Electroconvulsive therapy (ECT) is an alternative treatment for people with depression who have not responded to standard medication. While it has faced some controversy, it has promising results with its antidepressant effects.
Depression is a mental health condition that causes chronic feelings of sadness and guilt, a persistent depressed mood, and a loss of pleasure or interest in hobbies or daily activities.
There are different treatments available for people with depression, such as medication and psychotherapy. Those who experience a relapse of symptoms may also receive brain stimulation therapies such as ECT.
ECT uses electric currents to stimulate a person’s brain and induce a controlled seizure. This method aims to relieve severe depression.
This article explores ECT and depression, its benefits and risks, what to expect before ECT, the procedure, recovery, and alternative treatments.
ECT involves an electric current that healthcare professionals send through the brain while a person is under general anesthesia. This causes a brief surge of electrical activity in the brain, which people refer to as a seizure.
Doctors commonly use ECT to treat people with severe major depression.
What is depression?
Depression is a
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision, helps doctors diagnose people with depression. They must have
- depressed or irritable mood
- unintended weight loss
- sleep disturbances
- fatigue or low energy
- suicidal thoughts
Depression also presents in various types, such as:
- major depressive disorder
- persistent depressive disorder
- postpartum or perinatal depression
- seasonal affective disorder
- situational depression
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
The American Psychiatric Association has found ECT to be highly effective in relieving major depression. Clinical evidence suggests that ECT improves approximately 80% of cases.
Experts can observe the benefits of ECT after several sessions, and the results tend to be long lasting.
- changes in the brain’s blood flow
- a brief discontinuity in the blood-brain barrier
- changes in the electrical activity in parts of the brain, altering brain chemistry that can contribute to depression
- alterations in gene expressions and decrease inflammatory mediators
- growth of nervous tissues
- hormone and neurotransmitter stimulations, namely increasing dopamine
- changes in the brain volume and components
- 38% of people after 1 week
- 61% of people after 2 weeks
- 81% of people, after finishing the course of ECT over a few weeks
The 2022 research also suggests that ECT may be safer than antidepressants or antipsychotics in certain risk groups, including those who:
- have a debilitation
- are elderly
- are pregnant
- are nursing
However, psychiatrists have attempted to make ECT as safe as possible. As a result, experts introduced muscle relaxation and anesthesia alongside administering ECT to reduce its side effects.
On the other hand, the American Psychiatric Association has associated ECT treatment with temporary memory loss. Some people could not remember events before the treatment or even weeks earlier. In most cases, their memory improved within a couple of months, but some have experienced permanent gaps in memory.
General anesthesia also carries risks, similar to when doctors use anesthesia for surgeries, including:
A person can discuss potential risks with a psychiatrist for the best advice on managing the effects.
More severe risks
ECT poses more severe risks in people with the
- a pheochromocytoma, or an adrenal tumor
- increased pressure within the skull
- slowed heartbeat
- high risk pregnancies
- aortic and cerebral aneurysms
Before a person begins their ECT treatment, they will undertake a thorough psychiatric assessment to determine its safety. Before treatment, there will also be:
- a medical examination
- blood tests
- an EKG to check the heart
Doctors will also perform a physical examination to
The process will also include written informed consent before ECT takes place. In certain situations where a person is too ill for the procedure, state law may govern the decision to ensure they appoint a legal guardian before ECT occurs.
The person receiving ECT, their guardian, and their family need to discuss the treatment options with a trained professional. They should provide them with access to in-depth procedure information and the potential benefits, risks, and side effects.
People usually receive ECT two to three times weekly for 6 to 12 treatment sessions. The frequency depends on the severity of symptoms and a person’s response rate.
The procedure
Before ECT occurs, an anesthesiologist administers general anesthesia and a muscle relaxant to ensure the person remains asleep during the procedure.
Doctors also place a bite block during a seizure to protect the tongue and teeth. Trained staff continuously check vital signs, including blood oxygen saturation and heart activity.
Psychiatrists attach electrodes at specific locations on the scalp. The electrodes will stimulate the brain with a controlled series of electrical pulses to induce a temporary seizure within the brain.
This is either a brief pulse, between 0.5 and 2.0 milliseconds, or an ultra-brief pulse, less than 0.5 milliseconds. While the brief pulse is the standard, health experts consider the ultra-brief more tolerable.
Most therapeutic ECT seizures last between 15 and 70 seconds, and anything less than this may be ineffective.
A person will be asleep throughout the procedure, but when it finishes, they may awaken 5 to 10 minutes later and be in a recovery room.
Doctors will check blood sugar levels before the procedure and during the recovery, as ECT
People will need to recover both from the general anesthetic and ECT. Doctors will only discharge a person once they fully recover from the treatment.
Electroconvulsive therapy (ECT) involves sending an electric current through the brain while a person is under anesthetic, which causes a brief surge of electrical activity. This procedure induces a controlled seizure, which research has shown to be effective in relieving depression.
Experts have observed the benefits of ECT after a series of sessions, and the results tend to last in the long term.
Research considers ECT one of the most controversial forms of treatment. However, professionals have attempted to make it safe by administering muscle relaxants and anesthesia alongside ECT.
Once the procedure has finished, people will need to recover from both the anesthetic and ECT. However, ECT treatment may cause temporary memory loss in some people, but this usually improves within a few months.
Other methods to treat depression include medication, psychotherapy, and natural remedies.