Electroconvulsive Therapy

Our rating
For 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 electroconvulsive therapy (ECT), an electric current is passed through the brain to produce a brief 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?

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

Studies have compared ECT to sham ECT. In sham ECT, participants are placed under general anaesthetic but do not receive ECT. Overall, 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.

Some experts argue that the research on ECT and depression is weak and that the benefits may not last long. More research is needed on the long-term effectiveness of ECT.

ECT is usually only used for people with severe depression. There has been little research on ECT for people with mild or moderate depression.

Are there any disadvantages?

ECT can cause memory problems, such as losing memory of past events or problems in forming new memories. Research suggests that memory problems 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. 

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

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 delivered by a medical practitioner in a hospital setting. It is supervised by a psychiatrist who has special training and accreditation to perform ECT. If you are interested in ECT you should talk to your GP or other mental health care provider. 

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;
  • there is a persistent risk that a person will take their own life;
  • 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 www.ranzcp.org/news-policy/policy-submissions-reports/document-library/electroconvulsive-therapy-(ect) or archived on 20 March 2015 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.

Last reviewed and updated: 1 May 2019