ECT Electroconvulsive Therapy: Treatment for Severe Depression

What Is ECT and How Does It Work?

Electroconvulsive therapy (ECT) is a medical procedure that uses brief electrical pulses to induce a controlled seizure in the brain, helping to reset brain chemistry and relieve severe depression and other mental health conditions. The treatment is performed under general anesthesia, typically 2-3 times per week for a total of 6-12 sessions.

Electroconvulsive therapy, commonly known as ECT, is one of the most effective treatments available for severe mental health conditions. Despite outdated stereotypes from movies and media, modern ECT is a safe, well-controlled medical procedure that has helped millions of people recover from debilitating depression and other psychiatric conditions.

During ECT, small electrical currents are passed through the brain while the patient is under general anesthesia. These currents trigger a brief, controlled seizure that affects brain chemistry. While the exact mechanism is not fully understood, research shows that ECT affects important neurotransmitters in the brain—the chemical messengers that nerve cells use to communicate with each other. Studies also indicate that ECT can promote the growth of new nerve cells and connections in the brain, which may be particularly beneficial since severe depression can cause some brain cells and synapses to deteriorate.

The treatment is called "electroconvulsive" because it involves electrical stimulation that produces a convulsion (seizure). However, the muscle relaxants given during the procedure prevent any visible physical movement, and the patient remains asleep throughout. The actual electrical stimulation lasts only a few seconds, and the entire procedure is completed in about 5-10 minutes.

Conditions Treated with ECT

ECT is primarily used for severe depression, especially when other treatments have not been effective. However, it can also be beneficial for several other mental health conditions:

• Major depressive disorder: Particularly treatment-resistant depression or depression with psychotic features
• Bipolar disorder: Both severe depressive and manic episodes
• Postpartum depression: Severe depression following childbirth
• Postpartum psychosis: A serious condition requiring rapid treatment
• Schizophrenia: Especially when accompanied by catatonia or when other treatments have failed
• Catatonia: A condition characterized by unresponsiveness or unusual motor symptoms

ECT may be considered as a first-line treatment when rapid response is essential—such as in cases of severe suicidal ideation, when a patient cannot eat or drink due to their mental illness, or when the risks of other treatments outweigh the risks of ECT (such as during pregnancy).

What Happens Before ECT Treatment?

Before ECT, you will meet with a psychiatrist who will explain the procedure, discuss risks and benefits, and answer your questions. You will undergo a medical evaluation including blood tests and possibly an ECG. You must fast before the procedure (no eating, drinking, or smoking), and some medications may need to be adjusted.

Receiving ECT treatment is a significant decision, and the preparation phase is designed to ensure you fully understand the procedure and are medically ready for it. The process begins with a comprehensive consultation with a psychiatrist—a doctor who specializes in mental health conditions. This specialist will evaluate whether ECT is appropriate for your specific situation and explain what to expect.

During the consultation, you will have the opportunity to discuss the potential benefits and risks of ECT compared to other treatment options. The psychiatrist will ask about your medical history, current medications, and any previous experiences with anesthesia. This information helps the treatment team plan the safest and most effective approach for you.

Bring Someone for Support

It can be difficult to absorb complex medical information when you are not feeling well mentally. For this reason, it is often helpful to bring a family member or close friend to appointments. They can provide emotional support, help remember important information, and ask questions you might not think of. Both you and your support person can request written information about ECT to review at home. Taking notes during your appointment can also be helpful for remembering key details.

Your support person may also be trained on what to expect during your treatment course and how to help during your recovery. Having someone who understands the process can make the experience less stressful for everyone involved.

Medical Preparations

Before your first ECT treatment, you will undergo a thorough medical evaluation to ensure it is safe for you to receive anesthesia. This typically includes:

• Blood tests: To check your overall health and identify any conditions that might affect treatment
• ECG (electrocardiogram): To check your heart rhythm and ensure it can safely handle the procedure
• Medical history review: Including assessment by an anesthesiologist who will manage your sedation
• Medication review: Some medications can interfere with ECT effectiveness, so adjustments may be necessary
• Quality assessment questions: For ongoing monitoring and improvement of care

On the day of treatment, you must not eat, drink, or smoke before the procedure because you will be receiving general anesthesia. You will also need to remove any dental prostheses (dentures), glasses, chewing gum, or snus/tobacco products. The medical staff will help you with all preparations and ensure you are comfortable before the procedure begins.

How Is ECT Performed?

ECT is performed under general anesthesia and takes about 5-10 minutes. Electrodes are placed on your head and chest to monitor brain and heart activity. You receive anesthesia and a muscle relaxant, then brief electrical pulses cause a controlled seizure lasting 15-60 seconds. You wake up within 5-10 minutes after the treatment.

Understanding what happens during an ECT treatment session can help reduce anxiety about the procedure. The treatment is performed in a specialized treatment room, either as part of an inpatient stay or as an outpatient procedure where you come to the hospital and go home the same day.

When you arrive in the treatment room, medical staff will help you get comfortable. You will lie on a treatment bed, and electrodes (small sensors) will be attached to your chest and forehead. These electrodes allow the medical team to continuously monitor your heart rhythm and brain activity throughout the procedure, ensuring your safety at all times.

The Anesthesia Process

Before the treatment begins, you will breathe supplemental oxygen through a mask because your body needs extra oxygen during the procedure. Then, a fast-acting anesthetic medication is given through an intravenous (IV) line—a thin plastic tube inserted into a vein, usually on your hand or in the crease of your elbow. You will fall asleep within seconds.

An anesthesiologist or specialized nurse anesthetist remains with you throughout the entire procedure, continuously monitoring your heart rate, breathing, and oxygen levels. This ensures your vital functions remain stable and that you are safe throughout the treatment.

Muscle Relaxant and Bite Guard

Once you are asleep, you receive a muscle relaxant medication through the IV. This medication causes your muscles to temporarily relax completely, which is important because it prevents physical movement during the seizure. Without the muscle relaxant, the seizure could cause muscle strain or injury—but with it, only minimal movement occurs.

A bite guard (similar to a mouth guard) is placed in your mouth after you fall asleep. This protects your teeth and prevents you from accidentally biting your tongue during the treatment. You will not feel any discomfort from this because you are completely unconscious.

The Electrical Treatment

The actual ECT treatment is performed by a physician or specially trained nurse. Electrodes are held against specific positions on your head, and brief electrical pulses are delivered through them for just a few seconds. This causes a controlled seizure in your brain.

The seizure typically lasts between 15 and 60 seconds. Because of the muscle relaxant, you will not visibly convulse—the seizure activity is monitored through the brain activity electrodes. The medical team watches the brain wave patterns to ensure the seizure has the characteristics associated with therapeutic benefit.

Throughout this entire process, you are completely unconscious and feel nothing. When the anesthetic wears off, typically 5-10 minutes after the treatment, you wake up.

Typical Treatment Course

Most people who begin ECT treatment receive two to three sessions per week. Some individuals may need more frequent treatments initially, especially if symptoms are severe. You typically begin to feel better after just two to three treatments, though the full benefit usually develops over the course of 6-12 treatments.

After completing an initial course of ECT, some people benefit from continuing with less frequent "maintenance" ECT treatments. These might occur weekly, biweekly, or monthly to help prevent symptoms from returning. Your psychiatrist will work with you to determine the best long-term plan based on your response to treatment.

What Can You Expect After ECT?

After ECT, you wake up within 5-10 minutes and may feel tired or confused for a few hours. Common side effects include headache and muscle soreness, which can be treated with over-the-counter pain medication. You should not drive on treatment days. Memory effects are usually temporary and resolve within 2-4 weeks after treatment ends.

Waking up after ECT is typically a smooth process. Most people regain consciousness within 5-10 minutes after the treatment ends, though you may feel drowsy or slightly disoriented for a period afterward. This confusion is usually mild and resolves within a few hours.

Even though you are only under anesthesia for a few minutes, the medication affects your reaction time, attention, and coordination for the rest of the day. For this reason, you should not drive a car, operate machinery, or make important decisions on the day you receive treatment. If you are receiving ECT as an outpatient, it is best to have a family member or friend pick you up after the procedure.

Before leaving the treatment facility, medical staff will monitor your vital signs (pulse and blood pressure) to ensure you are stable. You may be asked to stay for observation for a period of time, especially after your first few treatments, so the team can watch for any delayed effects.

Common Side Effects

Like any medical procedure, ECT can cause side effects, though most are mild and temporary:

• Headache: Very common after treatment, typically mild to moderate, and responds well to over-the-counter pain medications
• Muscle soreness: Similar to the feeling after strenuous exercise, caused by the muscle relaxant and brief muscle tension during the seizure
• Fatigue: Feeling tired for several hours after treatment is normal
• Nausea: Some people experience mild nausea, which is more common with longer periods of anesthesia
• Confusion: Temporary disorientation immediately after waking is common and usually clears within an hour or two

Most of these side effects can be managed with simple over-the-counter medications. Your treatment team will provide guidance on managing any discomfort you experience.

Memory Effects

Memory changes are one of the most discussed aspects of ECT, and it is important to understand what to expect. During a course of ECT treatment, your memory is affected in several ways:

The most common effect is on short-term memory—you may have difficulty remembering events that occurred shortly before or after each treatment session. This happens because ECT temporarily disrupts your brain's ability to form and store new memories. Think of it like a temporary interruption in recording—the "recorder" pauses around the time of each treatment.

How much your memory is affected depends on several factors, including the specific ECT technique used (electrode placement and electrical dosing), your age, and how you are feeling mentally at the time of treatment. It can be difficult to separate memory effects of ECT from memory problems caused by depression itself, as severe depression can significantly impair concentration and memory.

The good news is that memory typically recovers within 2-4 weeks after completing treatment. Most people find that their ability to form new memories returns to normal relatively quickly. While some people report persistent gaps in memory for events around the time of their treatment, this is less common with modern ECT techniques.

Rarely, some individuals experience effects on long-term memory—memories formed before starting treatment. When this occurs, it typically affects memories from the weeks or months immediately preceding treatment rather than distant memories. Persistent long-term memory loss is uncommon, but it does occur in some cases.

What Do Patients Say About ECT?

Patient experiences with ECT vary widely. Many people with severe depression report that ECT was transformative, helping them recover when nothing else worked. Others found the side effects challenging. Satisfaction often depends on how well the treatment worked and whether memory effects were significant.

Understanding other patients' experiences can help you form realistic expectations about ECT. People's reactions to this treatment vary considerably, and both positive and negative experiences are valid and important to consider.

Many patients who have experienced severe, debilitating depression describe ECT as life-changing. For those who felt hopeless after trying multiple medications without success, ECT can provide relief that seemed impossible. These individuals often describe a gradual lifting of the crushing weight of depression, a return of energy and interest in life, and the ability to function again. For people who were severely suicidal, ECT can quite literally be life-saving.

However, not everyone has a positive experience. Some patients feel that the treatment did not help enough to justify the side effects, particularly memory problems that persisted longer than expected. Others found the process of repeated hospital visits and anesthesia to be burdensome or stressful. Some people choose not to undergo ECT again even if recommended, while others would choose it again without hesitation.

Your experience will depend on many factors: the severity of your condition, how well you respond to the treatment, the specific side effects you experience, and your personal values and preferences. The best approach is to have honest conversations with your treatment team about what you can expect, including realistic information about both benefits and risks.

How Does ECT Affect the Brain?

While the exact mechanisms are not fully understood, ECT affects neurotransmitters (brain chemicals), promotes neuroplasticity (brain adaptation), and may stimulate the growth of new nerve cells. These changes help reset brain chemistry and improve mood regulation in conditions like severe depression.

Despite decades of research and clinical use, scientists are still working to fully understand exactly how ECT produces its therapeutic effects. What we do know is that ECT causes several beneficial changes in brain function and structure.

Research shows that ECT affects neurotransmitters—the chemical messengers that brain cells use to communicate with each other. These include serotonin, dopamine, norepinephrine, and others that play crucial roles in mood, motivation, and emotional regulation. ECT appears to enhance the function of these neurotransmitter systems in ways that antidepressant medications also target, but often more powerfully and quickly.

Studies have also demonstrated that ECT promotes neuroplasticity—the brain's ability to form new connections and adapt. Brain imaging studies show that ECT can increase the volume of certain brain regions that are known to be smaller in people with depression. This suggests that ECT may help reverse some of the structural brain changes associated with severe, chronic depression.

Perhaps most remarkably, research indicates that ECT can promote the growth of new nerve cells (neurons) in certain brain areas. This process, called neurogenesis, is thought to be important for learning, memory, and emotional regulation. Severe depression has been shown to impair neurogenesis and even cause the loss of existing neurons and synapses (connections between nerve cells). ECT may help counteract these harmful effects.

The seizure itself appears to be necessary for the therapeutic effect—treatments that use the same anesthesia and procedure but without inducing a seizure do not have antidepressant effects. The seizure triggers a cascade of neurochemical and neurobiological changes that together produce improvement in mood and mental state.

Your Rights and Participation in Treatment

You have the right to receive complete information about ECT before deciding whether to have it. You can ask questions, request time to consider, and involve family members in discussions. In most cases, you must give informed consent, though emergency situations or legal frameworks may allow treatment without consent in rare circumstances.

Making decisions about medical treatment, including ECT, is your fundamental right as a patient. Healthcare providers are required to give you the information you need to make an informed decision, and you have the right to ask questions until you fully understand what is being proposed.

Informed Consent

Before starting ECT, you must provide informed consent. This means you should understand:

• What ECT is and how it works
• Why ECT is being recommended for your specific situation
• What the potential benefits are and how likely you are to experience them
• What the risks and side effects are, including memory effects
• What alternative treatments are available
• What happens if you choose not to have ECT

You can take time to think about your decision, discuss it with family members, or seek a second opinion. Feeling pressured is not acceptable—the decision to have ECT should be made when you feel adequately informed and ready.

If You Cannot Give Consent

In some situations, a person may be too ill to make their own medical decisions—for example, if they are experiencing severe psychosis, catatonia, or are in a life-threatening condition. In these rare circumstances, legal frameworks exist in most countries that allow treatment to be given to protect the person's life and health.

If you disagree with or are unhappy about any aspect of your care, you have the right to raise concerns. This might be through a patient advocate, an ombudsperson, or a formal complaint process. Your voice matters, and expressing concerns often helps improve care for yourself and future patients.

How to Access ECT Treatment

ECT is typically offered through psychiatric hospitals or specialized mental health centers. You usually need a referral from a psychiatrist who has evaluated your condition and determined that ECT may be beneficial. The treatment is covered by most health insurance plans and public healthcare systems.

If you or someone you care about is struggling with severe depression or another condition that might benefit from ECT, the first step is usually to see a psychiatrist. This might be through your regular healthcare provider, who can make a referral, or through a mental health crisis service if the situation is urgent.

ECT is not available at every healthcare facility—it requires specialized equipment, trained staff, and appropriate monitoring capabilities. Typically, ECT is offered at psychiatric hospitals, major medical centers with psychiatric departments, or specialized mental health clinics. Your psychiatrist can help you find an appropriate facility and coordinate the referral process.

In most healthcare systems, ECT is a covered service for appropriate medical indications. Public healthcare systems typically provide ECT as part of mental health coverage, and private insurance plans generally cover it as well. However, coverage details vary, so it is worth checking with your insurance provider about any requirements or costs.