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Electroconvulsive therapy

Shock treatment; Shock therapy; ECT; Depression - ECT; Bipolar - ECT

Electroconvulsive therapy (ECT) uses an electric current to treat depression and some other mental illnesses.

Description

During ECT, the electric current triggers a seizure in the brain. Doctors believe that the seizure activity may help the brain "rewire" itself, which helps relieve symptoms. ECT is generally safe and effective.

ECT is most often done in a hospital while you are asleep and pain free (general anesthesia):

• You receive medicine to relax you (muscle relaxant). You also receive another medicine (short-acting anesthetic) to put you briefly to sleep and prevent you from feeling pain.
• Electrodes are placed on your scalp. Two electrodes monitor your brain activity. Another two electrodes are used to deliver the electric current.
• When you are asleep, a small amount of electric current is delivered to your head to cause seizure activity in the brain. It lasts for about 40 seconds. You receive medicine to prevent the seizure from spreading throughout your body. As a result, your hands or feet move only slightly during the procedure.
• ECT is usually given once every 2 to 5 days for a total of 6 to 12 sessions. Sometimes more sessions are needed.
• Several minutes after the treatment, you wake up. You do not remember the treatment. You are taken to a recovery area. There, the health care team monitors you closely. When you have recovered, you can go home.
• You need to have an adult drive you home. Be sure to arrange this ahead of time.

Why the Procedure Is Performed

ECT is a highly effective treatment for depression, most commonly severe depression. It can be very helpful for treating depression in people who:

• Are having delusions or other psychotic symptoms with their depression
• Are pregnant and severely depressed
• Are suicidal
• Can't take antidepressant drugs
• Haven't responded fully to antidepressant drugs

Less often, ECT is used for conditions such as mania, catatonia, and psychosis that do not improve enough with other treatments.

Risks

ECT has received bad press, in part because of its potential for causing memory problems. Since ECT was introduced in the 1930s, the dose of electricity used in the procedure has been decreased significantly. This has greatly reduced the side effects of this procedure, including memory loss.

However, ECT can still cause some side effects, including:

• Confusion that generally lasts for only a short period of time
• Headache
• Low blood pressure (hypotension) or high blood pressure (hypertension)
• Memory loss (permanent memory loss beyond the time of the procedure is uncommon and is much less common than it was in the past)
• Muscle soreness
• Nausea
• Rapid heartbeat (tachycardia) or other heart problems

Some medical conditions put people at greater risk for side effects from ECT. Discuss your medical conditions and any concerns with your doctor when deciding whether ECT is right for you.

Before the Procedure

Because general anesthesia is used for this procedure, you will be asked not to eat or drink before ECT.

Ask your health care provider whether you should take any daily medicines in the morning before ECT.

After the Procedure

After a successful course of ECT, you will receive medicines or less frequent ECT to reduce the risk of another episode of depression.

Outlook (Prognosis)

Some people report mild confusion and headache after ECT. These symptoms should only last for a short while.

References

Hermida AP, Glass OM, Shafi H, McDonald WM. Electroconvulsive therapy in depression: current practice and future direction. Psychiatr Clin North Am. 2018;41(3):341-353. PMID: 30098649 pubmed.ncbi.nlm.nih.gov/30098649/.

Perugi G, Medda P, Barbuti M, Novi M, Tripodi B. The role of electroconvulsive therapy in the treatment of severe bipolar mixed state. Psychiatr Clin North Am. 2020;43(1):187-197. PMID: 32008684 pubmed.ncbi.nlm.nih.gov/32008684/.

Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380-387. PMID: 26813211 pubmed.ncbi.nlm.nih.gov/26813211/.

Welch CA. Electroconvulsive therapy. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 45.

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Review Date: 7/28/2022  

Reviewed By: Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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