Electroconvulsive Therapy

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(Therapy, Electroconvulsive; ECT)

Definition

Electroconvulsive therapy (ECT) sends an electronic current through the brain. This current causes brief seizure activity. This causes changes in brain chemistry. ECT can reduce symptoms associated with severe depression and other mental health conditions.

The Brain

During ECT, an electronic current is delivered to the brain.

Reasons for Procedure

ECT is commonly used to treat:

Severe depression that does not respond to medicine or that causes serious symptoms, like psychosis and suicidal thoughts
Schizophrenia
Severe mania that does not respond to medicine

In some cases, ECT may also be used for other mental or neurological conditions.

Possible Complications

Common complications include:

Short-term changes in blood pressure and heart rate
Short-term abnormal heart rate
Headache
Nausea
Muscle aches or soreness
Cognitive impairment, such as problems with thinking and memory—These usually go away after a couple of weeks. In some cases, memory problems may last for several months.

Rare complications may also occur, such as:

Heart attack
Long-lasting seizure
Death

Factors that may increase the risk of complications include:

Having a history of heart problems, stroke , or high blood pressure
Being pregnant—While ECT is used in pregnant women with severe depression, this form of therapy may increase the risk of complications in the fetus.
Not responding well to medicine
Increased age

Discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Prior to the procedure, your doctor will:

Do a physical exam
Do a complete medical and psychological history
Ask you about any medicines you are taking, including prescription and over-the-counter medicines
Have tests done, which may include blood tests, an electrocardiogram , and imaging of the brain
Have you meet with an anesthesiologist
Give you instructions about not eating or drinking before the procedure

You may feel confused after ECT. Arrange for someone to drive you home from the hospital. Also, arrange for someone to help you at home.

Anesthesia

General anesthesia will be used. You will be asleep during the treatment and will not feel any pain.

Description of Procedure

You will be connected to a machine that will monitor your vital signs and brain activity. Next, you will receive general anesthesia and a medicine to keep your muscles relaxed during the procedure.

After you are asleep, you will receive oxygen through a mask on your face. A mouth guard may also be placed to protect your tongue and teeth from injury. Next, the doctor will position electrodes on your head. These electrodes will be connected to a machine that will deliver an electric current to your brain. This will cause seizure activity. After the shock is given, the muscles that have not been affected by the medicine will contract for a few seconds. Next, your body will twitch, which can last up to a minute.

Immediately After Procedure

You will be taken to a recovery room where your vital signs will be monitored. You will wake up in 10-15 minutes. You may feel confused. This confusion can last minutes, hours, or sometimes longer.

How Long Will It Take?

About 30 minutes, including time to recover after the procedure

How Much Will It Hurt?

You will not feel any pain during the procedure. After ECT, you may have a headache and muscle aches or soreness.

Post-procedure Care

At the Care Center

When you are fully awake, you will be given something to eat and drink. In most cases, you will be able to go home the day of the procedure.

At Home

You will need to schedule an appointment for another ECT treatment. In most cases, you will need to have three treatments per week for one month. You will need to take medicine, such as antidepressants, and continue with therapy to prevent a relapse.

You may also need maintenance ECT to further prevent a relapse. Your doctor will help determine the right plan for you. This will depend on how you are progressing.

Follow any instructions your doctor gives you.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Worsening of symptoms, including feelings of hopelessness or helplessness and thoughts of suicide—If you have thoughts of suicide, call your doctor or therapist right away.
Confusion and memory loss that lasts longer than expected
Headache, muscle aches, or soreness that lasts longer than expected

In case of an emergency, call for medical help right away.

RESOURCES

Depression and Bipolar Support Alliance http://www.dbsalliance.org

Mental Health America http://www.nmha.org

CANADIAN RESOURCES

Canadian Mental Health Association http://www.ontario.cmha.ca

Canadian Psychiatric Association http://www.cpa-apc.org

References

Depression: how electroconvulsive therapy works. Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/common/mentalhealth/treatment/058.html . Updated September 2012. Accessed February 20, 2013.

Electroconvulsive therapy. Mental Health America website. Available at: http://www.nmha.org/go/information/get-info/treatment/electroconvulsive-therapy-ect . Accessed February 20, 2013.

Electroconvulsive therapy (ECT). El Camino Hospital website. Available at: http://www.elcaminohospital.org/Programs%5Fand%5FServices/Behavioral%5FHealth/Electroconvulsive%5FTherapy . Accessed February 20, 2013.

Electroconvulsive therapy (ECT) for depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 12, 2011. Accessed February 20, 2013.

Kellner CH, et al. ECT in treatment-resistant depression. Am J Psychiatry . 2012;169:1238-44.

5/13/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010;68(6):568-577.

Revision Information

Reviewer: Rimas Lukas, MD
Review Date: 03/2013 -
Update Date: 00/31/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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