Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) involves brief electrical stimulation of the brain. Often, electroconvulsive therapy is used to treat severe psychiatric disorders when other treatment options have not been successful for patients. The medical treatment has been proven to successfully treat symptoms of a number of severe mental illnesses including major depressive disorder, severe psychosis, catatonia, suicidality, and schizophrenia. ECT has also been used to treat other conditions such as neuroleptic malignant syndrome.

The discussion of mental health treatment may often be centered around psychotherapy and medication. While these treatment methods can be effective for many people, others may find that they don’t impact their symptoms as hoped.

Therefore, becoming aware of other treatments that are available, such as brain stimulation and ECT, may be helpful. One such treatment is called electroconvulsive therapy (ECT). Although somewhat controversial, there may be benefits to this practice.

What is electroconvulsive therapy (ECT)?

ECT is a medical procedure that involves administering electrical pulses to the brain while an individual is under a short-acting anesthetic or a muscle relaxant. It may simulate seizure activity in the brain. 

This medical procedure may cause changes in brain chemistry and brain function that can significantly alleviate symptoms associated with major depression and other severe mental health conditions. 

How does it work? 

Researchers are still unsure how ECT improves symptoms in individuals with severe mental illness. Several theories are that the electrical activities produced in ECT might trigger new brain cells to develop, shift the activity of current brain cells at the synapses, and increase neurotransmitters such as dopamine or serotonin.

Individuals typically undergo between 6-12 sessions of ECT, depending on how their symptoms respond to the multiple treatments. 

Is it effective? 

In randomized controlled trials, ECT has been proven to be an effective treatment method for individuals with severe mental illness. According to extensive research on ECT efficacy, ECT significantly reduces symptoms of depression for about 80% of individuals. ECT early treatments may also be considered for people with bipolar disorder who are not responding to other forms of ongoing treatment. 

Studies have shown that as long as ECT is provided safely, it can provide sustained recovery with minimal to no side effects. Researchers recommend maintenance treatment in order to sustain the improvements provided by the initial acute electroconvulsive therapy. 

Types of ECT treatment

There are two types of treatment:

1. Unilateral ECT may be right unilateral ECT or left unilateral ECT. It occurs when the electric current only passes through one side of the brain, 
2. Bilateral ECT is when the electric current passes through both sides of your brain. It may be high or moderate dose bilateral ECT.

Potential risks and benefits

While ECT may be considered generally safe, it also comes with several significant risks. This is why individuals who take part in this form of treatment are constantly monitored using a blood pressure cuff as well as other standard monitoring techniques to keep an eye on their vital signs. If you decide to partake in this treatment, you may first want to read up on the side effects and potential concerns published by research journals. 

One concern is that some patients undergoing ECT are still started on an electrical current that exceeds their seizure threshold, leading to long-term side effects. 

While short-term memory loss is sometimes a side effect of ECT, some patients may experience severe memory loss that lasts for longer periods of time. Cardiovascular complications and cognitive impairment can also occur a small fraction of the time. Elderly patients are at an increased risk of experiencing complications. 

Side effects

Following an ECT procedure, an individual might experience side effects from general anesthesia, including nausea, headache, and confusion. They may also experience memory loss or amnesia, according to information from clinical trials.

Short-term memory loss

One of the medical complications that can occur from ECT is short-term temporary memory loss in some individuals who have trouble remembering events from the weeks or months leading up to the ECT treatment. Many individuals find that their memory problems subside after a few months, while others may experience more long-term challenges with ECT.

Consider weighing these potential risks with the benefits of ECT treatments. Individuals who don’t experience symptom relief from medications or cannot tolerate medication may want to consider the treatment. 

Improvements for treatment-resistant illnesses

Since ECT and maintenance therapy in a controlled setting has been proven highly effective against treatment-resistant depression, it may be worth trying for those resistant to medications or therapy. ECT treatment may improve symptoms faster than medications, which could take several weeks to work. Also, ECT’s effectiveness is recognized by the American Psychiatric Association and the APA task force. The National Institute of Mental Health also discusses the efficacy of ECT for severe mental health disorders.

You may also find that the treatment aids in other distressing symptoms, such as anxiety, hallucinations, or mania. Talk to your primary care physician and mental health care team provider before deciding. They may help you determine whether the treatment will work for you. 

Typically, ECT is considered after an individual has not seen a substantial improvement in their symptoms from medication or therapy. Therefore, these methods may be recommended first before considering ECT. It may also be used in severe scenarios where a patient requires a rapid treatment reponse, such as thoughts of suicide. 

If you continue to experience severe depression or psychosis after trying other treatment methods, you may want to find a doctor who you can consult with about ECT. 

Alternative options to ECT treatments

Patients with mental illnesses may consider other brain stimulation treatments if they don’t feel that ECT is the right medical treatment for their needs. Vagus nerve stimulation uses a device to send electrical impulses to the vagus nerve. The device may be surgically implanted under the skin or held against the skin. Vagus nerve stimulation may be used to treat patients who have bipolar disorder or Alzheimer’s disease. It’s also been shown to successfully treat depressed patients who haven’t responded to other types of treatment such as therapy or antidepressant medication. 

During transcranial magnetic stimulation, an electromagnetic coil is placed on a person’s scalp close to their forehead. The coils send short, magnetic pulses into the area of the brain that controls a person’s mood. TMS can be used to treat OCD, PTSD, severe major depression, substance use disorder, and other mental illnesses. 

Therapy as an alternative to ECT 

Suppose you’re experiencing depression and want support but don’t feel comfortable with the risks of ECT. In that case, a mental health counselor may offer resources, personal attention, and support to benefit you during this time. If you’re uncomfortable visiting a therapist in person or find it difficult to leave home, online therapy may be a suitable choice. 

Online therapy has been found to be as effective as in-person therapy, and a University of Zurich study found that it can be more effective in the long term. The study showed that depression could no longer be detected in 53% of online therapy users by the end of treatment (compared to 50% of in-person therapy users). At three months post-treatment, this number increased to 57% for those who had used online therapy (and decreased to 42% for in-person treatment).

Efficacy of these treatments for severe depression and other conditions

Another review of multiple studies about online CBT found that the treatment significantly reduced anxiety and depression symptoms and was influential in treating PTSD, panic disorder, and specific phobias. If you feel more comfortable telling your symptoms and experiences in person, you might consider signing up for an online therapy platform such as BetterHelp.