The term “shock therapy” may conjure images of a painful or barbaric treatment, but this common misconception, which has been partly fueled by inaccurate depictions in movies and on television, is far from reality. In fact, electroconvulsive therapy (ECT) is a very safe and effective treatment that can help those living with mental illness improve their quality of life.
ECT can help those with severe depression and some other serious mood disorders, such as bipolar disorder and schizophrenia, when other treatments, including antidepressants and talk therapy, have failed. Nevertheless, many experts believe the procedure is underutilized.
Outdated perceptions of how the procedure is performed have contributed to its long, varied and somewhat stigmatized past. Here’s what you need to know about one of the most misunderstood practices in psychiatry.
What happens during ECT?
For patients undergoing ECT, small electrical currents are passed through electrodes to their brain. People are not awake and alert during this procedure. It’s performed under general anesthesia.
The goal? “We’re trying to induce a seizure,” says Dr. Stephen Yost, DO, a psychiatrist affiliated with Memorial Health University Medical Center in Savannah, Georgia.
It’s believed that the mass release of neurochemicals during a seizure may help the brain return to a homeostasis, or a stable, steady condition. “If you consider [mental illness] to be an alteration of the normal brain function, the brain’s effort to stop the seizure—by releasing these neurochemicals—may help the brain return to its normal state,” Yost explains.
It’s still unclear exactly how ECT helps. Some studies involving both people and animals suggest that the procedure may trigger the release of certain brain chemicals, such as endorphins, dopamine and serotonin. Research also suggests ECT could alter the volume, thickness, connectivity or metabolic activity of certain parts of the brain. Essentially, the procedure may change brain chemistry in ways that helps reverse the symptoms of depression and other mood disorders.
How the procedure has evolved
Over the years, ECT has been refined but it hasn’t changed dramatically.
Since seizures can cause full-body convulsions, patients undergoing ECT are also given a muscle relaxant prior to the procedure. “We’re trying to cause the brain to seize—not the body,” Dr. Yost points out.
This wasn’t done when ECT treatments were first introduced in the 1930s, which increased the likelihood that patients would suffer broken bones and other bodily injuries during these convulsions. Still, the cinematic portrayals of ECT have been far from realistic.
“It was never administered the way it’s shown in movies,” Yost says. “The electrical current isn’t very strong, so it’s not like the horror movies in which people are flailing in pain.”
In fact, from start to finish, the entire procedure—including recovery from anesthesia—takes about one hour. During this time, patients’ vital signs are closely monitored by an anesthesiologist.
Who might benefit from ECT
Electroconvulsive therapy is typically used as a last resort—when outpatient therapies, such as medication or talk therapy, have failed. In some cases, it’s an option for people with certain mood disorders who can’t tolerate their medication and for some pregnant women whose medication may harm their developing fetus.
Conditions that may be treated with ECT include:
- Major depressive disorder, a common condition that can lead to profound sadness, severe low mood and loss of interest in activities that were once pleasurable
- Schizophrenia, a serious mental disorder that may cause hallucinations, delusions and other severe symptoms
- Bipolar disorder, which is characterized by unusual shifts in mood, energy levels and the ability to perform routine daily tasks
- Catatonia, a disorder that affects one’s ability to speak and move, which can result in a total loss of movement or dangerous, uncontrolled movements, as well as refusal to eat or drink and the inability to respond to pain or even simple commands.
It’s not a cure but the vast majority of those with severe depression who receive ECT benefit from the treatment. A study by the American Psychiatric Association showed that 77 percent of participants with schizophrenia improved after undergoing ECT.
"Patients will return to a normal mood, which will improve their productivity, their sense of well-being, their ability to socialize, to work, to recreate. It helps them function again. Mood disorders take that away from you,” says Yost.
Unlike drugs and talk therapy which may improve symptoms over time, ECT can help alleviate symptoms relatively quickly. Some patients begin to see improvements in their symptoms after two to four sessions. It’s especially beneficial to those with suicidal thoughts and other urgent mental health conditions. If a patient’s mental health condition becomes life-threatening, ECT can be utilized as the first line of treatment, Yost points out.
If you or a loved one is having suicidal thoughts, call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255 or call, text, or chat 988 right away.
Weighing the risks and benefits
Aside from being very safe and fast-acting, ECT is associated with fewer side effects than some antidepressant medications.
The anesthesia and paralyzing agents administered during ECT minimize the likelihood that patients will have pain or suffer an injury but like any medical procedure, there are some risks involved.
Many patients experience memory loss at the time of treatment, according to Yost. “Patients often won’t have clear memories from the time they’re receiving treatment because seizures interfere with the ability to make memories,” he says. Typically, any memory loss sustained will improve in the days and weeks following the procedure.
Other side effects that can result from ECT include:
- Headaches, muscle aches or jaw pain
- Confusion
- Nausea
During ECT, patients’ heart rate and blood pressure increase. This could lead to stroke or heart attack. Keep in mind, heart complications stemming from ECT are relatively rare. These problems are usually limited to older people with heart disease.
Other risks associated with the procedure include:
- Aspiration pneumonia
- Injuries to the tongue, lips or cheeks, due to clenching of the jaw during treatment
- Complications linked to anesthesia
ECT can be done as an outpatient procedure but patients shouldn’t drive after their sessions. The memory loss associated with the procedure and the side effects of the anesthesia make driving extremely dangerous.
Relapse remains a concern
The goal of ECT is to provide immediate relief from mental illness symptoms but some patents may need to undergo multiple procedures. The course of treatment is completely customized to the individual—some patients may be able to return to medication or therapy after only one session, while others may require ongoing sessions, Yost explains. In most cases, six to 12 treatments are needed. Patients usually undergo three sessions per week.
More research is needed on the long-term effects of ECT as well as relapse after treatment. Research suggests that people’s genetics may play a role in how well they respond to this treatment.
“Like any medical treatment, you have to decide if the benefit is worth the risk,” Yost advises. “We believe the benefits appear to outweigh the risks. It works quickly when treatment needs to be done quickly.”
