What is Electroconvulsive therapy (ECT)?
Electroconvulsive therapy (ECT) is a safe and effective procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT causes changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.
ECT often works when other treatments are unsuccessful, but it may not work for everyone. It is one of the most effective treatments for depression with roughly 75% of patients responding with improvement in symptoms and over 50% experiencing total resolution of symptoms.
Much of the stigma associated with ECT is based on early treatments in which high doses of electricity were administered without anesthesia and current safety precautions. ECT is very safe today. ECT now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks.
How Does ECT Work?
Many people begin to notice an improvement in their symptoms after about 5-6 treatments. Full improvement may take longer and ECT is not guaranteed to work for everyone.
Many aspects of brain function are changed during and after seizure activity. These changes may build upon one another, reducing symptoms of depression or other mental illnesses. That is 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 psychiatric treatment. This includes antidepressants or other medications, or counseling (psychotherapy). People undergoing ECT should have ongoing engagement with their primary psychiatrist, PCP and/or therapist.
Is ECT Right for You?
Electroconvulsive therapy (ECT) can provide rapid and significant improvements in severe symptoms of several mental health conditions:
• Severe depression, particularly when accompanied by psychosis, suicidal thoughts or a refusal to eat.
• Treatment-resistant depression, a severe depression that has not improved with multiple trials of medications or other treatments.
• Mania associated with bipolar disorder, a state of intense euphoria, agitation or hyperactivity that can also include impaired decision-making, impulsive or risky behavior, substance abuse, and psychosis.
• Catatonia, a disorder that alters or disrupts a person’s awareness of their surroundings and can be characterized by a lack of movement, rapid movements or strange movements. Catatonia can be due to psychiatric disorders or some medical illnesses.
• Agitation and aggression associated with dementia, which can be difficult to treat and can negatively affect the quality of life of patients and caregivers.
Patient FAQs
ECT is used for people 16 and older. ECT is often effective in cases where medications do not provide sufficient relief of symptoms or in cases where the side effects are not tolerable.
If you think you may be a good candidate, reach out to your PCP or Primary Psychiatrist for a referral.
The ECT procedure takes about 10 minutes, but with added time for preparation and recovery, overall time for each session is about 1 hour. The first treatment takes longer due to necessary paperwork, taking 1.5-2 hours. ECT can be done while you are hospitalized or as an outpatient procedure.
ECT treatments are generally given two times weekly for up to three to six weeks — for a total of six to 12 treatments. This is considered the acute phase and is followed by slowly reducing the frequency of treatments, moving to weekly, then every other week, with the ultimate goal of monthly treatments for six months.
The number and type of treatments you'll need will depend on the severity of your symptoms and how rapidly they improve.
It is recommended not to drive or make important decisions for at least 24 hours after treatment. People can generally return to normal activities the day after procedure.
• You will have a brief physical exam and interview. This is to check your heart and lungs to assess your general wellbeing.
• You will have an intravenous (IV) line inserted. A treatment team member will insert an IV needle into your arm or hand through which medications and fluids can be given.
• You will have electrode pads placed on your head. These are about the size of a silver dollar. ECT can be administered as unilateral, in which electric currents stimulate only one side of the brain, or bilateral, in which both sides of the brain receive focused electric currents.
• You will have monitoring devices placed to check your blood pressure, heart rate and rhythm, oxygen level, and brain and muscle activity.
• Before treatment, you will receive general anesthesia. Therefore you are to consume no food or water after midnight and only a sip of water to take any morning medications.
All medical procedures have potential risks and patients should have a comprehensive conversation with their PCP or psychiatrists to discuss if ECT is appropriate for them.
• Confusion. May be experienced immediately after treatment and can last from a few minutes to several hours. On rare occasions it may last for days.
• Memory loss. Some people have trouble remembering events that occurred right before treatment or during the course of treatments. For most people, these memory problems improve as the frequency of the treatments is reduced. Rarely, people complain of difficulties with long-term memory.
• Physical complaints. On the days of an ECT treatment, some people experience nausea, headache, jaw pain or muscle aches. These typically can be alleviated with medications.
• Medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have a history of heart problems, you should be cleared by your cardiologist before starting ECT. If you have a history of neurological problems, you should be cleared by your neurologist before starting ECT.
Yes, most major insurance carriers, such as BCBS and Medicare, cover ECT treatment because it is effective and FDA approved.
Videos
Video about ECT Stigma
