Lehigh Regional begins electro-convulsive treatments as part of new mental health program

The electrical jolt sent to Carolyn Biss' brain triggers an immediate contraction of her facial muscles, producing an involuntary grimace for the nearly 10 seconds it's administered.

Once the power is off, a doctor removes the foam bite block from her mouth and takes note of Biss’ foot twitches for about another minute.

Soon she’ll wake from the anesthesia, groggy, but with no pain or memory of the electroconvulsive therapy that she has just undergone. Ideally this treatment, more commonly known as “electro-shock treatment," will have succeeded in lifting the worst symptoms of her severe form of depression.

“I usually feel a lot better," said Biss, a day later from her home in Bonita Springs. She's had more than 100 such treatments over years to keep her illness in check. "I do sometimes get nervous and used to have a hard time sleeping the night before I had to go in the next morning. But since they put you under you don’t remember anything about the procedure itself.”

This was the seventh such electroconvulsive therapy performed in little over an hour one recent morning at Lehigh Regional Medical Center.

The 88-bed private hospital, which is owned by the Ontario, California-based Prime Healthcare, has performed dozens since it began offering the procedure in March as part of its foray into mental health services.

In popular culture, the treatment is considered a barbaric relic or the stuff of TV and movie nightmares.

But despite fictional portrayals — and even the uncomfortable sight of it administered in reality — electroconvulsive therapy, or ECT, is a well-recognized and painless means of treating the severest forms of depression that don’t respond well to medication.

Biss, 57, who was diagnosed with depression in high school, said she can’t imagine her life without ECT. This was the second treatment she had received over the course of a week as part of a series of three her doctor has prescribed for this week.

"This is the only treatment that really gets her out of a depressive state," said Dr. Ivan Mazzorana, who administered the procedure and leads the hospital's new program. "She’ll go for an extended period of time and then she’ll cycle again into a depressive phase, (in) that medications really do not work for her.”

Lehigh Regional's $3.5-plus million mental health care expansion will also include a 27-bed unit dedicated to the mental health needs of adults 55 and older.

That unit, the construction of which is still undergoing state regulatory review, is expected to open before the end of the year, said Gary Bell, the hospital's CEO.

Key to the plan was the hiring of Mazzorana, the former chief medical officer of Park Royal Hospital, the only inpatient psychiatric hospital in Lee County. Mazzorana resigned from that post last year.

In addition to overseeing medical staff at Park Royal, Mazzorana operated its ECT program — the busiest in Southwest Florida. At its peak, the hospital performed thousands of ECTs a year.

“ECT is a pretty active service, not only here but elsewhere," Mazzorana said. "Depression tends to be a chronic illness, and oftentimes it’s a treatment-resistant type of illness."

How does it work?

Electricity in ECT is delivered to the brain via two hand-held paddles coated with conductive gel that are applied to the temples and/or top of the head. The amount of energy varies by the patient but is generally less than a third of that used in defibrillations.

As in the case of pharmaceutical anti-depressants, doctors are not exactly sure why the procedure works. Mazzorana said ECT encourages positive changes in the brain's chemistry.

"What we’re essentially doing is we’re resetting the electrical circuits within the brain," he said.

The American Psychiatric Association says ECT is "highly effective for the relief of major depression," in about 80 percent of patients receiving it. The cost of a course of treatment runs in the thousands of dollars, depending on the facility.

Carolyn Biss' hustand, Gordan, said their last bill was about $5,000. Insurers, including the Biss', generally cover most of that cost. Still, even covered patients may still see hundreds of dollars in out-of-pocket costs depending on their plans.

ECT is not without some risk. Because it employs anesthesia, ECT is about as dangerous as minor surgeries, experts say. One U.S. Department of Veterans Affairs study between 1999 and 2010 put deaths at one per 73,400 procedures.

More commonly, patients may experience minor memory loss, though most memory problems clear up within a matter of months, experts say.

Biss said she does not experience any lost memories, though sometimes grogginess from anesthesia lingers longer than she'd like. Either way, she said it's worth it. Without the treatment, she said the depression leaves her feeling hopeless, alone and makes it hard for her to sleep and concentrate.

"If it’s going to help I feel fine about it. It’s no fun going to bed at night and not being able to sleep," she said. "The combination of the medications and the treatments make a world of difference."

Expanded mental health services

The Florida Agency for Health Care Administration is now reviewing the plans to make sure construction of the new mental health unit complies with current hospital building codes. Assuming there are no hitches, Lehigh Regional expects the unit to open Dec. 1.

Why geriatric services? Part of it is demographics — Southwest Florida is home to one of the state's oldest populations, Bell said. Part of it is the fact that Mazzorana specializes in geriatric psychiatry, he said.

"I believe our whole service area is under-served for mental health," Bell said. "And there's a real need for this type of service."

Given that, hospitals are increasingly interested in mental health services.

The Golisano Children's Hospital of Southwest Florida has discussed creating an eight-bed inpatient psychiatric unit. The public Lee Health hospital system, which operates the children's hospital, already provides outpatient behavioral health services through its Lee Physician Group.

HCA Healthcare, the nation's largest hospital operator, hopes to build an 80-bed hospital in south Lee County that would include a 10-bed inpatient psychiatric unit.

It would also become the county's third facility receiving patients undergoing involuntary mental health evaluations under the state's Baker Act. State regulators are reviewing that plan.

Lehigh Regional's program will not provide Baker Act evaluations. But it will treat a range of mental illnesses affecting adults.

"Everywhere I go, people ask about it and are excited about it and tell me they have patients that need to come here," Bell said. "So, the demand is there. The need is there."

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