Electroconvulsive therapy (ECT)

Treatment Overview

Electroconvulsive therapy (ECT) is a procedure used to treat severe depression. It may be used in people with symptoms such as delusions, hallucinations, or suicidal thoughts or when other treatments such as psychotherapy and antidepressant medications have not worked. It is also used for other psychiatric and neurological conditions, such as schizophrenia and Parkinson’s disease.

Before ECT, you are given anesthesia to put you in a sleeplike state and medications to relax your muscles. Then an electrical current is briefly sent to the brain through electrodes placed on the temples or elsewhere on the head, depending on the condition and type of ECT. The electrical stimulation, which lasts up to 8 seconds, produces a short seizure. Because of anesthesia, the seizure activity related to ECT does not cause the body to convulse.

It is not known exactly how this brain stimulation helps treat depression. ECT probably works by altering brain chemicals (similarly to medications), including neurotransmitters like serotonin, natural pain relievers called endorphins, and catecholamines such as adrenalin.

ECT treatments are usually done 2 to 3 times a week for 2 to 3 weeks. Maintenance treatments may be done one time each week, tapering down to one time each month. They may continue for several months to a year, to reduce the risk of relapse. ECT is usually given in combination with medication, psychotherapy, family therapy, and behavioral therapy.

What To Expect After Treatment

Because of the effects of anesthesia, you may not remember the procedure. You may experience some short-term memory loss, confusion, nausea, headache, and jaw pain immediately following ECT. These effects may last several hours. A few people have reported long-term memory loss.¹

Why It Is Done

ECT is used for severe depression and other psychiatric or neurological conditions (such as Parkinson’s disease or schizophrenia).

Sometimes ECT is used for older adults who are taking multiple medications for other illnesses and who are not able to take additional medications for depression, or for those people who cannot tolerate the side effects of the medication.

How Well It Works

Studies have shown that ECT is an effective short-term treatment for depression.^{2, 3}

It is important to have follow-up treatment with medication or maintenance ECT to reduce the risk of relapse.

Risks

In rare cases, ECT may increase blood pressure, cause changes in heart rhythm, or produce seizures that last longer than expected. These physiologic changes typically occur immediately following the ECT treatment and can be managed by health professionals performing the procedure, if necessary. Often, however, these changes resolve quickly without treatment.

However, the risks of untreated, severe depression (refractory depression) are often greater than the risks of ECT.

Other side effects of ECT may include headaches, muscle pain, nausea, and short-term and possibly long-term memory problems.

What To Think About

A person undergoing ECT will have a thorough physical exam prior to the treatment.

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