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Electroconvulsive therapy (ECT) is a treatment for certain mental illnesses. During this therapy, electrical currents are sent through the brain to induce a seizure. The procedure has been shown to help 78 percent of people with clinical depression. It’s most often used to treat people who don’t respond to medication or talk therapy.
ECT has a checkered past. When ECT was first introduced in the 1930s, it was known as "electroshock therapy." In its early use, patients regularly suffered broken bones and related injuries during therapy. Muscle relaxants weren’t available to control the violent convulsions caused by ECT. Because of this, it’s considered one of the most controversial treatments in modern psychiatry.
In modern ECT, electrical currents are administered more carefully. Also, the patient is sedated to reduce the risk of injury. Today, both the American Medical Association and the National Institutes of Mental Health support the use of ECT.
ECT is most often used as a treatment of last resort for the following disorders:
This mood disorder is characterized by periods of intense energy and elation (mania) followed by severe depression.
This is a common mental disorder. People with this disorder experience frequent low moods and a lack of self-esteem. They may also not enjoy activities they once found pleasurable.
This psychiatric disease typically causes paranoia, hallucinations, and delusions.
There are two major types of ECT: unilateral and bilateral.
In bilateral ECT, electrodes are placed on either side of your head. The treatment affects your entire brain.
In unilateral ECT, one electrode is placed on the top of your head. The other is placed on your right temple. This treatment affects only the right side of your brain.
Some hospitals employ "ultra-brief" pulses during ECT. These last less than half a millisecond, compared to the standard one-millisecond pulse. The shorter pulses are believed to help prevent memory loss.
To prepare for ECT, you’ll need to stop eating and drinking for a specified period of time. You may also need to change certain medications. Your doctor will let you know how to plan.
On the day of the procedure, your doctor will give you general anesthesia and muscle relaxants. These medications will help prevent convulsions. You’ll fall asleep before the procedure and not remember it afterwards.
Your doctor will place two electrodes on your scalp. A controlled electrical current will be passed between the electrodes. This current causes a brain seizure, which is a temporary change in the brain’s electrical activity. It will last between 30 and 60 seconds.
During the procedure, your heart rhythm and blood pressure will be monitored. In outpatient procedures, you’ll typically go home the same day.
Most people receive benefits from ECT in as few as eight to 12 sessions over three to six weeks. Some patients require a once-a-month maintenance treatment.
According to a review by the U.S. Food and Drug Administration, 78 percent of patients with clinical depression improved after ECT. In addition, people who are treated with ECT have a 70 to 90 percent remission rate. This compares to a 20 to 30 percent rate for those taking medications.
The reason ECT is so effective remains unclear. Some researchers believe it helps to correct an imbalance in the brain’s chemical messenger system. Another theory is that the seizure somehow resets the brain.
ECT works for many people when drugs or psychotherapy are ineffective. There are typically fewer side effects than with medications.
ECT works quickly to relieve psychiatric symptoms. Depression or mania may resolve after only one or two treatments. Many medications require weeks to take effect. Therefore, ECT can be especially beneficial for those who are suicidal, psychotic, or catatonic.
However, some people may require maintenance ECT (or medications) to maintain the benefits of ECT. Your doctor will need to monitor your progress closely to determine the best follow-up care for you.
ECT may be safely used on both pregnant women and those with heart conditions.
Side effects associated with ECT are uncommon and generally mild. They can include:
If you or a loved one is dealing with suicidal thoughts, call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255 right away.
Written by: Michael Kerr
Medically reviewed on: Mar 09, 2016: Steve Kim, MD
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