What is Electroconvulsive Therapy (ECT)?

Electroconvulsive therapy is a non-medication treatment for mental health conditions. Though it was perceived poorly in the past, it’s now a relatively safe alternative to medicine.

Electroconvulsive therapy, or ECT, is a highly effective but historically controversial medical treatment. Since its introduction, public awareness about mental health has expanded and the treatment has become much safer. Now, people are once again considering ECT as an option for treating several different types of mental health conditions.

What Is Electroconvulsive Therapy?

There are many misconceptions about ECT online, so it is important to find well-sourced information about what electroconvulsive therapy does. So what is ECT, and how does ECT work?

Electroconvulsive therapy applies electricity to the brain to reset the pattern of the brain’s neurons. It is one of several different types of brain stimulation therapies. ECT is accomplished by connecting electrodes to the scalp, running electric current into the brain and causing a small, controlled seizure.

Though the exact mechanism of how ECT works is unclear, researchers know that ECT creates large-scale and small-scale physiologic changes that help reset the structure and functioning of the brain’s neurons. In particular, it affects neurons that are responsible for mood and reality processing.

How Does Electroconvulsive Therapy Work?

Before ECT begins, patients receive a thorough psychiatric and medical assessment and standard laboratory blood tests are drawn. Since the heart is also governed by an electric current, an electrocardiogram (ECG) is performed to ensure that the heart is healthy enough for the procedure.

Patients must provide express written consent for ECT (unless a patient is so gravely ill that a decision is made by a legal court or guardian in the patient’s best interest). Before agreeing to ECT treatment, it is important that patients discuss the situation with their psychiatrist, trusted friends and family.

Once consent is obtained, an ECT procedure can begin. An ECT treatment team usually consists of a psychiatrist, an anesthesiologist and either a nurse or physician assistant. Treatment begins by placing electrodes at specific locations on a person’s scalp. The patient is given general anesthesia and a muscle relaxant.

Once the patient is asleep from the anesthesia, the electrodes are activated and deliver electricity to the brain. This creates a small, controlled seizure that lasts for about one minute. Patients wake up from the procedure within minutes and can go home if someone else is driving.

Who Can Benefit from ECT?

Electroconvulsive therapy is usually reserved for situations where medication or psychotherapy have been unable to adequately treat a mental health condition. Certain mental health conditions are particularly responsive to ECT, and ECT is approved by the Food and Drug Administration to treat the following:

• Major depressive disorder
• Bipolar disorder
• Schizophrenia
• Schizoaffective disorder
• Catatonia

Treatment of schizoaffective disorder utilizes ECT for depression, bipolar disorder symptoms and schizophrenia symptoms.

You are likely to experience substantial ECT benefits if:

• You have a severe mental health condition
• You are at immediate risk for suicide due to a mental health condition
• You need or desire a fast-acting treatment
• You need or wish to be treated for a mental health condition without using medications
• You have not responded to medications or psychotherapy to treat a mental health condition
• You are pregnant and have a mental health condition
• You are an older patient with a mental health condition

ECT treatment has been well studied in pregnant women and the elderly, and it is usually safer than medications in these groups.

Electroconvulsive therapy works well and works quickly. Decades of research have shown that about 80% of patients with uncomplicated cases of depression improve after ECT treatment. The rate of improvement is similar in patients with bipolar disorder or schizophrenia.

Risks and Controversy

As with all other medical procedures, ECT treatment does have potential risks and side effects. It is important to talk with a psychiatrist about ECT risks. Common ECT side effects are:

• Nausea
• Lightheadedness
• Headache
• Fatigue
• Confusion
• Memory loss

Most of these side effects last only minutes to hours. Memory loss, however, can take weeks or months to resolve. Types of memory loss include:

• Short term memory loss
• Long-term memory loss
• Problems with word recall
• Learning difficulties

In addition, the use of general anesthesia poses risks related to minor surgery.

Despite ECT’s profound effectiveness, its public perception has a mixed history. The early days of ECT treatment would be considered highly unethical by today’s standards. The procedure was performed without anesthesia and without fully informed consent of some patients. ECT controversies typically tend to center around this time in its history.

Modern ECT is much safer, and patient protections are much more rigorous. For example, several states and jurisdictions require that two physicians must agree in writing that ECT treatment is necessary before a patient can undergo the treatment. In cases where patients are not capable of making decisions in their own best interests, informed consent is determined by state law or by a court-appointed guardian.

Other Brain Stimulation Therapies

Electroconvulsive therapy is one of several types of brain stimulation therapies. Other therapies have become more developed over the last 20 years.

Vagus Nerve Stimulation (VNS)

Vagus nerve stimulation is an FDA-approved treatment for major depression when medications and psychotherapy have been ineffective. Treatment with VNS occurs via a small box of electrodes placed under the skin. Like ECT, vagus nerve stimulation involves sending electric pulses to the body. Unlike ECT, its side effects do not include memory loss. However, since the vagus nerve is involved with many bodily functions, side effects of VNS can vary widely.

Transcranial Magnetic Stimulation (TMS)

Utilized to treat major depression, transcranial magnetic stimulation (TMS) uses a series of alternating magnetic fields to stimulate certain brain areas. A particular advantage of TMS is its side effect profile. Most TMS side effects are relatively minor, such as headaches and muscle twitches.

Deep Brain Stimulation (DBS)

Deep brain stimulation is best known for its effectiveness in treating the motor symptoms of Parkinson’s disease. In certain situations, it is also approved for treating obsessive compulsive disorder. DBS affects the patient by sending electrical impulses to certain areas of the brain, similar to how a pacemaker works with the heart. Though it is not approved for the treatment of depression, several studies have shown DBS to be an effective intervention for this condition. Since DBS requires an invasive neurosurgical procedure, however, its usage in treating mental health conditions is limited.

ECT in Mental Health Treatment

If you are considering ECT for mental health treatment, you should discuss the risks and benefits of ECT treatment with your psychiatrist. If you are considering ECT for depression treatment, you should also be aware of the potential non-medication treatment alternatives available to you.

Treatment for mental health conditions is vital for maintaining health and function. If you are seeking treatment for mental health conditions that stem from addiction, The Recovery Village can help you understand and manage them appropriately. Our expert staff has extensive experience in the treatment of mental health conditions and co-occurring substance use disorders. We will help you to identify resources to guide you toward a more stable and sustainable life. Make the call today.

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Kevin Wandler, MD

Kevin Wandler holds multiple positions at Advanced Recovery Systems. In addition to being the founding and chief medical director at Advanced Recovery Systems, he is also the medical director at The Recovery Village Ridgefield and at The Recovery Village Palmer Lake. Read more