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BluePages Depression Information

Electroconvulsive Therapy

Our rating
Severe depression in the short term 2 smilies: This treatment is useful. It is supported by scientific evidence as effective, but the evidence is not as strong.

What is it?

In ECT treatment, an electric current is passed into the brain to produce a seizure. The current can be given to one or both sides of the brain.

ECT is given when a person is under general anaesthetic. Muscle relaxant medication is also used, so that the person’s body does not show the jerky movements usually seen in an epileptic seizure. ECT treatment is given by specialist doctors in hospitals.

ECT treatment varies in different countries. In Australia, ECT is usually given from one to three times a week. A course of ECT involves 8-12 treatments on average.

After a successful course of ECT, further treatment is usually given to maintain the improvement and to help prevent relapse. The person may then have further sessions of ECT, medication or psychological treatment.

ECT is mainly used for people who are severely affected by depression or other psychiatric disorders. It can be used for people who can’t take medication for health reasons. It can work very quickly and may help when other treatments have not worked.

How does it work?

ECT causes physical and chemical changes in the brain but it is not clear how ECT works to relieve depression.

Is it effective?

Research on ECT has involved severely depressed people in hospital. There has been little research on ECT for people with mild or moderate depression.

Some studies have compared ECT to sham ECT. In sham ECT, only the general anaesthetic is given to people but they do not know if they have received ECT or not. In some of these studies, real ECT produced better results than sham ECT, at least in the short term. Studies have also found that ECT is more effective than some antidepressant medication and Transcranial Magnetic Stimulation in the short term.

ECT can be effective for severely depressed people who have not responded to other treatments such as antidepressant medications.

Some experts argue that the research on ECT and depression is weak. Others say that for people with severe depression, the evidence shows that ECT can be effective, at least in the short term.

More research is needed on the effects of ECT and whether the effects last.

Are there any disadvantages?

There are three main types of side effects commonly cited for ECT.

  1. some people experience short term side effects like headaches, muscles aches or nausea.

  2. ECT can cause memory problems. Research suggests this may affect at least a third of people who receive ECT. There is conflicting evidence as to how long these memory problems last. Some researchers say it occurs only immediately following treatment. Other researchers say it can last a few weeks and some say it can be permanent.

    People who receive ECT commonly report losing memories of past events. There is also some evidence that ECT also can cause problems in forming new memories for some people.

  3. Less commonly, ECT may cause serious physical problems and even death. Some of these risks are due to the need to have a general anaesthetic and muscle relaxant medications.

  4. People having ECT may also experience emotional distress related to the stigma and controversy that still surrounds this treatment.

Where do you get it?

ECT is given in public and private hospitals. It is supervised by a psychiatrist who has special training and accreditation to perform ECT.

Recommendation

ECT is an effective treatment for severe depression in the short term. Given its disadvantages, it may be most useful where a fast improvement is needed, such as where

  • all other treatments have failed or can’t be used for health reasons
  • where there is a persistent risk that a person will take their own life
  • where the depression is life-threatening because the person has stopped eating or drinking.

Key references

  • The Royal Australian and New Zealand College of Psychiatrists Position Statement 74 March 2014. Electroconvulsive Therapy (ECT). Available online https://www.ranzcp.org/Files/Resources/College_Statements/Position_Statements/74-Electroconvulsive-Therapy-GC2012-3.aspx or achived on 20 March 2015 http://www.webcitation.org/6X9oyeL3X
  • UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003; 361: 799-808.
  • Dunne RA, McLoughlin DM. Systematic review and meta-analysis of bifrontal electroconvulsive therapy versus bilateral and unilateral electroconvulsive therapy in depression. World Journal Biological Psychiatry. 2012; 13:248-58.
  • Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biological Psychiatry. 2010; 68:568-77.
  • Berlim MT, Van den Eynde F, Daskalakis ZJ. Efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (rTMS) versus electroconvulsive therapy (ECT) for major depression: a systematic review and meta-analysis of randomized trials. Depression and Anxiety. 2013; 30: 614-23.
  • Read, J. & Bentall, R. The effectiveness of electroconvulsive therapy: a literature review. Epidemiologia e psichiatria sociale. 2010; 19: 333-47.

For more detailed information about ECT, please see: http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/ect.aspx

This program aired on the SBS Insight program (24 Sept 2014) and includes conversations with people who have experienced ECT, as well as opinions from researchers and health professionals: http://www.sbs.com.au/news/insight/tvepisode/electroshock

This online peer discussion forum on BlueBoard includes posts from people who have had first-hand experiences with ECT: https://www.blueboard.anu.edu.au/showthread.php?t=19967

Last reviewed and updated: 26 March 2015