Electroconvulsive therapy (ECT) is a type of treatment sometimes known as “electroshock” therapy. The process involves attaching electrodes to the head that deliver pulses of electricity to the brain, triggering a seizure. ECT was widely used to treat psychiatric disorders in the 1940s and 1950s, when doctors used large amounts of electricity on patients who were not sedated with anesthesia. This created a stigma around ECT that still lingers. Through research and advances in technology, ECT is much safer today. It remains a treatment option for patients suffering from severe depression or other mental illnesses.
How ECT Works
Doctors administer ECT treatment while the patient is under anesthesia. The patient also receives a muscle relaxant to ensure the body does not convulse during the seizure. A doctor attaches electrode pads to different areas of the head, either on one or both sides of the brain. These are connected to an ECT machine. The doctor then presses a button on the ECT machine, which delivers an electric current that travels to the electrode pads on the head. This produces a seizure that typically lasts 30 to 60 seconds.
An electroencephalogram (EEG) machine records brain activity to show doctors when the seizure begins and ends. Shortly after the procedure, the anesthesia wears off, and the patient moves to a recovery room to be monitored. Most often, ECT treatments occur two to three times a week for up to four weeks on an outpatient basis.
Although there is no consensus on exactly how ECT helps treat depression, it appears to change chemical interactions in the brain. Some studies suggest that remission rates are higher for ECT patients than for those who opt for different treatments.
Who Is Treated with ECT?
ECT is generally recommended for patients who have not been able to treat depression with other therapies or who can’t physically tolerate the side effects of medications. Doctors first advise patients to try psychotherapy and/or antidepressants before opting for ECT. If a patient is severely delusional, manic or suicidal, ECT may be the preferred immediate treatment.
People with neurological disorders, pregnant women, children, and the elderly are not good candidates for ECT.
Possible Side Effects or Complications
Electroconvulsive therapy poses many risks and may cause long-term complications. Many patients experience confusion immediately following the procedure that can last from a few hours to several days or weeks. ECT may also cause:
- memory loss
- muscle spasm
- verbal or visual impairment
- high blood pressure
- brain damage
There have been few long-term studies to determine whether the adverse effects of ECT tend to be temporary or permanent.
What the Expert Says
Although doctors don’t recommend ECT as a first option for patients with depression, many agree that electroconvulsive therapy can be helpful under certain circumstances. “ECT is useful for certain patients with significant depression, particularly for those who cannot take or are not responding to antidepressants or who are at a high risk for suicide,” says Dr. Peter J. Panzarino, former chairman of the Department of Psychiatry and Mental Health at Cedars-Sinai Medical Center in Los Angeles. “ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms.”