Electroconvulsive Therapy (ECT) for Depression

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 portrayed by popular media as a harsh, cruel treatment. In reality, it is a painless medical procedure performed under general anesthesia that is considered one of the most effective treatments 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.

ECT is never used on someone who doesn't want it.

 

How Electroconvulsive Therapy Works

With ECT, an electrical stimulation 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.

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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 brief rise in heart rate and blood pressure during the procedure, so it 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.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on May 18, 2016

Sources

SOURCES:
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.
Depression and Bipolar Support Alliance: "Finding Peace of Mind: Treatment Strategies for Depression and Bipolar Disorder" and "Guide to Depression and Bipolar Disorder."
Fochtmann, L.J. and Gelenberg, A.J., Focus, Winter, 2005.
Folkerts, H.W., Acta Psychiatrica Scandanavia, 1997.
Glass R.M., JAMA, March 14, 2001.
Keller, M.B., Journal of Clinical Psychiatry, 2005.
Stimmel, G., Psychiatric Times, July 2002.

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