Electroconvulsive Therapy (ECT)

Treatment Overview

Electroconvulsive therapy (ECT) is a procedure used to treat severe depression. It may be used in people who have symptoms such as delusions, hallucinations, or suicidal thoughts. It's also used when other treatments such as psychotherapy and antidepressant medicines have not worked. And it can be used for other psychiatric and neurological conditions, such as schizophrenia and Parkinson's disease.

Before ECT, you will get anesthesia to make you sleepy, and you'll get medicines to relax your muscles. Then an electrical current is briefly sent to the brain through electrodes. They are placed on the temples or elsewhere on the head, depending on the condition being treated and the type of ECT. The electrical stimulation, which lasts up to 8 seconds, produces a short seizure. Because of anesthesia, the seizure activity related to ECT does not cause the body to convulse.

It's not known exactly how this brain stimulation helps treat depression. ECT probably works by altering brain chemicals (like medicines do). These chemicals include neurotransmitters like serotonin, natural pain relievers called endorphins, and catecholamines such as adrenaline.

ECT treatments are usually done 2 to 3 times a week for 2 to 3 weeks. Maintenance treatments may be done once each week, tapering down to once each month. They may continue for several months to a year. This will reduce the risk of relapse.

For mental health conditions, ECT is usually given along with medicine, counseling, or both.

Ask your doctor when you can drive after having an ECT treatment.

What To Expect

Because of the effects of anesthesia, you may not remember the procedure. As with medicine, there can be side effects from ECT.

After you wake up, you may have some confusion, nausea, a headache, or jaw pain. These effects may last a few hours. You may also notice some short-term memory loss. This should slowly get better within several weeks.

Ask your doctor when you can drive after having an ECT treatment.

It's possible to have long-term memory loss after ECT. For some people, memory returns. But for others, there are lasting gaps in memory.

You'll need to have follow-up treatment with medicine or maintenance ECT. This will reduce the risk of relapse.

Why It Is Done

ECT is used for severe depression and other psychiatric or neurological conditions (such as bipolar disorder, Parkinson's disease, or schizophrenia).

Sometimes ECT is used for older adults who are taking multiple medicines for other illnesses and who are not able to take additional medicines for depression. And sometimes ECT is used for people who cannot tolerate the side effects of the medicines for depression.

How Well It Works

Studies have shown that ECT is an effective short-term treatment for severe depression. ECT may be used after other treatments have not worked.

Risks

In rare cases, ECT may increase blood pressure, cause changes in heart rhythm, or produce seizures that last longer than expected. These physiologic changes typically occur right away after the ECT treatment and can be managed by the health professionals doing the procedure, if needed. Often, though, these changes resolve quickly without treatment.

The risks of untreated, severe depression are often greater than the risks of ECT.

Other side effects of ECT may include headaches, muscle pain, nausea, and short-term and possibly long-term memory problems.