Electroconvulsive therapy (ECT)

What is ECT?

Developed over 70 years ago, use of ECT declined in the 1960s and 1970s due to misperceptions about the treatment and the advent of modern antidepressant medications. Today, ECT use is on the rise again, thanks to significant improvements in the way the treatment is administered that make it safer and more comfortable for patients, and because it is often the single most effective tool for those who fail to respond to other treatments.

ECT applies brief electrical pulses to the brain through electrodes attached to the scalp.  The pulses excite brain cells, resulting in seizures. This approach has been proven safe and effective for treating a variety of psychiatric illnesses, especially depression.   

There are multiple theories to explain why ECT is effective.  The seizure activity itself may cause an alteration in neurotransmitters – the brain’s chemical messengers. ECT treatments also may adjust the brain’s regulation of stress hormones, affecting energy, sleep, appetite and mood. Finally, ECT probably alters brain neurotrophins. These and other mechanisms may interact to contribute to the effectiveness of ECT.

When is ECT recommended?

ECT is most commonly used to treat patients with severe depression, including those who do not respond to medications or who are unable to tolerate the side effects associated with medications. ECT may also be the preferred treatment method for patients who need a more rapid response than medications or psychotherapy can provide. This would include those who are severely agitated, delusional, suicidal, or not eating or drinking, as well as those who suffer from catatonia (a potentially life threatening trance-like state sometimes accompanying severe depression and other conditions). These treatments are also sometimes recommended when patients cannot tolerate medications, and when psychotherapies fail to help.

The use of ECT is not limited to the treatment of depression. It may also be used to stabilize bipolar illness during extreme episodes of mania or depression. Additionally, ECT can be used to halt psychotic episodes associated with schizophrenia. Once these individuals are stabilized, medications are started or resumed.

How are ECT treatments administered?

Patients are normally scheduled for three treatments per week, with a total of six to twelve treatments constituting a full course of treatment. The exact number is determined by the severity of symptoms and how rapidly the patient responds.  It sometimes requires six or more treatments to notice measurable improvements in symptoms. With the input of the patient, the doctor can determine the total number of treatments required.

ECT is typically performed by a specially-trained healthcare team, including a psychiatrist, an anesthesiologist, and nursing staff.  An intravenous catheter (IV) is inserted in the patient’s arm to administer necessary medications.  Anesthesia, oxygen and a muscle relaxant are provided.  Monitoring devices are placed on the patient’s head and upper body to monitor brain waves, heart rate, blood pressure and body movement during the procedure.

When the patient is completely asleep, small electrodes are then placed on the scalp through which a pulse of electricity is delivered.  The pulse causes one or more seizures that generally last 25 to 45 seconds. The entire treatment lasts approximately 10 to 20 minutes. By placing the electrodes in different locations to stimulate different areas of the brain, the timing of responses can be varied, which can increase effectiveness and decrease potential side effects.

Following treatment, vital signs are closely monitored until the patient awakens.  Most often the procedure can be administered on an outpatient basis, allowing the patient to return home with a caregiver the same day.

Are there side effects to ECT?

Occasionally, patients may suffer headaches, muscle aches or nausea after treatment.  Some patients may also exhibit mental confusion, resulting from the anesthesia and/or the ECT treatment.  This confusion typically lasts for less than an hour, during which time the patient is closely monitored by the healthcare team.

In some instances, ECT patients may suffer memory loss as a result of the treatment.  Either the loss of short-term memories (such as forgetting what he/she ate earlier in the day), or the loss of memories of past events may develop after ECT.  The ability to remember new information will generally return within a few weeks or months after treatment. Loss of some memories of past events, when experienced, is potentially permanent.

Is ECT safe?

Any medical procedure carries some risk.  The risk involved in ECT is regarded as similar to that of having an uncomplicated outpatient surgical procedure under anesthesia. ECT treatments themselves are very safe and severe complications are rare.

What comes after ECT?

Depression is a relapsing illness – especially when left untreated. It’s common for a patient to experience repeated episodes of depression, even after responding well to ECT.  Particularly when a patient has responded poorly to medications prior to ECT, the doctor may recommend a “tapered” series of ECT treatments called maintenance ECT over the course of several weeks or months to regulate depression.

It is also important to note that ECT is only one component of an individual’s treatment plan.  After ECT, medications and/or psychotherapy may be prescribed to manage symptoms and help patients cope better with the stressors of life. In addition, an individual’s own self care habits are important to the overall success of the treatment plan.