ECT, or electroconvulsive therapy, is a treatment used principally to address severe depression — though it can be used to treat mania, schizophrenia or obsessive-compulsive disorder — which has not resolved with other treatments. In this procedure, which is repeated two to three times a week for several weeks, a physician sends an electrical current through the brain, creating a seizure that lasts for approximately one minute. This is done under anesthesia and is not felt by the patient, though when the therapy was first developed, it was done on conscious patients, often against their will. Today it is rare to perform ECT therapy on anyone who has not asked for the procedure. Electroconvulsive therapy is now considered a viable treatment, though it may cause some memory loss, and many people find their depressive disorders improved, as a result of undergoing it.
There is a distinction between ending a depressive episode and ending depression. It has been suggested that about three quarters or slightly more of patients find that an ECT therapy course ends an episode. Patients will still need ongoing treatment, which may involve both medication and therapy. Typically, patients seek this treatment because they haven’t responded adequately to medication and therapy, and they may do better with these after treatment. The treatment shouldn’t be viewed as a cure of the underlying illness. In depression there’s a one in two chance that the illness will recur with a strong episode in the future. When this occurs, people may elect to have ECT again.
The delivery of ECT therapy has improved significantly. People are unconscious when they undergo it, and the procedure takes about 15 minutes from start to finish. This therapy may be performed in mental hospitals, at regular hospitals, or at outpatient surgical centers.
Most people will have a small amount of memory loss that may encompass the day they had ECT therapy and might reach farther back into their depressive bout. A small number have more strongly compromised memory, which is different than the confusion that occurs when people wake from an ECT procedure. Most people take a minute to several hours to reorient and understand where they are when they awake from the therapy. Though using anesthesia is considered a much more humane way to deliver ECT therapy, it also poses additional risk of adverse reaction.
Electroshock therapy has advantages in some treatment due to its minimal contraindications. It is typically not recommended if people are too weak to tolerate anesthesia or if they have recently experienced any type of stroke. Brain aneurysms are also problematic and the therapy is typically avoided if a patient is known to have one. ECT is still not first line therapy for treatment of mental illnesses and most clinicians prefer using a combination of drugs and therapy, especially to treat depression.