Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a treatment for severe symptoms of depression, mania and catatonia. This section explains what ECT is, when it is used and your rights to refuse this treatment.

Overview

  • ECT uses an electrical current which passes through your brain. The current causes a fit or seizure.
  • Health professionals use ECT to treat severe depression, catatonia or mania. It may be considered to treat schizophrenia, but this is uncommon.
  • Doctors may offer you ECT if other treatments don’t work or your symptoms are very bad.
  • Your doctor may offer you ECT if they think that it will improve your symptoms. You don’t have to agree to treatment if you don’t want it. Even if you are under the Mental Health Act.
  • Doctors can give you ECT without your agreement in an emergency or if it is in your best interests.
  • 2 health professionals have to agree that you should have ECT if you lack mental capacity to consent to treatment whilst under the Mental Health Act.
  • You can make an advance decision to refuse ECT in the future. An advanced decision is legally binding. It has to be followed, unless it is an emergency.

What is ECT?

What is ECT?

ECT is a treatment for some mental illnesses. ECT is when electrical currents are passed through your brain to cause seizures or fits. The seizures or fits can be very small and minor. They usually last less than a minute. There are 2 types of ECT.

  • Bilateral ECT. This is when the current is passed through both sides of your head.
  • Unilateral ECT. This is when the current is only on one side of your head.

ECT will last about 5 to 10 minutes. With extra time for preparation and recovery.

Before you get ECT, doctors will give you muscle-relaxing medicine. And give you general anaesthetic. This means you will be asleep during the treatment.

Doctors are not sure how ECT works. But they think that ECT changes the way the chemicals in your brain work. Changes to these chemicals seem to have a positive effect on some mental health symptoms. It is thought that ECT can make these chemicals work better in your brain. This can sometimes help treat mental health symptoms.

You often get short courses of ECT treatment of about 6-12 sessions. ECT is usually given twice a week. Sometimes it is given once every 2 weeks or once a month to stop symptoms from coming back.

What is ECT used for?

What is ECT used for?

ECT should be used to gain fast and short-term improvement for mental health conditions. It can be used to treat the following mental health conditions.

  • Severe depressive illness.
  • A long or severe episode of mania. Common symptoms of mania are delusional thoughts and behaviours.
  • Catatonia. Common symptoms of catatonia are not responding to anyone or anything. And slow movement.
  • Schizophrenia.

Doctors should offer you other treatments such as, medication and talking treatments before ECT. The National Institute of Health and Clinical Excellence (NICE) recommends that ECT should only be used when:

  • all other treatments have not worked, or
  • your illness may be life-threatening.

But ECT should not be used as a long-term treatment to prevent a depressive episode coming back. And it should not be used in the general management of schizophrenia.

Doctors can offer ECT to treat schizophrenia but it’s not common. And not recommended by NICE. NICE think that more research is needed.

Research suggests that ECT may be effective to treat certain types of schizophrenia and reduce relapse. And that ECT used with antipsychotic medication may be more effective than medication alone. But results are not conclusive.

You can find more information about NICE in the ‘further reading’ section at the bottom of this page.

You can find more information about:

  • depression by clicking here.
  • bipolar disorder by clicking here.
  • schizophrenia by clicking here.

What are the side effects?

Are there side effects?

ECT is generally safe. But ECT can cause side effects. These effects may be short-term or long-term side effects.

What are short-term side effects?

Short-term side-effects you may get on the day of your treatment are:

  • headache,
  • sore muscles,
  • feeling sick,
  • confusion,
  • memory loss,
  • increased heart rate and blood pressure,
  • a seizure that lasts a long time,
  • difficulty breathing,
  • difficulty talking,
  • nerve damage in your arms, hands, legs or feet. This will affect how your muscles move or feel.

What are long-term side effects?

Long-term side effects may be:

  • memory loss,
  • difficulty making new memories or
  • heart problems, in rare cases.

But for some people it is not clear if memory problems experienced are caused by ECT or if they are a symptom of long-term mental illness. This is because memory problems are quite common for people with mental health conditions.

How will my side effects be monitored?

Healthcare professionals will assess you after each session of ECT. This assessment will check if:

  • you have responded to treatment, and
  • you have any side effects.

You won’t need to have any more ECT sessions if you have responded well to treatment.

If you have any serious side effects doctors should stop the treatment.

The way that you process information should also be monitored regularly. This is called your cognition. As a minimum, it should be assessed at the end of each course of treatment.

Can ECT cause brain damage?

There is no evidence to suggest that ECT causes brain damage.

Are there higher risk groups of people for ECT?

Doctors need to think carefully before they give you ECT if you are:

  • pregnant,
  • elderly, or
  • under 18 years old.

This is because you may be more likely to get side effects.

Is there a risk if I have general anaesthetic?

There is no evidence that having ECT is more dangerous than any other procedure needing a general anaesthetic. An anaesthetist will assess you before your ECT treatment starts.

Death from general anaesthetic is rare. It is around 1 death for every 100,000 who are given a general anaesthetic. But the risk is higher if:

  • you are older, or
  • you have an existing health condition such as heart disease.

Do I have to agree to ECT?

Can I have ECT?

Your doctor should offer you ECT if they think that it is a good option for you. They should explain the pros and cons of treatment. Your relatives, carers or an advocate should be involved in the discussion too.

If you don’t want ECT you don’t have to have it. You should not be pressured by your doctor to have ECT if you don’t want it.

You can stop ECT at any time if you decide to try it and don’t like it.

Can I have ECT if I have had it before?

Your doctor can talk to you about having more ECT if you have catatonia or mania. And you have responded well to ECT.

If you have had ECT before and you didn’t respond well, it should only be offered to you again if they have tried everything else. And they have spoken to you about the risks and benefits of ECT.

Doctors may talk to your carer, advocate or relatives to help you decide if you want more ECT. They can explain ECT to you.

Can doctors give me ECT if I don’t consent to it?

In certain situations, doctors can give you ECT without you agreeing to it. These are if you:

  • lack the mental capacity to consent, or
  • need emergency treatment under the Mental Health Act. See below for more information.

What does lacking mental capacity to consent mean?

Doctors can give you ECT if you lack the mental capacity to make a decision about your treatment. This is called making a ‘best interests’ decision.’ A best interest can only be considered for you if you lack mental capacity in line with the Mental Capacity Act.

A best interest’s decision to give you ECT can be made, even if you are not detained under the Mental Health Act. But this is very rare. Doctors should consider your view’s and views of your family, carers. They also need to consider the views of people who can make a legal decision on your behalf before they decide to treat you.

If you don’t have anyone who can give their opinion about your treatment you should have an independent mental capacity advocate (IMCA) to help. An IMCA is free to use and don’t work for the NHS.

The Court of Protection can make a decision if there are disagreements about if ECT would be in your best interests.

But ECT shouldn’t be given if you have a valid advance decision in place to refuse ECT. See below for more information.

You can find more information about

• Mental capacity and mental illness by clicking here.
• Mental Health Act by clicking here.
• Advocacy by clicking here.

Can I be given ECT if I am detained under the Mental Health Act?

You can accept or refuse ECT if you have the mental capacity to make the decision about your treatment.

A medical professional will certify that you have agreed to the treatment and that you have the mental capacity to make this decision. But you don’t have the right to refuse most other mental health treatments whilst detained in hospital under the Mental Health Act.

What happens if I have the capacity to refuse treatment, but it is an emergency?

If you are in hospital under the Mental Health Act 1983 (MHA) you can have ECT without your consent if:

  • there is a real risk to your life,
  • to stop you from becoming seriously unwell, or
  • to stop you becoming seriously unwell and a risk to yourself or others.

What happens if I don’t have the mental capacity to consent to ECT?

A Second Opinion Appointed Doctor (SOAD) must agree with your doctor that it is in your best interests to have ECT if you lack mental capacity.

The SOAD will:

  • interview you,
  • talk about your treatment with the doctor in charge of your care, and
  • talk to a registered nurse and a non-medical professional who are involved in your treatment.

The SOAD must write down if they think you should have ECT or not. Their decision doesn’t have to be shared with you if they think it would cause mental or physical harm to you or anyone else. But in most cases, you should be able to see the SOAD’s decision.

There are 2 situations when the SOAD will not be able to agree that you need ECT.

  • You have a valid advance decision refusing ECT.
  • Someone has the legal right to make treatment decisions for you and they refuse it on your behalf.

People who are able to make legal decisions on your behalf are:

  • an attorney. You would have an attorney if you made a lasting power of attorney for your welfare decisions,
  • a Deputy. Your deputy will be appointed by the Court of Protection, or
  • The Court of Protection.

You can find more information about:

• Mental Health Act by clicking here.
• Mental Capacity Act by clicking here.
• Advocacy by clicking here.
• Money matters – Dealing with someone else’s money by clicking here.

What is an advance decision?

An advance decision is legally binding. It gives you the legal right to refuse specific medical treatment in future when you may not have the mental capacity to make the decision for yourself at that time. An advanced decision can’t be used for anything else.

You can make an advance decision if you don’t want ECT in the future.

We recommend that you write down your advance decision and share it with your relatives, carers and your healthcare team. It is your responsibility to make people aware of your advance decision.

If you make a valid advance decision refusing ECT then doctors can only give you ECT in an emergency situation to:

  • save your life, or
  • stop you getting very unwell from something that can’t be reversed.

To make a valid advance decision you have to:

  • be over 18 and
  • have mental capacity to make the decision.

You can find more about ‘Planning your care – advance statements and advance decisions’ by clicking here.

What should my doctor tell me about ECT?

What should my doctor tell me about ECT?

Your doctor should tell you about the risks and possible benefits of having ECT.

The National Institute of Clinical Excellence (NICE) recommends that your doctor should give you an information leaflet to help you decide if you want ECT.

The leaflets should:

  • be based on evidence,
  • include information about the risks of ECT,
  • explain alternative treatments, and
  • be available in different languages and formats.

Ask your doctor for information on ECT.

Your doctor should document both the risks and benefits of ECT. As part of the assessment the doctor will think about:

  • the risks of having an anaesthetic,
  • whether you have other illnesses,
  • the possible side effects of ECT, and
  • the risks of not having ECT.

What are the risks if I decide not to have ECT?

Risks might be:

  • your mental health deteriorates,
  • you are a serious risk to yourself, or
  • you are a serious risk to other people.

Talk to your doctor if you have concerns about ECT.

Further reading

NICE (National Institute of Health and Clinical Excellence)

NICE guidelines are evidence-based recommendations for health and care in England. They set out the care and services suitable for most people with a specific condition or need, and people in particular circumstances or settings. Health professionals should use them to help them to make decisions about patient health, care and wellbeing.

NICE has written a booklet on ECT for patients, carers, advocates and the general public. You can get this booklet from:

www.nice.org.uk/guidance/ta59/resources/electroconvulsive-therapy-ect-371522989.

You can read the full NICE Guidance on the use of electroconvulsive therapy here: www.nice.org.uk/guidance/ta59.

 

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