Anxiety and depression were running Gary Gulman’s life. He was in constant panic mode. The successful comedian, who’d performed on Late Show with David Letterman, Late Night with Seth Meyers, and Conan, and also had released two Comedy Central specials, could hardly get himself out of bed. He wasn’t sure he wanted to live anymore.
Gulman had tried almost every combination of medication during 30-plus years with his mental illness. But it would be electroconvulsive therapy (ECT) in 2016 and 2017 that would ultimately set the 47-year-old on a path toward remission and back on the stage.
“I resisted for years because of its reputation, and the name of it was daunting: electro, and then you add convulsive to it — I had these images of Jack Nicholson,” Gulman said. “And then the side effects of memory loss made me even more fearful of it.”
Like many who’d seen the 1975 film, “One Flew Over the Cuckoo’s Nest,” Gulman had imagined what ECT would entail. But his experience with ECT was nothing like Hollywood portrayed. ECT is a procedure where small electric currents are passed through the brain while the patient is under general anesthesia.
“It’s not a mind eraser, it’s not dangerous, and honestly, I can say it’s physically painless,” Gulman said.
Dr. Konoy Mandal, a psychiatrist and medical director of UCHealth Refractory Depression Clinic – Longs Peak Hospital, offers ECT to his patients and said the treatments have changed dramatically in recent years.
“Modern-day ECT has a fraction of the side effects of ECT even 10 years ago,” said Mandal, who has not treated Gulman.
Gulman went through his ECT treatments in New York. And four years after his treatment and the release of his HBO comedy special “The Great Depresh,” he told UCHealth Today he’s grateful he put those false images aside and went forward with a treatment that ultimately changed his life.
“ECT is one of the most evidence-based interventions around to get a client into remission,” Mandal said. “Remission is not only feeling better. It is being indistinguishable from someone who does not have an illness. It is not a cure but total control of the illness. No other treatment in psychiatry has better data to return a person to their pre-illness functioning.”
Advancements in electroconvulsive therapy
Gulman had learned about electroconvulsive therapy as most did in the 1970s: from Hollywood. But it’s been around much longer than that. The first human trial was successfully conducted in 1938 on a 39-year-old man with schizophrenia in Italy. And doctors soon found it could help with other neurological and psychiatric conditions including major depression.
But since it first came into the mainstream, there have been significant advances in ECT, Mandal said.
“One has to remember ECT was initially developed when electricity was not able to be managed as it is now,” he said. “Alternating currents were the only option back then, and brain imaging was science fiction.”
In much the same way as electric currents to the heart can restore a normal rhythm to patients with an irregular heartbeat, ECT restores the patient’s brain “beat” to a healthy pattern, reversing symptoms of certain mental health conditions.
Dealing with deep depression and anxiety
In his recent HBO special, “Gary Gulman: The Great Depresh,” Gulman talks about his childhood, life-long therapy, endless medications, and ultimately, how electroconvulsive therapy changed his life.
He had been suffering on and off for years. One bout in 2015 was so relentless that Gulman felt his comedy career would be over unless he got help. Gulman decided it was finally time to explore something that had scared him since his doctor first suggested it back in 2007.
“My depression had lasted so long and was so severe I was up to trying something new,” Gulman said in an interview with UCHealth Today. “Most of my treatment up until that point included ketamine and a number of other depressants — others that I had used so long that I was cycling through them again.”
Once he decided to consider ECT, he began doing his own research on what it involved, side effects and treatment advances.
Breaking down the stigma of ECT
Gulman’s view of electroconvulsive therapy first started to change after listening to a broadcast interview with Kitty Dukakis, the wife of former Massachusetts Gov. Michael Dukakis. She had battled depression for years before finally trying ECT. She and her husband are now advocates and work to discredit the stigma associated with it.
“She was very open about it; its effectiveness and how it helped her,” Gulman recalled.
That interview spurred more research. That’s when Gulman came across a TED talk from Yale School of Medicine professor, surgeon, and author Sherwin Nuland, who discussed the development of ECT and his personal experience with the therapy that changed his life.
But Gulman still wasn’t ready to commit; he was worried about the most significant side effect: memory loss. How could he go on with his life — his passion — as a comedian if he suffered from memory loss? On the other hand, how could he go on without the treatment?
Gulman was sleeping 14 hours a day, and he could hardly make it around the block with his wife, Sade, to walk their dogs, much less do stand-up.
His depression was so severe that he no longer wanted to live.
“It couldn’t significantly reduce my quality of life as much as depression and anxiety had. I didn’t want to live,” Gulman admitted.
Gulman’s experience with electroconvulsive therapy
That’s when he decided it was time to try ECT.
With the support of his wife, Gulman checked himself into Weill Cornell Psychiatry NewYork-Presbyterian Westchester Behavioral Health Center in January 2016 for three weeks to undergo treatment three days per week.
“There was a first appointment where I talked with the doctor who would be performing it,” Gulman recalled. “Then I was awoken at 7 a.m. or so. A nice nurse put me in a wheelchair with a blanket over my legs and wheeled me downstairs. I’d wake up very depressed and anxious but felt very comfortable with the nurse.”
The procedure only takes about three minutes, but the appointment lasts about two hours because nurses put in an IV and the patient goes under general anesthesia for a short time.
“The three seconds while the anesthesia took over my body and brain were the best part of my day because I was soon to be in comfortable oblivion,” Gulman said. “My time awake around then was agony and had been for years.”
How does electroconvulsive therapy (ECT) work?
Mandal explained that various doctors use slightly different schedules for electroconvulsive therapy. He offers it as an outpatient procedure where patients come three days a week for three weeks, then once a week for four weeks, after which they wean down to a treatment once a month, once every two months and one time after a three-month period. With this schedule, along with an exercise and psychotherapy plan developed in conjunction with Mandal, patients have an 80% chance of staying in remission years after they are done with ECT, he said.
“No other data in psychiatric medicine comes close to the long-term remission possible with ECT plus follow-up talk therapy,” he stressed.
But why is this schedule so important? Mandal said, “We do that because we want to remind the brain that the illness is the enemy. We don’t want the illness to get back into that driver seat and tell the electricity where to go.”
Gulman noticed his anxiety disappeared after just three treatments, and after nine treatments he left the hospital. Although his depression wasn’t 100% gone, he said he was able to return to life.
“I had relief,” he said. “I didn’t feel as well as I feel now, but I felt significantly better. At least 50% of my depression was gone and 100% of my anxiety was gone.
“Anxiety is hard to live with. If I had to choose depression or anxiety, I’d choose depression because anxiety is incredible. It was a tremendous burden lifted.”
Risk and side effects of ECT
Because of advancements in imaging technology — specifically, positron emission tomography and functional magnetic resonance imaging (PET/fMRI) scans — doctors have a much better ability to aim at specific brain areas affected by psychiatric illness. The use of an electroencephalogram — a brain electrical wave like an EKG for the heart — during electroconvulsive therapy means ECT specialists can objectively tell if they are providing a good treatment and how to modify the electrical pulse and position if needed.
“Unlike anything else we have, EEG monitoring gives us objective data to show whether we are making a difference or not with ECT,” Mandal said. “With medication and therapy, there is no way to objectively measure how well we are doing.”
About half of ECT patients deal with short-term memory loss, Mandal said.
“The memory center is right next to most of the psychiatric machinery of the brain,” he explained. “My job is to hit the mood disorder circuits and miss memory as much as possible.”
If memory is affected, Mandal said he can change his aim and modify intensity to rapidly improve memory.
“The exact position of a patient’s memory system relative to their mood disorder circuit cannot be known without a few treatments,” Mandal said, adding that there are 10% of patients who cannot get good ECT treatment without significant memory issues. Those patients are easily identified within a few weeks and they will return to pre-ECT memory function within a few weeks of stopping treatment.
Nine months after Gulman’s first ECT treatment, he got a second ECT treatment at a Manhatten behavioral health hospital. Between treatments, he continued behavioral health therapy and finally found a medication combination that worked.
ECT is not the end-all treatment option
Mandal stresses that electroconvulsive therapy doesn’t stand alone in one’s path to remission.
“There are four evidence-based interventions to improve mental health illnesses: electrical and magnetic fields modulations, medication, psychotherapy and exercise,” he said. “Those are the big four. The four horses needed to pull you out. And ECT is the strongest, fastest and quickest horse. But you can’t rely on that horse the whole time. You use it to get out and then have those others kick in.”
Many people can’t find success with these other interventions, Mandal said, because their illness has redirected their brain electricity, preventing them from utilizing their frontal lobes to successfully apply psychotherapy and exercise interventions. When a patient isn’t responding to those other treatments — which is the case in about 20% of people experiencing severe depression — ECT should then be discussed.
“ECT puts the lights on in that part of the brain,” Mandal said. “But we can’t just leave it at that. We need to teach the brain resilience — to be able to suffer without falling.”
Mandal said he explains this process to his patients like this:
“We are moving the brain from a standard sedan to a Jeep, and it’s on the road of life. And yes, it can suck. Those boulders, ravines, gullies and slopes are still on the trail, but in your Jeep, you’re going to go over them. ECT gets you that Jeep, but it doesn’t drive it. You got to get the packaged deal.”
How ECT jumpstarted Gulman’s path to remission
“ECT got me to the point that I could do a number of things that contributed to my recovery,” Gulman explained.
After his second round of electroconvulsive therapy, he started slowly returning to his life, first by going out to meet friends, then enjoying other activities again.
“I started to exercise slowly at first; long walks with the dog. Then I took short jogs, used the elliptical, and built on that. Exercise has helped lift my mood, an amplifier to positivity.”
He joined a mood disorder support group, gaining strength from being understood by others with whom he could identify. And he began reading again.
“My anxiety before treatment was so significant that it was running my life. I was in constant panic mode, unable to concentrate or read,” he said. “I use to read 50 to 60 books a year, but I couldn’t get my brain to slow down.”
After his first three treatments, he saw that dramatically change: “The first book I read was “Sirens of Titan” by Kurt Vonnegut. I finished it, so that was something.”
Other things became easier as well.
“It made the idea of living and hoping more attractive,” he said.
Talking about depression and behavioral health treatment
Gulman has returned to the stage, able to talk about his depression and experiences.
“I had a revolution regarding my creativity,” he said. “I had to stop judging my worth based on my work as a performer and comedian. I had to give myself permission to fail — let it be part of the process and not discourage me. That was something I was not able to address if I was in that despair. I needed to get to that level of well-being to address it with perspective.”
And when he opened up his life on stage, he was surprised and grateful for his audiences’ reactions.
“I was reluctant to share with strangers. I didn’t want to scare them off or think I’m more troubled than I let on, or feel bad for me or pity me. But once I started talking about it, I found it is more common than I thought and people were indeed hungry to talk about it.
“I learned how many lives (ECT) has saved. Lots (of people) have come up to me after the show, or emailed, where ECT was crucial in saving their quality of life.”
Gulman said he’s felt good and strong since his last treatment in October 2017. His life challenges have not disappeared, but as Mandal put it, Gulman now has the vehicle in which to get over those bumps.
Two years ago, Gulman’s dog died and he felt he might relapse. He called his doctor and they reassessed his medications.
“I still missed my dog and was grieving, but I was not feeling that hopelessness; that life was a miserable endeavor,” he said.
Now and then, he still needs to address his mood during the day. He admitted that sometimes he feels sluggish and considers taking a nap rather than playing basketball.
“I use to ask myself the questions, ‘How bad do you feel? Hospital? Increase meds? But I would say I’ve never gotten beyond, ‘You should probably go exercise and see how you feel after that.’ Not once, thank God, have I not been able to address a sluggish mood or negative day — wipe those feelings out — through vigorous exercise. It’s good to know there are steps I can take.”
Behavioral health specialists help individuals to overcome mental health challenges and addiction disorders. Whether you’re dealing with the stress of daily living or facing a crisis, you can find compassionate care at a UCHealth facility. Our network of hospitals and facilities gives you access to evidence-based treatment from leading experts across Colorado. We offer behavioral health services for people of all ages, from infants, children, and teens to adults at all stages of life. Learn more at uchealth.org/services/behavioral-health/
Electroconvulsive therapy, or ECT, is a treatment for patients with severe depression or bipolar disorder that have not responded to traditional medication or psychotherapy. To learn more visit UCHealth Refractory Depression Clinic – Longs Peak Hospital