Electroconvulsive therapy (ECT)

What is electroconvulsive therapy (ECT)?

Electroconvulsive therapy, or ECT, is a medical treatment for certain mental health conditions that don’t respond well to medications or other treatments. It involves applying a small electrical stimulus to your brain to trigger a brief, controlled seizure.

ECT happens while you’re under general anesthesia. This means you won’t feel anything during the procedure.

It’s the most effective treatment for severe depression. It may also treat bipolar disorder, catatonia and schizophrenia, among other conditions.

Experts aren’t exactly sure how ECT works. But one leading theory is that it helps brain cells grow and form new connections. This process is called neurogenesis. It may help reverse changes in your brain caused by depression and other mental health disorders.

Doctors began using ECT in 1938, and the procedure improved significantly over the decades.

What conditions are treated with ECT?

ECT may help manage the following conditions:

• Bipolar disorder
• Catatonia
• Major depressive disorder
• Mania
• Neuroleptic malignant syndrome
• Schizoaffective disorder
• Schizophrenia

Who is a good candidate for ECT?

You may be a candidate for ECT if you have a severe mental health condition and:

• Are at risk of hurting yourself or others
• Are pregnant or breastfeeding
• Didn’t respond well to antidepressants or other medications
• Have symptoms that prevent you from eating or completing your daily routine

How do I prepare for ECT?

Your provider will give you instructions to follow before your ECT. These may include:

• Don’t eat or drink for at least eight hours before treatment.
• If you need to take morning medications, take them with small sips of water, only if your doctor says it’s OK.
• Bring a case for your dentures or partials.
• Don’t wear earrings. Remove facial piercings if you can.

What happens during electroconvulsive therapy?

Here’s what you can expect on the day of your ECT treatment:

1. Check in at the hospital’s registration desk and go to the treatment area.
2. Have an IV placed in a vein so you can receive medication.
3. Meet with the psychiatry and anesthesia teams.
4. Receive medication (general anesthesia) through your IV to fall asleep and relax your muscles. You may get other medications as well (your care team will explain).
5. Breathe oxygen through a mask while you’re asleep. Your vital signs will be closely monitored.
6. Undergo ECT. Using electrodes, a small electrical current will trigger a seizure. It usually lasts 30 to 60 seconds.

What happens after ECT?

After treatment, you’ll start to wake up in about five minutes. It’s normal to feel groggy or confused at first, but this usually fades within 20 to 30 minutes. You’ll stay in the treatment area for 30 to 45 minutes until it’s safe to go home.

Follow these steps after each treatment to stay safe and support your recovery:

• Don’t drive during a course of ECT (two or three treatments per week). After finishing your acute series, your outpatient provider must clear you before you can drive again. If you’re on maintenance ECT (one treatment per week or fewer), you may drive 24 hours after treatment, but only after getting clearance.
• Avoid using heavy machinery or making important decisions on the day of treatment.
• Plan ahead for any childcare needs on treatment day.
• Have a responsible adult drive you to and from each treatment. You can’t use a taxi or ride-share service to go home.
• Make sure someone stays with you for 24 hours after each treatment.

How often do I need ECT?

ECT isn’t a one-time treatment. Instead, it’s a course of treatments. You may need it two to three times a week. The total number of treatments depends on your condition, how ECT is done and how well you respond. Plan to spend at least two hours at each visit, from check-in to discharge.

ECT side effects

Common side effects of ECT include:

• Headache
• Muscle aches
• Nausea
• Temporary rise in blood pressure

Your care team can give you medications to reduce or prevent the most common side effects.

Rare or serious side effects include:

• Memory loss
• Heart rhythm problems
• Death (this is extremely rare)

It’s important to note that memory problems after ECT are usually worse right after treatment and get better over time. You may have trouble remembering events from the weeks or months before starting treatment. This usually improves within a few weeks. But in rare cases, it may last longer. Very rarely, there have been reports of permanent memory loss.

Benefits of electroconvulsive therapy

Some of the benefits of ECT may include:

• It may provide relief when other treatments like medication or therapy haven’t worked.
• It often works faster than other treatments, which helps in emergencies.
• It may be an option if you can’t take certain medications.
• It can be used safely during pregnancy with close monitoring.
• It’s often used alongside medication to enhance its effectiveness.

Does electroconvulsive therapy work?

Research shows that ECT is an effective procedure to manage depression, catatonia, psychosis and other mental health conditions. The results may appear quickly and can last for a few years. You may need repeat treatments to maintain the effects.

When should I call my healthcare provider?

Your provider will tell you what symptoms to watch for after ECT. Call your provider or go to the nearest emergency room if you have:

• A fast or irregular heartbeat.
• Any concerns about your mood or mental health.
• A severe headache.
• No symptom improvement after two to three days, or if you feel worse.

You should get emergency care if you have thoughts about harming yourself or others. You can contact 911 or your local emergency services number if you’re in immediate danger. If you need someone to talk to, you can call or text 988. This is the Suicide & Crisis Lifeline (U.S.). Someone is available to help you 24/7.