What to Expect During Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a safe and effective treatment for certain psychiatric disorders such as major depression, catatonia, certain types of psychosis, and sometime for 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 in ways that lead to clinical improvement.

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

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 for the first time:

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. 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 muscle contractions 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 will 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. Headaches, jaw pain, and muscle soreness may occur. ECT requires a series of treatments, often initiated two to three times a week for a few weeks and then the frequency is tapered down. As the treatment course progresses, short-term memory loss for things recently learned is not uncommon.

People who undergo ECT are advised not to drive the day of treatment and have someone stay with them immediately afterwards.