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The Gold Standard

Robert Ostroff, MD, takes the low-tech road when commuting to work each day. He rides his bike to Yale New Haven Psychiatric Hospital, where conversely he runs the very high-tech electroconvulsive therapy (ECT) program. “This is the gold standard,” says Ostroff, a psychiatrist who launched the program at YNHPH. “ECT is the most effective treatment for treatment-resistant depression.”

ECT—sometimes referred to as electroshock therapy—has greatly advanced since 1938, when Italian neurologist Ugo Cerletti developed a method of inducing brief seizures, by giving electrical stimulation to the brain, for successfully treating patients with depression. The major changes include the use of general anesthesia during the procedure, advancements in ECT equipment to improve dosing of electrical energy, targeted electrode placement and increased understanding of the specific mental conditions that ECT benefits most.

Employing these advancements, Ostroff’s team of specially trained psychiatrists, nurses, anesthesiologists and patient care associates (PCAs) have established a safe, effective and highly personalized ECT program, utilized on both an inpatient and outpatient basis. “It used to be that everyone received exactly the same treatment,” Ostroff says. “Now treatment is individually designed for each patient.”

ECT is primarily recommended for patients diagnosed with severe depression, usually after several different treatments with antidepressant medications and/or psychotherapy have not proven effective. It is also used to treat patients with bipolar disorder, acute schizophrenia and catatonia. Compared to medication treatment, ECT can show results in days rather than weeks. While the efficacy of ECT in these disorders varies, it is most effective in the treatment of depressed individuals with psychotic symptoms, producing a nearly 92 percent response rate.

The electrical stimulation itself lasts between 30 and 60 seconds; with preparation and recovery, the procedure takes about an hour. Typically patients receive eight ECT sessions over a two- to three-week period, and some remain in the ECT program for years.

Ostroff and his fellow ECT psychiatrists at YNHPH have been involved in research on the therapy, at times in conjunction with faculty members at Yale School of Medicine’s Department of Neurology. “The neuroscience in ECT is very important in understanding how the electrical energy interacts with the central nervous system, for both side effects and efficacy,” Ostroff explains. Ostroff also has participated in clinical trials combining ECT with ketamine, an anesthetic medication that has proven to be a rapid-acting antidepressant.

Along with being a part of the medical and technical advances in ECT, Ostroff’s stake in developing the program at YNHPH is personal, too. “It’s rewarding to see the difference it makes in people’s lives, especially after they’ve tried so many different treatments,” he says. “We see them get their lives back.”