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Clinically depressed man 

   

   
Electroconvulsive Therapy


What is it?

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure.  ECT seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses.  It often works when other treatments are unsuccessful.
       

What type of patient is treated with ECT?

  • Patient diagnosed with severe, debilitating and/or chronic depression (treatment-resistant depression) who is unresponsive to other forms of therapy.
  • Patient who poses a severe threat to themselves or others and their situation is too dangerous to wait until medications take effect.
  • Pregnant patient who cannot take medications that might harm the developing fetus.
  • Older adult patients who can’t tolerate drug side effects.
  • Patients who prefer ECT treatments over taking medications.
  • Patients who have had previous success with ECT.

Why is ECT done?

Rapid, significant changes in severe symptoms need the expediency of ECT in cases of:
  • Suicide threat
  • Refusal to eat
  • Detachment from reality (psychosis)
  • Schizophrenia accompanied by psychosis
  • Severe mania, a state of euphoria, agitation or hyperactivity that occurs as part of bipolar disorder
  • Catatonia, characterized by lack of movement, fast or strange movements, lack of speech and other symptoms.

How is ECT done?

Prior to an ECT treatment, a patient is given a muscle relaxant and is put to sleep with a general anesthesia.  Electrodes are placed on the patient’s scalp and a finely controlled electric current is applied.  This current causes a brief seizure in the brain. Because the muscles are relaxed, the visible effects of the seizure will usually be limited to slight movement of the hands and feet.  Patients are carefully monitored during the treatment.  The patient awakens minutes later, does not remember the treatment or events surrounding it, and is often confused. The confusion typically lasts for only a short period of time. When used, ECT is usually given up to three times a week for a total of two to four weeks, but it can vary by person and condition.
       

What are the risks of ECT?

Although ECT is generally considered safe, there are known risks and side effects.  These include:
  • Memory loss.  ECT can affect a person’s memory in several ways. There may be difficulty remembering events that occurred before treatment began, a condition known as retrograde amnesia. It may be hard to remember things in the weeks or months leading up to treatment, although some people do have problems with previous years’ memories, as well. The patient may also have trouble recalling events that occurred during the weeks of their treatment. And some people have trouble with memory of events that occur even after ECT has stopped. These memory problems usually improve within a couple of months.
        
  • Confusion.  Immediately after an ECT treatment, the patient may experience a period of confusion. They may not know where they are or why they're there. This confusion may last from a few minutes to several hours. It may be possible to return to work and normal activities right away or rest may be needed for several hours after treatment. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.
          
  • Physical side effects.  Following an ECT treatment, the patient may experience nausea, vomiting, headache, jaw pain, muscle ache or muscle spasms. These are common and generally can be treated with medications.
          
  • Medical complications.  As with any type of medical procedure, especially one in which anesthesia is used, there are risks of medical complications.  During ECT, heart rate and blood pressure increase, and in rare cases, this can lead to serious heart problems. If the patient already has heart problems, ECT may be more risky.
Sources:  Mayo ClinicPsych Central  

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Last Reviewed: November 12, 2013