Electroconvulsive Therapy (ECT)
What is electroconvulsive therapy (ECT)?
Electroconvulsive therapy (ECT) is a form of brain stimulation. It involves passing a controlled electrical current through the brain while a person is under general anesthesia. The current produces a brief seizure that lasts about 40 to 60 seconds. Scientists believe this stimulates changes in brain chemistry or communication that effectively treats certain psychiatric disorders.
In the past, ECT was called electroshock therapy. It was a much cruder procedure and developed quite a stigma. Patients did not have anesthesia and the dose of electricity was much higher. This resulted in significant side effects, such as permanent memory loss and broken bones.
Modern ECT uses electrical pulses that are one millisecond in length. Some centers use even shorter bursts that are a fraction of a millisecond long. These shorter pulses result in less memory loss and other cognitive side effects. Doctors also use medication to prevent the rest of the body from moving violently during the seizure. Today, ECT is considered a safe and effective mental health treatment by the American Psychiatric Association, the American Medical Association, and the National Institute of Mental Health.
Why is electroconvulsive therapy (ECT) performed?
Doctors most often use electroconvulsive therapy for depression that is severe and resistant to medications and psychotherapy. ECT can also treat the following mental health disorders when other treatments fail:
- Bipolar disorder or severe mania
- Depression with psychotic symptoms
In general, doctors reserve ECT as a last resort after medication and psychotherapy options have been exhausted. However, ECT may be useful for certain people as a first-line treatment. This includes situations when medications aren’t an option, such as pregnant women with severe depression and older adults who aren’t likely to tolerate medication side effects. Doctors may also use ECT in emergent situations when medications can’t work fast enough, such as in someone who is suicidal.
Who performs electroconvulsive therapy (ECT)?
A specially trained psychiatrist performs electroconvulsive therapy (ECT). Psychiatrists are medical doctors who specialize in diagnosing and treating mental and emotional disorders. They focus on the biological, psychological and social components of diseases, disorders and conditions. When choosing a psychiatrist for ECT, look for one with significant experience using the procedure to treat your specific condition.
How is electroconvulsive therapy (ECT) performed?
An electroconvulsive therapy procedure can take place in the hospital or in an outpatient setting. It requires general anesthesia to put you to sleep during the procedure. Doctors use a short-acting anesthetic to knock you out for about 10 minutes. Doctors will also give you a muscle relaxant to limit the amount your body moves during ECT. This helps prevent injury during the seizure.
What to expect the day of your ECT
In general, this is what happens the day of your ECT:
- You will change into a hospital gown and remove all jewelry. It’s a good idea to leave valuables at home or with a family member.
- You will talk with a preoperative nurse. The nurse may check your heart and lungs and will start an IV (intravenous) line. The nurse will also place electrodes on your head. Some electrodes monitor your brain activity and some are for administering the electrical pulses.
- You will talk with an anesthesiologist or nurse anesthetist about your medical history and general anesthesia.
- You will be hooked up to a heart monitor with electrodes on your chest, a blood pressure monitor, and possibly oxygen to breathe through a mask. Your team may give you a mouth guard to protect your teeth and tongue.
- Your team will place a blood pressure cuff around one ankle or forearm. Inflating it prevents the muscle relaxant form affecting the foot or hand. This lets your doctor check for seizure activity in that foot or hand during the electrical pulses.
- Your team will give you general anesthesia and a muscle relaxant. Shortly thereafter you will drift asleep.
- Your doctor will start the electrical pulses to induce a seizure that will last for 60 seconds or less. Your body will not convulse due to the muscle relaxant. But your doctor can verify seizure activity in the hand or foot with the blood pressure cuff. An electroencephalogram (EEG) will also show seizure activity in your brain waves.
- Your team will take you to a recovery area to allow the effects of general anesthesia and the muscle relaxant to wear off.
The total time it takes for an ECT procedure is about an hour, including preparation, treatment and recovery. The treatments are usually repeated 2 to 3 times a week for 3 to 4 weeks, up to 12 treatments. The number of treatments you need will depend on your response.
What are the risks and potential complications of electroconvulsive therapy (ECT)?
Like any procedure, electroconvulsive therapy (ECT) has risks. This includes risks from having general anesthesia, such as nausea, allergic reactions, and problems with breathing.
Potential complications of ECT
Potential ECT risks include:
- Confusion lasting for a few minutes to several hours. This is more noticeable in older people. In rare cases, confusion can last for days.
- Fatigue, headache and muscle soreness, which are usually short-lived
- Heart and blood pressure problems due to increases in heart rate and pressure during ECT
- Short-term memory loss that tends to affect events that happened in the weeks leading up to and during ECT. This usually improves after ECT treatments are complete. In rare cases, long-lasting memory problems, including permanent memory gaps, can occur. This is much less common than in the past with EC treatments.
Talk with your doctor to find out if electroconvulsive therapy benefits outweigh any potential risks for you.
Reducing your risk of complications
You can reduce your risk of certain complications by:
- Following activity, dietary and lifestyle restrictions and recommendations before your ECT and during recovery
- Notifying your doctor immediately of any concerns
- Taking your medications exactly as directed
- Telling all members of your care team if you have allergies
How do I prepare for electroconvulsive therapy (ECT)?
Your doctor will give you specific instructions to prepare for ECT. You can take steps beforehand that can improve your comfort and outcome. This generally includes:
- Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Arranging a ride home from the procedure.
- Getting any preoperative testing your doctor orders. For ECT, this may include a complete medical exam, psychiatric assessment, blood tests, and an EKG (electrocardiogram, or ECG).
- Not eating or drinking before ECT as directed. Your care team may cancel your ECT if you eat or drink too close to the start of the procedure because you can choke on stomach contents during anesthesia.
- Taking or stopping medications exactly as directed.
Questions to ask your doctor
It’s important to have all your questions answered before undergoing ECT. Here is a list of questions you may want to ask:
- Why are you recommending ECT for me? Are there any other alternatives?
- How many treatments will I need?
- Will I still need to take medication after ECT?
- What exactly is involved in the procedure?
- How many ECT procedures have you performed on people like me?
- How much success have you seen with ECT in people like me? Do you have outcome data to share?
- What are the most common side effects you have seen with ECT? How do you manage them?
- What are the possible long-term effects of ECT?
- What happens if ECT doesn’t help me?
- How should I contact you if I have a concern or emergency? Ask for numbers to call during and after regular hours.
What can I expect after electroconvulsive therapy (ECT)?
Knowing what to expect makes it easier to plan and prepare for a successful treatment series and recovery.
How long will it take to recover?
Because ECT involves general anesthesia, it generally takes about 24 hours to recover. You should not drive during that time or return to work. The physical side effects, such as fatigue and headache, usually only last a few hours. You may feel confused for several hours, as well. It’s a good idea to have someone with you during the first 24 hours.
Short-term memory problems can take longer to resolve. Memory problems may continue during the weeks of treatment. Most people see an improvement in memory within a couple of months after treatment ends. This may affect your ability to return to work and other normal activities.
Will I feel pain?
When should I call my doctor?
You will see your doctor regularly during your ECT treatment series. Contact your doctor if you have any questions or concerns between appointments.
How might the treatment affect my everyday life?
ECT is highly effective at improving symptoms of depression and other mental illnesses. Most people see an improvement in symptoms within six treatments. This translates to about 2 to 3 weeks. The full effect of ECT can take longer, but is usually still quicker than medications, which can take up to three months for the full effect.
ECT has a response rate of about 70 to 90%, which is higher than antidepressant drugs. However, it doesn’t help everyone and some people don’t respond to it. In addition, its effects are not long-lasting. Most people need to take medications to help control their symptoms and prevent a recurrence. Some people benefit from periodic ECT treatments. This maintenance ECT may involve monthly or yearly treatments.