FAQs About ElectroConvulsive Therapy

Q. What disorders are commonly treated with ECT?

A. ECT is indicated when patients need rapid improvement because they are suicidal, self-injurious, refuse to eat or drink, cannot or will not take medication as prescribed, or present some other danger to themselves. It is a suitable treatment for single episode or recurrent major depression, bipolar disorder and chronic schizophrenia.

Q. How is ECT administered?

A. ECT is essentially an electrical stimulation of the brain. It's used to induce cerebral seizures that disrupt normal electrical activity in the brain. A patient is first given an intravenous anesthetic. Once the patient is asleep, a muscle relaxant is administered intravenously and pure oxygen is given through a face mask. An electrical stimulus is then briefly applied to the scalp, causing seizure activity in the brain and mild muscle contractions. The seizure usually lasts 30 seconds to one minute. The patient is awake five to 20 minutes after the procedure.

Q. Why does ECT work?

A. The brain is an organ that functions through complex electrochemical processes, which may be impaired by certain types of mental illnesses. Scientists believe ECT acts by temporarily altering some of these processes.

Q. What are the risks associated with ECT?

A. Any medical procedure entails a certain amount of risk. However ECT is no more dangerous than minor surgery under general anesthesia, and may at times be less dangerous than treatment with antidepressant medications. This is in spite of its frequent use with the elderly and those with coexisting medical illnesses. A small number of other medical disorders increase the risk associated with ECT, and patients are carefully screened for these conditions before a psychiatrist will recommend them for the treatment.

Q. What are the side effects of treatment with ECT?

A. Immediate side effects from ECT are rare except for headaches, muscle ache or soreness, nausea and confusion, usually occurring during the first few hours following the procedure. Over the course of ECT, it may be more difficult for patients to remember newly learned information, though this difficulty disappears over the days and weeks following completion of the ECT course. Some patients also report a partial loss of memory for events that occurred during the days, weeks, and months preceding ECT. While most of these memories typically return over a period of days to months following ECT, some patients have reported longer lasting problems with recall of these memories. However, other individuals actually report improved memory ability following ECT, because of its ability to remove the amnesia that is sometimes associated with severe depression. The amount and duration of memory problems with ECT vary with the type of ECT that is used and are less a concern with unilateral ECT (where one side of the head is stimulated electrically) than with bilateral ECT.

Q. How soon will I see results?

A. ECT works quickly - usually showing a response after several treatments, generally within the first week

Q. Does ECT cause brain damage?

A. Researchers have found no evidence that ECT damages the brain. There are medical conditions such as epilepsy that cause spontaneous seizures which, unless prolonged or otherwise complicated, do not harm the brain. ECT artificially stimulates a seizure; but ECT induced seizures occur under much more controlled conditions than those that are "naturally occurring" and are safe. A recent study by Coffey and colleagues found no changes in brain anatomy with ECT, as measured by very sensitive scans of the brain using magnetic resonance imaging (MRI) equipment. Other research has established that the amount of electricity which actually enters the brain, (only a small fraction of what is applied to the scalp) is much lower in intensity and shorter in duration than that which would be necessary to damage brain tissue.

This is, however, a very controversial question, and not all experts agree.

Q. Is ECT safe for use during pregnancy?

A. During pregnancy. ECT has been found safe during all trimesters of pregnancy by the American Psychiatric Association. However, all ECT on pregnant women should occur in a hospital with facilities to manage a fetal emergency.

Q. How many ECT treatments are required?

A. The total number of treatments a patient will receive depends upon many factors such as age, diagnosis, the history of illness, family support, and response to therapy. Patients with depression, for example, usually require six to 12 treatments. Treatments are usually administered every other day, three times a week.

Q. Does ECT help borderline personality disorder?

A. The symptoms of borderline personality disorder may or may not improve with ECT. Sometimes symptoms of BPD improve significantly with effective treatments for depression, such as with medication and ECT. It's not known why BPD improves in some cases but not in others. However, ECT is not a recommended treatment for BPD alone.