzorana said. "It's a very simple procedure, safer,
and it's a lot quicker than the medication."
therapy today is a procedure widely accepted by the medical community
and one, absent a rare court order, that is done with patient consent.
But it is also a treatment that lingers in the public imagination as a
crude medical holdover almost as dated as bloodletting. Many outside of
psychiatry are surprised to learn that the procedure still exists at
ECT has seen a resurgence at many U.S. health centers in recent
decades, experts say, and is now doing a brisk business here in
Royal, the only inpatient psychiatric hospital in Lee County, has
already treated nearly 200 people with ECT, most receiving multiple
treatments. The number represents roughly 10 percent of all Park Royal's
admissions since it opened in early 2012.
The hospital is a for-profit facility owned by the Tennessee-based Acadia Healthcare Co.
had been widely available before Lee County's last inpatient
psychiatric hospital, Charter Glade, closed in 2000. Separately, one
physician had provided ECT services in Collier County before retiring
several years ago.
Otherwise in Southwest Florida, Riverside Behavioral Health in Punta
Gorda offers the treatment, though it performs far fewer than Park
Royal. Riverside's Dr. Bernardo Arias estimates his facility performs
150 treatments a year. Park Royal estimates it has performed more than
2,000 in the last year.
Most of those who
have received ECT at Park Royal - patient ages have ranged from 18 years
to those in their 90s - suffer from severe depression or bi-polar
disorders. About 90 percent are inpatients. Others are referred from
other parts of Florida, according to the hospital. A few are snowbirds
who come in for ETC "maintenance" treatments.
Mayo Clinic calls the treatment, which has a reported success rate of
70 percent to 80 percent, the "gold standard" treatment for severe
depression. The most common side effect, according to proponents, is
temporary short-term memory loss.
was afraid, to be honest with you," said Ron Spesia, a 71-year-old Fort
Myers Beach retiree who suffered a deep, multi-year depression that did
not respond to medication. He had 12 treatments and said he started
feeling better after the third. "Then one day I decided, 'Hey, you know
what? It's time to put the big boy pants on and pursue this.' Smartest
move I ever made."
ECT has its critics. Some, including patients of decades past and
anti-ECT groups, say it is little more than intentional brain damage.
This, despite the psychiatric community's endorsement of it and positive
testimonials from many of the estimated 100,000 Americans who get the
treatment each year.
A News-Press reporter was recently allowed to witness about a half dozen such procedures at Park Royal.
even hospital administrators remain sensitive to the ECT stigma. Though
a patient agreed to be photographed during one such procedure, and to
have it recorded on video, the hospital overruled that consent.
hospital also prohibited patient interviews inside the building, though
other medical facilities routinely allow such interactions if patients
are willing. David Edson, the Park Royal's director of business
development, cited concerns about privacy and "the very delicate nature
of the ECT treatment."
Despite that, Mazzorana said he wants to demystify the treatment and those who get it.
seems like an extreme, dramatic treatment," Mazzorana said. "It's a
matter of really educating the psychiatric community, so then we can
treatments at Park Royal begin at 7 a.m. Mondays, Wednesdays and
Fridays, and continue throughout the mornings. Staff usually see up to
10 ECT patients on these days.
process bears little resemblance to its horrific depictions in popular
culture. At Park Royal, it starts when patients come to a medical
preparation area adjacent to the ECT treatment room, where staff hook
them up to IVs - they will eventually get medication to paralyze their
muscles during the treatment - as well as heart and brain monitors
attached to their skin.
a quick chat with medical staff, who assess their conditions, patients
bite down on foam "bite blocks" before they are put fully under.
paddles coated with a blue conductive gel are placed on each temple
(bilateral treatment) or one goes on the right temple and the top of
their heads (unilateral treatment), depending on the type of ECT the
patients need. Bilateral ECT is recommended in more severe cases of
mental illness and may produce more memory loss, experts say.
a quick buzzing sound, patients' bodies tense for about five seconds.
Patients typically wake a minute or so after the procedure and are sent
off to a recovery area until the anesthesia fully wears off. They
remember nothing of the treatment itself.
New patients must typically stay in the hospital for the first half of the standard dozen ECT treatments.
the former ECT patient, said the IV injection was the most painful part
of the process. The most unpleasant, he said was the hospital stay.
Now, months after the process, he said the only lingering side effect
has been some short-term memory loss.
I can remember is them giving me the rubber bite block and then them
putting the (anesthesia) mask on and telling me to breathe deeply." he
said. "Absolutely painless."
Nancy Kish, a 74-year-old Fort Myers resident who has received dozens
of treatments over the years, said her memory of treatments from years
past is fuzzy but that her mind is otherwise as sharp as it has ever
been. She said the treatment is a better alternative to the high doses
of medication she otherwise took, drugs that largely left her
"I feel pretty good," said Kish. "I get upset easy, and I get anxiety attacks. But other than that, I'm better than what I was."
Much like therapeutic mystery behind anti-depressant medication experts are not exactly sure why ECT works for some patients.
said two theories dominate: One says that electroconvulsive therapy
enhances certain beneficial brain chemicals that are lacking in
different parts of the brain. Another states that it causes the release
of hormones that have a beneficial effect on mood and promote the growth
of healthy brain cells, he said. Other recent research suggests that
ECT works by reducing "hyper-connectivity" in the minds of severely
the exact mechanism, ECT's endorsements include the American
Psychiatric Association, the American Medical Association, and the U.S.
you raise ECT, people's eyes always roll up in their heads and their
family says, 'Oh my God, you're a monster!'" said Fort Myers
psychiatrist Steve Machlin, who performed the procedure more than a
decade ago for Lee County's last inpatient psychiatric hospital, the
now-shuttered Charter Glade Hospital. "There's always going to be people
on the outside who say it's not proven but, if you've looked at the
science, it's been proven to be effective."
Southwest Florida psychiatrist and researcher, Fred Schaerf, said
opposition to the treatment is largely anti-psychiatry bias and from the
treatment's early days, when it was performed without anesthesia.
think there is a misconception about the treatment - that it's
barbaric, cruel," Schaerf said. "It has to do with that stigma and
people's belief system with psychiatry."
Dr. Arias, the Riverside Behavioral Center physician, said the
treatment was hard to find a decade ago in Southwest Florida, but
largely for economic reasons.
insurance, including Medicare, covers the treatment. But most physicians
didn't want to offer it in years past because of the low payments for
it and the cost of malpractice coverage, he said. Those rates have
improved in recent years, he said.
the Park Royal Hospital business development director, said the health
center generally charge insurers $500 a treatment, though that does not
include the costs of the anesthesiologist and hospital stay. Mazzorana
said the total cost is about $1,000.
who is not connected to Park Royal or familiar with its operation,
estimates that a physician generally earns $100 per treatment; the
anesthesiologists earns about $300; and hospitals earn about $700.
and patient endorsements aside, some patient groups believe it does
little more than cause brain damage. A quick Internet search turns up a
long list of anti-ECT websites, many of which include testimonials from
people claiming to have suffered negative effects from the treatments.
the most vocal opponents is the Philadelphia-based National Mental
Health Consumers' Self Help Clearinghouse, which urged the U.S. Food and
Drug Administration in 2011 not to reduce federal oversight of ECT
devices. It also sharply criticized the Surgeon General's endorsement of
ECT in 1999.
group points to published studies suggesting that ECT leads to memory
loss and may be far more dangerous for the elderly than medication
alone. Susan Rogers, the organization's director, said patients aren't
warned enough about the risks.
are not given the opportunity for truly informed consent," said Rogers,
who has not had the procedure herself. "People are not advised of the
enormous risks as well as the benefits. They're given a whitewashed
version of the facts. They're not told it might cause permanent
cognitive impairment, and I think that's wrong."
She said she is not opposed to the treatment itself.
about 100,000 people a year receive ECT in the United States and, I'm
sure for many of those people, they're satisfied with those results,"
she said. "There are also many people who feel that ECT has destroyed
psychiatric community commonly uses the 1 in 10,000 patients mortality
figure (or 1 per 80,000 treatments), figures anti-ECT groups say
dramatically under-estimates the risk, particularly among older
patients. A 1995 USA Today investigation found that it may have been as
high as 1 in 200 among elderly patients, based on some state reports at
the time and some earlier studies.
recent Veterans Administration review of ECT between 1999 and 2010
found no ECT deaths at VA hospitals during that period. It placed the
mortality risk at 1 per 14,000 patients, or 1 per 73,400 treatments.
does not closely track ECT usage. But Texas, which does, reported that
none of the 2,079 patients receiving ECT last year died during the
procedure. Two died shortly after treatment in 2012, the state report
noted, but neither case was related to the treatment.
Five years of reports show that roughly 2 percent of patients experience some level of memory loss shortly after treatment.
of Park Royal's ECT patients have died during the procedure, said
Christina Brownwood, the hospital's ECT coordinator. Nor have any needed
emergency medical care immediately after a treatment, she said.
Mazzorana said treatment is immediately stopped for patients showing any
signs of significant memory loss.
reality, the procedure is not really that dangerous," said Arias, the
Charlotte County physician who has performed the treatments since 1995.
"At least what I've seen in my practice. We haven't seen any
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