Electroconvulsive therapy (ECT) is a safe and effective treatment for major depression, mania, and certain forms of schizophrenia. Developed almost sixty years ago — and sometimes misunderstood and neglected — it still is a valuable treatment.
In treating major depression, ECT provides highly efficacious and rapid relief of serious symptoms, like depressed mood, delusions, suicidal drive, poor appetite, and weight loss. For depressed people with psychosis or extensive physiological disturbance (poor appetite, constipation, lack of energy, or severe insomnia), it is often given as a first-line treatment. At times, its effect is dramatic and life-saving.
The modern form of ECT is much improved over earlier versions. The patient is given a short-acting anesthetic by IV, which induces unconsciousness. The muscle relaxant succinylcholine (Anectine) is administered, electrodes are applied to the head, and a measured dose of electrical current generated by a special machine is delivered, inducing a generalized seizure. The seizure is a therapeutic brain event with little or no bodily expression because of the muscle relaxant. The patient then wakes up some minutes later in a recovery room and rapidly recovers.
The treatment is usually given three times a week — anywhere from six to 12 or more treatments — in inpatient settings, although it can also be given to outpatients.
Memory loss and even confusion can occur, especially when the electrodes are applied to both sides of the head (bilaterally) — as opposed to one side only. These effects mostly clear up within two weeks after the end of treatment, and completely within months. Some patients may never recover some memory of the time around treatment. Although critics have charged that ECT causes irreversible brain damage, this has not been supported by studies and clinical experience. ECT involves brief, general anesthesia, which always carries a small risk. Patients need to be monitored closely when confused.