Electroconvulsive therapy (ECT)

3-minute read

What is ECT?

Electroconvulsive therapy (ECT) is a relatively safe and effective treatment for some severe mental health conditions that are considered life threatening. ECT involves passing brief, carefully controlled electric currents through the brain. It is used to treat certain psychiatric disorders.

ECT should only be used with the informed consent of the person being treated.

When is ECT used?

ECT is used to treat:

severe forms of depression
severe manic symptoms, including bipolar disorder

ECT is useful because it works more quickly than other treatments such as medicines or therapy. It is used cautiously because it is more intrusive than other treatments and may cause memory problems. Since the effects are short-lived, long-term treatment with antidepressant or mood-stabilising medicine is usually needed.

How is ECT given?

ECT is administered by a psychiatrist and an anaesthetist. A general anaesthetic is given before the ECT procedure. Electrodes are then placed on one (unilateral) or both (bilateral) sides of the scalp to deliver a small electric current in order to trigger a brief seizure. The seizure temporarily changes the chemistry in the brain and improves some symptoms quickly.

The person being treated doesn’t feel discomfort and usually wakes up 5 to 10 minutes after the procedure.

Typically, treatments are given 2 to 3 times a week. Most people show improvement after 3 to 4 sessions, though some may need 20 to 25, depending on the nature of the illness and the response to treatment.

Informed consent

Before ECT can be used, the person being treated must give informed consent to show that they understand the treatment, as well as the risks and benefits. If they are unable to give consent because of their mental health, their psychiatrist will seek a decision from the state’s mental health authority in consultation with family or carers.

A person who gives consent can withdraw it at any time.

What are the side effects of ECT?

The main side effect of ECT is short-term memory loss. It can also cause varying degrees of memory problems, including long-term and even permanent memory loss.

People can also feel disorientated and confused straight after ECT. Other side effects include heart rhythm disturbances, low blood pressure, headaches, nausea and sore jaw muscles.

Alternatives to ECT

Alternatives to ECT currently available in Australia include:

transcranial magnetic stimulation (TMS) — a coil that creates a magnetic field is held next to the head to stimulate the relevant parts of the brain
transcranial direct current stimulation (tDCS) — a brain stimulation technique that uses a constant, low intensity current delivered through electrodes placed on the scalp to subtly modify brain activity

ECT may also be considered if other approaches, such as antidepressants or talking therapies such as cognitive behaviour therapy (CBT), have not been effective.