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Electroconvulsive therapy (ECT) has been around since the late 1930s, and it has been clear from the beginning that it is an effective treatment for patients with certain types of mental illness, including severe depression, severe mania, and catatonia.
Despite this potential to provide dramatic relief for patients, stigma surrounding the procedure—partially fostered by misleading portrayals of ECT in Hollywood productions as well as discouragement from other sources—has influenced many who might benefit greatly from ECT to shy away from getting the treatment. However, with the help of advocacy from prominent figures who have had profoundly positive experiences with ECT, such as Kitty Dukakis and Carrie Fisher, more and more people are choosing ECT.
As a practitioner and advocate of ECT myself, I believe that is important to spread the truth about ECT—including both its benefits and its risks. Below, I have addressed some of the most common questions I am asked about ECT.
ECT is done under general anesthesia—meaning that the patient is asleep—so the patient doesn’t feel any pain during the procedure and is also unaware while the procedure is taking place. Generally, the only potential discomforts for patients occur when they get a little pinprick before the procedure to insert the IV for the anesthesia, and after the first one or two treatments, when some patients experience mild headaches.
Many years ago, before we started using general anesthesia and muscle relaxants, there was a risk of injuring bones, joints, or teeth because of the convulsions associated with the seizure induced by ECT. Now, however, by using anesthesia and a muscle relaxant, patients remain still throughout the procedure and significant complications are rare.
ECT does induce a seizure. This is intentional, as it is believed that this seizure helps to reset the brain and bring a patient back to their baseline—the person they used to be before they became sick. However, it is important to note that this induced seizure doesn’t cause a seizure disorder (i.e., future seizures).
In fact, there is evidence that this induced seizure can even be used to stop a prolonged seizure. It’s as though the induced seizure is acting as a vaccine, causing the brain to fix itself.
Numerous imaging studies over the years have consistently demonstrated that ECT doesn’t cause any structural damage to the brain. In fact, there is evidence that ECT causes growth in the hippocampus, and some people have postulated that this neurogenesis (new nerve growth) is an instrumental part of how ECT helps patients. It’s noteworthy that many antidepressant medications also cause some neurogenesis.
It can. There are two main types of memory loss that we see. One is anterograde memory, which is the ability to remember new things. However, that is a very short-lived side effect of ECT. In fact, when we test people two months or so after they have had ECT treatment, they typically test better on anterograde memory and cognitive function assessments than they did prior to having ECT treatment.
This doesn’t mean that ECT is making people smarter. It means that ECT is helping to make people less depressed. When people are depressed, that has a profound effect on cognition and memory, and ECT can dramatically reduce symptoms of depression, including memory and cognition impacts.
The impact on retrograde memory—the ability to remember things that have already occurred—is a little less clear, with part of the issue being that retrograde memory is very difficult to test. The greatest risk appears to be for events that happened within a few months before ECT treatment. For instance, you wouldn’t forget who your daughter is, but you might forget the details of a play you attended three months ago. Sometimes, however, these details come back with prompting or with time. Rarely, some patients describe much more significant retrograde memory loss, but with advances in ECT, this is much less common and usually only occurs in cases of severe illness and long or repeated courses of ECT.
The type and amount of ECT appear to be factors in memory loss, so we try to be as conservative as possible when treating patients. Newer ECT techniques have helped by making it easier to protect memory. We discuss these factors and other risks and benefits with our patients before determining how to proceed, and we monitor memory throughout the course of treatment.
There is no known cure for depression, psychosis, or any other illnesses that ECT treats. The goal of ECT is to bring patients back to their baseline. Once we get them back to their baseline, our goal then is to keep them there, to keep them from relapsing. This can often involve an ECT taper, medications, and talk therapy support, although everyone is different.
ECT is administered involuntarily rarely and only when there is a court order. It’s important to note that of all the patients who are treated involuntarily, my experience has been that the majority are very grateful afterward.
I don’t think of ECT as a last resort anymore—the risk-benefit has shifted. It’s so much more comfortable, so much safer. It does have some side effects, but it is a safe procedure.
It is a very powerful tool in the toolbox. Save it for when it’s needed, and for some patients, especially those who have become very ill very quickly and are suicidal, that tool should be used much sooner.
There is no question that ECT works. We have more than 70 years of data to back up this claim. No other treatment has ever been shown to be more effective in the acute treatment of depression than ECT.
One of the beautiful things about ECT is that the more someone needs it to work, the more likely it is to work. The further someone is from their baseline—the way they used to be—the more they can count on ECT working for them.
With psychotic depression, a debilitating condition, response rates are around 85 to 90%. Catatonia, which is potentially life threatening, has a similar success rate, 80 to 90%.
It’s quite remarkable. ECT helps bring people back to their true self.
Stephen J. Seiner, MD, is director of the Psychiatric Neurotherapeutics Program, the Electroconvulsive Therapy (ECT) Service, and Medical Student Education at McLean Hospital. McLean’s ECT Service performs over 7,000 treatments a year, making it one of the largest ECT centers in the country.
Learn more about receiving ECT treatment at McLean Hospital.