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Electroconvulsive Therapy

Definition

Electroconvulsive therapy (ECT) sends an electronic current through the brain. This current causes brief seizure activity. This causes changes in brain chemistry. ECT can reduce symptoms associated several mental health conditions.

The Brain
Color coded brain
During ECT, an electronic current is delivered to the brain.
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

ECT is commonly used to treat:

  • Severe depression that does not respond to medication or that causes serious symptoms, like psychosis and suicidal thoughts
  • Schizophrenia
  • Severe mania that does not respond to medication

In some cases, ECT may also be used for other mental or neurological conditions.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems like:

  • Short-term changes in blood pressure and heart rate
  • Short-term abnormal heart rate
  • Headache
  • Nausea
  • Muscle aches or soreness
  • Cognitive impairment, such as problems with thinking and memory, usually go away after a couple of weeks. In some cases, memory problems may last for several months.

Rare complications include:

Factors that may increase the risk of complications include:

  • Having a history of heart problems, stroke, or high blood pressure
  • Pregnancy—this form of therapy may increase the risk of complications in the fetus
  • Not responding well to medication
  • Increased age

What to Expect

Prior to Procedure

Prior to the procedure, your doctor will:

  • Do a physical exam
  • Do a complete medical and psychological history
  • Ask you about any medications you are taking, including prescription and over-the-counter medications
  • Have tests done, which may include blood tests, an electrocardiogram, and imaging of the brain
  • Have you meet with an anesthesiologist
  • Give you instructions about not eating or drinking before the procedure

You may feel confused after ECT. Arrange for someone to drive you home from the hospital. Also, arrange for someone to help you at home.

Anesthesia

General anesthesia will be used. You will be asleep during the treatment and will not feel any pain.

Description of Procedure

You will be connected to a machine that will monitor your vital signs and brain activity. Next, you will receive general anesthesia and a medication to keep your muscles relaxed during the procedure.

After you are asleep, you will receive oxygen through a mask on your face. A mouth guard may also be placed to protect your tongue and teeth from injury. Next, the doctor will position electrodes on your head. These electrodes will be connected to a machine that will deliver an electric current to your brain. This will cause seizure activity. After the shock is given, the muscles that have not been affected by the medication will contract for a few seconds. Next, your body will twitch, which can last up to a minute.

Immediately After Procedure

You will be taken to a recovery room where your vital signs will be monitored. You will wake up in 10-15 minutes. You may feel confused. This confusion can last minutes, hours, or sometimes longer.

How Long Will It Take?

About 30 minutes, including time to recover after the procedure

How Much Will It Hurt?

You will not feel any pain during the procedure. After ECT, you may have a headache and muscle aches or soreness.

Post-procedure Care

At the Care Center

When you are fully awake, you will be given something to eat and drink. In most cases, you will be able to go home the day of the procedure.

At Home

You will need to schedule an appointment for another ECT treatment. In most cases, you will need to have two to three treatments per week, for many weeks. You will need to take medication, such as antidepressants, and continue with therapy to prevent a relapse.

You may also need maintenance ECT to further prevent a relapse. Your doctor will help determine the right plan for you. This will depend on how you are progressing.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

  • Worsening of symptoms, including feelings of hopelessness or helplessness and thoughts of suicide—If you have thoughts of suicide, call your doctor or therapist right away.
  • Confusion and memory loss that lasts longer than expected
  • Headache, muscle aches, or soreness that lasts longer than expected
  • Any new symptoms or concerns

If you think you have an emergency, call for medical help right away.

Revision Information

  • Depression and Bipolar Support Alliance

    http://www.dbsalliance.org

  • Mental Health America

    http://www.nmha.org

  • Canadian Mental Health Association

    http://www.ontario.cmha.ca

  • Canadian Psychiatric Association

    http://www.cpa-apc.org

  • Depression: how electroconvulsive therapy works. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/depression/treatment/how-electroconvulsive-therapy-works.html. Updated September 2012. Accessed June 26, 2013.

  • Electroconvulsive therapy. Mental Health America website. Available at: http://www.mentalhealthamerica.net/ect. Accessed June 26, 2013.

  • Electroconvulsive therapy (ECT). El Camino Hospital website. Available at: http://www.elcaminohospital.org/Programs%5Fand%5FServices/Behavioral%5FHealth/Electroconvulsive%5FTherapy. Accessed June 26, 2013.

  • Electroconvulsive therapy (ECT) for depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 11, 2013. Accessed June 26, 2013.

  • Kellner CH, et al. ECT in treatment-resistant depression. Am J Psychiatry. 2012;169:1238-44.

  • 5/13/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010;68(6):568-577.