Electroshock
What Is Electroconvulsive Therapy (ECT, "Brain Shock Therapy")?
Clear answers to your questions and concerns
Reading time: about 10 minutes | Prepared and reviewed by: the Anesthesiology and Psychiatry Team, Iranian Hospital
Initial consultation and appointments: 021-44723330 to 6 (ext. 210-211)
- 1What is ECT and how does it work?
- 2How does the modern procedure differ from the common perception?
- 3What is ECT used for, and which patients is it suitable for?
- 4ECT or other treatments: which is more suitable?
- 5What should you do before a session?
- 6What happens during a session?
- 7What aftercare is needed after a session?
- 8What are the possible side effects of ECT?
- 9Who should undergo ECT with extra caution?
- 10The importance of timely treatment in severe cases
- 11Frequently asked questions about ECT
- 12Scientific references
Introduction
If you need urgent help
If you are currently having thoughts of self-harm or suicide, or you know someone who is, please call the Iranian Hospital emergency department immediately at 021-44723330 to 6 (ext. 222), or go to the nearest medical center.
What is ECT? Electroconvulsive therapy (ECT), often called “brain shock therapy” in Persian, is a psychiatric treatment. In this procedure you are placed under brief general anesthesia, and a controlled electrical current is used to trigger a short seizure in the brain. It is mainly considered for severe depression, catatonia and some other conditions, and is carried out under the supervision of a psychiatrist and an anesthesia team.
Some patients with severe depression, bipolar disorder or other psychiatric conditions do not respond adequately even after medication and psychotherapy, or after methods such as repetitive transcranial magnetic stimulation (rTMS). When symptoms are severe or the patient’s life is at serious risk, ECT may even be considered as the first treatment option.
This method, which is sometimes casually called “shock therapy”, is one of the oldest psychiatric treatments. Based on meta-analyses of clinical trials, ECT is an effective short-term treatment for depression. Much of the concern about it comes from how it has been portrayed in films and TV series. This article explains what ECT really is, the conditions it is used for, and what happens in a real session today.
What is ECT and how does it work?
In ECT, a controlled electrical current passes into the brain through electrodes placed on the scalp and triggers a brief seizure. During the session you are under anesthesia and asleep, and you feel no pain or discomfort. ECT has been used in medicine since the 1930s, and over that time it has improved considerably in both safety and technique.
How does the modern procedure differ from the common perception?
If you are asking what ECT is, the short answer is this: a controlled treatment performed under anesthesia by a psychiatry and anesthesia team, not what you have seen in films.
If your only experience of ECT comes from films or television, it is natural to feel unsure about it, because these portrayals of shock treatment are usually inaccurate and exaggerated, and they rarely show the anesthesia or the real safety measures. Part of this negative image goes back to the early years, when the procedure was not yet performed under anesthesia. In modern ECT, before the session begins you receive brief general anesthesia and a muscle relaxant; visible muscle contraction is kept to a minimum, and the entire process is carried out under continuous monitoring of your vital signs.
What is ECT used for, and which patients is it suitable for?
ECT is used when other treatments have not worked well enough, or when the patient’s life is at risk and symptoms need to improve quickly. How fast people respond varies, and a course of treatment usually takes several weeks. The conditions for which it is considered:
| Condition | Description |
|---|---|
| Severe depression | Including cases with serious suicidal thoughts (the emergency number is given in the box at the start of the article). This use is listed in the FDA classification. |
| Catatonia | A state in which the patient becomes severely immobile or unresponsive. This use is listed in the FDA classification. |
| Bipolar mania | Severe manic episodes in bipolar disorder; used according to the guidelines of psychiatric associations. |
| Treatment-resistant schizophrenia | In some cases; used according to the guidelines of psychiatric associations. |
In 2018, the US Food and Drug Administration (FDA) placed ECT devices in the moderate-risk category (Class II) for catatonia and for severe episodes of depression (in major depression or bipolar disorder) in people aged 13 and over who have not responded to treatment or need rapid improvement.
Adolescents
This treatment is mostly used in adults, but it can also be used in adolescents from the age of 13. Because the evidence at this age is more limited, however, it is considered only in exceptional cases and after a careful specialist assessment.
Older adults
In older adults, taking several medications at once and greater sensitivity to drug side effects can make drug treatment riskier. In such circumstances, because ECT does not depend on daily medication, the doctor may judge it to be a more suitable option.
Pregnancy
In pregnancy too, because many psychiatric medications can cross the placenta and affect the fetus, ECT is sometimes considered a lower-risk option for the baby. The final decision is always made through a joint assessment by the psychiatrist and the obstetrician.
Only a medical and psychiatric assessment can give a precise answer. For an initial consultation, call the Iranian Hospital admissions unit: 021-44723330 to 6 (ext. 210-211)
ECT or other treatments: which is more suitable?
The choice of treatment depends on the severity of symptoms, previous treatments and your doctor’s opinion. Based on meta-analyses of clinical trials, this treatment is effective in the short term and is probably more effective than drug therapy; it may also be a suitable option for patients who have not responded adequately to antidepressants or other methods. However, ECT does not replace all other treatments. It is one of the options used in specific circumstances and for selected patients, usually by joint decision of the psychiatrist, the patient and, if needed, the patient’s family.
What should you do before a session?
The initial assessment for ECT is carried out by a psychiatrist or an ECT specialist. Before the course of treatment begins, the procedure, its benefits and its possible side effects are fully explained to you, and informed consent is obtained before the first session. An electrocardiogram (ECG) and an anesthesia consultation are also carried out before treatment starts, to make sure you are ready for general anesthesia. To prepare for the session:
- Fasting is mandatory: avoid light food for at least 6 hours, fatty food for at least 8 hours, and any fluids (even water) for at least 3 hours before the session. Your doctor or nurse will give you more detailed instructions.
- Alcohol must be stopped before the session because of the general anesthesia; please tell the anesthesia team about any recent alcohol use.
- When the psychiatrist orders the start of treatment, give them a complete list of the medications you take; some medications may need a temporary adjustment.
- It is essential to bring a responsible person to take you home and stay with you for 24 hours after the session.
What happens during a session?
A session goes through these steps:
| Step | What happens |
|---|---|
| 1. IV line | An intravenous (IV) line is placed to give medications. |
| 2. Anesthesia | You receive a short-acting anesthetic that puts you to sleep for a few minutes, together with an injection of a muscle relaxant. |
| 3. Mouth guard | A mouth guard is also placed in your mouth to protect your teeth and tongue. |
| 4. Monitoring | Throughout the session, your vital signs and heart activity are monitored continuously. |
| 5. Treatment | Electrodes are placed on the scalp and a controlled electrical current is delivered by the ECT device; the treatment team sets its intensity and duration, and it triggers a brief seizure. |
| 6. Time at the hospital | Your total time at the hospital, from arrival to the end of initial recovery, is usually about one to two hours. |
What aftercare is needed after a session?
When the session ends, you stay under observation in a calm setting; full alertness usually returns within a few minutes. Because of the possibility of confusion and temporary memory loss, follow these points for 24 hours after the session:
- Do not drive or operate machinery.
- Do not drink alcohol.
- Avoid important personal or official decisions (such as signing documents).
- Your companion should stay with you during this time.
The doctor decides the number of sessions based on your response; sessions are initially held several times a week, and if you respond well, the intervals between them are gradually extended.
If you feel unusual or worrying discomfort after a session, you can call the ECT unit at Iranian Hospital: 021-44723330 to 6 (ext. 224)
What are the possible side effects of ECT?
Temporary memory loss
The most common side effect is temporary memory loss. After ECT, part of the ability to learn and concentrate may decrease for a while, whereas long-term memory, attention, language and spatial perception usually remain intact. Some patients experience memory loss for events close to the treatment period, which in most cases improves over time.
Other possible side effects
Other possible side effects include the following:
- Headache
- Muscle pain
- Nausea
- Temporary grogginess after the session
- A temporary rise in heart rate and blood pressure during the session, due to the anesthesia and the muscle relaxant; these are continuously monitored.
For headache or muscle pain, you may use plain acetaminophen if needed (not combined with codeine or other painkillers), unless your doctor has given you a specific restriction.
Who should undergo ECT with extra caution?
ECT has no specific absolute contraindication, but in the following cases the treatment team will carry out a more careful assessment of the benefits and possible risks before deciding:
- A recent heart attack or stroke
- Unstable cardiac arrhythmia
The importance of timely treatment in severe cases
The assessment before deciding on ECT should also consider the consequences of delaying treatment. In severe depression with serious suicidal thoughts, timely treatment is very important; in catatonia with prolonged refusal to eat and drink, delay may also lead to severe dehydration. In these cases, ECT can be an effective treatment and, in some cases, is considered a first-line option.
Frequently asked questions about ECT
What is ECT?
A psychiatric treatment carried out under general anesthesia; its full definition appears at the beginning of this article.
Is ECT painful?
No. It is performed under brief general anesthesia, and the patient is unconscious during the session.
Does ECT cause memory loss or brain damage?
The most common side effect is temporary memory loss, not permanent brain damage. Details are in the section “What are the possible side effects of ECT?” (section 8).
Does ECT cure symptoms completely and permanently?
ECT can increase the chance of responding to treatment and of rapid symptom improvement. How long the effect lasts varies from person to person; for many patients, continuing medication or having maintenance sessions at longer intervals helps maintain the result in the long term.
What does follow-up look like after the course of treatment?
Your condition is reviewed periodically by the treatment team; if you respond well, maintenance sessions at longer intervals or maintenance medication usually continue to reduce the risk of relapse.
How much does ECT cost?
To find out the cost of each session, call the Iranian Hospital admissions unit; the number is given in the box below.
Does insurance cover the cost?
Insurance coverage varies by type of insurance; for exact details, both ask the admissions unit and check with your insurance company.
Summary
ECT is one of the psychiatric treatment options that, after a specialist assessment and under a doctor’s supervision, is considered for selected patients. This content is not a substitute for an in-person consultation with a specialist doctor.
For an initial assessment and details about the treatment, call the Iranian Hospital admissions unit: 021-44723330 to 6 (ext. 210-211)
Scientific references
The content on effectiveness, history of the method and classification of ECT devices is based on the following sources:
[1] UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003;361(9360):799-808. doi:10.1016/S0140-6736(03)12705-5
[2] US Food and Drug Administration. Neurological devices; reclassification of electroconvulsive therapy devices; effective date of requirement for premarket approval for electroconvulsive therapy devices for certain specified intended uses; final order. Federal Register. 2018;83(246):66103-66124.
