For some people with severe or hard-to-treat depression, electroconvulsive therapy (ECT) is the best treatment. This treatment, sometimes referred to as "electroshock therapy," is often misunderstood and incorrectly viewed as a harsh, cruel treatment. In actuality, it is painlessly performed under general anesthesia and is considered the most effective treatment for severe depression. It can be lifesaving.
ECT works quickly, which is why it's often the treatment of choice for people with highly severe, psychotic, or suicidal depression. For these people, waiting for antidepressants or therapy to work might be dangerous. However, the drawback is that the effects of ECT usually don't last, and further treatments will likely be necessary.
Almost everyone has dark thoughts when his or her mood is bad. With depression, though, the thoughts can be extremely negative. They can also take over and distort your view of reality.
Cognitive therapy can be an effective way to defuse those thoughts. When used for depression, cognitive therapy provides a mental tool kit that can be used to challenge negative thoughts. Over the long term, cognitive therapy for depression can change the way a depressed person sees the world.
Studies have shown...
With ECT, an electric charge is delivered to the brain and causes a seizure. For reasons that doctors don't completely understand, this seizure helps relieve the symptoms of depression. ECT does not cause any structural damage to the brain.
The procedure itself typically requires a stay in the hospital, although more and more it is being performed on an outpatient basis. During the procedure, you will be put to sleep under general anesthesia. You won't feel anything. Your doctor will also give you a muscle relaxant. Electrodes will be applied to your scalp and deliver an electric current. This electrical stimulation causes a brief seizure. The seizure is controlled with medications so your body doesn't move. You will wake up a few minutes later without any memory of the treatment.
The number of required sessions varies. Many people have six to 12 sessions over a period of several weeks. After initial treatment, you might require further ECT treatments in addition to depression medicine and therapy to prevent your depression from returning.
Studies have shown that ECT works for many people who have treatment-resistant depression. One study of 39 people with treatment-resistant depression compared the effects of an antidepressant with ECT. After two to three weeks, 71% of people who received ECT had a positive response to treatment. But only 28% who received the antidepressant had a positive response after four weeks of treatment. The results were published in 1997 in the medical journal Acta Psychiatrica Scandinavia.
Risks and Side Effects of ECT
The most common side effect of ECT is short-term memory loss. However, some people report that they have long-term memory loss as well. ECT also causes a rise in heart rate and blood pressure and may not be recommended in people with unstable heart problems. A physical examination and basic laboratory tests including an electrocardiogram (ECG) are necessary before starting ECT to assure that no medical problems are present that could interfere with the safe administration of ECT.
ECT can often work quickly, but 50% or more of the people who receive this treatment will relapse within several months if there is no subsequent treatment (for example, medicines) to prevent relapse. Your doctor will typically advise a medication regimen including antidepressants, or possibly additional periodic ("maintenance") ECT sessions to help prevent relapse.
American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depression, 2000.
Cadieux, R.J., American Family Physician, December 1998.
Compton M.T., ACP Medicine, Psychiatry II, 2003.
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Fochtmann, L.J. and Gelenberg, A.J., Focus, Winter, 2005.
Folkerts, H.W., Acta Psychiatrica Scandanavia, 1997.
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Keller, M.B., Journal of Clinical Psychiatry, 2005.
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