What is Electroconvulsive Therapy, How Does ECT Work, Procedure, Benefits and Side Effects

Electroconvulsive therapy is a safe and controlled procedure for the treatment of depression and other psychological disorders that do not respond well to other forms of treatment. In this type of treatment, a small amount of electric current is passed through the brain to cause a brief seizure. Electroconvulsive therapy is typically administered under anesthesia, and it can be given in both outpatient and inpatient hospital settings. Here’s everything you need to know about electroconvulsive therapy, along with its benefits and risks.

Electroconvulsive therapy (ECT) is a type of treatment for certain types of mental illnesses, especially clinical depression and other psychological disorders that do not respond to other forms of treatment. In Electroconvulsive therapy, a small amount of electric current is passed through the brain in order to trigger a brief seizure. It was earlier known as electroshock therapy, and this form of therapy has been in use since 1938 for treating various psychiatric conditions. However, in the early days of Electroconvulsive therapy use, people being treated with Electroconvulsive therapy often experienced damage to their bones and teeth, as well as a lot of pre-treatment anxiety. However, today ECT is an effective treatment that has a high safety record.

According to the World Health Organization, it is believed that an estimated 3.8 percent of the global population is affected by depression, including five percent of adults and 5.7 percent of adults over the age of 60.⁽¹⁾ Depression is also one of the leading causes of disability in the United States, and it is generally assumed that the condition is not that easy to treat.⁽²⁾

Nearly 60 to 70 percent of people who have been diagnosed with major depressive disorder respond to antidepressant medications.⁽²⁾ And ECT is believed to help those people who do not find any relief from medications and other forms of treatments.

Electroconvulsive therapy is administered under anesthesia, and it can be taken in both inpatient and outpatient settings. Research has found that between 70 to 90 percent of patients experience a rapid improvement in their symptoms after taking ECT.⁽³⁾

Electroconvulsive therapy is also believed to help those who are acutely suffering from psychosis, mania, catatonia, agitated dementia, post-traumatic stress disorder, and suicidal thoughts. The American Psychiatric Society (APA) has established clear guidelines for the use of Electroconvulsive therapy in the treatment of psychological disorders like depression and others.⁽⁴⁾ ECT is known to be sage for adolescents and older people, and even for pregnant women.

Continued opposition to the use of Electroconvulsive therapy and the portrayal of Electroconvulsive therapy as being harmful has made the public generally wary of this procedure, and there is a significant amount of stigma attached to this form of treatment. Nevertheless, there is a lot of evidence today that shows Electroconvulsive therapy to be a valuable and often underutilized form of therapy that can help manage and even reduce the symptoms of many severe and persistent psychiatric illnesses.⁽²⁾

Electroconvulsive therapy sends a small electric pulse or shock to the brain that only lasts for one to two seconds while the patient is under general anesthesia. This causes the brain cells to begin firing in unison, which replicates or causes a brief seizure. As the patient is asleep and their muscles are in a relaxed state, the only evidence of this seizure can be observed through the activity of the brain waves seen on a monitor.

The exact reasons for why Electroconvulsive therapy is so effective are still not clear, though it is believed that the small electric pulse triggers an immediate increase in the production of serotonin and dopamine, which are the main neurotransmitters in the body associated with depression.^{(5, 6, 7, 8)}

Treatment with Electroconvulsive therapy also causes the body to release several important hormones and natural mood-boosting chemicals known as endorphins.⁽⁹⁾ Antidepressants also stimulate the same type of reaction, but it can take several weeks along with different drug combinations to experience the same effectiveness.⁽¹⁰⁾

To prepare for Electroconvulsive therapy, your doctor will advise you to stop eating and drinking anything for a certain amount of time. You might also need to stop or change some of your medications. Your doctor will make you aware of the entire plan a few days before the procedure.

On the day of the ECT procedure, your doctor will administer general anesthesia and muscle relaxants. These medications help prevent the convulsions associated with the triggered seizure activity that happens in Electroconvulsive therapy. You will fall asleep before the procedure begins and won’t even remember it after waking up.

To begin with, your doctor will place two electrodes on your scalp, and a controlled electrical current will be passed between these electrodes. The electrical current will trigger a brain seizure, which will cause a temporary change in the brain’s electrical activity. The seizure is very small and will only last for between 30 to 60 seconds.

Your doctor will continue to monitor your heart rhythm and blood pressure closely during the procedure. If you are having this procedure as an outpatient, you will be allowed to go home after the therapy is completed. If you are having Electroconvulsive therapy as an inpatient procedure, you will be kept overnight and discharged the next day.

Electroconvulsive therapy has been shown to work for many people for whom psychotherapy or medications did not work. There are also fewer side effects associated with Electroconvulsive therapy as compared to medications.

Electroconvulsive therapy works rapidly to relieve psychiatric symptoms. Mania or depression may even resolve after only receiving one or two rounds of Electroconvulsive therapy. As compared to this, some medications can take several weeks to start showing any effect. Therefore, Electroconvulsive therapy can be especially beneficial for patients who are:

• Psychotic
• Catatonic
• Suicidal

However, some people may need some maintenance Electroconvulsive therapy or some medications to help maintain the benefits of the therapy. Your doctor will closely monitor your progress to determine what is the best follow-up treatment for you.

Electroconvulsive therapy is also safe for pregnant women and people with heart conditions.

Side effects with Electroconvulsive therapy are pretty rare and typically mild. They can include:^{(11, 12)}

• Confusion following the treatment.
• Muscle ache or headache in the hours after the therapy.
• Short-term or long-term memory loss.
• Nausea, usually for just a short time after the treatment.
• Irregular heart rate, but this is a rare side effect.

Some other side effects, especially after your first few sessions, may include:^(13,14)

• Jaw ache
• Shakiness
• Temporary anxiety, disoriented feelings, and fear
• Muscle stiffness
• Fatigue and intense sleepiness
• Possible hallucinations

Older people tend to feel more unsteady and even experience falls. Pain relief and anti-nausea medication can help decrease many of these unwanted side effects.

While complications of Electroconvulsive therapy are very rare, but as is the case with any procedure performed under anesthesia, there is a risk of developing serious heart problems or other reactions to the anesthesia.

Electroconvulsive therapy can be fatal, but deaths following ECT treatments are extremely rare, and only around 1 in 10,000 people actually end up dying from Electroconvulsive therapy.⁽¹⁵⁾ This is actually lower than the suicide rate in the US, which is believed to be 12 in 100,000 people.

It is important to understand that Electroconvulsive therapy is not a first-line treatment for most psychiatric conditions. And most doctors do not consider prescribing Electroconvulsive therapy until after several months or years of medication and other therapy without achieving any positive results.

Electroconvulsive therapy is a safe and effective treatment for depression and other such psychiatric conditions. It is also a low-risk option for people who experience a variety of mental health or brain-related disorders.

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