Questions about electroconvulsive therapy, answered

The term “shock therapy” may conjure images of a painful or even barbaric treatment for patients with mental health issues. This stems in large part from inaccurate depictions of the procedure in movies and on television.

But this common misconception is far from reality. In fact, “shock therapy”—also known as electroshock therapy or electroconvulsive therapy (ECT)—is a safe and effective treatment that can help people living with mental health conditions and improve their quality of life.

Electroconvulsive therapy can be especially helpful for people with serious mental health conditions that have not responded to treatment. These may include depression, schizophrenia, and bipolar disorder. Nevertheless, many experts believe the procedure is underused, given its potential benefits.

Perceptions of how the procedure is performed have contributed to its stigma. Here’s what to know about electroconvulsive therapy.

What happens during ECT?

During a typical ECT procedure, small electrical currents are passed through electrodes to the brain. People are not awake and alert during this procedure. It’s performed under general anesthesia.

What is the goal of the procedure?

“We’re trying to induce a seizure,” says Stephen Yost, DO, a psychiatrist affiliated with Memorial Health University Medical Center in Savannah, Georgia. It’s believed that the large-scale release of brain chemicals during a seizure may help the brain return to a stable, steady state, also known as homeostasis.

“If you consider mental illness to be an alteration of the normal brain function, the brain’s effort to stop a seizure caused by ECT—by releasing these neurochemicals—may help the brain return to its normal state,” Dr. Yost explains.

It’s still unclear exactly how ECT helps. The procedure may trigger the release of certain brain chemicals, such as endorphins, dopamine, and serotonin. It may also help the way brain cells communicate. Or it might help create new brain cells. Essentially, the procedure may change brain chemistry or function in ways that help improve the symptoms of depression and other mood conditions.

How has the procedure evolved?

ECT hasn’t changed drastically since it was developed, but it has been refined over the years.

Because seizures can cause full-body convulsions, people having ECT today are given a muscle relaxant medication prior to the procedure.

“We’re trying to cause the brain to seize—but not the body,” Yost says.

This precaution wasn’t taken when ECT treatments were first introduced in the 1930s, which increased the likelihood of broken bones and other bodily injuries during these convulsions.

“That said, it was never administered the way it’s shown in movies,” Yost explains. “The electrical current isn’t very strong, so it’s not like the movies in which people are flailing in pain.”

The electric currents are administered in a controlled way to minimize risk and to get the most benefit from treatment. 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, a medical doctor who specializes in anesthesia.

Who might benefit from ECT

Electroconvulsive therapy is typically used as a last resort when outpatient therapies, such as medications and talk therapy, have not worked. In some cases, it’s an option for people with certain mood conditions who can’t tolerate their medication and for some pregnant people with mental health issues whose medication may harm their developing fetus.

Conditions that may be treated with ECT include the following:

Depression: This is a common condition that can lead to profound sadness, severe low mood, and loss of interest in activities that were once pleasurable.

Schizophrenia: This is a serious mental health condition that may cause hallucinations, delusions, and other severe symptoms. ECT can also be helpful in treating other similar psychotic disorders.

Bipolar disorder: This condition is characterized by unusual shifts in mood and energy levels, as well as the inability to perform routine daily tasks. The hallmarks of the condition include periods of highly animated behavior (called mania) and periods of deep depression. ECT may also be an appropriate treatment for other health conditions involving mania.

Catatonia: This condition affects one’s ability to speak and move, which can result in a total loss of movement or dangerous, uncontrolled movements. The condition may also contribute to a person’s refusal to eat or drink and the inability to respond to pain or even simple commands.

ECT is not a surefire cure, but the vast majority of people with severe depression who receive ECT benefit from the treatment. According to the American Psychiatric Association, about 80 percent of participants with severe major depression will experience substantial improvement after having 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 medications 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 of ECT. 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 used as the first line of treatment, Yost points out.

If you or a loved one is having suicidal thoughts, call 911 or call, text, or chat the 988 Suicide & Crisis Lifeline at 988 right away.

Weighing the risks and benefits of ECT

Aside from being very safe and fast-acting, ECT is associated with fewer side effects than some antidepressant medications.

The anesthesia and medicines that immobilize the body used during ECT minimize the likelihood of pain or injury. But like any medical procedure, there are some risks involved.

Many people experience memory loss at the time of treatment.

“Patients often won’t have clear memories from the time they’re receiving treatment because seizures interfere with the ability to make memories,” Yost says. Typically, memory loss improves 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
• Fatigue

During ECT, a patient’s heart rate and blood pressure increases. This could lead to stroke or heart attack. That said, heart complications stemming from ECT are relatively rare. These problems are usually limited to older people with heart disease.

ECT can be done on an outpatient basis, which means you can go home after the procedure. But people who have ECT shouldn’t drive after their sessions. The memory loss associated with the procedure and the side effects of the anesthesia make driving dangerous.

Relapse remains a concern

The goal of ECT is to provide immediate relief from mental illness symptoms. Most people, however, need to undergo multiple procedures.

The course of treatment is customized to the individual, but in most cases, six to 12 treatments are needed. This may involve two to three treatments per week for several weeks.

More research is needed on the long-term effects of ECT as well as relapse after treatment. Some research shows that relapse is fairly common and that long-term treatment plans are important. Research suggests that long-term mood stabilizer medications and maintenance ECT treatments, as well as a patient’s genetics, may play important roles in determining the risk of relapse.

“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.”

Alternative treatments

Recently, more and more alternative treatments to ECT have become available. These include:

Transcranial magnetic stimulation (TMS): This is a non-invasive treatment that can be done while the person is awake. It uses magnetic fields to stimulate the brain’s nerve cells and improves symptoms for 30 to 64 percent of patients with depression, according to the National Alliance on Mental Illness.

Ketamine therapy: Ketamine is a drug administered at the office of a healthcare provider (HCP) under their supervision. It can be effective within 40 minutes for people with severe depression, but it is not a cure, nor a first-line treatment.

Vagus nerve stimulation (VNS) and deep brain stimulation (DBS): VNS uses a device placed in the chest and tiny wires that run along a major nerve in the neck. DBS involves tiny wires that are placed in the brain using surgery. These treatments stimulate certain areas of the brain. VNS is coming into wider use but may not necessarily be covered by insurance. Due to risk of complications, DBS is still not widely available for treatment of mood conditions but may be in the future.

If you have a serious mental health condition, talk with your HCP team to determine the most appropriate course of action for your situation.