Electroconvulsive Therapy

Electroconvulsive Therapy (ECT) is an evidence-based medical treatment used to treat patients with severe depression who have not been responsive to other treatments, including medication and psychotherapy.  ECT is also used to treat bipolar disorder, schizophrenia, and catatonia.  

Because ECT begins working more rapidly than medication or therapy, it is also considered for use in situations where an individual is at high risk, as for suicidal or catatonic patients, who require a rapid treatment response.

ECT’s effectiveness in treating severe mental illnesses is recognized by the American Psychiatric Association, the American Medical Association, the National Institute of Mental Health, and similar organizations in Canada, Great Britain, and many other countries.

How it Works

ECT works by delivering brief electrical stimulation to the brain to induce activity while the patient is under anesthesia.

ECT is performed by a team of trained medical professionals, including a psychiatrist, anesthesiologist, and a nurse (or physician’s assistant). When a patient arrives, they are connected to a heart monitor and the treatment team administers sedatives. Once the person is asleep, a controlled seizure, which usually lasts for one minute, is induced by electrical currents delivered through the electrodes on the scalp.

Since patients are asleep and the muscles are relaxed, patients do not feel any pain or discomfort during ECT.  The procedure lasts for about 15 – 20 minutes and then approximately 30 minutes is spent in the recovery room.

Unilateral and Bilateral

Your doctor will determine whether unilateral or bilateral ECT is the best treatment option for you.  These types of ECT refer to the placement of the electrodes on the head.

In Unilateral ECT, one electrode is placed on the right temple and the other is placed on the crown of the head.  Patients may require a few more sessions than those receiving bilateral ECT to achieve the best results. Unilateral ECT is associated with fewer memory problems than bilateral ECT, in which electrodes are placed on both the left and right temples. Bilateral ECT is the traditional form of ECT and is often used with patients suffering from severe symptoms including psychosis, extreme mania, and those at a high risk for suicide.

Course of Treatment

A standard course of treatment is two to three times per week for approximately twelve sessions; the length of treatment varies for each person. Significant improvement is typically seen after four to six sessions.

Following ECT, medication and psychotherapy are typically continued and maintenance ECT may be administered to prevent relapse.

Side Effects

The most common side effects associated with EDT are: headaches, nausea, confusion, fatigue and sore muscles, and memory loss — typically memories around the time of treatment.  Memory issues occur more frequently with bilateral ECT than unilateral and improve over the days and weeks following treatment. 

Effectiveness

Extensive research has found ECT to be highly effective for the relief of major depression. Clinical evidence indicates that for individuals with uncomplicated, but severe major depression, ECT will produce substantial improvement in approximately 80 percent of patients. It is also used for other severe mental illnesses, such as bipolar disorder and schizophrenia.

Resources

• American Psychiatric Association
• National Institute of Mental Health