Sunrise Health - September 23, 2019

The term “shock therapy” may conjure images of a painful or barbaric treatment, but this common misconception, which has been partly fueled by inaccurate depictions in movies and on television, is far from reality. In fact, electroconvulsive therapy (ECT) is a very safe and effective treatment that can help those living with mental illness improve their quality of life.

ECT can help those with severe depression and some other serious mood disorders, such as bipolar disorder and schizophrenia, when other treatments, including antidepressants and talk therapy, have failed. Nevertheless, many experts believe the procedure is underutilized.

Outdated perceptions of how the procedure is performed have contributed to its long, varied and somewhat stigmatized past. Here’s what you need to know about one of the most misunderstood practices in psychiatry.

What happens during ECT?

For patients undergoing ECT, small electrical currents are passed through electrodes to their brain. People are not awake and alert during this procedure. It’s performed under general anesthesia.

It’s still unclear exactly how ECT helps. Some studies involving both people and animals suggest that the procedure may trigger the release of certain brain chemicals, such as endorphins, dopamine and serotonin. Research also suggests ECT could alter the volume, thickness, connectivity or metabolic activity of certain parts of the brain. Essentially, the procedure may change brain chemistry in ways that help reverse the symptoms of depression and other mood disorders.

How the procedure has evolved

Over the years, ECT has been refined but it hasn’t changed dramatically.

Since seizures can cause full-body convulsions, patients undergoing ECT are also given a muscle relaxant prior to the procedure. This wasn’t done when ECT treatments were first introduced in the 1930s, which increased the likelihood that patients would suffer broken bones and other bodily injuries during these convulsions. Still, the cinematic portrayals of ECT have been far from realistic.

In fact, from start to finish, the entire procedure — including recovery from anesthesia — takes about one hour. During this time, patients’ vital signs are closely monitored by an anesthesiologist.

Who might benefit from ECT

Electroconvulsive therapy is typically considered when outpatient therapies, such as medication or talk therapy, have failed. In some cases, it’s an option for people with certain mood disorders who can’t tolerate their medication and for some pregnant women whose medication may harm their developing fetus.

Conditions that may be treated with ECT include:

  • Major depressive disorder, a common condition that can lead to profound sadness, severe low mood and loss of interest in activities that were once pleasurable
  • Schizophrenia, a serious mental disorder that may cause hallucinations, delusions and other severe symptoms
  • Bipolar disorder, which is characterized by unusual shifts in mood, energy levels and the ability to perform routine daily tasks
  • Catatonia, a disorder that affects one’s ability to speak and move, which can result in a total loss of movement or dangerous, uncontrolled movements, as well as refusal to eat or drink and the inability to respond to pain or even simple commands

It’s not a cure, but the vast majority of those with severe depression who receive ECT benefit from the treatment. A study by the American Psychiatric Association showed that 77 percent of participants with schizophrenia improved after undergoing ECT.

Unlike drugs and talk therapy which may improve symptoms over time, ECT can help alleviate symptoms relatively quickly. Some patients begin to see improvements in their symptoms after two to four sessions. It’s especially beneficial to those with suicidal thoughts and other urgent mental health conditions.

If you or a loved one is having suicidal thoughts, call 911 or the National Suicide Prevention Lifeline at (800) 273-8255 right away.

Weighing the risks and benefits

Aside from being very safe and fast-acting, ECT is associated with fewer side effects than some antidepressant medications.

The anesthesia and paralyzing agents administered during ECT minimize the likelihood that patients will have pain or suffer an injury, but like any medical procedure, there are some risks involved. Typically, any memory loss sustained will improve in the days and weeks following the procedure.

Other side effects that can result from ECT include:

  • Headaches, muscle aches or jaw pain
  • Confusion
  • Nausea

During ECT, patients’ heart rate and blood pressure increase. This could lead to stroke or heart attack. Keep in mind, heart complications stemming from ECT are relatively rare. These problems are usually limited to older people with heart disease.

Other risks associated with the procedure include:

  • Aspiration pneumonia
  • Injuries to the tongue, lips or cheeks, due to clenching of the jaw during treatment
  • Complications linked to anesthesia

ECT can be done as an outpatient procedure but patients shouldn’t drive after their sessions. The memory loss associated with the procedure and the side effects of the anesthesia make driving extremely dangerous.

Relapse is possible

The goal of ECT is to provide immediate relief from mental illness symptoms but some patients may need to undergo multiple procedures. In most cases, six to 12 treatments are needed. Patients usually undergo three sessions per week.

More research is needed on the long-term effects of ECT as well as relapse after treatment. Research suggests that people’s genetics may play a role in how well they respond to this treatment.

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