ECT has been used for over half a century in many different countries, and its effectiveness is well documented. Approximately eight out of 10 people who undergo ECT will experience dramatic improvement. The reason why this treatment is so effective is still unclear.
The brain functions using electrochemical messages, and it is thought that ECT-induced seizures interrupt these messages. ECT is generally used when other forms of treatment, including medication and psychotherapy, have failed. However, ECT is often the first treatment of choice in life-threatening situations, such as a potential suicide in the context of severe depression, because of the rapid results.
Electroconvulsive treatment procedure ECT is performed under supervision of a consultant psychiatrist. The person is anaesthetised and given muscle relaxants. Depending on the problem, one side unilateral or both sides bilateral of the brain will be stimulated. A series of brief, low-frequency electrical pulses prompt a convulsion. The person is under anaesthesia before the treatment is applied, and the muscle relaxant reduces the intensity of muscular spasms.
The person wakes up after a few minutes. Some of the immediate side effects of ECT these tend to resolve within a few hours include headache, sore muscles, queasiness and confusion. During the course of the treatment, many people experience problems with short-term memory, but this side effect usually lasts a few days or weeks.
It can relieve symptoms of the most severe forms of depression more effectively than medication or therapy , but because it is an intrusive procedure and can cause some memory problems, ECT should be used only when absolutely necessary. ECT is used for fast treatment of severe depressive, manic or psychotic symptoms e. It may be used when the situation is thought to be life-threatening or after all other treatment options have failed.
Decisions to use ECT are always made very carefully. Together with the person wherever possible, a mental health specialist e. The decision is made by weighing the risks for the person against the potential danger of leaving the condition untreated. It is important to remember the person can seek a second opinion from another doctor. Informed consent must be gained by the person, if able to do so.
If the person has been able to provide informed consent, they can withdraw consent at any stage in the process. ECT is administered by a medical practitioner usually the treating psychiatrist and an anaesthetist in a hospital environment.
Before the ECT procedure, the person is given a general anaesthetic and a muscle relaxant. Electrodes are placed on one unilateral or both bilateral sides of the scalp and a small electric current is passed between these until a brief generalised seizure occurs.
The person does not feel anything due to the anaesthetic, and does not convulse due to the muscle relaxant. The person wakes up five to 10 minutes after treatment and is usually clear headed within 30 minutes. Often, people do not clearly recall the time around the ECT treatment and, at first, may have little memory about the period of illness around the treatment.
Sometimes it is given once every 2 weeks or once a month to stop symptoms from coming back. ECT should be used to gain fast and short-term improvement for mental health conditions.
It can be used to treat the following mental health conditions. Doctors should offer you other treatments such as, medication and talking treatments before ECT.
But ECT should not be used as a long-term treatment to prevent a depressive episode coming back. And it should not be used in the general management of schizophrenia. And not recommended by NICE. NICE think that more research is needed.
Research suggests that ECT may be effective to treat certain types of schizophrenia and reduce relapse. And that ECT used with antipsychotic medication may be more effective than medication alone.
But results are not conclusive. ECT is generally safe. But ECT can cause side effects. These effects may be short-term or long-term side effects. But for some people it is not clear if memory problems experienced are caused by ECT or if they are a symptom of long-term mental illness. This is because memory problems are quite common for people with mental health conditions. Healthcare professionals will assess you after each session of ECT.
This assessment will check if:. The way that you process information should also be monitored regularly. This is called your cognition. As a minimum, it should be assessed at the end of each course of treatment. There is no evidence that having ECT is more dangerous than any other procedure needing a general anaesthetic. An anaesthetist will assess you before your ECT treatment starts. Death from general anaesthetic is rare. It is around 1 death for every , who are given a general anaesthetic.
But the risk is higher if:. Your doctor should offer you ECT if they think that it is a good option for you. They should explain the pros and cons of treatment. Your relatives, carers or an advocate should be involved in the discussion too. Your doctor can talk to you about having more ECT if you have catatonia or mania.
And you have responded well to ECT. And they have spoken to you about the risks and benefits of ECT. Doctors may talk to your carer, advocate or relatives to help you decide if you want more ECT. They can explain ECT to you. Doctors can give you ECT if you lack the mental capacity to make a decision about your treatment.
But this is very rare. They also need to consider the views of people who can make a legal decision on your behalf before they decide to treat you. The Court of Protection can make a decision if there are disagreements about if ECT would be in your best interests. See below for more information. You can accept or refuse ECT if you have the mental capacity to make the decision about your treatment.
A medical professional will certify that you have agreed to the treatment and that you have the mental capacity to make this decision. Guidance on the use of electroconvulsive therapy. National Institute for Health and Care Excellence. Kolar D. Current status of electroconvulsive therapy for mood disorders: A clinical review. Evidence-Based Mental Health. Weiner RD, et al. Key updates in the clinical application of electroconvulsive therapy.
International Review of Psychiatry. Rasmussen KG, et al. An open-label, pilot study of daily right unilateral ultrabrief pulse electroconvulsive therapy. Journal of ECT. Acharya D, et al. Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia. International Journal of Geriatric Psychiatry. Geduldig ET, et al. Electroconvulsive therapy in the elderly: New findings in geriatric depression.
Current Psychiatry Reports. Depression basics.
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