An Overview of Electroconvulsive Therapy (ECT)

Electroconvulsive therapy is rarely used.

An analysis of studies worldwide found that it was used to treat only approximately 0.02% of people with treatment-resistant depression – depression that has not improved with other treatments.

Due to this therapy’s quick results compared to medication and talk therapy, it may be a choice for you if you’re experiencing:

• hallucinations
• delusions
• extreme paranoia
• suicide ideation

During ECT, an electric current is used to trigger a seizure in the brain. The session takes place under anesthesia, and muscle relaxants are administered to ensure you remain injury-free.

The entire session lasts 5-10 minutes.

In the 1930s, when this therapy was first developed, it was known as “electroshock therapy.” At the time, injuries were common, muscle relaxants weren’t available, and patients didn’t have the benefit of anesthesia.

Modern ECT is far safer, though it remains one of the most controversial treatment options in modern psychiatry.

There are two main types of ECT used, determined by where the electrodes are placed on the head.

• Bilateral ECT. Electrodes are placed on opposites sides of the head to affect the entire brain.
• Unilateral ECT. One electrode is placed on the top of the head and one on the temple for single-sided brain treatment.

Your medical team may decide to try unilateral ECT first. This type of ECT is often just as effective as bilateral ECT but may have fewer memory-related side effects.

A brief pulse of electricity is sent through the brain, typically for 0.5 to 2.0 milliseconds (ms). Ultra-brief pulses of less than 0.5 ms are considered more tolerable and may be used to help minimize any potential memory loss.

This electrical pulse causes a seizure that lasts 15 to 70 seconds. During this time, your medical team monitors your body, which is under anesthesia.

When the seizure has concluded, your brain goes into a post-seizure quiet state, often considered a “reset.” This can result in a decrease in depression symptoms.

The antidepressant effects of successful ECT have been known to last for years.

If your symptoms of depression are not improving with medications and talk therapies, ECT becomes a possible option.

ECT can quickly improve your symptoms. It may be recommended if depression is causing you major impairment during your day-to-day activities or if you’re experiencing symptoms of psychosis.

Psychosis – when your brain loses the ability to identify reality – may cause hallucinations and delusions, both of which can pose safety concerns for you and those around you.

ECT is primarily used to treat major depression, but it may also be a part of treatment for:

• schizophrenia
• schizoaffective disorder
• catatonia
• neuroleptic malignant syndrome
• bipolar disorder

ECT is one of the few treatments for depression considered safe for pregnant women and older people because of minimal medication-related side effects.

The exact reasons behind the effectiveness of ECT are not well understood. Overall, ECT is known to change blood flow and regional metabolism in the brain.

Within that process, many factors are linked. Research supports a number of theories, including how this therapy may:

• reset the brain’s chemical messaging system for dopamine and serotonin
• create an anti-inflammatory response in the brain linked to cytokines
• increase blood-brain barrier permeability
• influence genetic expression
• improve brain plasticity
• encourage the production of new neurons

In 2017, research published in the journal Neuropsychopharmacology suggested ECT used for depression caused molecular changes in the brain. These changes allowed better communication between neurons in the same area of the brain responsive to antidepressants.

Several comparative trials have established greater antidepressant effects with ECT than medication.

ECT also has a higher remission rate: You’ll likely remain free of depression symptoms longer than if you were relying on only medication.

Even though the mechanisms behind why ECT works are not well understood, the therapy is considered highly effective. It is supported by the American Psychiatric Association, American Medical Association, and the National Institutes of Mental Health.

Before you undergo your first ECT session, you’ll need a medical exam and a psychiatric evaluation.

Once you’ve been approved for therapy, your doctor will speak with you about food and drink restrictions before ECT. Many anesthetic procedures require patients to limit or cease food intake due to side effects such as nausea and vomiting.

Certain medications may have to be stopped or decreased before the procedure if they can interfere with seizure induction.

When you arrive at the ECT location, your medical staff will administer muscle relaxants and place you under general anesthesia.

All vital signs, including your blood oxygen saturation levels, will be monitored. Also, a bite block will be placed to protect your teeth and tongue.

Two electrodes will then be positioned on your scalp for bilateral or unilateral stimulation. An electric current will pass between the electrodes for up to 2 ms to induce a seizure response that lasts approximately a minute.

During the seizure, your reactions are closely monitored, with safety as the top priority.

Within 5-10 minutes, your ECT treatment is over. You’ll then be taken to a quiet area to recover from the effects of anesthesia.

You’ll most likely be able to return home the same day as your ECT session.

Treatments typically occur 2-3 times a week for 6 to 12 treatments, according to the American Psychiatric Association. Some people experience a notable improvement in as little as 3 weeks.

Once you know how ECT affects you, you and your doctor can develop an ECT maintenance schedule that allows you to benefit from ECT with as few follow-up sessions as possible.

As with most procedures, there are some potential complications from ECT. Before your ECT session, your doctor will explain general complications and any side effects related to your personal health and history that may occur.

Here are some common side effects of ECT.

Memory loss

After ECT, you may have difficulty remembering events leading up to the procedure. This is called retrograde amnesia and is common in ECT patients.

Memory loss may be more extreme for some people, lasting longer and affecting other memories. Almost everyone who receives ECT experiences some memory loss. Most people have an improvement in memory a few weeks post-treatment.

There’s no way to predict what level of memory loss you may experience. In some cases, memory loss is permanent.

Concentration and attention problems

Post ECT treatment, you may also have difficulty focusing or concentrating. This side effect often clears up a few weeks after your treatment session. Some people, though, may experience this long-term.

General confusion

Immediately after your ECT session, you may experience confusion. This resolves after a few hours for most people, but it can sometimes take days to go away.

Confusion may make you question where you are, who is with you, or what you are doing.

Physical reactions

ECT may cause you some temporary physical reactions such as:

• vomiting
• nausea
• headaches
• muscles aches and spasms

These effects generally resolve within hours or days after therapy.

Other potential complications

ECT is not for everyone. Your doctor may not recommend this therapy if you have:

• severe cardiovascular disease
• a space-occupying intracranial lesion with evidence of elevated intracranial pressure
• history of an acute cerebral hemorrhage or stroke
• an unstable vascular aneurysm
• severe lung disease

You’ll also want to consider the possible complications of anesthesia before undergoing ECT.

ECT is an effective therapy option for treatment-resistant depression and other select disorders.

Compared to medication and talk therapy, ETC often provides faster results. It is considered safe for pregnant women and older patients.

Most people experience some form of memory loss after ECT. There is no way to predict how serious your memory loss will be.

If you feel current therapies are not improving depression symptoms, consider talking with your doctors about ECT. It’s not your fault medication and talk therapy have not made an impact on your symptoms.