CRMC wants to change stigma around electroconvulsive therapy

Mar. 22—CHEYENNE — In the 1975 film "One Flew Over the Cuckoo's Nest," Jack Nicholson's character receives a gruesome electroconvulsive therapy treatment — an electrically induced seizure used to treat mental disorders.

Cheyenne Regional Medical Center's Dr. J.J. Chen has been conducting these treatments in Cheyenne for nearly a decade, and he's trying to change the stigma associated with what he says has been proven safe and effective.

At CRMC, Chen said he has had a 100% success rate in treating mental disorders with ECT. The most common conditions he has treated through the years are patients with severe refractory depression that is not being optimally treated with medication and those who suffer from catatonia.

Oftentimes, patients are referred by their doctor to do ECT when medications are not effectively treating their condition. Chen said that isn't always the case, but ECT is often considered a last-resort care option due to stigmas rooted in historic pop culture references and lack of education within the medical community. For patients with acute suicidal ideation or acute decompensation functions, he would recommend ECT as the first and fastest effective form of treatment.

"ECT is not defined as a failure, it's an opportunity," Chen said.

When he first arrived at CRMC, he said he spoke with providers, therapists, psychiatrists and nurses about ECT and what it really is: the most effective and rapid treatment available for elderly patients with depression, bipolar disorder and psychosis, according to a 2014 study published in Neuropsychiatry (London).

Before the procedure, the patient is put under general anesthesia by an anesthesiologist and given paralytic medication to ensure the body remains as stationary as possible during the controlled seizure — neither of which Nicholson's character received in "One Flew Over the Cuckoo's Nest."

The psychiatrist then administers electric currents through the patient's brain, triggering a seizure. This stimulates the brain, allowing neurotransmitters to reset to the original beneficial homeostatic ratio.

"ECT is sort of like a global reset," Chen said.

The "reset" does not typically come after one treatment, however. Chen said he usually administers between six and 12 treatments over three to four weeks. He is one of only two psychiatrists in the state certified to administer ECT. The other, Dr. Benjamin Johnson, is also at CRMC. The procedures are supervised by a psychiatrist, an anesthesiologist and a nurse.

Success is measured through a nine-question survey that patients complete before and after every procedure, as well as conversations with the families and loved ones of the patients. He said the survey results typically reflect improvement after three or four treatments.

"My goal is to return folks back to the workplace, happily back to the home environments. If they're taking care of grandchildren, you know, doing that in a happy way, in a loving way. They want to go back to their regular 100% functional lives. I think ECT is a very, very great way to achieve that, along with medication, along with long-acting injectable medications that we can give that are increasingly more and more accessible now, fully covered by insurance," Chen said.

Along with stigma and lack of education around ECT, one of the biggest deterrents to the treatment option is access to care and affordability.

In the United States, the average cost for one session of ECT is around $2,500, according to Medicare.org. This number is dependent on certain factors, including where you live and who your physician is.

For outpatient procedures, which is the norm for CRMC ECT sessions, patients with Medicare will likely pay 20% of the approved amount for services if the medical providers accept assignment, along with the deductible, which was $185 per year as of 2019.

"That's where the issue of justice to treatment comes into play for ECT because, while people may benefit, folks who do not have insurance yet, or are working on getting Medicaid or Medicare, may not be able to do a treatment right away if they meet criteria, unless an insurance status change happens. That, to me, has always been a sore point for ECT," Chen said. "It pains me that we still live in a world where people who need it desperately the most can't get the treatment."

He said he hopes that if more attention and awareness is brought to the efficiency and efficacy of ECT, the procedure may become more accessible, and there may be more funding support options for patients.

In the United States, roughly 100,000 patients receive ECT annually, according to Mental Health America. Unipolar depression was ranked the fourth cause of disease burden — defined as the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicators — in 2002. It is projected to be the second worldwide and the first in high-income countries (e.g., United States) in 2030, according to a study from PLoS Medicine. This means there may be an elevated need for mental health services and access to them across the country.

Chen recalled one success story of a patient who would not interact with her parents and would seldom leave the basement. He said the family started to notice improvement after just a few ECT sessions.

"I speak to family, always, before and after treatments. They were telling me 'Oh my god, Dr. Chen, she's starting to say 'Dad, I love you' before I go to bed.' She hasn't done that for 10 years. ... She's spending more time out of her basement; she's going out and about. I mean, that's just, it almost brings tears to my eyes," Chen said. "Because I know if I were in my patients' shoes, I would want the same experience."

Noah Zahn is the Wyoming Tribune Eagle's local government/business reporter. He can be reached at 307-633-3128 or nzahn@wyomingnews.com. Follow him on X @NoahZahnn.