Electroconvulsive therapy (ECT) refers to the most effective and rapidly acting treatment that we have today for severe depression and other conditions. ECT is an approved medical treatment that involves the use of electricity to produce a brief seizure in a person under general anesthesia (while the person receiving the treatment is asleep). The seizure usually lasts about a minute or less and body movement (convulsion) is very little because of a strong muscle relaxant medication which is given following the anesthetic drug. ECT is given 2-3 times per week, usually for 6 to 12 treatments. ECT is performed by medical physicians (a psychiatrist and an anesthesiologist), assisted by nurses and other medical staff.
ECT is recommended when a severe clinical depression is not responding to other treatments (such as psychotherapy and medications), or when there is a need for a rapid response (such as when there is a high risk of suicide, or the when the depression itself is threatening the health of the person). As such, ECT can be a lifesaving treatment because it is rapidly effective, even when other treatments fail. Even though ECT has been around for many years, modern ECT bears little resemblance to its historical portrayal and has been modernized.
What are the benefits of ECT?
ECT results in rapid resolution of the symptoms of major depression (including depressed mood, lack of interest, appetite and weight disturbance, sleep disturbance, feelings of hopelessness and helplessness, loss of self esteem, and thoughts of suicide). Remission, which is the likelihood of having complete resolution of symptoms, is reported to range from 70-90% with ECT. It is much more effective than any medication we have at present, which typically have remission rates around 20-30%.
ECT is also effective in the manic phase of bipolar disorder. Response is particularly high for depressed people who are psychotic or catatonic. ECT can also be used in other conditions when other treatments are not sufficiently effective, such as schizophrenia, Parkinson’s disease, and treatment-resistant epilepsy (including status epilepticus, which is a life-threatening condition).
How does ECT work?
The “active ingredient” of ECT is the seizure. There are many theories about how seizures works in depression. Seizures result in many measureable changes in brain function and chemistry. We can see these changes using special types of brain scans and other types of medical testing.