Bridge House & ECT: An Exploration of a Misunderstood Gold Standard Procedure

Electroconvulsive therapy, known as ECT for short, is an often misunderstood tool used to improve a variety of debilitating mental health conditions. Many people hear the acronym ECT and think about negative portrayals in media without realizing how misrepresented the actual treatment itself has been since its inception. The reality is that ECT can significantly improve the quality of life for individuals struggling with certain conditions and has been proven in clinical trials over decades to be a gold standard treatment for certain conditions seen at Bridge House.

What exactly is ECT?

ECT is a psychiatric procedure that falls under the category of “neuromodulation” - a term that is defined by the use of technology to alter nerve activity for therapeutic purposes. Unlike its portrayal in mainstream media, ECT is not a painful procedure, nor is it akin to any kind of abuse or torture. Rather, it is a brief (approximately fifteen-minute) process that occurs when a person is under general anesthesia.

While a patient is placed under general anesthesia, electrodes are affixed in strategic locations on the patient’s head. Under close supervision by multiple medical professionals, an electrical impulse is emitted through the electrodes, causing a brief, controlled seizure in specific areas of the brain. Although medical researchers still don’t know the exact mechanism by which the treatment improves symptoms, the leading theory is that the induced seizure causes a reset of neurotransmitters that can treat refractory psychiatric symptoms. The patient wakes up from the procedure with no pain, and the most common side effect afterwards is memory loss of the brief window before and after the procedure occurred. Patients can be released shortly after the procedure, provided the medical team finds it clinically indicated to do so.

What does ECT treat?

ECT can treat a variety of mental health conditions, including severe depression, catatonia, mania, and agitation and aggression in people diagnosed with dementia. Studies have shown that in many cases, ECT can be a more effective treatment for severe depression than medications alone. Regarding catatonia, ECT has become the gold standard for treatment. Studies have shown that when a catatonic patient receives ECT quickly after the onset of symptoms, the likelihood of resolving those symptoms with fewer medications is significantly greater.

Who is a candidate, and will insurance cover ECT?

To receive ECT treatment, a person must meet with a medical professional to determine if they are a suitable candidate based on their presenting symptoms and other factors in their medical history. Factors that indicate someone may not be a good fit for ECT include active substance abuse, mood symptoms that originate more from a personality disorder, and primary anxiety disorders. Insurance typically covers ECT treatments, and out-of-pocket payment is not recommended because each procedure can be quite expensive due to the use of anesthesia. The recommended frequency of ECT varies significantly and depends on the unique presentation of each individual and their response to the treatment. ECT can be administered in an inpatient hospital setting or on an outpatient basis, depending on the individual's specific needs.

When and how does Bridge House utilize ECT?

Bridge House has found great success utilizing ECT with specific resident profiles. When we see residents who struggle with catatonia, severe depression, or prolonged disorientation and confusion, ECT can be an excellent reset for their neurological systems. Bridge House’s Psychiatrist and Medical Director can recognize when ECT is the best course of action for a resident.  The option will be reviewed with the resident's prior care providers, the resident's family, and involved referral sources before coordinating with local hospitals to create a treatment plan.

An ECT treatment plan for a Bridge House resident often (but not always) involves a short inpatient stay at the treating hospital for a period of time while the resident begins treatment. By utilizing an inpatient level of care, medical professionals can determine if the ECT treatments are working effectively and what frequency would be most beneficial based on the patient’s response. Bridge House maintains close contact with the resident and their family while they are inpatients at the hospital.  The Bridge House team will facilitate visits during visiting hours and coordinate care between all involved professionals. If an inpatient stay is required for an ECT patient, we follow this protocol and then bring the resident back to Bridge House once medically indicated. Doctors often recommend a maintenance treatment plan of one or more ECT sessions per week for a period after the initial treatment, which Bridge House can accommodate by transporting the resident back and forth to the hospital and accompanying them during their hospital stay. The frequency and duration of these visits will depend on the person, their specific diagnosis, and their response to treatment.

Closing Impressions

Unfortunately, ECT has developed a misleading reputation through media representations over the years, as seen in films like One Flew Over the Cuckoo’s Nest. Despite this, ECT is actually an incredibly helpful, evidence-based treatment for many conditions and can greatly improve the quality of life for those who receive it with very few side effects. Bridge House’s Medical Director, Dr. Kiera Schlansky, recommends watching “The Great Depresh” by Gary Gulman to hear a firsthand account of one person’s ECT journey.

The Bridge House admissions and medical teams are happy to answer any questions or clarify any misconceptions about the use of this treatment.

About Bridge House:

Set in a comfortable home-like environment in Utah, Bridge House provides stabilization, assessment, diagnostics, and treatment for adults struggling with mental illness, cognitive differences, and substance use disorders. Each program component is designed to help our residents better understand their illness and associated challenges while developing the skills required to live a life with purpose and fulfillment. To learn more about Bridge House, please visit www.bridgehousehealth.com or contact the Admissions Team at 801-542-9525.