Electroconvulsive therapy (ECT)

ECT is a treatment which involves passing a carefully controlled electrical current through the brain. The current affects the brain’s electrical activity in a way which can lessen depressive and psychotic symptoms.

ECT is used as a treatment for severe depression, bipolar disorder and psychotic illnesses such as schizophrenia.

The facts

• ECT was developed in 1938, and was an unregulated treatment during the 40s and 50s. This led to many misconceptions about shock therapy and ECT. 
• ECT is used in many countries, and its safety and effectiveness is well documented.
• ECT is effective approximately 70-90% of the time. 

The myths

• myth: ECT is ‘shock therapy’ that leaves a patient brain damaged and writhing in pain.
• reality: ECT does induce seizures, but patients are first given a muscle relaxant and general anaesthetic. There is no evidence that ECT causes brain damage. Media depictions of ECT, such as in the film One Flew Over the Cuckoo’s Nest, are inaccurate and further stigmatise a safe and effective treatment.
• myth: ECT is given without your consent.
• reality: If your psychiatrist suggests that ECT might be helpful for you, you can refuse the treatment. Where a patient is not able to provide consent – for example, if they are unresponsive or severely delusional – their family and carers help the psychiatrist to make a decision in their best interests and in these instances, approval from the mental health authority is usually required.
• myth: ECT erases memory.
• reality: Most patients experience some short-term memory loss, which often improves with time. It is rare to experience long-term memory loss from ECT
• myth: ECT is only used for depression.
• reality: ECT most commonly used for people with severe depression that has not responded to other treatments. It is also used to treat people with bipolar disorder, schizophrenia and psychosis.

How ECT works

ECT is used for the fast treatment of severe depression, mania or psychosis. It may be used when symptoms are severe, when a situation is life-threatening, or when other forms of treatment have been ineffective.

ECT is administered in a hospital, usually by the treating psychiatrist and an anaesthetist. The person being treated is given a general anaesthetic and a muscle relaxant, so is unconscious during the treatment.

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 after five or ten minutes of treatment. They may feel groggy at first, but will be clear-headed within 30 minutes.

Treatment is typically repeated a number of times. While most people show some improvement after 3 to 4 sessions, some may need 20 to 25. Treatments are usually given 2 to 3 times a week.

Despite the controversial history of ECT, there is now a clear body of scientific evidence that ECT is effective in improving depressive and psychotic symptoms in the short term.

To make the return of symptoms less likely, doctors may prescribe medication and psychotherapy. Some people may require several courses of the treatment over their lifetime.

Risks and side effects

Despite its controversial history, the risks and side effects of modern ECT are very low.

Like any procedure involving anaesthesia, ECT carries a small degree of risk. The most common side effects are headache, stomach upsets, aching muscles and short-term memory loss.

Studies have shown that ECT does not harm the brain or change its anatomy in any way, as the strength of the electrical current is too low to cause damage.

Finding out more

Your GP, psychiatrist or mental health professional will be able to give you advice on ECT as a treatment option. If your psychiatrist has recommended ECT but you aren’t sure about it, you can get a second opinion from another mental health professional.

The Epworth Hospital in Melbourne has a helpful factsheet about the ECT treatment process.

The NSW Mental Health Review Tribunal provides information about ECT and consent.