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t m c » p u l s e | a p r i l 2 0 1 7 12 Ready to Reset Electroconvulsive therapy can help patients with depression A nurse places electrodes on Natalia Rodriguez's forehead, prepping her for bilateral ECT treatment. B y B r i t n i N . R i l e y I'm normal now. I walk my dogs every morning. I get up and make breakfast, see my grandkids—I'm just active all day. — NATALIA RODRIGUEZ Ben Taub Hospital patient S itting in bed in a recovery room at Ben Taub Hospital, Natalia Rodriguez waits for her 35th mainte- nance treatment of electroconvulsive therapy. "I've always had my depression, but I didn't recognize it until way later, because I didn't want to," Rodriguez said. "I didn't want to appear weak in front of my kids. I had to be strong so I just worked, worked, worked. And then it hit me." In 2011, Rodriguez was diagnosed with severe depression. She began taking antidepressants. "At first, I was at another facility and they gave me all kinds of medicine, and it was so bad, it gave me hallucinations for a month," Rodriguez said. "After that, I ended up at another facility—an inpatient clinic—because I was having such bad crying spells." After she was discharged from the hospital, her depression continued and "They ended up sending me to another facility and that's where I was introduced to ECT, but there they treated you like it was a revolving door," she said. "So I didn't know what was happening; they just told me that I needed to do it." ECT, sometimes called shock therapy, is used mainly when antide- pressant medication fails to treat severe depression. The procedure pushes small electric currents through the brain to trigger a brief seizure, which changes the brain's chemistry and, in many cases, reverses the symptoms of some types of mental illness. the medication did not help. "I think the depression was brought on by everything that I have been through," she said. "I was molested when I was young. … I have been in and out of prison, had low self-esteem." Although she worked full time in the billing department of an orthopedic clinic, Rodriguez struggled to support her three children. She was sent to prison in 2005 on a drug-related convic- tion and served for almost five years. In prison, Rodriguez said she was a leader in a block with 180 women. "I ran the county, I ran it," she said. "They saw me as a person in charge." After she was released from prison, depression consumed her. Weeks went by when she didn't leave her room. When she tried to commit suicide, her care team finally realized she required immediate attention. In 2013, Rodriguez began receiving electrocon- vulsive therapy (ECT). Bilateral treatments In 2014, Rodriguez found her way to Strawberry Health Center in Pasadena, Texas—an outpatient clinic that is part of Harris Health System. She began working with Robin Livingston, M.D., medical director of ECT services at Ben Taub Hospital. "When I met Natalia, she was severely depressed and had attempted suicide," Livingston said. "Because of that, we decided to give her bilateral treatment, which is electrodes on both sides of the head." When a patient receives unilateral treatment, the seizure occurs only on the left side of the brain, causing fewer cognitive side effects. When a patient receives bilateral treatment, the seizure occurs on both sides of the brain. Bilateral treatment is not proven to work better, but it is proven to work faster. Asim A. Shah, M.D., chief of psy- chiatry at Harris Health System and Ben Taub Hospital, brought Livingston to Ben Taub to restart Harris Health System's ECT program. "ECT is truly the best treatment when it comes to treating depression," Shah said. "There is no treatment that works as quickly as ECT. Antidepressants have an efficacy of 40 to 45 percent. ECT has an efficacy of 70 percent. Why should we not use a treatment that works for 70 percent of people?" Once a seizure has been stimulated, it will last anywhere from 25 seconds to two minutes. The seizure changes the neurochemicals in the patient's brain, which works in various ways. ECT has been proven to increase serotonin, increase norepinephrine, decrease dopamine, work as a brain cell stabilizer and reduce stress.