Electroconvulsive therapy (ECT) can make a significant difference in some cases of severe mental illness, but it’s an often misunderstood treatment. Because electroconvulsive therapy involves anesthesia and must be done by a highly trained healthcare team in a medical setting, some may worry that it’s a harmful way to treat mental illness. However, done safely by healthcare professionals, electroconvulsive therapy can be a helpful option for some. Below, explore electroconvulsive therapy, what it’s used for, and ways to get help for mental illness or mental health challenges so you can make an informed decision about your own mental health care.

What is electroconvulsive therapy (ECT)?

Electroconvulsive therapy is a medical procedure designed to stimulate various areas of the brain via mild, brief electrical pulses delivered through an ECT machine. Electroconvulsive therapy seems to change a person’s brain waves and brain chemistry, potentially relieving various mental health symptoms. This stimulation may reduce symptoms of treatment-resistant depression or other mental disorders.  

What is ECT used for?

What is typical preparation for ECT? 

Before the first treatment, individuals typically undergo a series of tests, including blood and urine tests. Specifically, doctors may order a metabolic panel, blood count, and kidney and thyroid function tests. They may also order imaging tests of the skull, spine, and brain, and an electrocardiogram (EKG). These tests verify the patient's health to reduce the risk of the procedure. 

What happens during an ECT procedure?

It is a common misconception that individuals remain fully awake; however, during treatment sessions, an anesthesiologist on the medical staff administers a general anesthetic injection so patients are asleep during the procedure. After the patient is asleep, a doctor places electrodes on the head with a conductive gel to prevent skin irritation or burning. There are three types of ECT: bilateral ECT, right unilateral ECT, and bitemporal ECT. These refer to the placement of the electrodes, which doctors determine depending on a person’s symptoms. 

Using the electrodes, a psychiatrist stimulates the brain with a mild electric current, which causes a brief seizure. The current usually only lasts a few seconds, and the seizure typically lasts between 30 and 90 seconds. If a seizure lasts longer, a doctor can administer an injection to stop it. The seizure induced by the electrical current typically changes the way certain areas of the brain function, which can lead to significant improvement in mental health symptoms for some people. In some cases, come effects immediately take place after ECT sessions.

Safety, risks, and possible side effects

ECT is generally safe, but there are risks and possible side effects, primarily temporary ones such as headaches, muscle aches, nausea, fatigue, confusion, and memory issues (especially for recent events). Less common long-term side effects might include persistent loss of personal memories (called retrograde amnesia); however, severe, lasting loss is rare. A brief rise in blood pressure is also among the less common/longer-term adverse effects.

Serious risks are rare but include cardiac issues (due to anesthesia) and potential long-term memory loss for some, though severe effects are uncommon. Risks are managed with screening, monitoring, and modern techniques, but individuals with recent heart attacks, strokes, or severe lung/brain pressure conditions are often not candidates. 

There is debate over the effectiveness of ECT: some critics say there is little evidence of long-term benefits. In contrast, others argue that the treatment can be highly beneficial when delivered safely and under monitoring. The Care Quality Commission (CQC) monitors ECT services, but critics highlight a gap between NICE (National Institute for Health and Care Excellence) guidelines, which approve ECT for severe cases, and the limited independent oversight, with some calls for suspending ECT until better research emerges.

When ECT is offered in the UK

Compared with more conventional treatment options, only a small number of cases are offered ECT under certain conditions. Typically, ECT is considered an emergency treatment option for people with a life-threatening condition, such as those at risk for suicide or who may pose a risk to health or safety. People may also benefit from ECT when other methods, such as medications or talk therapies, don’t work. 

In the UK, if a doctor thinks a patient lacks the mental capacity to consent or refuses urgent treatment with ECT, a second opinion appointed doctor (SOAD) must assess them and agree that ECT is clinically appropriate and necessary, or that the patient cannot make the decision for themselves, to allow treatment to proceed. This ensures the patient's rights and views are considered under the Mental Capacity Act and Mental Health Act. The SOAD is an independent psychiatrist who checks capacity, hears the patient's views, and speaks with care team members, but cannot override a valid advance refusal of treatment. 

Legal protections and consent & lasting power of attorney

In the UK, ECT is generally administered with consent from those with the capacity to make an informed decision, and is protected under the Mental Capacity Act 2005. In UK criminal law, “sectioned” individuals who are unable to consent—either because of diminished mental capacity or because they pose a serious risk to themselves or others—may be eligible for ECT when recommended by a second opinion appointed doctor (SOAD). Second-opinion and best-interest assessments typically include input from family and/or caregivers as an additional safeguard to protect the patient’s rights. Additionally, an individual may appoint a lasting power of attorney (LPA) for health to make care decisions on their behalf (including ECT) if they lose capacity later. However, an LPA may not refuse ECT if the individual is sectioned, though the conditions are complex, and legal advice is critical for specifics. 

Working with your healthcare team

Your team will consist of highly trained healthcare professionals, including psychiatrists, anaesthetists, nurses, and, in some cases, support workers (ECSWs). When working together, be sure to ask questions about the process, your rights, and any potential risks or side effects. Before you begin treatment, your healthcare team will likely encourage you to involve trusted family members or caregivers for support in making an informed decision as to whether ECT is the best course of action throughout the process. 

What does literature say about ECT?

The National Institute for Health and Care Excellence recommends that ECT be used for depression only if a person has had positive results with ECT in the past, if other treatments haven’t helped, or if a person’s life is at risk. 

In recent years, researchers have found ECT to be effective for severe depression. The Royal College of Psychiatrists has an Electroconvulsive Therapy Accreditation Service (ECTAS), which has created one of the most extensive datasets on ECT in the world. The ECTAS tracked more than 1,800 adults who had undergone ECT in 2021. The Royal College of Psychiatrists stated, “Of those who received acute ECT, 68% were found to be ‘much improved’ or ‘very much improved’ following the treatment.” Also, 41% of patients who received ECT for depression experienced complete remission. Full remission is defined as the absence or near absence of depression symptoms, as measured by clinical rating scales. 

Researchers in the United States have also found ECT to be effective. The American Psychiatric Association states, “Clinical evidence indicates that for individuals with uncomplicated but severe major depression, ECT will produce substantial improvement in approximately 80% of patients. The treatment is also used for other severe mental illnesses, such as bipolar disorder and schizophrenia.”

Alternative treatments & talking therapies

Many people who experience depression never undergo ECT, as NICE guidelines recommend the procedure as a last resort if therapy and medication don’t work. Therapists may use other treatment options, like cognitive-behavioral therapy (CBT), to treat depression symptoms. In some cases, people take medicines alongside therapy. Medication may help people get the most from psychotherapy. However, consult a doctor before starting, changing, or stopping any medication. You may also want to check with your insurance provider to see whether they cover these types of therapy.

The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action without consulting a qualified medical professional.

Online counselling for mental health conditions

For some people experiencing depression, leaving home for therapy sessions can be challenging. However, mental health support is still available through online counselling. With online counseling through a platform like BetterHelp, you can be matched with a credentialed therapist who has experience treating depression or other mental disorders. You can communicate with a therapist via audio, video, or live chat. In addition, you can reach out to your therapist at any time via in-app messaging, and they’ll respond as soon as they can. This option may be useful for days when you experience more severe symptoms of depression. 

Online therapy has been shown to be effective for numerous mental disorders. In one meta-analysis and systematic review published in 2020, researchers found that electronic cognitive-behavioral therapy (eCBT) was just as effective as in-person therapy. After looking at 17 studies, the authors concluded, “Our results demonstrated that eCBT was more effective than face-to-face CBT at reducing depression symptom severity.”