The Interventional Psychiatry Service was created to offer treatments to adults with treatment-resistant depression who are currently on antidepressant medication but still experience significant symptoms and have not found relief with traditional medication treatment.
Available Treatments
(To determine if these therapies may be right for you, please speak with one of our behavioral health specialists.)
Electroconvulsive Therapy (ECT)
This therapy is delivered to the brain, which releases a surge of neurotransmitters that help
What Is ECT?
Electroconvulsive therapy, a medical procedure to treat psychiatric and neurological illnesses, is highly effective and efficient. ECT’s use dates to 1938, but technological advancements have made the modern application look much different. The goal is to generate a controlled seizure, occurring multiple times during treatment, to help the brain “reset” neurotransmitters and alleviate symptoms.
Electricity, the stimulus that generates the seizure, is optimized to the lowest amount that will cause seizure activity for 30 to 60 seconds. A course of treatment consists of a session every 2 to 3 days for 6 to 12 treatments.
ECT is not a cure for mental illness, but it can help a patient recover from an acute episode after not responding to previous treatments. ECT may be administered on an inpatient or outpatient basis, depending on the symptoms.
Symptoms treated by ECT
Severe depression (including Major Depressive Disorder and Bipolar Depression)
- Imminent risk: First-line treatment for acute safety risk to life or medical status.
- Treatment resistant depression: No improvement after several medication trials.
- Depression during and after pregnancy.
- Severe mania.
- Catatonia.
- Refractory psychosis as seen in schizophrenia: Limited or failure to respond after several medication trials.
ECT Procedure
Preparations
- Physical examinations include an electrocardiogram and laboratory tests.
- Anesthesia consultation.
- Consent for ECT and anesthesia.
Prior to Treatment
- Nothing by mouth after midnight, including food, water and medication.
- Wear comfortable clothes.
- Use the restroom to empty bladder, if needed.
Procedure (5 to 10 minutes)
- Verification of patient identifying information, procedure type, and allergies.
- Monitors placed, including blood pressure cuff, pulse oximeter, EKG, EEG and IV.
- General anesthesia and muscle relaxant administered.
- Oxygenation by bag masking.
- Mouthguard placed to protect teeth and soft tissue from the clenching of teeth produced by the electrical stimulus.
- Stimulus administered.
- Seizure activity for approximately 30 to 60 seconds.
- Respirations are supported until consciousness is regained.
Recovery (20 to 30 minutes)
- Vital signs monitored.
- Orientation and alertness assessed.
- Assessed for side effects and treated as needed.
Limitations
- No driving during the course of ECT and for 2 weeks thereafter.
- Due to possible cognitive side effects, patients may not be able work during the course of treatment.
- No alcohol or illicit drugs during treatment.
Common Risks
- Transient: Headache, muscle ache and nausea.
- Short-term memory deficits: Typically, transient and primarily affect memory formation around the time of treatment, making it difficult to recall specifics or unable to recall events entirely. Rarely impairs long-term memory or biographical information. The memory may or may not be recovered after a course of ECT is complete. Individuals with preexisting cognitive deficits are at higher risk.
Rare Risk
- Death: Extremely low risk with a mortality of less than 1 per 70,000 treatments. Reduced by optimizing physical health, specifically heart and lung function.
Benefits
- Severe depression: 60 to 90 percent respond to ECT.
- Faster and more effective than antidepressant medications.
- The fastest way to reduce acute safety risk from mental illness in terms of suicidal thinking and restore functioning in the form of self-care and nutritional intake.
- Significantly improves quality of life.
Referrals
Your healthcare provider can make a referral by calling 475.210.3900, or an outpatient consultation will be scheduled to discuss current symptoms and determine if ECT is an appropriate option.
ECT Outpatient Service
2400 Main Street
Bridgeport, CT 06606
475.210.3900
Directions >>
Transcranial Magnetic Stimulation (TMS)
This therapy is a form of neuromodulation that delivers focused, MRI-strength magnetic pulses to stimulate nerve cells in an area of the brain linked to depression.
What Is TMS?
TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation. It stimulates nerve cells in an area of the brain that is linked to depression and OCD by delivering highly focused MRI-strength magnetic pulses.
Patients being treated by TMS Therapy do not require anesthesia or sedation and remain awake and alert. It is a 20-to-40-minute outpatient procedure that is prescribed by a psychiatrist and performed in a psychiatrist’s office. The treatment is typically administered daily for 4-6 weeks.
TMS Therapy has been demonstrated through rigorous clinical trials to be safe, effective and well-tolerated by patients. No side effects such as weight gain, sexual problems, stomach problems, sleepiness, or dry mouth were seen during clinical trials, and there were no negative effects on memory or ability to concentrate.
The most reported side effect related to treatment was scalp pain or discomfort during the treatment session. This side effect was generally mild to moderate and occurred less frequently after the first week of treatment. Less than 5% of patients treated with TMS Therapy discontinued treatment due to side effects.
How it Works
Hartford Healthcare’s Fairfield Region Behavioral Health Network utilizes the MagVenture TMS device, which has been approved by the U.S. Food and Drug Administration for the treatment of patients with Major Depressive Disorder and Obsessive Compulsive Disorder (OCD).
Through a treatment device, a TMS Therapy system generates highly concentrated magnetic fields that turn on and off very rapidly. These magnetic fields are the same type and strength as those produced by a magnetic resonance imaging (MRI) machine.
The treatment device is applied to the head above the left prefrontal cortex. This part of the brain is involved with mood regulation and, therefore, is the location where the magnetic fields are focused. These magnetic fields do not directly affect the whole brain; they only reach about 2-3 centimeters into the brain directly beneath the treatment device. As these magnetic fields move into the brain, they produce very small electrical currents. These electrical currents activate cells within the brain, which are thought to release neurotransmitters.
MagVenture TMS Therapy® is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode and for the treatment of OCD.
Referrals
Your healthcare provider can make a referral by calling 203.221.8899. An outpatient consultation will be scheduled to discuss current symptoms and determine if TMS is an appropriate option.
TMS Outpatient Service
1 Lois Street
Norwalk, CT 06851
203.221.8899
Directions>>