Is Electroconvulsive Therapy (ECT), Or Shock Therapy, Safe And Beneficial?

Electroconvulsive therapy (ECT)—formerly known as shock therapy or electroshock therapy—can be safe and beneficial in some cases. It generally involves triggering a seizure by passing electrical currents through the brain. This typically happens under anesthesia and can help with certain severe, treatment-resistant mental illnesses. The usual course of treatment with ECT involves two or three sessions per week for three to four weeks. It can be important to discuss this type of therapy with a licensed mental health professional to determine whether it might be the right choice for you. You may speak with a therapist about ECT in person or online.

What is shock therapy?

Shock therapy is a type of treatment often used for chronic mental conditions. This treatment normally involves passing electrical currents through the brain to trigger a seizure.

Is shock therapy still used to treat mental illness?

Doctors still use shock therapy to treat mental conditions in some cases, but they usually refer to this type of treatment as electroconvulsive therapy or ECT. The treatment has changed dramatically; where once large currents were used, the new technique typically uses only small currents, and the seizure is usually very brief.

In general, ECT is no longer administered without general anesthesia. One other area that has changed recently may be the type and use of equipment. Scientists have discovered better ways to place the leads to potentially produce the best results with fewer risks and side effects.

When do doctors prescribe electroconvulsive therapy (ECT)?

Doctors typically use ECT only in extreme cases now. Either the condition may be very severe and resistant to other treatments, or there may be an urgent need to relieve the condition immediately.

Reasons why a doctor might suggest electroconvulsive therapy (ECT)

Some of the reasons a doctor might suggest or prescribe ECT are the following:

• Severe depression, if it's accompanied by psychosis, suicidal actions*, or a refusal to eat
• Treatment-resistant depression
• Severe mania
• Catatonia, if not caused by a medical condition can be treated in other ways
• For people with dementia who become extremely agitated and aggressive
• For women who can't take needed psychiatric medications because they're pregnant or nursing
• For older adults who experience extreme difficulty with the side effects of needed psychiatric medications
• For people who would rather go through ECT treatment than take medications
• For people who have benefitted from ECT in the past

*If you or a loved one is experiencing suicidal thoughts, please contact the National Suicide Prevention Lifeline at 988.

How does shock therapy or ECT work?

As small electrical currents pass through the brain and trigger a brief seizure, they can quickly change the brain's chemistry. As a result, the size of certain brain structures can be changed as well.

The hippocampus is generally the center of emotion, memory, and the autonomic nervous system. People with a smaller hippocampus volume tend to benefit the most from ECT because the treatment can increase the size of this structure. The result is usually that they respond more positively to cues in their environment.

The amygdala, the structure in the brain involved with experiencing emotions, can also change structurally following ECT. These changes are currently being studied to better understand why ECT can help some people and not others. The goal is generally to find out who may be the best candidates for ECT.

What is the procedure for getting ECT?

If you walked into a clinic where ECT was being done, you might be surprised to see how calm the environment is. Because ECT is usually done with the patient's consent and is normally scheduled in advance, treatment tends to run smoothly.

Preparing for the electroshock therapy

Before making the final decision to give you ECT, your doctor will normally take your medical history, give you a physical exam, do a psychiatric assessment, take basic blood tests, and do an ECG to check your heart.

Your doctor or the clinic staff may give you instructions on what you need to do the night before the treatment. For example, you might be asked not to smoke, drink caffeine, or eat after a certain time.

When you arrive for your treatment, which is usually done in the morning, a nurse will normally set up an IV for the anesthesia. Then, they may place electrode pads at specific places on your head. For example, if you have bilateral ECT, the leads will generally be on both sides of your head. For unilateral ECT, they'll typically only be on one side of your head.

The nurse will usually put a blood pressure cuff around your ankle. Finally, you may be hooked up to monitors so your doctor can check your brain, heart, blood pressure, and oxygen to ensure you are doing well throughout the procedure. You may also be given an oxygen mask and a mouthguard.

The anesthesiologist may then administer the anesthetic and a muscle relaxer to minimize the seizure and keep you from injuring yourself. The rest of the procedure normally happens while you are under general anesthesia and unaware of what is happening.

The shock therapy process

Because of the muscle relaxant, you might show few or no signs of seizure activity in your body. The blood pressure cuff on your ankle usually keeps the muscle relaxant from entering your foot. The doctor can watch this foot to know when you're seizing.

Watching the foot and the monitors for signs of a seizure, the doctor can then press a button on the ECT machine to pass the electrical current through your brain. With the muscle relaxant in your system, you may remain visibly relaxed, although the EEG monitoring your brain waves should show a dramatic spike in activity at the start of the seizure. The seizure typically lasts less than one minute.

Aftercare

After the doctor finishes the ECT treatment, you may go to a recovery room. A nurse may come and cover you with a heated blanket and offer you something to drink. When the anesthetic and muscle relaxant are out of your system enough that you can walk safely, you can generally go home. However, you typically must have someone else transport you home, as you should not drive immediately after ECT.

Once home, you may take a nap. Although doctors usually do not recommend taking more than a half-hour nap during the day, they often suggest a long nap after ECT. After that, you can go back to eating and drinking fluids as you normally do. You should talk to your doctor about when you can go back to work and drive. Usually, between 24 hours and two weeks after your last treatment, you can go back to life as usual.

How many ECT treatments will I need?

In the US, the usual course of ECT is two to three times per week for three to four weeks. However, a new technique called right unilateral ultra-brief pulse ECT usually requires a slightly different procedure every weekday. In either case, the number of treatments can vary depending on your individual needs and preferences.

If you want to change your mind about having ECT, you can talk to your doctor about stopping the treatments. Likewise, if you feel significantly better and believe that the treatments have reached maximum effectiveness for you, you can approach your doctor about discontinuing treatment.

Risks and side effects of shock therapy

After the treatment, you may experience nausea, headache, jaw pain, and muscle aches. One benefit of taking a nap after treatment is that it often relieves these side effects. If not, you can take medications for these side effects.

Memory loss is what many people fear most about ECT. The procedure can cause some memory problems. What you have trouble remembering is usually what happened just before treatment, either on that day or in the weeks, months, or years before the treatment started.

Forgetting what happened on the day of treatment can be common. However, forgetting what happened years before is a condition commonly called retrograde amnesia, and it's typically very rare, even in people who have had ECT. Most often, your memory problems will clear up within a few months of treatment.

It can also be common to feel confused in the moments after you wake up from treatment. The confusion can last up to a few hours for some people. Only rarely do people remain confused for days. Older adults tend to be more susceptible to confusion after ECT than younger people.

ECT can be fatal, but it's extremely rare. Only about 1 in 10,000 (or 10 per 100,000) people who have ECT die from it. Surgery generally always carries a risk; even liposuction has a mortality rate of 20 per every 100,000 people. Although the risk of death may exist, it tends to be lower than for many other conditions and medical procedures.

Possible benefits of ECT

Researchers are still studying ECT to find out who can benefit from it the most. However, for the people that are helped by it, it can offer several benefits.

One benefit may be that it tends to work much faster than medical therapy alone. Usually, there are dramatic improvements within six treatments, about two weeks after beginning ECT. In fact, people with depression or mania may recover completely after only one to two treatments.

It can be very effective for many people, too. For example, about 78% of people who receive ECT for depression improve, and of all the people who receive ECT, 70% to 90% go into remission from their condition. In comparison, with medications, the remission rate is usually only 20% to 30%!

Questions to ask your doctor about ECT

Here are a few questions you can ask your doctor to find out more about how ECT will work for you:

• Will I have unilateral or bilateral ECT?
• What are the steps of the procedure?
• What will I physically feel like after treatments?
• When can I expect my symptoms to decrease?
• How many treatments might I need?
• How will you decide when I've had enough treatments?
• Will I need other types of treatment along with or after ECT?

Could a doctor give me shock treatments without my consent?

Doctors these days tend to be much more hesitant to use ECT than they were in the past. In addition, ECT is generally required by law to be used only by your consent or under the most severe conditions, such as:

• To save your life
• If urgently needed to prevent a rapid worsening of your condition

You could possibly be given ECT against your will if you cannot understand the information given to you to ask for informed consent and if you have not made an advance decision. Another doctor typically gives a second opinion that you need to receive the treatment before ECT may be given.

You still do not generally need to worry about getting unwanted ECT because you can opt out of ECT ahead of time if you choose. You do this by making an advanced formal decision to refuse ECT treatments or by giving a Lasting Power of Attorney to your lawyer along with instructions to refuse ECT.

Why would I choose to get electroconvulsive therapy (ECT) voluntarily?

Although you can prevent doctors from giving you ECT, you might want to consider it before making that formal decision. Many people choose to have ECT voluntarily, and some even bring it up to their doctors.

When you are living with severe depression, every day can feel extremely difficult. People who face this extreme condition will often do anything to relieve the pain they may feel. When people who are living with such emotional pain are introduced to the possibility of feeling better very quickly after using ECT, they may choose to do it to get back to feeling like themselves again. The same thing can happen to many people with other psychiatric disorders.

Once you understand how safe and effective ECT can be now, you might feel less afraid of it. Then, if other treatments do not work, you may choose to follow your doctor's suggestion and try it to overcome your mental health challenges. Sometimes, even if you do not get ECT, just knowing that it is another option can make you feel less hopeless.

Is ECT the complete solution for my mental health challenges?

ECT can help certain people quickly and dramatically. However, you may still need other treatments as well. For example, some people may need infrequent follow-up treatments. Others may also take medications for routine maintenance.

In any case, you will probably need psychotherapy of some kind to help you develop healthier habits and ways of coping with stress.

A therapist can help you manage depression and other mental conditions before, during, and after you complete ECT. They can also help you work on your problems before they become so severe that you need ECT. In addition, if a family member has ECT, you may also benefit from therapy to help you understand how to help them thrive.

One way to conveniently attend therapy sessions may be to join an online therapy platform, where you can be matched with a licensed therapist who can provide you with the support and guidance you deserve.

As one study explains, online therapy is generally just as effective as traditional in-office therapy, which can make it a good alternative to visiting a therapist in person. It is often more affordable than traditional therapy as well.