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Electroconvulsive Therapy

What Is Electroconvulsive Therapy?

Highlights

  1. ECT has been shown to help 78 percent of people with clinical depression.
  2. ECT is generally a very safe procedure with low risk. It’s even safe enough for pregnant women.
  3. ECT can be administered in two ways: bilaterally, which affects your entire brain, and unilaterally, which targets a specific area of your brain.

Electroconvulsive therapy (ECT) is a treatment for certain mental illnesses. During this therapy, electrical currents are sent through the brain to induce a seizure. The procedure has been shown to help of people with clinical depression. It’s most often used to treat people who don’t respond to medication or talk therapy.

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History

History of ECT

ECT has a checkered past. When ECT was first introduced in the 1930s, it was known as “electroshock therapy.” In its early use, patients regularly suffered broken bones and related injuries during therapy. Muscle relaxants weren’t available to control the violent convulsions caused by ECT. Because of this, it’s considered one of the most controversial treatments in modern psychiatry.

In modern ECT, electrical currents are administered more carefully. Also, the patient is sedated to reduce the risk of injury. Today, both the American Medical Association and the National Institutes of Mental Health support the use of ECT.

Uses

Why Is ECT Used?

ECT is most often used as a treatment of last resort for the following disorders:

Bipolar Disorder

This mood disorder is characterized by periods of intense energy and elation (mania) followed by severe depression.

Major Depressive Disorder

This is a common mental disorder. People with this disorder experience frequent low moods and a lack of self-esteem. They may also not enjoy activities they once found pleasurable.

Schizophrenia

This psychiatric disease typically causes paranoia, hallucinations, and delusions.

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Types

Types of ECT

There are two major types of ECT: unilateral and bilateral.

In bilateral ECT, electrodes are placed on either side of your head. The treatment affects your entire brain.

In unilateral ECT, one electrode is placed on the top of your head. The other is placed on your right temple. This treatment affects only the right side of your brain.

Some hospitals employ “ultra-brief” pulses during ECT. These last less than half a millisecond, compared to the standard one-millisecond pulse. The shorter pulses are believed to help prevent memory loss.

The Procedure

What to Expect

To prepare for ECT, you’ll need to stop eating and drinking for a specified period of time. You may also need to change certain medications. Your doctor will let you know how to plan.

On the day of the procedure, your doctor will give you general anesthesia and muscle relaxants. These medications will help prevent convulsions. You’ll fall asleep before the procedure and not remember it afterwards.

Your doctor will place two electrodes on your scalp. A controlled electrical current will be passed between the electrodes. This current causes a brain seizure, which is a temporary change in the brain’s electrical activity. It will last between 30 and 60 seconds.

During the procedure, your heart rhythm and blood pressure will be monitored. In outpatient procedures, you’ll typically go home the same day.

Most people receive benefits from ECT in as few as eight to 12 sessions over three to six weeks. Some patients require a once-a-month maintenance treatment.

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Effectiveness

How Effective Is ECT?

According to a review by the , 78 percent of patients with clinical depression improved after ECT. In addition, people who are treated with ECT have a remission rate. This compares to a rate for those taking medications.

The reason ECT is so effective remains unclear. Some researchers believe it helps to correct an imbalance in the brain’s chemical messenger system. Another theory is that the seizure somehow resets the brain.

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Benefits

Benefits of ECT vs. Other Therapies

ECT works for many people when drugs or psychotherapy are ineffective. There are typically fewer side effects than with medications.

ECT works quickly to relieve psychiatric symptoms. Depression or mania may resolve after only one or two treatments. Many medications require weeks to take effect. Therefore, ECT can be especially beneficial for those who are suicidal, psychotic, or catatonic.

However, some people may require maintenance ECT (or medications) to maintain the benefits of ECT. Your doctor will need to monitor your progress closely to determine the best follow-up care for you.

ECT may be safely used on both pregnant women and those with heart conditions.

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Side Effects

Side Effects of ECT

Side effects associated with ECT are uncommon and generally mild. They can include:

  • headache or muscle ache in the hours following treatment
  • confusion shortly after treatment
  • nausea, usually shortly after a treatment
  • memory loss (short-term or long-term)
  • irregular heart rate (rare)

ECT can be fatal, but deaths are extremely rare. About die from ECT. This is lower than the U.S. suicide rate, which is estimated to be .

If you or a loved one is dealing with suicidal thoughts, call 911 or the at 1-800-273-8255 right away.

Article resources
  • Electroconvulsive therapy (ECT). (2009). Retrieved from
  • Electroconvulsive therapy (ECT). (n.d.). Retrieved from 
  • Electroconvulsive therapy today. (n.d.). Retrieved from
  • Hughes, J., Barraclough, B., & Reeve, W. (1981, April). Are patients shocked by ECT? Journal of the Royal Society of Medicine, 74, 283-285. Retrieved from
  • Kramer, B. A. (1999, December). Use of ECT in California, revisited: 1984-1994 [Abstract]. Journal of ECT, 15(4), 245-51. Retrieved from
  • Meeting to discuss the classification of electroconvulsive therapy devices (ECT). (2011, January 27). Retrieved from http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/NeurologicalDevicesPanel/UCM240933.pdf
  • Suicide facts. (n.d.). Retrieved from
  • Treating severe depression with electroconvulsive therapy. (2013, August 27). Retrieved from
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