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After more than eight decades as a tried and tested treatment, electroconvulsive therapy (or ECT for short) just might be starting to outrun its stigmatized past.
With more awareness around mental health, the use of electroconvulsive therapy is gaining traction as a controlled and safe procedure used for the treatment of specific mental health conditions.
ECT is one of the most effective treatments for major depressive disorder and in patients at high risk for suicide, possibly even more so than medication and therapy (UK ECT Review Group, 2003).
What is electroconvulsive therapy?
Leave it to Hollywood to twist a legitimate and effective treatment option into something terrifying.
From the cult classic One Flew Over the Cuckoo’s Nest to more recent binge-worthy Netflix dramas like Homeland, ECT continues to get a bad rap. But for patients and their families, attitudes toward ECT treatment and its outcomes are generally positive (Rajagopal, 2013).
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Electroconvulsive therapy has been around for decades. It was first used in Rome by a psychiatrist-neurologist team who used an electric current to cause a seizure with the hope of treating mental illness. They based this treatment on the idea that people with schizophrenia who experienced seizures had improvements in mental health symptoms (Gazdag, 2020).
ECT is a 5–10 minute procedure involving brain stimulation with ultra-brief currents of electricity passed through electrodes placed on the scalp. First patients are sedated, and then controlled electrical currents are used to induce a short seizure. This causes changes in brain chemistry that can rapidly alleviate symptoms of severe depression (Salik, 2020).
While scientists have explored other types of brain stimulation therapies as treatments for major depression, transcranial magnetic stimulation (TMS) is the only one that showed any benefit. Still, ECT was more effective (Gazdag, 2020).
What does ECT treat?
ECT treatment is a safe option for people with treatment-resistant depression, which is depression that persists despite treatment with antidepressants or therapy.
It is also helpful for people with mood disorders who need rapid treatment, such as those at risk of harming themselves or others (Salik, 2020). Other indications for ECT include bipolar disorder, schizophrenia, catatonia, and pre-and postpartum psychosis (Gazdag, 2019).
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What are the benefits of electroconvulsive therapy?
One of the most astounding benefits of ECT treatment is the physical change that happens in the brain.
ECT contributes to changes that correlate with treatment responses. For some, these can be seen on brain scans as early as after the first ECT session, along with a significant reduction in symptoms of depression. Depression continued to improve with each subsequent session (Joshi, 2016).
ECT is a quick option with few adverse effects when people can’t use drugs due to age (antidepressants can increase the risk for falls in older people), pregnancy, and breastfeeding.
Since more severe mental health issues can be associated with refusal to eat or drink, as well as suicidal tendencies, ECT is an effective option for immediate treatment while waiting for other therapies (like drugs and psychotherapy) to take effect (Salik, 2020).
Persistent depressive disorder: long term depression
Side effects of electroconvulsive therapy
Some people experience same-day side effects of ECT, such as headaches, muscle or jaw soreness, nausea, confusion, and disorientation. These are typically short-lived and resolve within an hour or two after treatment.
Long-term side effects sometimes include memory problems. People typically forget events that happened just before or after the ECT procedure. However, no major memory loss was detected when people were evaluated six months after their final session (Gazdag, 2020).
What to expect with ECT
If a healthcare provider decides that ECT is the right option, they’ll first put you through a range of tests to make sure it’s safe.
This includes a physical exam, blood tests, and a heart test (ECG) before the procedure. Sharing a complete medical and medication history with your provider is important to ensure the best outcome.
People with severe heart disease, lung disease, bleeding disorders, or a history of stroke may not be good candidates for ECT.
ECT can be done in a clinic or hospital. Patients are asked not to eat or drink beforehand. Throughout the procedure, your breathing, blood pressure, blood oxygen, and heart rate are monitored closely.
Electrodes are placed on the scalp, and an IV is placed in the arm to administer medications. Sedation medication and muscle relaxants are used to reduce side effects and ensure a pain-free experience.
The entire procedure typically lasts one hour, with the patient asleep for 5-10 minutes and monitored for the remaining 20-30 minutes. Once fully awake, they’ll be released home. If it sounds a little scary, know the actual electrical stimulation part lasts less than 30 seconds (Salik, 2020).
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Afterward, patients wake up and have no recollection of the treatment. They may feel disoriented or confused initially, however, the antidepressive effect is felt almost immediately.
Most people will need to complete more than one session to manage depressive symptoms. Patients should also expect to continue medical treatment like medication and therapy.
While ECT isn’t a cure, it is a safe and effective treatment option for certain mental health conditions. It may even be more effective for some people than the predominant combo of drugs and therapy.
Although ECT has been associated with many false beliefs, these associations are changing as the treatment becomes more widespread. When delivered in a controlled setting, ECT provides immediate benefits with mild, short-term memory problems as side effects.
- Gazdag, G., & Ungvari, G. S. (2019). Electroconvulsive therapy: 80 years old and still going strong. World Journal of Psychiatry, 9(1): 1-6. doi: 10.5498/wjp.v9.i1.1. Retrieved from https://www.wjgnet.com/2220-3206/full/v9/i1/1.htm
- Joshi, S. H., Espinoza, R. T, Pirnia, T., et al. (2016). Structural Plasticity of the Hippocampus and Amygdala Induced by Electroconvulsive Therapy in Major Depression. Biological Psychiatry, 79(4), 282–292. doi: 10.1016/j.biopsych.2015.02.029. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25842202
- Rajagopal, R., Chakrabarti, S., & Grover, S. (2013). Satisfaction with electroconvulsive therapy among patients and their relatives. The Journal of ECT, 29(4), 283-90. doi: 10.1097/YCT.0b013e318292b010. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23670027/
- Salik, I., & Marwaha, R. (2021). Electroconvulsive therapy. [Updated 2020 Nov 29]. In: StatPearls [Internet]. Retrieved on Aug. 4, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK538266/
- UK ECT Review Group. (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet, 361(9360):799-808. doi: 10.1016/S0140-6736(03)12705-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12642045/