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Electroconvulsive therapy (ECT)

Reviewed by Mary T. Johnson, RN, MSN

An electroconvulsive therapy (ECT) concept featuring a brain.

Electroconvulsive therapy (ECT) applies electrical pulses to the brain in order to treat mental health disorders like severe depression and bipolar disorder. It is also used in situations where medications are not working to control symptoms or are causing intolerable side effects.

ECT has been shown to improve symptoms of depression in 70–90%1 of patients. This rate is higher than for many antidepressants, although the benefits of ECT must be weighed against the possible adverse effects of the treatment.

What Is Electroconvulsive Therapy (ECT)?

During ECT, patients are placed under general anesthesia. Then, electrical currents are passed through the brain to create a mild seizure, which creates changes to the neurons and chemicals in the brain. 

Electroconvulsive Therapy History

Once called electroshock therapy, ECT was first used in the late 1930s and early 1940s. Used to treat mental health disorders like depression, the therapy gained a controversial reputation. Due to the methods used and the lack of muscle relaxants, the procedure resulted in full-scale, violent convulsions which could break bones and cause other injuries.

As antidepressant medications began to be more widely used, ECT decreased. Over time, organizations like the American Psychiatric Association (APA) recommended techniques and procedures that made ECT therapy safer and more humane. These included using informed consent from the patient before use of the therapy, use of muscle relaxants, and changes to the devices used in ECT therapy, which changed the way electricity was used.

How Does ECT Work?

Electroconvulsive therapy has two major types:

  • Unilateral: In this form, one electrode is placed on one side of the head (typically the right temple) and the other on the top of the head. Only one side of the brain is treated with the pulses.
  • Bilateral: With bilateral ECT, electrodes are placed on both sides of the head. The pulses treat the entire brain.

Before an ECT treatment, the patient is given muscle relaxants and anesthesia. Patients fall asleep before the treatment and do not remember the treatment after it is finished. The patient’s heart and blood pressure are monitored throughout.

During the treatment, electrical pulses are passed between the electrodes, causing a seizure in the brain that lasts between 30 and 60 seconds. 

Most patients can go home the same day as a treatment, typically after just an hour or two of observation. Patients often benefit from eight to 12 treatments over three to six weeks. However, some patients may need a monthly treatment or additional treatments on other schedules.

What Is ECT Used For?

ECT for Depression

ECT is an effective treatment for severe depression. Because ECT relieves symptoms quickly, it is used with severe or suicidal depression. It is also used for people whose symptoms of depression have not been relieved by medication. Studies2 have found that ECT can be one of the most effective treatments for elderly patients experiencing depression. 

ECT for Bipolar Disorder

ECT for bipolar disorder can help patients who are experiencing severe mania or depression. ECT can be particularly useful when the patient isn’t responding to medication or when the individual is suicidal.

ECT for Schizophrenia

Another use of ECT is for schizophrenia. Studies3 have found that ECT can be an effective treatment for schizophrenia, particularly for those who are severely ill. However, it is not commonly used as a treatment for schizophrenia.

ECT Side Effects

While modern electroconvulsive therapy has fewer adverse effects than historical use, there are still some that patients may experience. These include:

  • Physical side effects: Patients may experience headaches or muscle pain after a treatment. Nausea can also be a side effect. These physical side effects are typically treated with medication.
  • Confusion: Immediately after a treatment, the patient may experience confusion. This can last from just a couple of minutes to several hours. This effect occurs most often with older individuals.
  • Memory loss: Some people may experience memory loss after ECT. Usually, this is limited to time right before the treatment, but some people may experience memory loss that covers months or even years. However, many people experience an improvement in their memory issues after treatment is complete.
  • Medical issues: In rare cases, ECT can cause medical complications. This can be from the use of anesthesia or from the treatment itself, which can raise heart rate and blood pressure and could potentially create heart damage in rare cases.

Other Brain Stimulation Therapies

In addition to ECT, there are several other brain stimulation therapies that are used to treat some mental health disorders. 

  • Transcranial magnetic stimulation (TMS): TMS uses magnetic fields to stimulate parts of the brain in an effort to treat depression. An electromagnetic coil is placed on the patient’s forehead and short pulses are sent into the brain. These pulses target an area of the brain believed to control mood. Patients are usually awake and conscious during the procedure, and adverse side effects are typically mild.
  • Vagus nerve stimulation (VNS): This therapy involves using a pulse generator on a patient’s chest to stimulate the vagus nerve. This nerve carries messages to the parts of the brain that help control mood and sleep. Although this treatment has been approved by the FDA for hard to treat depression, it is a controversial treatment and is rare.
  • Deep brain stimulation (DBS): With deep brain stimulations, two sensors are surgically placed in the brain, and one pulse generator is put in the chest. Adjustments can be made to the electrodes over time. While the treatment is largely experimental, it has been used to treat obsessive-compulsive disorder (OCD), Tourette syndrome, and depression.

Is ECT Right For You?

ECT may be a treatment option for you if medications or other forms of therapy haven’t worked well. It can also be an option if a treatment is needed to act quickly to reduce the chances of suicide. If you are currently suicidal, reach out for help:

To explore the option of ECT and whether it is right for you, visit our directory of therapists to make an appointment today.

About the author

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