By Martha McLaughlin
Electroconvulsive therapy (ECT) is a safe and effective treatment for severe depression and a variety of other mental health concerns, but because of its history and portrayal in popular media, it may be misunderstood or even feared. The treatments first used in the 1940s were problematic, but today’s ECT bears little resemblance to those early versions of the therapy. Modern ECT is a valuable treatment option for many patients, especially those not helped through other modalities.
What is it?
ECT involves passing a small electrical current through the brain after a patient has been given a muscle relaxant and placed under general anesthesia. The current, which is introduced through two electrodes, produces a brief period of seizure activity, generally lasting no more than a minute. Medical staff monitor the brain’s activity through an electroencephalogram (EEG). People may fear that the treatments will be painful or uncomfortable, but because anesthesia is used, patients are unaware of the procedure, and the medications prevent muscle contractions and associated pain. ECT is generally given as a series of six to 12 treatments, two or three times a week. Sometimes patients believe that they must be hospitalized to receive the treatment, but ECT can be given on both an inpatient and outpatient basis.
When is it used?
ECT is most often used for severe depression, especially when patients experience dangerous symptoms such as suicidal thoughts or lack of desire to eat. It may also be indicated for depression which has failed to resolve through medication or psychotherapy approaches. Sometimes medication is contraindicated, such as in pregnancy, and ECT can be an effective, non-drug option in such cases.
Although ECT is extremely helpful for depression, it is a misconception to believe that is its only use. In addition to depression, ECT can help alleviate mania, catatonia, and the agitation that sometimes accompanies dementia. Psychosis may also resolve through the use of ECT, whether it’s associated with severe depression, schizophrenia or another health condition. A study published in the American Journal of Psychiatry reported on a patient with methamphetamine-induced psychosis who responded quickly to ECT.1
How does it work?
As with many widely-used medical treatments, the method by which ECT exerts its effects is not completely understood. The electrical current may stimulate the release of certain brain chemicals or make the brain more sensitive to them. ECT changes metabolism and blood flow and may cause the brain to grow new cells and nerve pathways. The hippocampus is an area of the brain associated with emotional control, and in people suffering from depression, the hippocampus is often smaller than normal. A study reported in the Journal of ECT found that ECT treatment significantly increased hippocampal volume.2
How does it compare to other treatments?
An analysis of studies comparing ECT to other treatments found “a significant superiority of ECT in all comparisons.”3
These included comparisons of ECT with antidepressant medications in general, MAOI medications, tricyclic antidepressants, simulated ECT and placebo. ECT has also been shown to be more effective than other therapies that stimulate the brain, such as transcranial magnetic stimulation. The effectiveness of ECT for depression is estimated to be between 80 to 90%, which is much superior to the effectiveness of any other available treatment. It also works much more quickly than other treatments do.
What are the side effects?
Patients treated with ECT may experience a degree of memory loss, generally of events that occurred immediately prior to treatment. Sometimes patients fear that this will be permanent, but in most cases it resolves within a few months. Immediately after an ECT treatment, patients may experience confusion, lasting from a few minutes to several hours. They may also experience side effects from the anesthesia, such as nausea. Medical staff can monitor patient response and make adjustments as indicated, such as changing the anesthesia used or passing the electrical current through a different part of the brain.
How long do the positive effects last?
The duration of beneficial effects is highly variable, ranging from weeks to years or even a lifetime. Sometimes doctors will prescribe antidepressant medication for patients to take after their ECT treatments. These may prevent a return of symptoms, even in patients who were not helped by medications prior to ECT. Other patients find it helpful to have “maintenance” sessions of ECT every few months, or more frequently when indicated.
It is always wise for patients and their loved ones to educate themselves about the benefits and risks of any treatment and to be informed medical consumers. This includes understanding how the current reality of a given treatment may differ from the way it was administered in the past. ECT is an important tool in the toolbox of mental health treatments, and it is prudent for patients who could benefit from it to give it serious consideration.
1 Grelotti, David J. et al. “Remission of Persistent Methamphetamine-Induced Psychosis After Electroconvulsive Therapy: Presentation of a Case and Review of the Literature.” The American Journal of Psychiatry, January 1, 2010.
2 Nordanskog, Pia et al. “Increase in Hippocampal Volume After Electroconvulsive Therapy in Patients With Depression: A Volumetric Magnetic Resonance Imaging Study.” Journal of ECT, vol. 26, no. 1, March 2010, pp. 62-67.