Fort Myers, Florida (News-Press) -- The patients are rolled on gurneys into a small screened-off area atPark Royal Hospital every 15 minutes with assembly line regularity.
Oneis a woman in her 60s, who, like the others, gets a momentary jolt ofelectricity sent through her head, causing a brain seizure and her bodyto tense for several seconds. The hope: That this treatment - theelectroconvulsive, or "electro-shock," therapy - will ease the symptomsof her bipolar disorder that has so far not responded well to drugs.
Theprocedure, one of thousands performed at Park Royal since the 76-bedhospital opened last year, has worked on the woman in the past, says Dr.Ivan Mazzorana, who performs all of them on patients here. And, hesaid, it's likely to do so again.
These days, the treatment goes by its more clinical-sounding acronym, "ECT."
"Whenyou bring it up, most people say, 'Oh my God! Not ECT, that's somethingfrom the past,'" Mazzorana said. "It's a very simple procedure, safer,and it's a lot quicker than the medication."
Electroconvulsivetherapy today is a procedure widely accepted by the medical communityand 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 acrude medical holdover almost as dated as bloodletting. Many outside ofpsychiatry are surprised to learn that the procedure still exists atall.
Despite that,ECT has seen a resurgence at many U.S. health centers in recentdecades, experts say, and is now doing a brisk business here inSouthwest Florida.
ParkRoyal, the only inpatient psychiatric hospital in Lee County, hasalready treated nearly 200 people with ECT, most receiving multipletreatments. The number represents roughly 10 percent of all Park Royal'sadmissions since it opened in early 2012.
The hospital is a for-profit facility owned by the Tennessee-based Acadia Healthcare Co.
ECThad been widely available before Lee County's last inpatientpsychiatric hospital, Charter Glade, closed in 2000. Separately, onephysician had provided ECT services in Collier County before retiringseveral years ago.
Otherwise in Southwest Florida, Riverside Behavioral Health in PuntaGorda offers the treatment, though it performs far fewer than ParkRoyal. Riverside's Dr. Bernardo Arias estimates his facility performs150 treatments a year. Park Royal estimates it has performed more than2,000 in the last year.
Most of those whohave received ECT at Park Royal - patient ages have ranged from 18 yearsto those in their 90s - suffer from severe depression or bi-polardisorders. About 90 percent are inpatients. Others are referred fromother parts of Florida, according to the hospital. A few are snowbirdswho come in for ETC "maintenance" treatments.
TheMayo Clinic calls the treatment, which has a reported success rate of70 percent to 80 percent, the "gold standard" treatment for severedepression. The most common side effect, according to proponents, istemporary short-term memory loss.
"Iwas afraid, to be honest with you," said Ron Spesia, a 71-year-old FortMyers Beach retiree who suffered a deep, multi-year depression that didnot respond to medication. He had 12 treatments and said he startedfeeling better after the third. "Then one day I decided, 'Hey, you knowwhat? It's time to put the big boy pants on and pursue this.' Smartestmove I ever made."
Still,ECT has its critics. Some, including patients of decades past andanti-ECT groups, say it is little more than intentional brain damage.This, despite the psychiatric community's endorsement of it and positivetestimonials from many of the estimated 100,000 Americans who get thetreatment each year.
A News-Press reporter was recently allowed to witness about a half dozen such procedures at Park Royal.
Buteven hospital administrators remain sensitive to the ECT stigma. Thougha patient agreed to be photographed during one such procedure, and tohave it recorded on video, the hospital overruled that consent.
Thehospital also prohibited patient interviews inside the building, thoughother medical facilities routinely allow such interactions if patientsare willing. David Edson, the Park Royal's director of businessdevelopment, cited concerns about privacy and "the very delicate natureof the ECT treatment."
Despite that, Mazzorana said he wants to demystify the treatment and those who get it.
"Itseems like an extreme, dramatic treatment," Mazzorana said. "It's amatter of really educating the psychiatric community, so then we caneducate patients."
Thetreatments at Park Royal begin at 7 a.m. Mondays, Wednesdays andFridays, and continue throughout the mornings. Staff usually see up to10 ECT patients on these days.
Theprocess bears little resemblance to its horrific depictions in popularculture. At Park Royal, it starts when patients come to a medicalpreparation area adjacent to the ECT treatment room, where staff hookthem up to IVs - they will eventually get medication to paralyze theirmuscles during the treatment - as well as heart and brain monitorsattached to their skin.
Aftera quick chat with medical staff, who assess their conditions, patientsbite down on foam "bite blocks" before they are put fully under.
Flashlight-shapedpaddles coated with a blue conductive gel are placed on each temple(bilateral treatment) or one goes on the right temple and the top oftheir heads (unilateral treatment), depending on the type of ECT thepatients need. Bilateral ECT is recommended in more severe cases ofmental illness and may produce more memory loss, experts say.
Followinga quick buzzing sound, patients' bodies tense for about five seconds.Patients typically wake a minute or so after the procedure and are sentoff to a recovery area until the anesthesia fully wears off. Theyremember nothing of the treatment itself.
New patients must typically stay in the hospital for the first half of the standard dozen ECT treatments.
Spesia,the former ECT patient, said the IV injection was the most painful partof the process. The most unpleasant, he said was the hospital stay.Now, months after the process, he said the only lingering side effecthas been some short-term memory loss.
"AllI can remember is them giving me the rubber bite block and then themputting the (anesthesia) mask on and telling me to breathe deeply." hesaid. "Absolutely painless."
Nancy Kish, a 74-year-old Fort Myers resident who has received dozensof treatments over the years, said her memory of treatments from yearspast is fuzzy but that her mind is otherwise as sharp as it has everbeen. She said the treatment is a better alternative to the high dosesof medication she otherwise took, drugs that largely left herbed-ridden.
"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.
Mazzoranasaid two theories dominate: One says that electroconvulsive therapyenhances certain beneficial brain chemicals that are lacking indifferent parts of the brain. Another states that it causes the releaseof hormones that have a beneficial effect on mood and promote the growthof healthy brain cells, he said. Other recent research suggests thatECT works by reducing "hyper-connectivity" in the minds of severelydepressed patients.
Whateverthe exact mechanism, ECT's endorsements include the AmericanPsychiatric Association, the American Medical Association, and the U.S.Surgeon General.
"Whenyou raise ECT, people's eyes always roll up in their heads and theirfamily says, 'Oh my God, you're a monster!'" said Fort Myerspsychiatrist Steve Machlin, who performed the procedure more than adecade ago for Lee County's last inpatient psychiatric hospital, thenow-shuttered Charter Glade Hospital. "There's always going to be peopleon the outside who say it's not proven but, if you've looked at thescience, it's been proven to be effective."
AnotherSouthwest Florida psychiatrist and researcher, Fred Schaerf, saidopposition to the treatment is largely anti-psychiatry bias and from thetreatment's early days, when it was performed without anesthesia.
"Ithink there is a misconception about the treatment - that it'sbarbaric, cruel," Schaerf said. "It has to do with that stigma andpeople's belief system with psychiatry."
Dr. Arias, the Riverside Behavioral Center physician, said thetreatment was hard to find a decade ago in Southwest Florida, butlargely for economic reasons.
Mostinsurance, including Medicare, covers the treatment. But most physiciansdidn't want to offer it in years past because of the low payments forit and the cost of malpractice coverage, he said. Those rates haveimproved in recent years, he said.
Edson,the Park Royal Hospital business development director, said the healthcenter generally charge insurers $500 a treatment, though that does notinclude the costs of the anesthesiologist and hospital stay. Mazzoranasaid the total cost is about $1,000.
Arias,who is not connected to Park Royal or familiar with its operation,estimates that a physician generally earns $100 per treatment; theanesthesiologists earns about $300; and hospitals earn about $700.
Medicaland patient endorsements aside, some patient groups believe it doeslittle more than cause brain damage. A quick Internet search turns up along list of anti-ECT websites, many of which include testimonials frompeople claiming to have suffered negative effects from the treatments.
Amongthe most vocal opponents is the Philadelphia-based National MentalHealth Consumers' Self Help Clearinghouse, which urged the U.S. Food andDrug Administration in 2011 not to reduce federal oversight of ECTdevices. It also sharply criticized the Surgeon General's endorsement ofECT in 1999.
Thegroup points to published studies suggesting that ECT leads to memoryloss and may be far more dangerous for the elderly than medicationalone. Susan Rogers, the organization's director, said patients aren'twarned enough about the risks.
"Peopleare not given the opportunity for truly informed consent," said Rogers,who has not had the procedure herself. "People are not advised of theenormous risks as well as the benefits. They're given a whitewashedversion of the facts. They're not told it might cause permanentcognitive impairment, and I think that's wrong."
She said she is not opposed to the treatment itself.
"Apparentlyabout 100,000 people a year receive ECT in the United States and, I'msure for many of those people, they're satisfied with those results,"she said. "There are also many people who feel that ECT has destroyedtheir lives."
Thepsychiatric community commonly uses the 1 in 10,000 patients mortalityfigure (or 1 per 80,000 treatments), figures anti-ECT groups saydramatically under-estimates the risk, particularly among olderpatients. A 1995 USA Today investigation found that it may have been ashigh as 1 in 200 among elderly patients, based on some state reports atthe time and some earlier studies.
Arecent Veterans Administration review of ECT between 1999 and 2010found no ECT deaths at VA hospitals during that period. It placed themortality risk at 1 per 14,000 patients, or 1 per 73,400 treatments.
Floridadoes not closely track ECT usage. But Texas, which does, reported thatnone of the 2,079 patients receiving ECT last year died during theprocedure. Two died shortly after treatment in 2012, the state reportnoted, 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.
Noneof Park Royal's ECT patients have died during the procedure, saidChristina Brownwood, the hospital's ECT coordinator. Nor have any neededemergency medical care immediately after a treatment, she said.Mazzorana said treatment is immediately stopped for patients showing anysigns of significant memory loss.
"Inreality, the procedure is not really that dangerous," said Arias, theCharlotte County physician who has performed the treatments since 1995."At least what I've seen in my practice. We haven't seen anycomplications."
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