Electroconvulsive Therapy (ECT) is a medical treatment used in psychiatry, and it is not a diagnostic “test.” It involves the controlled application of a brief electrical stimulus to the brain to intentionally induce a generalized seizure while the patient is under general anesthesia. Since its introduction in the late 1930s, ECT has been continually refined with advancements in technology and technique. Modern ECT is a highly effective option for severe mental health conditions, recognized for its ability to rapidly improve symptoms.
Therapeutic Applications
ECT is typically reserved for cases where patients have not responded adequately to standard treatments like pharmacotherapy and psychotherapy, or when a rapid clinical response is medically necessary. It is widely considered the most effective treatment for severe, treatment-resistant major depressive disorder, with response rates estimated between 60% and 80%. The treatment is also highly effective for acute mania and severe catatonia, where response rates can exceed 80%. Furthermore, ECT is used when a patient’s condition poses an immediate threat, such as life-threatening refusal to eat or drink or a high risk of suicide. It may also be employed for certain psychotic illnesses, including schizophrenia unresponsive to antipsychotic medications.
Patient Preparation and Consent
The decision to proceed with ECT requires a thorough medical and psychiatric evaluation to ensure patient suitability and safety. This initial workup typically includes a detailed medical history, a comprehensive physical exam, a mental health assessment, basic blood tests, and an electrocardiogram (ECG). The patient is advised to fast for at least eight hours before the procedure, similar to preparation for minor surgery. A crucial component is informed consent, where the patient must fully understand the treatment’s benefits, potential risks, and available alternative therapies. Treatment is typically delivered in an acute course of 6 to 12 sessions, scheduled two or three times per week, followed by potential maintenance ECT to sustain improvement.
The ECT Procedure
The ECT procedure is conducted in a specialized suite with a dedicated team, usually consisting of a psychiatrist, an anesthesiologist, and a nurse. Before the electrical stimulus is delivered, the patient receives general anesthesia through an intravenous (IV) line. A muscle relaxant is also administered to prevent the large, uncontrolled muscular movements that would otherwise occur during the induced seizure. Monitoring devices are attached, including an electroencephalogram (EEG) to record brain activity and an ECG to track heart rate. Electrodes are placed on the patient’s scalp in precise locations, either bilateral (stimulating the entire brain) or unilateral (targeting one hemisphere, usually the right, for fewer cognitive side effects). Once the team confirms the patient is ready, a controlled electrical current is delivered, typically lasting one to six seconds, inducing a therapeutic seizure that generally lasts for less than 60 seconds.
Recovery and Post-Treatment Effects
Immediately following the procedure, the patient is moved to a recovery area where they are closely monitored as the effects of the general anesthesia wear off. Waking up usually occurs within five to ten minutes, and it is common for the patient to experience some temporary confusion or grogginess, which typically resolves within 20 to 30 minutes. Most patients are able to return to their normal activities a few hours later. The most discussed potential side effect relates to memory, specifically anterograde amnesia (difficulty forming new memories during treatment) and retrograde amnesia (difficulty recalling events before treatment). Anterograde memory impairment generally resolves within a few weeks after the final treatment session, while retrograde amnesia is often most marked for events occurring in the weeks or months leading up to the treatment, and this impairment can take weeks to months to resolve.