Electroconvulsive therapy (ECT) has been in continuous use worldwide for over 80 years. There are few treatments in all of medicine that can make such a claim. Despite its long record of safety and efficacy, ECT remains poorly understood by the general public. ECT is a modern, mainstream medical procedure and roughly 100,000 patients receive ECT in the United States every year.
ECT is not an initial treatment plan and is reserved for those who have symptoms that are not responding to other types of procedures, therapy, and medications. ECT is considered the best treatment when depression symptoms are occurring alongside suicidal ideation and/or self-harm.
Because the treatment requires general anesthesia, ECT treatments must be done in a hospital setting. This is another reason why it is reserved for only severe and life-threatening conditions.
During treatment, an electrical current is applied to the scalp to stimulate the brain and intentionally cause a controlled seizure. Thanks to the anesthesia, the process is painless.
This modern ECT technique has significantly decreased or eliminated most of the troublesome side effects previously associated with this treatment. It is a safe and effective procedure and is considered the best therapy option when others have not worked.
Electroconvulsive therapy (ECT) is a procedure reserved for those suffering from severe cases of major depressive disorder (MDD) and bipolar mood disorders. In order for ECT to become a treatment option for a patient, their depression must be categorized as treatment-resistant depression (TRD). TRD means that the patient has not found success, or relief of their depression symptoms, through medications or antidepressants. As a result, alternative treatment options are considered to help them find relief.
Typically, patients try alternative treatment options such as Transcranial Magnetic Stimulation (TMS) therapy or esketamine nasal spray before being recommended ECT as a treatment plan. ECT is considered the best therapy option when others have not worked and is also considered the most effective form of treatment when severe depression coexists with ideas of suicide and or self-harm. It is considered almost as a last resort because it is a more intensive treatment than antidepressants, TMS, and esketamine, but it does have an amazing success rate. 75-83% of patients experienced relief from their symptoms following a course of ECT treatment.
Before having the first ECT treatment, a patient will need a full evaluation, which usually includes:
- Medical history
- Complete physical exam
- Psychiatric assessment
- Basic blood tests
- Electrocardiogram (ECG) to check heart health
These exams help to make sure that the general anesthesia will be safe for you and won’t have any adverse side effects that prevent the procedure from working safely. It is the same medical clearance required for outpatient surgical procedures. This ensures that the overall process is safe for each individual and can be a good alternative to other forms of therapy or medications from a procedure protocol standpoint.
Before the procedure begins, the patient has an IV inserted with general anesthesia to put them to sleep. Once asleep, a direct electric current is sent to the brain in order to stimulate the area where the depression or mood disorder occurs.
The goal is to stimulate this area where the chemical blockage is occurring as many experts believe most mental health conditions are caused by a chemical imbalance in the brain. Being able to target the source directly allows for progress in the areas that medication and other alternatives can’t reach.
The electric current triggers a brief motor seizure that lasts just under a minute. The patient is under anesthesia for only 5-10 minutes total. After they wake up, they are monitored in a recovery room to make sure they are safe, comfortable, and healthy before they go home.
ECT treatments are generally given three times weekly for three to four weeks. Most people require 6 to 12 treatments to see the desired results, but some cases can require up to 20 or more based on the level of severity.
Results from ECT treatments happen quickly. Roughly 80% of patients experience significant symptom relief, but unfortunately, the benefits of ECT don’t last for many patients. About half of all patients who receive ECT treatments experience a relapse of their depression or mental health symptoms within a year. For this reason, doctors often recommend maintenance ECT usually in combination with antidepressant drug therapy. However, your physician will help you determine your customized treatment plan based on your unique needs.
ECT is a safe treatment. It is endorsed by the National Institute of Mental Health, the American Psychiatric Association, the American Medical Association, and the US Surgeon General.
Arguably more important than those endorsements is the fact that roughly 100,000 patients are treated with ECT every year in the United States. Those thousands of patients experience ECT without complications and can find relief from their severe depression.
ECT treatments are closely monitored by professionals while the patient is under anesthesia, and each step of the process is controlled in a safe and clean hospital environment.
Immediately after ECT treatments, patients may experience common side effects such as:
- Dizziness and imbalance
Most patients will be drowsy and feel “out of it” after their ECT appointment. Because patients often experience dizziness and are at risk of falling, they are carefully monitored before they go home. These side effects are common enough that it is actually required for patients to arrange a ride home because they should not drive after treatment. However, after taking acetaminophen or ibuprofen for any headaches and getting some rest, patients should be fine to return to their normal activities the next day after their appointment.
There are small thinking and memory-related side effects that are common with the procedure as well. Patients may experience slight memory difficulty and distorted thinking during the treatment period because these currents are directly targeting the brain. However, memory issues almost always go away after treatment. Long-term memory loss is significantly less common. Also, ECT causes far fewer memory issues than it did in previous decades. For most patients, a small degree of temporary memory difficulty is a reasonable side effect to tolerate given the likelihood of substantial improvement in depressive symptoms.
ECT is typically used as a treatment option in addition to antidepressants. Unlike antidepressants, which temporarily impact mood and behavior by working through the bloodstream, ECT delivers direct stimulation to the brain. This stimulation helps to release neurotransmitters and hormones such as serotonin and dopamine. Many experts believe that depression and other mental health conditions are linked to an imbalance of these neurotransmitters. ECT works to restore that balance and can provide a more lasting impact on relieving depression symptoms than using antidepressants alone.
However, because ECT requires the use of anesthesia and causes a controlled seizure, providers will consult with their patients regarding any impact that ECT treatments may have on their current medications.
Mental health treatments are not one-size-fits-all situations. Because of this fact, treatment plans will vary depending on each patient’s unique needs and concerns. Overall, each patient will work closely with their provider to collaborate on a treatment plan that works best for them. And as treatments continue, the treatment plan will be adjusted as needed to make sure patients are continuing on their path to wellness.
Antidepressants are invaluable aids in the treatment of clinical depression and other mood disorders, but they’re not for everyone. According to the World Journal of Psychiatry, antidepressants don’t improve symptoms in 10–15 percent of people with depression and only partially improve symptoms in 30–40 percent. Also, many people experience side effects from antidepressants that can impact their overall well-being.
On the other hand, electroconvulsive therapy (ECT) has shown significantly better results when used alongside antidepressants. Patients with severe depression or bipolar depression have seen a success rate of 75-83%, where their symptoms were significantly decreased or even not present at all. But unfortunately, the benefits of ECT don’t last for many patients. Approximately half of all patients receiving ECT experience a return of their depression symptoms within a year. For this reason, doctors often recommend maintenance ECT usually in combination with antidepressant drug therapy.
It is important to understand that mental health treatment plans are not a one-size-fits-all situation. Because of this situation, treatment plans may take longer or require different treatment option combinations to work best for certain patients. It is important for patients to communicate clearly with their provider about how their treatment plan is working. Collaboration between patient and provider can greatly impact the results of a patient’s wellness journey.