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.

If you would like more advice or information you can contact our Advice and Information Service by clicking here.

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.

Need more advice?

If you need more advice or information you can contact our Advice and Information Service.

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 aren't 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's 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?

Is ECT safe and are there side-effects?

Is ECT safe?

The NHS say that ECT is generally safe. The death rate following ECT is less than that for other minor surgical procedures.

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. If they think it’s not safe for you to have an anaesthetic, you won’t have ECT.

Death from general anaesthetic is rare, with a rate of about 1 in every 100,000. But the risk is higher if:

  • you are older,
  • you have an existing health condition such as heart disease,
  • you’re having major or emergency surgery, or
  • if you were ill or injured before the operation.

Even then, the risk of dying is still low.

What side-effects can ECT cause?

ECT can cause some side-effects. Straight after ECT, you might experience some or all the following:

  • Tiredness until the effects of the anaesthetic wear off
  • Headache
  • Sickness or nausea
  • Aching in the jaw
  • Aching in the muscles
  • Confusion for a short time, particularly if you are elderly

You might experience memory problems after ECT. For most people the problems end within 2 months and they aren’t too distressing. But about 2 in every 100 people have severe memory problems after ECT.

About 1 in 5 people say that their memory was already causing them problems before having ETC, often because of their mental illness. So, it can be hard to say whether the problems were caused by the ETC, their illness, or both.

Very rarely, ECT can trigger a long seizure.

You can ask your doctor about possible side-effects before you have ECT.

Are there long-term side-effects?

Most people benefit from ECT, but a small amount of people report some longer-term side-effects.

ECT is only used when you are severely ill or other treatments haven’t worked. So, it can be difficult to know whether side-effects that people report are caused by ECT or the illness it’s treating.

Scientific research hasn’t found any evidence of increased risk of brain damage, epilepsy, stroke or dementia after ECT.

Some people experience longer term memory loss, and difficulty making new memories.

But some people do say after ECT they experience brain damage, a change in their personality, a loss of creativity, a lack of energy or drive, or lack of emotions. But studies about these things vary widely, depending on how they’re done.

How will my side-effects be monitored?

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

  • you’ve responded to treatment, and
  • you’ve any side-effects.

Your ETC sessions will stop if:

  • the aim of the treatment has been achieved, or
  • there are side-effects that healthcare professionals are concerned about.

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.

Are some people at greater risk if they have ECT?

Because of increased risks, doctors need to think carefully before they give you ECT if you’re:

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

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.

You will be medically examined to make sure you’re well enough to have the ECT.

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 further down this page 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 further down this page 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 capacity and mental illness by clicking here.
  • Mental Health Act by clicking here.
  • Advocacy 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.

 

Need more advice?

If you need more advice or information you can contact our Advice and Information Service.
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