Frequently Asked Questions About ECT

Please note—we are not giving medical advice.  This website is designed only to provide general information and education about ECT.

What is ECT?

Electroconvulsive therapy (ECT) involves a procedure in which an electrical current is sent briefly (generally 4-6 seconds or so) to the brain.  The current flows from electrodes placed on the temples (or perhaps elsewhere on the head).  The electric current then triggers a brief seizure.  The seizure may be indicated by the movement of a toe, a foot, or an arm. Because the ECT patient has received anaesthesia, the patient is unaware of the treatment and suffers no pain, and a muscle relaxant is also given so that the seizure does not cause convulsions for the patient.  The entire treatment usually lasts no more than fifteen minutes or so, with more time added for preparation and recovery.  During the procedure, patients are monitored by electroencephalogram (EEG).

Please note that different medical centers are likely to have somewhat different standards and policies that dictate how they deliver ECT.  While ECT providers give fundamentally the same treatment, the number of treatments they give, the amount of time between treatments, and other factors may all differ from provider to provider.

How does it work?

Doctors do not know precisely how ECT works, but it seems to work by changing brain chemistry (just as medications do).

What conditions does ECT treat?

ECT can reverse symptoms of certain mental illnesses, sometimes quite quickly.  ECT can be one of the fastest treatments to relieve symptoms for patients suffering from mania or severe depression.  It is used to treat patients with severe depression, but may also be used for symptoms including delusions, hallucinations, or suicidal thinking.  ECT may also be used for other neurological and psychiatric conditions, such as schizophrenia and Parkinson’s disease.

A number of studies have demonstrated that ECT can be an effective short-term treatment for depression.  Some doctors use ECT for patients only when other treatments (such as psychotherapy or anti-depressant medications) have not worked.  Others use it an earlier stage for patients.

ECT is often given along side other forms of treatment, including medication, psychotherapy, or others.

How many treatments does a patient receive?

An acute course of treatments is usually around eight to twelve treatments, but can be shorter or longer depending on how quickly the individual responds.  Then continuation or maintenance ECT, on a less frequent basis, can help solidify and maintain the response.  Some patients may receive maintenance ECT for periods after the initial treatment—that is, they will receive ECT weekly or monthly in regular, periodic treatments to prevent a relapse of depression or the underlying illness.  When patients do receive on-going ECT, their frequency of treatment may change over time.

Treating physicians usually expect to have people feel better after the second week of treatment (in or around treatments 4 or 5), but loved ones caring for the patient receiving the treatment may well notice improvement before then.  By contrast, people generally find that antidepressant medications will take several weeks or longer to improve symptoms.

What happens after a treatment?

After a treatment, patients undergo recovery, generally for 30-60 minutes.

For some patients, the use of ECT alone will ultimately relieve the symptoms.  Others may need to use anti-depressant medications or other forms of medicine or treatment (for example, complementary medicines such as acupuncture) to effectively respond to the depression or other condition. 

What are the risks or side effects?

People may have short-term memory loss or confusion. Short-term memory impacts in this case refer to how recently the memories are that are affected (not whether the memory impacts are for a temporary period or permanently).  For ECT patients with short-term memory problems, rather than long-term memory problems, it means that  events and data ranging from a couple of months before the treatments to a couple of months after the treatments are most vulnerable to memory problems.  But even if some of this memory is affected, most of an individual’s memory will not be. For most individuals, the short-term memory loss will disappear within eight weeks or less.  There are a few people who have said that they have suffered long-term memory loss from ECT treatments. 

Other side effects may include nausea, headaches or jaw pain, which can often be treated with medication.

Because ECT is a medical procedure, and anesthesia is involved, there are always risks of more severe medical complications.  In extreme cases, serious heart problems may arise, or strokes.  Individuals with heart problems may find ECT more risky than the alternatives. 

How do you prepare for ECT?

A patient will need to have an internal-medicine evaluation and a physical examination.

Prior to the administration of ECT, a patient will have an IV inserted in an arm or hand. 
A patient will receive an anesthetic through the IV to ensure that the patient is unconscious.  After the anesthetic (usually), a patient will also have electrode pads, the size of large coins, placed on his or her head.  A patient will also receive a muscle relaxant to help prevent any convulsions.  A patient will not be aware of the procedure taking place.

ECT may be unilateral, in which only one side of the brain receives electricity, or bilateral, when both sides receive electricity.

Regulation of ECT

First, different states may have different rules regarding ECT.  Some states, for example, are more restrictive than others about allowing ECT and in particular, there may be strict state rules about using ECT for children.  You should consult with your physician or psychiatrist about any state rules that may apply to you or your family in connection with the use of ECT.

The FDA conducted hearings in early 2011 on the question of whether it should regulate ECT machines and mandate that there be full clinical testing of ECT machines.  To date, it has not yet issued a ruling on that issue.

There are other good sources of information about ECT, including:

Mayo Clinic

WebMD

Here are some good sources for information about mental health and mental illness:

Minding Your Mind Foundation

National Alliance on Mental Illness

National Institute of Mental Health

WebMD Depression Health Center

Play Frank Maroney's song, "A Light in the Darkness."