Electroconvulsive Therapy (ECT)

What is electroconvulsive therapy (ECT)?

In electroconvulsive therapy (ECT) a controlled electric current is passed through the brain, producing a very brief seizure. Used mainly to treat severe depression, ECT creates some of the same changes that medications do in patients with depression. It is often used when medication has not been effective.

Although in the past ECT has been depicted as dangerous and cruel, the risks have been reduced by the modern use of anesthetics and muscle relaxants. While ECT remains somewhat controversial, it can produce results quickly and is widely regarded as both safe and effective for older adults.

ECT is usually done in a hospital and can be performed on an outpatient basis under the supervision of a psychiatrist.

When is it used?

ECT is used for people with severe forms of depression, schizophrenia, and bipolar disorder when other forms of treatment such as psychotherapy or medications:

• have not worked
• would take too long (as when someone is suicidal)
• have had too many side effects.

ECT is also sometimes used when people hear voices or have delusions.

How does ECT work?

No one knows exactly how ECT works. What is known is that the brain is made up of cells that communicate with each other through both chemical and electrical signals. The effects of ECT are thought to cause the regions of the brain that control emotions and thoughts to return to a more stable condition.

What are my rights as I consider ECT?

Before you receive ECT, you and your health care provider need to discuss the planned treatment.

You should ask what other treatments are available to treat your condition, and the benefits and risks these procedures may have.

Ask questions about how many treatments are planned, what will be done to you during the procedure, and how will you be kept informed of progress as the treatment continues.

You may withdraw your decision to have ECT at any time.

How do I prepare for the procedure?

Your doctor will order lab tests to make sure you have no physical problems that would keep you from having ECT.

Your doctor will tell you when to stop drinking or eating before your procedure and whether you should change your medicine for the day. An intravenous (IV) line will be started so medications can be put directly into a vein. You will be given a general anesthetic to put you to sleep and medicine to relax your muscles.

What happens during the procedure?

Your heart rhythms will be monitored. Sensors on your forehead will measure brain waves. You will have a blood pressure cuff on one arm, and a device on one finger to measure the oxygen level in your blood. After you are asleep, electrodes are applied to one or both temples. A controlled electric pulse is delivered to the electrode(s), which causes a generalized seizure in your brain. The electrical stimulation may be delivered continuously or in pulses. Because you are asleep and your muscles are relaxed, you should feel no pain and will not be injured.

What happens after the procedure?

You will be watched carefully until you wake up from the procedure. Your blood pressure and heart rhythm will be checked. When you are awake, you will be told when you can have food and medicine and when you can resume normal activities. If the ECT was done on an outpatient basis, you will be ready to go home in a few hours.

You may have 2 or 3 ECT sessions a week and from 6 to 10 sessions over a 3-to-6-week period. Some people are on a maintenance schedule of an ECT treatment a month.

What are the benefits of ECT?

About 80% of depressed people who have ECT get better after a full course of treatment. ECT has worked for people who do not respond to other forms of treatment. You and your doctor should discuss the benefits of this treatment as part of your treatment plan.

What are the risks of ECT?

Any medical procedure has a certain amount of risk. Risks from ECT include:

• a slight possibility of death due to the use of a general anesthetic
• rarely, irregular heart rates and rhythms
• short-term memory loss that may take weeks to go away.

The most common side effects of ECT are headaches, muscle aches or soreness. These usually occur in the first few hours after the procedure. Some people have a period of confusion that may last for a few hours but is later forgotten. Some people cannot remember at all what took place right before the treatment.

When should I call the doctor?

If you have questions or concerns after your procedure, contact your doctor.