Electroconvulsive therapy

Definition

Electroconvulsive therapy (ECT) is a very effective and safe treatment for depression that uses electricity to trigger a seizure.

Alternative Names

Shock treatment; Shock therapy; ECT

Description

Electroconvulsive therapy (ECT) is most often done in a hospital operating or recovery room while you are asleep and pain-free (under general anesthesia).

• You will receive medicine to relax you (muscle relaxant), put you briefly to sleep, and prevent you from feeling pain (short-acting anesthetic).
• A small amount of electric current will then be delivered to your head to cause seizure activity in the brain. It lasts for about 40 seconds. You will receive medicine to prevent the seizure from spreading throughout your body. As a result, there will be only slight movement of your hands or feet during the procedure.
• ECT is usually given once every 2- 5 days for a total of 6 - 12 sessions, but sometimes more sessions are needed.

Indications

ECT is a highly effective treatment for depression, most commonly severe depression. It can be especially helpful for treating depression in patients who:

• Are having delusions or other psychotic symptoms with their depression
• Are pregnant and severely depressed
• Are suicidal
• Cannot take antidepressant drugs
• Have not responded fully to antidepressant drugs

Less often, ECT is used for conditions such as mania, catatonia, and psychosis that do not improve enough with other treatments.

Risks

ECT has receivved bad press, in part for its potential effects on memory. Since ECT was introduced in the 1930s, the dose of electricity used in ECT has been decreased significantly. This has greatly reduced the side effects of this procedure.

However, ECT can still cause some side effects, including:

• Confusion that lasts for only a short period of time
• Headache
• Low blood pressure (hypotension) or high blood pressure (hypertension)
• Memory loss (permanent memory loss beyond the time of the procedure itself is much less common than it was in the past)
• Muscle soreness
• Nausea
• Rapid heartbeat (tachycardia) or other heart problems

Some medical conditions put patients at greater risk for side effects from ECT. Discuss your medical conditions and any concerns with your doctor when deciding whether ECT is right for you.

Expectations after surgery

ECT is one of the safest and most effective treatments for depression that does not respond fully to medication.

After a successful course of ECT, you will receive medications or less frequent ECT to reduce the risk of another depression episode.

Before You Have the Procedure

Because general anesthesia is used for this procedure, you will be asked not to eat or drink before ECT.

Ask your health care provider whether you should take any daily medications in the morning before ECT.

Convalescence

You will wake up several minutes after ECT and will not remember the treatment.

Some people report mild confusion and headache after ECT. These symptoms should only last for a short while.

Hospital staff will monitor you closely after the procedure.

visHeader

References

Smith GE, Rasmussen KG Jr., Cullum CM, Felmlee-Devine MD, Petrides G, Rummans TA, et al. A randomized controlled trial comparing the memory effects of continuation electroconvulsive therapy versus continuation pharmacotherapy: results from the Consortium for Research in ECT (CORE) study. J Clin Psychiatry. 2010;71:185-193.

Tess AV, Smetana GW. Medical evaluation of patients undergoing electroconvulsive therapy. N Engl J Med. 2009;360:1437-1444.