What to Expect During Electroconvulsive Therapy

A Step-By-Step Guide to Help You Prepare

electroconvulsive therapy (ECT)

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Electroconvulsive therapy (ECT) is a safe and controlled treatment for certain psychiatric disorders such as major depression, psychosis, or severe cases of bipolar mania.

During the ECT procedure, a small amount of electrical current is passed through the brain while the individual is placed under general anesthesia. This triggers a seizure that affects brain activity, ideally interrupting impulses, behaviors, or moods that have been causing the person harm.

While ECT is a scary concept to most people, by understanding the procedure and what to expect, you can make an informed choice if the treatment is recommended.

Before the Procedure

The ECT procedure takes around five to 10 minutes to perform, not including preparation and recovery time. The day before the procedure, you would be placed on dietary restrictions, typically with no food or drink allowed after midnight and only a sip of water permitted in the morning to take medication.

Upon arriving at the hospital:

  1. You would meet with a nurse who will take your vital signs and ask about any health conditions you may have or medications you may be taking.
  2. You may also meet with the anesthesiologist who will inquire whether you have had anesthesia in the past and if there were any adverse reactions.
  3. Once in the treatment room, an intravenous (IV) line would be inserted into a vein through which the anesthesia, fluids, and other medications will be delivered.
  4. Your nurse would then place electrode pads on your head, each of which is about the size of a silver dollar. Depending on the treatment plan, the electrodes may be placed on one side of the head (unilateral) or both (bilateral).
  5. You would then be hooked up to various machines to monitor your blood pressure, respiration, heart rate, and brain activity.

During the Procedure

Once you have been prepped, your doctor and anesthesiologist will start the procedure, first by putting you under general anesthesia and then by delivering electrical currents through the brain with the following steps:

  1. The anesthesiologist delivers two drugs through the IV line: anesthesia to put you asleep and a muscle relaxant to minimize seizures during the procedure itself.
  2. A blood pressure cuff inflates around your ankle to prevent the muscle relaxant from entering the foot. This allows the doctor to monitor seizure activity by looking at the "unmedicated" foot.
  3. An oxygen mask is placed over your face. You may also be given a mouth guard to help protect your teeth and tongue.
  4. Once you are asleep, the doctor delivers the electrical current by pressing a button on the ECT machine. This would trigger a seizure that usually lasts less for than 60 seconds or so. The doctor will be able to see this in your free foot as well as on the monitor of the electroencephalogram (EEG) machine.

After the Procedure

Once the procedure is complete, the effects of the short-acting anesthetic and muscle relaxant will quickly begin to wear off. You will be taken to a recovery area where you will be monitored for any complications. When you awaken, you may experience a period of disorientation lasting from a few minutes to several hours. Short-term memory loss is common.

People who undergo ECT for the first time are often advised not to drive or return to work for a week or two. As ECT is usually prescribed in over several treatments, the side effects tend to wane as the treatment progresses. By the end of the course, you may only need to avoid work or driving for a few days.

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  • American Psychiatric Association. "What Is ECT?" Arlington, Virginia; updated January 2016.
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