Many people think electroconvulsive therapy (ECT) is a thing of the past, but it is still being used today, given its effectiveness in treating major depression. In recent years, the National Institute of Mental Health, the American Psychiatric Association, and the U.S. Surgeon General have all concluded that ECT is a valuable tool in the treatment of certain mental disorders, particularly depression. Before ECT, an individual with depression typically first receives psychotherapy, antidepressant medication, or a combination of the two. While these treatments are often effective, they take time to work. This delay can be dangerous for people whose depression is accompanied by intense suicidal thoughts or delusions. For these individuals, who are at immediate risk for self-injury or suicide, ECT can work much more quickly than antidepressants and is therefore a good option.
ECT can help other people as well. It may be recommended when antidepressant medications do not work. It can also be useful for older people who cannot tolerate antidepressants and for pregnant women (if there is concern that medication might affect the health of the fetus). People suffering from bipolar disorder or schizophrenia may also benefit from ECT.
ECT can be performed in an inpatient or outpatient setting. After the patient is given general anesthesia and a muscle relaxant, electrodes are placed on two areas of the scalp. A short, controlled set of electrical pulses is then administered for about a minute. The electrical pulses must produce generalized seizures to be effective. (Because patients are under anesthesia and have taken muscle relaxants, they do not convulse or feel the current.)
Patients awaken about five to 10 minutes after the end of the treatment. Most are oriented and alert within 30 minutes. If done as an outpatient procedure, a family member or friend must drive the patient home after the procedure (driving is not allowed during a course of ECT) and stay until he or she goes to sleep that night.
Typically, ECT is given two to three times a week for a total of six to 12 sessions. These sessions typically improve depression in 50 to 60% of patients—a response rate similar to that of antidepressant drugs—and in 80 to 90% of people using it as first-line therapy. According to a recent report of 24 ECT patients, most said they were glad they had received the treatment, felt safe having it, and would choose ECT again in the future if recommended by a psychiatrist.
A major limitation of ECT treatment is that the benefits may be short-lived. Within a year, 50 to 60% of people experience a relapse, and they may have to take antidepressant medication or continue receiving ECT periodically to prevent relapse.
The immediate side effects of the procedure include headaches, nausea, muscle aches and soreness, disorientation, and confusion lasting about an hour. A person may also temporarily experience difficulty recalling newly acquired information. It is possible to lose memories formed up to six months before the procedure as well. But these learning and memory problems usually disappear within a few weeks or months following the last treatment. Memories of events immediately surrounding an ECT session may be permanently lost, however.
Problems with learning and memory can be moderated with unilateral ECT (electrodes placed on one side of the head) rather than bilateral ECT. Unilateral ECT requires a higher current, and concerns exist that it is not as effective; however, a recent study suggests that it is just as effective. Researchers found that 73% of participants who received ultrabrief unilateral ECT responded favorably, compared with 65% of those who received standard-pulse, bilateral ECT. New evidence shows that placing the electrodes near the front of the head lowers the risk of cognitive problems. Also, memory problems are less frequent when people undergo the procedure two rather than three times a week.
No one is sure how ECT helps certain mental disorders. It may flood the brain with neurotransmitters such as serotonin and dopamine, which are known to play a role in conditions such as depression and schizophrenia. ECT may also help regulate hormones that play a role in these disorders.