Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.
ECT often works when other treatments are unsuccessful and when the full course of treatment is completed, but it may not work for everyone.
Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.
ECT is much safer today. Although ECT may still cause some side effects, it now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks.
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of several mental health conditions. ECT is used to treat:
ECT may be a good treatment option when medications aren't tolerated or other forms of therapy haven't worked. In some cases ECT is used:
Although ECT is generally safe, risks and side effects may include:
Before having your first ECT treatment, you'll need a full evaluation, which usually includes:
These exams help make sure that ECT is safe for you.
The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you're hospitalized or as an outpatient procedure.
To get ready for the ECT procedure:
At the start of the procedure, you'll receive these medications through your IV:
You may receive other medications, depending on any health conditions you have or your previous reactions to ECT.
During the procedure:
When you're asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electric current to pass through the electrodes to your brain, producing a seizure that usually lasts less than 60 seconds.
A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You're taken to a recovery area, where you're monitored for any potential problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.
In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments. Some doctors use a newer technique called right unilateral ultrabrief pulse electroconvulsive therapy that's done daily on weekdays.
The number and type of treatments you'll need depend on the severity of your symptoms and how rapidly they improve.
You can generally return to normal activities a few hours after the procedure. However, some people may be advised not to return to work, make important decisions, or drive until one to two weeks after the last ECT in a series, or for at least 24 hours after a single treatment during maintenance therapy. Resuming activities depends on when memory loss and confusion are resolved.
Many people begin to notice an improvement in their symptoms after about six treatments with electroconvulsive therapy. Full improvement may take longer, though ECT may not work for everyone. Response to antidepressant medications, in comparison, can take several weeks or more.
No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses. That's why ECT is most effective in people who receive a full course of multiple treatments.
Even after your symptoms improve, you'll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, or psychological counseling (psychotherapy).