Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.
Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.
ECT is much safer today and is given to people while they’re under general anesthesia. Although ECT still causes some side effects, it now uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks.
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of a number of mental health conditions. It may be an effective treatment in someone who is suicidal, for instance, or end an episode of severe mania. ECT is used to treat:
- Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.
- Treatment-resistant depression, a severe depression that doesn’t improve with medications or other treatments.
- Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision making, impulsive or risky behavior, substance abuse, and psychosis.
- Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It’s associated with schizophrenia and some other psychiatric disorders. In some cases, catatonia is caused by a medical illness.
- Agitation and aggression in people with dementia, which can be difficult to treat and negatively affect quality of life.
ECT may be a good treatment option when medications aren’t tolerated or other forms of therapy haven’t worked. In some cases ECT is used:
- During pregnancy, when medications can’t be taken because they might harm the developing fetus
- In older adults who can’t tolerate drug side effects
- In people who prefer ECT treatments over taking medications
- When ECT has been successful in the past
Although ECT is generally safe, risks and side effects may include:
- Confusion. Immediately after an ECT treatment, you may experience a period of confusion that can last from a few minutes to several hours. You may not know where you are or why you’re there. You may be able to return to normal activities right away, or you may need to rest for several hours after treatment. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.
- Memory loss. ECT can affect memory in several ways. You may have trouble remembering events that occurred before treatment began, a condition known as retrograde amnesia. It may be hard to remember things in the weeks or months leading up to treatment, although some people do have problems with memories from previous years, as well. You may also have trouble recalling events that occurred during the weeks of your treatment. And some people have trouble with memory of events that occur even after ECT has stopped. These memory problems usually improve within a couple of months.
- Physical side effects. On the days you have an ECT treatment, you may experience nausea, vomiting, headache, jaw pain, muscle ache or muscle spasms. These generally can be treated with medications.
- Medical complications. As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky.
Before having your first ECT treatment, you’ll need a full evaluation, which usually includes:
- A medical history
- A complete physical exam
- A psychiatric assessment
- Basic blood tests
- An electrocardiogram (ECG) to check your heart health
These exams help make sure that ECT is safe for you. You may also see an anesthesiologist to go over the risks of anesthesia.
What can I expect when I have ECT?
The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you’re hospitalized or as an outpatient procedure.
Before the procedure
To get ready for the ECT procedure:
- Since you will have general anesthesia, you will be instructed to not eat after midnight before the treatment. You may drink clear liquids (liquids you can see through) up to 3 hours before your ECT treatment. You should take your morning medications with a sip of water on the morning of your treatments.
- The anesthesiologist will do a brief physical exam to check your heart and lungs.
- You will have an intravenous (IV) line inserted. Your nurse or another health care team member inserts an IV tube into your arm or hand through which medications or fluids can be given.
- The ECT nurse places electrode pads on your head. Each pad is about the size of a silver dollar. ECT can be unilateral, in which electrical currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electrical currents.
Anesthesia and medications
At the start of the procedure, you’ll receive these medications through your IV:
- An anesthetic to make you unconscious and unaware of the procedure
- A muscle relaxant to help minimize the seizure and prevent injury
You also may receive other medications, depending on any health conditions you have or your previous reactions to ECT.
A blood pressure cuff placed around your ankle stops the muscle relaxant medication from entering the foot and affecting the muscles there. When the procedure begins, your doctor can monitor seizure activity by watching for movement in that foot.
During the procedure, monitors constantly check your heart, blood pressure and oxygen use. You may be given oxygen through an oxygen mask. You will also be given a mouth guard to help protect your teeth and tongue from injury
Inducing a seizure
When you’re asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electrical current to pass through the electrodes to your brain, producing a seizure that usually lasts less than 60 seconds.
Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you’re having a seizure may be a rhythmic movement of your foot if there’s a blood pressure cuff around your ankle. But internally, activity in your brain increases dramatically. A test called an electroencephalogram (EEG) records the electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.
A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You will be taken to a recovery area, where you’re monitored for problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.
Series of treatments
In the United States, ECT treatments are generally given two to three times weekly for three to four weeks. Most people require six to 12 treatments, although up to 20 or more treatments are needed in some cases. The number of treatments you will need depends on the severity of your symptoms and how rapidly they improve. After the initial series of treatments, additional treatments may be given on a less frequent basis to prevent the return of depression or other symptoms.
The physicians at SeattleNTC, Drs. Melman, Burns, Bess, and Kerns are highly experienced brain stimulation psychiatrists, performing by far the most ECT and TMS in the Pacific Northwest. Dr. Melman has been treating patients with ECT since 1985 and has performed many thousands of treatments during this time. Dr. Burns has been treating patients with ECT for many years, having established and directed an ECT treatment program on the East Coast and performed ECT while on the faculty of New York University School of Medicine before joining SeattleNTC. Dr. Bess, also very experienced in ECT, was an active member of the ECT team at University of Michigan while serving as Inpatient Medical Director at University Hospital. Prior to her arrival at SeattleNTC, Dr. Kerns completed her psychiatric residency and ECT training at Duke University Medical Center, one of the foremost brain stimulation programs and an internationally renowned training site for ECT. While later completing a neurostimulation fellowship and as a faculty member at the Medical University of South Carolina, she was an active member of the ECT service, performing standard ECT as well as experimental forms of ECT such as FEAST (focal electrically administered seizure therapy). She has also created an ECT training program for residents and medical students that has been presented at several national conferences such as the American Association for Directors of Psychiatric Residency Training and the International Society for ECT and Neurostimulation.
The SeattleNTC doctors understand that the decision to have ECT is an important step for patients, and make every effort to educate patients and their families about ECT before, during and after this decision is reached. They also are dedicated to remaining current with new advances in the field. As a result, their treatment methods are always up to date and state of the art. Furthermore, by working together as a team, the SeattleNTC doctors frequently review their patients’ progress and make necessary modifications to the treatment plan.
Most importantly, the SeattleNTC psychiatrists have deep concern for their patients and are committed to providing the highest quality of care possible.
"I would say that SeattleNTC is an incredible partner for anyone suffering any kind of mental health issue. Again, I can primarily speak for those with depression, but I would tell anyone who’s dealing with mental health issues: SeattleNTC is on the cutting edge. The staff and the doctors are extremely caring and extremely talented people. Compassionate. Very interested in the outcome and the ongoing of all their treatment." - ECT & TMS patient - Karen (45yo)
"I started the TMS. Overnight, it's like I came back to life. So far, it's kept sticking around and I've reconnected with my church groups, my community of work." – TMS patient - Jim (62yo)
"I'm very, very satisfied with the results and I think I made the right decision. SeattleNTC and Dr. Melman came highly recommended in this field. One of the best! This gave me a lot of confidence going into the treatment. I wake up every morning with gratefulness that I am now happy. My energy level is off the charts. My family is no longer suffering due to my depression. The closeness and love we share is priceless!" – TMS patient – Jessica (41yo)
"There’s never a glitch or a moment of stress. Everybody’s attuned to you. Somebody’s there to make sure you’re ok. It’s amazing. They hold your hand through the whole procedure. I can’t say enough good about it" - ECT patient – Bertie (71yo)
"I knew that there had to be something. I couldn’t had run out of luck at this point." - TMS patient – Maria (45yo)
Nulla pretium, purus vitae euismod posuere, elit enim laoreet odio, eu condimentum dolor ligula vitae dui. Praesent nulla turpis, rhoncus vel dui et, congue semper neque.