Electroconvulsive Therapy Procedure
Overview
Electroconvulsive therapy (ECT) uses controlled electrical currents to trigger a quick seizure in the brain while the person is asleep under anesthesia. Doctors often choose this procedure when other treatments haven’t improved serious mental health conditions.
ECT changes brain activity in ways that can bring fast relief from symptoms, especially for severe depression and mood disorders. Today, medical teams perform ECT with strict safety measures and anesthesia to reduce discomfort.
The process typically involves multiple sessions. Patients may experience side effects such as headache or temporary trouble with memory, but serious complications rarely occur.
| Feature | Details |
|---|---|
| Anesthesia Used | Yes |
| Number of Treatments | Multiple sessions are common |
| Common Use | Severe depression, mood disorders |
| Possible Side Effects | Headache, brief memory loss |
Reasons for Use
Doctors may recommend electroconvulsive therapy (ECT) for serious mental health problems that don’t respond to other treatments. Psychiatrists often use ECT for major depressive disorder when symptoms persist despite trying medication and therapy—known as treatment-resistant depression.
ECT can also help manage episodes of bipolar disorder with severe mania, as well as catatonia. In some cases, it helps people with schizophrenia who have hallucinations, delusions, or catatonia that don’t improve with medicine. ECT may also be considered for people with strong suicidal thoughts or those who cannot safely take psychiatric drugs.
Sometimes, doctors choose ECT when medication side effects are too difficult to handle, or when quick improvement is needed. Specialists might also recommend ECT for child and adolescent patients, or for older adults who don’t tolerate standard medications well.
Common reasons ECT might be used:
| Condition | Some Examples |
|---|---|
| Major depression | Severe, with psychosis or suicidality. |
| Bipolar disorder | Serious mania or mood swings. |
| Schizophrenia | Persistent hallucinations or delusions. |
| Catatonia | Lack of movement, speech, or unusual behavior. |
| Dementia-related agitation | Aggression or distress unmanageable by other treatments. |
Some people continue ECT as maintenance therapy to keep their symptoms managed. The decision to use ECT involves careful discussion between patients, families, and mental health professionals, especially when it’s medically necessary and other treatments have failed or are unsafe.
What To Watch Out For
People who undergo ECT may experience certain risks and side effects. The most common issues are temporary confusion and memory problems. Some individuals feel confused for a short time after treatment, which can last from several minutes up to a few hours. This confusion often affects older adults more strongly.
Memory Issues
People sometimes experience memory loss after ECT. This can make it hard to remember things that happened shortly before or during the treatment series. These memory problems, called retrograde amnesia, usually improve within two months, but in rare cases, some memory gaps can last longer.
Common Physical Side Effects
Many people feel physical effects on the days they receive treatment. These can include:
- Headache
- Nausea
- Muscle aches
- Jaw pain
Healthcare providers can often help manage these symptoms with medication.
Other Possible Complications
Doctors use medications to make the person sleep through the procedure. These medicines can cause short-term changes in heart rate and blood pressure. For those with serious heart conditions, ECT carries higher risks and may require extra care. The table below summarizes some side effects:
| Side Effect | How Long It Lasts |
|---|---|
| Confusion | Minutes to hours |
| Memory loss | Weeks to months (rarely longer) |
| Headache | Usually short-term |
| Nausea | Usually short-term |
| Muscle/jaw pain | Usually short-term |
How You Get Ready
Preparing for treatment involves a few important steps. Patients typically undergo a review of their medical and mental health history, a physical exam, blood tests, and a heart test (ECG).
Doctors will also discuss the risks of general anesthesia and go over any medications or psychotropic drugs the patient currently takes. Patients are usually advised to avoid eating or drinking after midnight and to remove items like jewelry before the procedure.
What You Might Expect
What Happens Before the Procedure
On the day of treatment, most people are told not to eat or drink after midnight. Sometimes, a small sip of water is allowed in the morning if it’s needed for medicine.
Before the procedure, patients change into a gown and have an IV line placed for medications and fluids. A quick checkup is done to confirm there are no recent changes in heart or lung function.
Staff place electrodes on the head to deliver the electrical current and use leads on the chest to monitor the heart. Electrodes on the scalp also track brain activity using an EEG. Depending on the treatment plan, the stimulation may target one side or both sides of the brain.
Medications Used
Right before starting, staff give medicine through the IV. This usually includes:
| Medication Type | Purpose |
|---|---|
| Anesthetic | Induces sleep and blocks pain |
| Muscle Relaxant | Limits muscle movements during seizure |
| Extra Medications | Manages blood pressure, heart rate, nausea |
- An Anesthetic: Ensures the person is fully asleep and doesn’t feel pain.
- A Muscle Relaxant: Keeps the body mostly still and stops strong movements.
- Other Medications: Sometimes given to keep blood pressure and heart rate steady or to help with side effects like headaches or nausea.
These medicines make the ECT procedure safer and more comfortable. Doctors choose specific drugs based on medical history and how the body handled past treatments.
Devices and Machines Used
Staff use many kinds of equipment for safety and to get information during the procedure. These include:
- Blood Pressure Monitor: Checks changes before, during, and after ECT.
- Heart Rate Monitor (ECG): Tracks the heartbeat to watch for any issues.
- Brain Wave Monitor (EEG): Records changes in electrical activity during the seizure.
- Oxygen Mask: Helps the patient breathe during the procedure.
- Mouth Guard: Protects teeth and tongue from injury.
- Electrodes: Deliver the electrical current to start the seizure.
Doctors and nurses watch the readings from all these monitors. They also observe the patient’s feet or hands for any small movements, as the muscle relaxant keeps the rest of the body still.
Brief Seizure Stimulation
Once everything is ready and the patient is asleep, the medical team sends a mild electrical current through electrodes attached to the scalp. This starts a short seizure in the brain that lasts less than one minute.
Even though the person has a seizure, they are not aware of it because of the anesthesia. Outwardly, only some twitching in the toes or fingers may be seen. The EEG machine displays when brain activity spikes and when the seizure ends.
After the seizure, the anesthesia and muscle relaxant begin to wear off. Staff move the patient to a recovery space, where they closely monitor heart rate, blood pressure, and alertness. Some people wake up feeling confused, and this confusion may last from a few minutes to several hours.
Multiple Sessions
ECT is not just a one-time treatment. To get the best results, most people need a series of treatments. In the United States:
- Usually, staff administer treatments two or three times each week.
- Most people complete between 6 to 12 sessions.
- Providers base the plan on symptom severity and how well each person responds.
After each session, most patients return to normal activities within a few hours. However, doctors often suggest waiting before driving, making important decisions, or going back to work.
For series therapy, it’s common to hold off on these activities until memory and thinking are back to usual, which might be up to one or two weeks after the last treatment.
Study Outcomes
Electroconvulsive therapy (ECT) visibly improved symptoms for many patients after about six sessions. Some patients reached full symptom remission with continued treatments, though results varied between individuals.
ECT works faster than some alternative treatments like antidepressant medications, but it may not be effective for everyone. Key findings:
- Faster Symptom Relief: Most patients reported improvement within weeks rather than months.
- Brain Stimulation Effects: Repeated sessions changed brain chemistry and supported recovery from severe depression and other psychiatric disorders.
- Ongoing Management: After initial symptom relief, patients often continued maintenance treatments, including medicines and psychotherapy, to prevent recurrence.
| Treatment Type | Onset of Improvement | Additional Requirements |
|---|---|---|
| ECT | ~6 sessions | Ongoing medication, therapy, possible maintenance ECT |
| Antidepressants | ~6 weeks | Monitoring, possible dose adjustments |
| Psychotherapy | Weeks to months | May be combined with medication |
Alternative treatments such as talk therapy and antidepressants remain a part of long-term care, even for those who respond well to brain stimulation treatment.
