Electroconvulsive therapy (ECT)

ECT may be used as a treatment in major depression, mania, catatonia and occasionally for schizophrenia. All of these conditions are now most commonly treated through medications, counselling and psychological.
Some people have reported preferring to have the option of a short course of ECT instead of years of medication taking. It is on this basis of respecting individual patient choice that has kept this procedure in use (despite the efforts of some groups to have it banned), and available to those that want or (in extreme cases) need it.

ECT is used mainly within NHS hospitals (although some private hospitals may use the procedure) for those with more severe conditions and who are not responding to conventional treatments for major depression (change in mood), mania (extreme elevation of mood - highs), and catatonia (disturbances in movement), and for some cases of schizophrenia.

What does it involve

ECT is when an electrical current is passed through a person, usually by electrodes attached onto the head (electrodes can both be on one side, or one electrode either side near the temples), so that the electrical current travels through the brain causing a fit (seizure). ECT is not done while you are awake – it is given under a general anaesthetic and with muscle relaxants.

ECT treatment is most often given in short courses, twice a week for 3-6 weeks (so usually involving 6-12 sessions in total), although maintenance may be necessary with a session given fortnightly or monthly in order to help keep people stable.

NICE recommends the use of ECT for these illnesses only when; ECT would allow for fast or long term improvement of symptoms in severe cases after all other treatment options have failed, where the current illness situation is seen as life-threatening and other treatments have not provided sufficient therapeutic benefit

Side effects

The most common side effect of ECT is short and long term memory loss, which is found to affect about 1/3 of all those who have the treatment. Memory loss usually involves the time just before the treatment, but older memories can be affected too. Memory loss may last days or weeks after the final treatment, but has been noted in a number of cases to last several months and longer.

The treatment has also been known to affect heart rhythm and blood pressure in more extreme cases. Research also suggests that the risks from ECT are greater for pregnant women and older and younger individuals in particular.

Potential patients also need to know the health risks associated with the use of the general anaesthetic during ECT - as the use of general anaesthetic carries a risk to patients for any procedure where it is used.

Risks and consequences of not taking the ECT treatment (psychotic relapse, section, suicide, a danger to others for example) should also be thought about, as the affects of the treatment are known to happen quicker than for other types of treatment (such as some anti-depressants which may take a couple of months to begin working).

You should be assessed and checked for signs of side effects of the treatment between / before each new session of ECT (i.e. whether you are showing any signs of memory loss). On any sign of a side effect from the ECT, treatment should be stopped immediately.

Do I have to have ECT if it is recommended for me?

It has been suggested that many people may have consented to ECT treatment, under pressure from their doctors, or who are unaware that those with mental capacity can refuse to have the treatment and opt for another way of managing mental illness, such as with medications or psychological therapies.

ECT should never be imposed on any person who is considered to have mental capacity who does not consent to have the procedure done, even if under section at the time that treatment is being considered. Doctors involved in the discussions about the ECT should not put pressure on patients to consent to the treatment, and you do have the right to change your mind about providing consent to treatment at anytime.

In cases where a patient may be experiencing a crisis / episode of severe illness and is too ill to be able to make such a decision about consent, ECT may only be used without the patients consent when approval is given by a Second Opinion Approved Doctor (SOAD) and if

  • there is a real risk to life
  • to prevent serious deterioration of the condition
  • to alleviate suffering
  • or if the treatment is needed to prevent violence or danger to the patient or others.

If you do not want to receive ECT, even in emergencies, one way that this wish can be communicated to the medical professionals who may be deciding whether to approve use of the treatment for you, during times of severe illness, is through the use of an advance directive.

An advance directive is a written statement of how you wish to be treated, which is written and witnessed (by your GP and another individual) during a time when you are stable, in case there comes a time when you are unable to make decisions for yourself.

National Advice Service Factsheets

The information on this page is taken from the NAS factsheet, which you can download in pdf format and print for individual use.

Electroconvulsive Therapy (ECT) factsheet