Electroconvulsive therapy can help when medications don't work

If you're struggling with depression and nothing seems to be working—not drugs, not talk therapy—don't lose hope. An option you may not have considered is electroconvulsive treatment (ECT), which is the most effective type of antidepressant treatment available. ECT can be a lifeline for people with depression that's life-threatening or difficult to treat.

ECT used to have a bad reputation. Indeed, when it was first introduced in the late 1930s, patients would thrash around so violently that they could wind up with broken bones. Now that patients receive anesthesia and a muscle relaxant, the treatment is virtually painless and seizures are barely visible. It's even safe enough to be used in pregnant women and people with heart disease.

Each year, an estimated 100,000 people in the United States undergo ECT for depression and other psychiatric problems. The reputation of ECT is changing dramatically.

What is ECT?

ECT involves passing a carefully controlled electrical current through a person’s brain. The current needs to be strong enough to generate epileptic activity (a seizure), which is a rapid discharge of nerve impulses throughout the brain. After an anesthesiologist puts the patient briefly under general anesthesia and administers a muscle relaxant, a specially trained psychiatrist places two electrode pads, each about the size of a silver dollar, on two areas of the scalp. A short, controlled set of electrical pulses is then passed between the electrodes by a machine designed for this purpose. The current lasts for a couple of seconds, and the resulting epileptic discharge typically lasts for about a minute.

People wake up about five minutes after the treatment is over. Most people feel confused for the next half hour or so and may experience headache, muscle stiffness or nausea.

When ECT is used

In recent practice guidelines, the American Psychiatric Association (APA) recommends ECT as a treatment option for people with severe depression that has not responded to either drugs or psychotherapy. The APA also recommends ECT for treatment of severely depressed people who are psychotic (having hallucinations or delusions), catatonic (immobile), dangerously suicidal or starving themselves. ECT can be the best choice for people in emergency situations like these because it is so effective and tends to work more rapidly than medication.

Drugs usually take four to eight weeks to take effect, and people sometimes try two, three or even four medications in an effort to find one that works for them. The process can take months. By contrast, ECT usually takes just two or three weeks to work. Sometimes, improvement is seen after just one treatment. Most people who undergo ECT will require treatment two or three times a week, for a total of six to 12 sessions.

Publication Review By: Karen L. Swartz, M.D.

Published: 21 Aug 2013

Last Modified: 21 Aug 2013