What Is Electroconvulsive Therapy (ECT)?

Electroconvulsive therapy machine

Nasko / Wikimedia Commons

In This Article

What Is Electroconvulsive Therapy?

Electroconvulsive therapy (ECT) is a form of psychiatric treatment that involves inducing seizures with the use of electrical stimulation while a patient is under general anesthesia. An estimated one million people worldwide have ECT each year.

ECT is most often used for cases of treatment-resistant depression and some other psychiatric conditions including bipolar disorder and psychosis, although its use still remains somewhat controversial in the general public. Approximately 70% of ECT patients are women. More than a third of ECT patients are age 65 and older.

Use in children and teens remains relatively rare. Some states, including Colorado and Texas, prohibit the use of ECT in children and adolescents under the age of 16.

Types

Generally speaking, the two types of ECT are:

  • Bilateral ECT: Where the electrodes are placed on both sides of the head
  • Unilateral ECT: Where one electrode placed on top of the head and the other on one temple, usually the right

Uses

ECT is often used when people are unresponsive to other mainstream treatments, like antidepressant drugs and psychotherapy. ECT has also been found effective in people who require a rapid treatment response due to the severity of their condition or risk for suicide.

ECT is used to treat the following:

  • Aggression and agitation in dementia, which can be related to the disease itself or the emotional impact of dementia.
  • Catatonia, a psychomotor condition in which a person may appear immobile, rigid, or mute; it often results from psychiatric disorders such as bipolar disorder or schizophrenia.
  • Parkinson's disease, particularly Parkinson's related depression as well as “on-off” syndrome, neuroleptic malignant syndrome, and intractable seizure disorders.
  • Postpartum psychosis and severe depression in pregnant women; ECT may reduce the risks associated with medication exposure to the fetus and in the nursing infant.
  • Schizophrenia, especially when a person is not responding to available treatments like antipsychotics.
  • Severe depression, especially when a person also experiences psychosis, suicidal thoughts, or refusal to eat in addition to the usual symptoms of depression.
  • Treatment-resistant depression, a type of severe depression that does not respond to medication or psychotherapy treatment, or that returns after brief improvements.

How It Works

Prior to receiving ECT, you'll need to a full health evaluation, including:

  • Physical exam
  • Psychiatric assessment
  • Blood and lab tests (including electrocardiogram to check your heart health)

Having certain medical conditions may rule out ECT as an option. At this time, your doctor will weigh your personal risks and also discuss the risks of anesthesia, which vary from procedure to procedure and person to person.

The number and type of treatments you will need depend on the severity of your symptoms. ECT is initially typically given two to three times a week for an average of six to 12 sessions and is often tapered over time.

A newer ECT technique, right unilateral ultrabrief pulse electroconvulsive therapy, may allow for fewer memory issues with the treatment.

ECT can be done while you’re in the hospital or as an outpatient procedure. You won’t be able to drive the day of the treatment.

On the day of the procedure, you can expect the following:

  • You’ll receive a short-acting anesthetic to briefly put you to sleep and prevent you from feeling any pain or discomfort from the procedure. You will also receive a muscle relaxant to prevent muscle contractions that would otherwise accompany the seizure.
  • Two sets of electrodes are placed on your scalp: one to monitor your brain activity and another to deliver a small and painless electric current.
  • When you are asleep, a small amount of electric current delivered to your head will cause seizure activity (for about 40 seconds) in the brain.
  • Several minutes after the treatment, you wake up in a recovery area but do not remember the actual treatment.

Researchers are yet to know the exact reason why ECT works, but one theory is that it helps to correct imbalances in the brain’s chemical messenger system. Others say that the seizure “resets” the brain. Several treatments may be needed to see a lasting effect.

Side Effects

People may feel relief from their symptoms fairly quickly, but it often takes several treatments to experience the benefit. They may also experience side effects ranging from minor to more severe.

  • Confusion
  • Headache
  • Hypotension (low blood pressure) or hypertension (high blood pressure)
  • Increased risk of cardiac issues, particularly in those who have coronary artery disease
  • Jaw pain
  • Memory loss
  • Muscle aches
  • Nausea

Memory loss, usually short term and retrograde (things learned in the recent past), during the acute course of the treatment is one of the most commonly reported side effects of ECT.

Benefits

While the use of ECT maintains some stigma, many studies and literature reviews suggest that it can be a safe and effective treatment, particularly in the case of depression, catatonia, psychosis, and suicidality.

  • Severe depression: One study found that 42.8% of people who had ECT achieved remission of depressive disorder symptoms.
  • Psychosis: Yet another study found that ECT gave older patients with psychotic depression the best chance at reducing the risk of relapse.
  • Catatonic depression: Research suggests that ECT works for about 80% to 100% of people with catatonia.
  • Suicidality: Studies have found that ECT significantly improves suicidal ideation accompanying a variety of mental illnesses.

History of ECT

Originally known as electroshock therapy, ECT was first introduced by a pair of Italian psychiatrists in 1938. However, the use of induced seizures to treat mental illness dates back as far as the early 1500s.

It became a popular psychiatric technique during the 1940s and 1950s, particularly in the treatment of severe depression. By 1941, electroconvulsive therapy (ECT) was used by nearly half of the mental health institutions in the United States.

Stigma attached to the use of ECT led to a decline in its use during the 1960s. The emergence of effective psychiatric medications to treat depression also contributed to its decline. Between 1975 and 1980, there was a 46% decline in ECT use in the United States. ECT use then remained steady throughout the 1980s and began to rise again through the next decade.

A Word From Verywell

Before undergoing ECT, talk with your doctor to make sure you have explored other options and discuss the risks. It’s also important to keep in mind that ECT is not a cure. People with serious mental illness will need to continue maintenance treatment, including psychotherapy, medication, and ongoing ECT treatments.

Was this page helpful?
Article Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Leiknes KA, Jarosh-von Schweder L, Høie B. Contemporary use and practice of electroconvulsive therapy worldwideBrain Behav. 2012;2(3):283–344. doi:10.1002/brb3.37

  2. Kerner N, Prudic J. Current electroconvulsive therapy practice and research in the geriatric populationNeuropsychiatry (London). 2014;4(1):33–54. doi:10.2217/npy.14.3

  3. Van den Berg J, Kruithof H, Kok R, et al. Electroconvulsive therapy for agitation and aggression in dementia – a systematic reviewAm J Geriatr Psychiatry. 2018 Apr;26(4):419-434. doi:10.1016/j.jagp.2017.09.023

  4. Luchini F, Medda P, Mariani MG, Mauri M, Toni C, Perugi G. Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response. World J Psychiatry. 2015;5(2):182-92. doi:10.5498/wjp.v5.i2.182

  5. Grover S, Somani A, Sahni N, et al. Effectiveness of electroconvulsive therapy (ECT) in Parkinsonian symptoms: A case series. Innov Clin Neurosci. 2018;15(1-2):23-27. 

  6. Babu GN, Thippeswamy H, Chandra PS. Use of electroconvulsive therapy (ECT) in postpartum psychosis--a naturalistic prospective study. Arch Womens Ment Health. 2013;16(3):247-51. doi:10.1007/s00737-013-0342-2

  7. Phutane VH, Thirthalli J, Kesavan M, Kumar NC, Gangadhar BN. Why do we prescribe ECT to schizophrenia patients?. Indian J Psychiatry. 2011;53(2):149-51. doi:10.4103/0019-5545.82544

  8. Salik I, Marwaha R. Electroconvulsive Therapy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.

  9. MedlinePlus. Electroconvulsive therapy. Updated July 8, 2018.

  10. Brus O, Cao Y, Gustafsson E, et al. Self-assessed remission rates after electroconvulsive therapy of depressive disorders. Eur Psychiatry. 2017;45:154-160. doi:10.1016/j.eurpsy.2017.06.015

  11. Jelovac A, Kolshus E, Mcloughlin DM. Relapse following successful electroconvulsive therapy for major depression: A meta-analysis. Neuropsychopharmacology. 2013;38(12):2467-74. doi:10.1038/npp.2013.149

  12. Luchini, F, et al. Electroconvulsive therapy in catatonic patients: Efficacy and predictors of responseWorld J Psychiatry. 2015; 5(2): 182-192. doi:10.5498/wjp.v5.i2.182

  13. Oji C, Moore T, Gutierrez C. A review of electroconvulsive therapy in suicidality. Mental Health Clinician. 2015;5(5):212–215. doi:10.9740/mhc.2015.09.212

  14. Thompson JW, Weiner RD, Myers CP. Use of ECT in the United States in 1975, 1980, and 1986. Am J Psychiatry. 1994;151(11):1657-61. doi:10.1176/ajp.151.11.1657

  15. American Psychiatric Association. What is Electroconvulsive therapy (ECT)? Updated July 2019.