Depression: Treatment with Electroconvulsive Therapy

What conditions does electroconvulsive therapy treat?

Electroconvulsive therapy (also called ECT) may help people who have the following conditions:
  • Severe depression with insomnia (trouble sleeping), weight change, feelings of hopelessness or guilt and thoughts of suicide (hurting or killing yourself) or homicide (hurting or killing someone else).
  • Severe depression that does not respond to antidepressants (medicines used to treat depression) or counseling.
  • Severe depression in patients who can't take antidepressants.
  • Severe mania that does not respond to medication. Symptoms of severe mania may include talking too much, insomnia, weight loss or impulsive behavior.
  • Schizophrenia that does not respond to medication.

How does ECT work?

It is believed that ECT works by using an electrical shock to cause a seizure (a short period of irregular brain activity) in the brain. This seizure releases many chemicals in the brain. These chemicals, called neurotransmitters, deliver messages from one brain cell to another. The release of these chemicals makes the brain cells work better. A person's mood will improve when his or her brain cells and chemical messengers work better.

What steps are taken to prepare a person for ECT treatment?

First, a doctor will perform a physical exam to make sure you're physically able to handle the treatment. If you are, you will meet with an anesthesiologist, a doctor who specializes in giving anesthesia. Anesthesia is medicine used to put you in a sleep-like state so that you don't feel any pain or discomfort. The anesthesiologist will examine your heart and lungs to see if it is safe for you to have anesthesia. You may need to have some blood tests and an electrocardiogram (a test showing the rhythm of your heart) before your first ECT treatment.

How are the ECT treatments given?

ECT may be given during a hospital stay, or a person can go to a hospital just for the treatment and then go home. ECT is given up to 3 or 4 times a week. Usually no more than 12 treatments are needed to relieve depression. Treatment is given by a psychiatrist.

Before each treatment, an intravenous (IV) line will be started so medicine can be put directly into your blood. You will be given an anesthetic (medicine to put you into a sleep-like state) and a medicine to relax your muscles. Your heart rate, blood pressure and breathing will be watched closely. After you are asleep, an electrical shock will be applied to your head. The shock will last only 1 or 2 seconds and will make your brain have a seizure. This seizure is controlled by medicines so that your body doesn't move when you have the seizure.

You will wake up within 5 to 10 minutes after the treatment and will be taken to a recovery room to be watched. When you are fully awake, you can eat and drink, get dressed and return to your hospital room or go home.

What are some side effects of ECT?

Side effects may result from the anesthesia, the ECT treatment or both. Common side effects include temporary short-term memory loss, confusion, nausea, muscle aches and headache. Some people may have longer-lasting problems with memory after ECT. Sometimes a person's blood pressure or heart rhythm changes. If these changes occur, they are carefully watched during the ECT treatments and are immediately treated.

What happens after all of the ECT treatments are done?

After you have finished all of your ECT treatment, your depression will improve and you will probably be started on an antidepressant medicine. It is important for you to keep taking this medicine the way your doctor suggests so that you won't become depressed again.

More Information

For more information talk to your doctor.

Source

Written by familydoctor.org editorial staff.

American Academy of Family Physicians

Reviewed/Updated: 02/08
Created: 09/00