Electroconvulsive therapy (ECT) is a modern medical procedure used to treat severe mental health conditions, often when other treatments have not been effective. While commonly searched as an “ECT test,” this procedure is a treatment method involving the application of a controlled electrical current to the brain. This therapeutic intervention is always performed under general anesthesia to intentionally induce a generalized seizure. The goal of ECT is to alter brain chemistry and rapidly improve symptoms associated with serious psychiatric illnesses.
How the Treatment Works
The modern ECT procedure is highly controlled and involves a coordinated team of medical professionals, including a psychiatrist, an anesthesiologist, and nurses. Preparation begins with placing an intravenous (IV) line for medications and attaching standard monitoring devices. These monitors include an electrocardiogram (ECG) to track heart rhythm and an electroencephalogram (EEG) to record brain wave activity.
Once the patient is in the dedicated ECT suite, they receive a short-acting general anesthetic. Following anesthesia, a muscle relaxant, such as succinylcholine, is given. This muscle paralysis is a safety measure to prevent the patient from experiencing the full motor convulsions of the induced seizure, thereby avoiding physical injury like bone fractures.
The treating psychiatrist places two electrodes on the patient’s scalp, with placement being either bilateral (on both sides) or right unilateral (on one side). A controlled, brief electrical pulse, typically lasting less than a few seconds, is delivered through these electrodes. This precisely measured current is calculated to be just above the patient’s seizure threshold.
The electrical stimulus induces a generalized cerebral seizure that usually lasts less than a minute. Due to the muscle relaxant, the seizure is monitored solely through the EEG recording. A blood pressure cuff is often inflated on an ankle or wrist before the muscle relaxant is given to allow a small, visible motor seizure in that limb, providing a secondary measure of seizure duration. Once the seizure concludes, the patient is moved to a recovery area for close observation as the effects of the anesthetic and muscle relaxant quickly wear off.
Medical Conditions Where ECT Is Indicated
ECT is primarily used when psychiatric conditions are severe, life-threatening, or have proven resistant to standard treatments like medication and psychotherapy. It is considered one of the most effective acute treatments for severe major depressive disorder. This is especially true when the patient is at imminent risk of suicide, experiencing psychosis, or refusing to eat.
The procedure is also a definitive and highly effective treatment for catatonia, a syndrome characterized by motor and behavioral dysfunction. ECT is often the preferred choice in situations requiring rapid symptom resolution, such as severe mania, psychosis during pregnancy, or neuroleptic malignant syndrome. A full course of treatment typically involves multiple sessions, administered two to three times per week, with a total of six to twelve treatments needed to achieve full remission.
Potential Side Effects and Patient Monitoring
While ECT is generally safe, the most common temporary side effect is memory impairment. Patients may experience retrograde amnesia (difficulty recalling events just before and during treatment) and anterograde amnesia (a temporary struggle with forming new memories immediately following a session).
For most individuals, the ability to form new memories returns to normal within a few weeks after the treatment course is complete. Retrograde memory loss for past events usually resolves over weeks to months, though some patients report small, persistent gaps in memory surrounding the treatment period. Acute physical side effects include headache, nausea, and muscle soreness, which are managed with standard medications and resolve within a day.
Patient safety is ensured through rigorous monitoring protocols. Standard American Society of Anesthesiologists (ASA) monitors are used, continuously tracking heart rate, blood pressure, and oxygen saturation. Because ECT causes a temporary increase in heart rate and blood pressure, patients with pre-existing cardiac conditions require close ECG monitoring. The recovery nurse monitors vital signs and mental status until the patient is stable and immediate confusion has cleared.
Common Misconceptions and Modern Context
Apprehension surrounding ECT often stems from outdated historical practices and inaccurate media portrayals. Early versions of the procedure, which did not use anesthesia or muscle relaxants, are vastly different from the refined, modern treatment.
There is a misconception that ECT causes permanent brain damage, but extensive research has not found evidence of structural harm. Instead, studies suggest that ECT may promote the release of neurotransmitters and increase levels of Brain-Derived Neurotrophic Factor (BDNF), a substance linked to the regeneration of nerve cells.
ECT is not solely a last resort; it is often considered a first-line option when a patient’s condition is life-threatening or when the potential risks of other treatments are higher. Modern ECT is a highly regulated and evidence-based procedure, representing a safe and rapidly effective intervention for specific, severe psychiatric disorders.