Gerald Miles was not himself.

He didn’t leave the house, not even to check the mailbox, and slept most of the day.

His once voracious appetite for the beef tips and rice cooked by his wife, Debbie, was replaced with skepticism that perhaps she had not fully cooked the meat.

Tasks that once were simple, such as hanging a picture, became impossible feats for Gerald. He didn’t want to get out of bed. The anxiety and depression was constant and crippling.

“He just lost all confidence and, you know, being able to do much of anything,” Debbie Miles, 68, said of her 75-year-old husband. “When you get that depressed, you know, you’re somewhere else, you’re not here anymore.”

Gerald has mild bouts of depression in adulthood, but a dramatic change in personality occurred in a matter of hours one afternoon in 2020 not long after the pandemic prompted stay-at-home orders and business closures.

Gerald doesn’t remember much of his lows since 2020 and Debbie, who teared up upon recounting that time, said she’s glad he doesn’t.

“He remembers our life together and that’s what matters,” Debbie said.

Debbie and Gerald, from Brunswick, met after hours at an Americus post office in 1973 when the two were in school. The married a year later and Gerald got a job at Xerox in Macon.

The couple bought a house off Watson Boulevard and raised three kids there.

They’re now grandparents who enjoy time together in the rocking chairs on their front porch.

‘Feeling helpless’

When the pandemic hit in spring of 2020, Debbie and Gerald caught a cold but recovered.

One day, Debbie remembers she came home from an errand and found Gerald hallucinating with a high fever.

“That was scary,” she said. “He was saying a lot of things that weren’t true and was obviously confused. And so it continued to get worse.”

Gerald was admitted to a hospital for a week and misdiagnosed with dementia.

“We knew that wasn’t right but that was when COVID first started and you couldn’t get in to see anybody,” Debbie recalled. “We struggled along with the meds they had given him and for a couple of weeks it seemed to be better … but then it started going downhill again.”

Debbie Miles told their adult children about their father.

“It was just exhausting for him,” she said. “And for me too.”

One of their daughters posted a call for help on Facebook, “Can anyone recommend a good psychiatrist?”

A friend recommended inpatient care at Piedmont Macon’s Center for Behavioral Health. Though Miles’ doctor didn’t have admitting privileges there, the hospital made an exception.

Gerald stayed in the hospital for nearly six weeks and doctors tried a number of medications with no improvement.

“They just could not figure him out,” Debbie Miles said. “You’re just wanting to help and feeling helpless.”

One possible next step, doctors explained to Debbie, was to try electroconvulsive therapy or ECT, which is one of the oldest and most controversial psychiatric treatments. It gained notoriety decades ago from brutal portrayals in books and films created in a time when general anesthesia was not used during the treatment.

“I didn’t know what to expect,” Gerald said, “but I didn’t have any reservations.”

After only a few treatments, he showed marked improvement.

“He was so much better mentally and all that so we never went back for any more treatments and he was doing okay,” Debbie said.

Then, in fall 2021, the couple contracted COVID. Gerald was hospitalized for more than two months and on a ventilator for about three weeks.

“I don’t think anyone thought he was going to make it,” Debbie said.

After months of physical rehab and recovery, Gerald seemed to be OK.

“Then, in April, he started slipping away again,” Debbie said. “He finally just got so bad with paranoia and anxiety and all that that we just went to the hospital.”

Doctors again tried combinations of medicines during his nine-day stay. The pills, the couple was told, would take time, but Debbie observed, “he was just getting worse. Finally, I told him, ‘I think we might have to go back.’”

After another two weeks in the hospital with no improvement, doctors restarted the ECT.

Following several ECT treatments, Gerald was home again and acting like himself.

“It was a world of difference. I mean, 1,000 times better,” Debbie recalled. “It takes a few (treatments) to get you back to where you were normal.”

One recent afternoon, Gerald washed his wife’s car and rotated the tires. He cuts the grass and checks the mail. His appetite for Debbie’s beef tips and rice has returned and the paranoia of undercooked meat vanished.

“This is not ‘One Flew Over the Cuckoo’s Nest’ ”

Dr. Leslie Tomek, director of the ECT program at Piedmont Macon, said scientists don’t yet have a clear understanding how ECT works, but it is not the same sensationalized procedure depicted in movies and books from the ‘60s such as “One Flew Over the Cuckoo’s Nest.”

Dated images and descriptions of people convulsing while strapped to a table with a bite block between their teeth is far from today’s reality. The procedure was developed 84 years ago, according to a 2019 scientific article on the National Center for Biotechnology Information’s website.

“What we do now is really different,” she said. An electrical voltage “causes a seizure, but in a way that’s not harming you.”

The ECT procedure works like this: Patients are sedated with general anesthesia then electrodes are placed on one or both sides of their head. The electrodes are wired to a machine plugged into a wall outlet. At the press of a button, a controlled voltage passes from the machine, which modifies the electricity to make it less toxic, to the brain, inducing a seizure, Tomek said. The seizure is monitored with devices that record brain and heart activity.

Tomek performed ECT treatments at hospitals in Rochester, New York, and Fargo, North Dakota, before moving to Macon in 2016. Piedmont Macon had a machine before Tomek arrived but did not offer the procedure until 2017. It is the only hospital in Middle Georgia to offer ECT with the closest alternatives in Savannah and Atlanta.

Over the past five years, the ECT procedures have helped change the lives of about 45 patients, hospital spokesperson Andy Drury said.

Patients include business executives, civic leaders, doctors, lawyers, teachers and “just regular folks out in the community,” Tomek said. “I think there’s a lot of people that could benefit from ECT and they just either don’t know about it or they know outdated information about it.”

Many ECT patients are referred to the hospital by psychiatrists but some have independently sought the treatment. Drury said ECT is covered by most insurance companies including Medicaid.

Trials of ECT for major depressive disorder in patients with treatment-resistant depression have shown pooled response rates of 60 to 80% and pooled remission rates of 50 to 60%. While it is proven to be 70-90% effective in treating major depression, ECT is not the most convenient.

“You can’t eat that morning, you have to come to the hospital, you’re here a large portion of the day” and under general anesthesia for about 30 minutes, Tomek said. “We try to use other less invasive techniques. So therapy and medication are the two biggest ones that we rely on. So after ECT, we really start to very much focus on those two.”

How often a patient needs treatment depends on the individual. For example, if someone is acutely depressed, they may receive a series of three treatments a week for two to three weeks. Typically, patients need eight to 12 treatments “to get to that plateau where they’re doing really well,” Tomek said.

Once a patient is stable, Tomek said she increases the intervals between treatments. Some patients only need it every three months to maintain and prevent relapse.

Many treatments for depression come with side effects. Short term memory loss is commonly reported with ECT.

For Debbie Miles, the benefits outweigh the drawbacks.

“If he has some short term memory loss, that doesn’t concern me,” she said. “I just don’t want him to lose our history.”

Tomek said the stigmatization of mental health issues is waning as the younger generation is “more open to the concept and that it’s okay to have mental illness … With the older generation, there’s still a stigma, but I think it’s starting to change.”

Debbie said she and Gerald know the stigma still exists but decided to share their story “to help other people.”

“It’s embarrassing, I guess, or, you know, to have to admit you had to have that done, which seems, in some people’s minds, to be probably a very severe option I mean, you know, that you had…  to resort to this really dramatic, severe thing,” Debbie said of ECT. “All we could think about was, you know, goodness, is saying, ‘We did this and it’s made a world of difference and brought him back to me and to his family.’ Why wouldn’t you share that to help other people? Just let people know, ‘It’s, it’s okay.’”

To contact Civic Journalism Fellow Laura Corley, call 478-301-5777 or email [email protected].

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