When her illness is at its worst, Rachel Perez goes days without sleeping. The lack of sleep brings about delusions. Perez believes she is scheduled to perform with a famous singer or chat with the president. She gets hyper-religious and spends too much money.
Perez, 35, of Nampa, has bipolar disorder. It usually shows up in manic episodes. She was diagnosed in 2003 and has taken lithium for many years. But even with that medication, a few things can trigger mania — the extended sunlight in the spring, or holiday shopping in the winter.
When she had a severe episode about seven years ago, a doctor suggested trying something new: electroconvulsive therapy.
“When I go in [to a manic state], I go in deep, really deep, and it’s hard to get me back,” Perez said. “I probably would have been in some kind of psychiatric hospital if it weren’t for ECT.”
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The closest place to get ECT at the time was Salt Lake City. So her husband, Mike, took her there.
After several 20-minute sessions over a few weeks, the old Rachel Perez was back. Her husband was astonished.
For years, when she slipped into a manic episode, Mike Perez would persuade her to come with him to Salt Lake City for treatments.
But last year, when Rachel was showing symptoms around Thanksgiving, the couple got in the car and drove just a few minutes to an outpatient office in Caldwell.
It’s something that a lot of people are afraid [to try], because they just don’t know enough about it.
James G. Saccomando Jr., a Boise psychiatrist who offers ECT treatment in Caldwell
James G. Saccomando Jr. and Richard Montgomery are doctors at North End Psychiatry in Boise. A year ago, after going through advanced training, they began offering ECT at the Idaho Surgery Center, part of West Valley Medical Center.
“It’s something that is kind of the top of the pyramid for depression and a lot of severe mental illness ... and people weren’t even thinking about it a lot of the time because it just wasn’t around [locally],” Saccomando said. “A lot of doctors were sending their patients down to Salt Lake City to get it done. Or maybe Portland or Seattle.”
Misunderstood and feared
Also called electroshock therapy, the procedure uses electricity to bring on a seizure in a patient.
How it works is a bit of a mystery, “and that’s the truth about a lot of psychiatry,” Saccomando said.
“One way to look at it is like we’re resetting the computer of the brain,” he said. “Like when your computer locks up, we just start it over again and it reboots.”
Unlike the depiction of ECT as a torture device in “One Flew Over the Cuckoo’s Nest,” or as a painful last resort for the bipolar character in “Homeland,” a patient in real life feels no discomfort during the procedure. The patient is under anesthesia and has taken a paralyzing medication. There is no arched back, no flopping around, no anguished screaming.
“ ‘One Flew Over the Cuckoo’s Nest,’ that’s probably the worst movie that ever happened for ECT, because people see that and they’re just like, ‘No way,’” Saccomando said. “And it’s just not like that. ... It’s not a scary thing. It’s a very controlled situation. They’re asleep, they’re not present for any of it, and then they wake up.”
Local doctors and nurse practitioners have been sending patients to the surgery center for ECT at an increasing rate, he said. The treatment is offered only to adults at this point.
In the first eight months, the psychiatrists administered 397 treatments to 37 patients, mostly from the Treasure Valley.
The standard treatment regimen takes about a month. Patients with severe cases usually have ECT three times a week to start. It takes two weeks to see significant improvement. After a dozen treatments, even severe cases of depression have lifted. A patient who was catatonic will start smiling, leaving the house, feeling better.
During treatment, the doctors will try medication changes as a way to keep patients at a healthy plateau after they stop getting ECT. Some patients return for ECT later.
That’s the case with Perez. Now that she better understands her illness and its patterns, she is talking with doctors about possible “maintenance” treatments to get ahead of a springtime episode, or at least to stop it early.
‘Totally changed my life’
The worst side effects? She awakens from the procedure with bloodshot eyes, and she usually does not remember some things that happen around that time.
But the days leading up to ECT are so hard on his wife that a foggy memory of them is probably a good thing, Mike Perez said.
Mike Perez said his wife’s personality, intelligence and emotions are no different now than before she began treatment.
Patients can feel out of it or, as Rachel Perez calls it, like a “zombie” in the early days of treatment. That lifts quickly, she said. Rare side effects include headaches, muscle pain or nausea.
The procedure is expensive, Saccomando said.
The patient’s cost could range from $175 to $1,800 per procedure, depending on insurance deductible and copays. Patients without insurance can receive a discount.
According to a spokeswoman for West Valley Medical Center, ECT is covered by most insurance plans including Medicare, Medicaid, and plans sold on the Idaho health insurance exchange.
Despite its cost, the therapy is a ‘biggest bang for your buck’ treatment in the long run, Saccomando said. It is safer and works faster than prescription drugs. It prevents a drawn-out recovery or hospitalization for people who struggle with severe mental illness.
That’s why insurance companies have been eager to cover ECT, he said.
Rachel Perez has insurance through Medicare because of her disability, and her treatments are covered, she said.
Now that she doesn’t have to travel to Salt Lake City, she can spend more of her time staying healthy and raising her two sons.
“ECT has totally changed my life,” she said. “It’s really a gentle procedure. And I would suggest it to anyone who especially doesn’t respond to medication.”