Jonathan Becker, DO, the medical director overseeing Vanderbilt Psychiatric Hospital’s electroconvulsive therapy (ECT) program, spends a fair amount of time explaining to patients what electroconvulsive therapy is not.
ECT is a medical treatment that involves a brief electrical stimulation of the brain while a patient is under anesthesia. It’s administered in the Psychiatric Hospital’s Neuromodulation Suite, and is most commonly used in patients with severe major depression or bipolar disorder that have not responded to treatment.
ECT is widely known by moviegoers as the harrowing treatment that Jack Nicholson underwent in “One Flew Over the Cuckoo’s Nest,” and has suffered from a historically negative stigma and misconceptions through the media. But despite its depiction in the movie, ECT is a safe and effective procedure, Becker said.
“While there have been advancements that limit the cognitive side effects, the administration of ECT has not changed much,” he said. “The film depicted it as being used without anesthesia and to try to brainwash and control people, which was used for shock value and was not an accurate representation of the procedure. At that time, anesthesia was being used, so it was not a traumatic event for the patient, as the movie made it seem.”
The anesthetic administered to patients undergoing the procedure and changes in the type of electricity used and the way seizures are triggered have made the procedure safer and more effective. In the past it could result in more significant memory loss. Now it can result in some short-term memory deficits, but they aren’t permanent, said Becker, assistant professor of Clinical Psychiatry and Behavioral Sciences and medical director of the Neuromodulation Suite.
“Most of our patients who undergo ECT have been receiving other kinds of treatment for years,” said Becker.
“They’ve tried a variety of medications and therapies and either haven’t gotten well or haven’t stayed well,” Becker said.
Over time, the list of conditions for which ECT is effective has been whittled down, he said. “We know that it is not effective for posttraumatic stress disorder, obsessive compulsive disorder or personality disorders. It’s very effective for mood disorders like major depression and for bipolar disorder and catatonia — resulting in about 80-90 percent remission rates for depression and almost 100 percent for catatonia,” in which patients hold a rigid, immobile position for a considerable length of time. If severe catatonia is untreated, it’s nearly always fatal, Becker said.
ECT is one of two treatments provided in the Psychiatric Hospital’s Neuromodulation Suite. There’s a room dedicated to transcranial magnetic stimulation (TMS), a non-invasive procedure used to improve symptoms of depression. Electrical pulses are sent by a device placed on top of the head over the prefrontal cortex, the region of the brain linked to mood. The patient, who sits in a chair similar to a dentist’s chair, is not sedated. Last year, there were about 1,900 total ECT treatments in the Neuromodulation Suite. Most patients have an average of 12 treatments.
Becker, whose primary clinical interests are mood and anxiety disorders, including major depressive disorder, bipolar disorder and obsessive compulsive disorder, said seeing people’s lives change dramatically after treatment is tremendously rewarding. It’s the reason he chose psychiatry for a specialty.
“Many patients who come to us for ECT or TMS have suffered from depression for many years. Their quality of life has suffered; their family life has suffered; their professional life has suffered. Many of these people say ‘I have never not been depressed.’”
Becker especially remembers one septuagenarian patient whose life was dramatically impacted.
“I remember this older gentleman who told me, ‘If I don’t get better, today, I’m going to kill myself. I can’t live like this.’ He looked miserable. When you see people like that, it sucks the life out of the room around them.”
Becker saw the man shortly after he received ECT treatments, and the transformation was startling. “He had a glow about him. He was smiling when I saw him and said he wasn’t depressed. I got to see him go from being in a miserable state, not bathing and not sleeping, to him telling me, ‘I haven’t felt this good in 20 years.’ His wife was so appreciative and I felt like we had really saved someone’s life.”
Becker supervises ECT all day on Fridays, and TMS procedures five days a week. The rest of his time is spent seeing patients on the Psychiatric Hospital’s inpatient unit, and in clinic for medication management and to assess whether they are candidates for neuromodulation.
A native of Memphis, Tennessee, Becker received bachelor’s and master’s degrees from Tulane University in New Orleans in 2003 and 2004, respectively, then worked for a year at Louisiana State University as a research assistant in the Department of Psychiatry. During a clinical internship at New Orleans Charity Hospital, he decided taking care of patients with psychiatric needs was what he wanted to do as his life’s work.
He left New Orleans two weeks before Hurricane Katrina hit the city in 2005 to attend Des Moines University, where he graduated with a Doctor of Osteopathy (DO) degree in 2009.
He joined the Vanderbilt faculty in 2013 after completing his adult psychiatry residency training at Vanderbilt. He served as chief resident during his third year of training and received the Marc H. Hollender award for outstanding performance by a psychiatry resident.
“I chose Vanderbilt for my residency because I was really impressed with the opportunities here, mainly because of Vanderbilt’s standalone psychiatric hospital. I didn’t see that in the other programs I visited. Most of them just had large units as part of their medical centers. Also, the psychiatry program here was a growing program with a new chair (Stephan Heckers, MD) so I had a lot of excitement about the department and our services.”
Becker and his wife have three children — 6- and 10-year-old boys, and a 4-year-old girl. He spends as much time as possible with his children in his time away from VUMC, practicing with and watching his sons play baseball in recreational leagues.
He’s also an avid soccer fan. He played soccer in high school and currently plays in a few leagues around Nashville. “Most people I play with are 10 to 15 years younger than me,” he said, laughing. “But I really enjoy it.”
