Mental Health: Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is typically used to treat severe depression. During ECT, an electric current is briefly applied through the scalp to the brain, inducing a seizure.

Why is ECT Used?

ECT is one of the fastest ways to relieve symptoms in severely depressed or suicidal patients, or patients who suffer from mania or other mental illnesses. ECT is generally used as a last resort when severe depression is unresponsive to other forms of therapy, or when these patients pose a severe threat to themselves or others and it is dangerous to wait until medications take effect.

How Is ECT Performed?

Prior to ECT treatment, a patient is put to sleep using general anesthesia and a muscle relaxant is given. Electrodes are placed on the patient's scalp and a finely controlled electric current is applied which causes a brief seizure in the brain.

Because the muscles are relaxed, the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment and awakens minutes later, not remembering the treatment or events surrounding it. The patient is often confused, but this confusion typically lasts for only a short period of time. ECT is usually given up to three times a week for two to four weeks.

A course of ECT is usually followed by psychotherapy and medicine under a psychiatrist's care.

ECT: A Controversial Treatment

ECT remains misunderstood by the general public, although it has been used since the 1940s and 1950s. Many of the risks and side effects have been related to the misuse of equipment, incorrect administration and improperly trained staff. There is also a misconception that ECT is used as a "quick fix" instead of long-term therapy or hospitalization. Unfavorable portrayals in movies or television shows, accompanied by misrepresentation in news reports and media coverage have added to the controversy of this treatment. In fact, ECT is safe and among the most effective treatments available for depression.

Making an Informed Decision About ECT

Before ECT is considered, you should discuss all available treatment options for your condition with your doctor. If ECT is recommended, you should receive a complete medical examination including a history, physical, neurological exam, ECG (heart test) and lab tests. Your medication history should be carefully evaluated and monitored.

If you are considering ECT as a treatment option, be advised that it may provide temporary improvement but has a high relapse rate. Many doctors advocate follow-up treatment that includes medicine or ECT given at less regular intervals, called "maintenance ECT." Short-term memory loss is the major side effect, although this usually goes away within 1-2 weeks after treatment.

You should be educated and informed about ECT and any treatment prior to receiving it. Ask for educational literature, videos and have an honest discussion with your doctor about the potential benefits and side effects.

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.