Schizophrenia is a severe mental health condition that affects a person’s thoughts, feelings, and behavior. For treatment-resistant schizophrenia, doctors may recommend ECT along with other medical therapies.
Schizophrenia is a serious, complex, long-term mental health condition that can affect a person’s quality of life, including social interactions. Common symptoms include delusions, hallucinations, disorganized thinking, and lack of motivation.
Psychiatrists typically recommend psychotherapy and antipsychotic medications to treat schizophrenia. Doctors may recommend ECT if those treatments are ineffective.
In ECT, doctors induce a brief seizure using mild electrical currents. Health experts believe that stimulating such generalized seizures can help improve schizophrenia symptoms.
This article provides an overview of ECT for schizophrenia, including the benefits, procedure, and success rate, as well as alternative treatments.
Doctors often recommend ECT for people with depressive disorders. They may also recommend it for people with schizophrenia when other treatment options fail. Studies suggest that it is a safe and effective treatment for schizophrenia that results in minimal cognitive side effects.
The American Psychiatric Association (APA) notes that ECT may offer significant benefits for people who need a rapid treatment response because of the severity of their condition, such as people at risk of suicide.
The APA guidelines state that ECT is generally safe for pregnant people, adolescents, and older adults.
Before a person undergoes ECT, doctors will conduct a thorough medical examination and psychiatric assessment. They may also order a blood test and an electrocardiogram (ECG) to check the heart.
Doctors need written consent before performing ECT, either from the person with schizophrenia or from a court-appointed guardian if the person is too unwell to consent.
Doctors should fully inform the person with schizophrenia and their family or guardian about the procedure before people give consent. A person should also have the opportunity to discuss all treatment options with a doctor before consenting to ECT.
The person having ECT should not eat for
ECT can take place in an inpatient or outpatient clinic. A team of medical professionals — including a psychiatrist, an anesthesiologist, and a nurse — usually oversees the procedure. An ECT session is usually painless and lasts 5–10 minutes.
Doctors
- The doctor administers general anesthesia intravenously — through a vein, usually in the arm.
- Once the anesthesia takes effect and the person is unconscious, the doctor gives a muscle relaxant to reduce the risk of muscular contractions.
- The doctor places an oxygen mask over the person’s face and a mouth guard in their mouth.
- The doctor places two padded electrodes on one or both temples.
- The doctor presses a button on a machine to deliver an electrical current to the brain. The electrical current triggers a brief seizure lasting 15–70 seconds.
- After the session, the medical team will monitor the person in a recovery area before discharging them.
A few minutes after an ECT session, the anesthesia should start to wear off. A person should be able to go home the same day.
People with schizophrenia typically need 2–3 sessions per week and 6–12 treatments total. The treatment schedule depends on how severe the symptoms and how a person responds.
A 2021 study suggests that people who receive ECT for schizophrenia are less likely to be readmitted to the hospital than people who do not. Readmission rates 3 and 6 months after initial hospitalization were:
- 11.37% and 17.95%, respectively, for people who had ECT
- 18.79% and 29.36%, respectively, for those who did not have ECT
The researchers concluded that people who received 9 or more ECT treatments were less likely to need readmission.
As with other medical procedures, people with schizophrenia may experience side effects after undergoing ECT.
Memory loss after ECT is common, but some people find that their memories gradually return as they recover. People may experience the following side effects immediately after treatment:
- nausea
- headache
- confusion
- drowsiness
- muscle aches
- loss of appetite
In rare cases, people may experience:
- prolonged seizures
- injuries to their mouth, teeth, or muscles
- confusion between treatments
- restlessness or agitation
In a
- attention
- orientation
- memory
- language
- visuospatial construction
Many patients had deficits in those areas immediately after having ECT, but after 3 months, their cognitive abilities had returned to normal. Language was the least affected cognitive ability.
It is worth noting that not everyone who had ECT experienced significant cognitive deficits. Some people’s measurements fell within the normal range both immediately after ECT and 3 months later.
A doctor may recommend any of the following brain stimulation therapies to treat schizophrenia. To date, there is little reliable evidence that these therapies are as effective as or more effective than ECT for treating schizophrenia. Further research is underway, so they could become standard treatments in the future.
Transcranial magnetic stimulation (TMS)
TMS is a painless, noninvasive procedure that uses magnetic fields to stimulate the brain’s cerebral cortex. This can help improve brain centers that schizophrenia affects and relieve symptoms. TMS treatment does not involve anesthesia, and a session may last around 20–30 minutes.
The authors of a 2015 review concluded that there is insufficient evidence that TMS effectively treats schizophrenia symptoms.
Learn about TMS for depression here.
Deep brain stimulation (DBS)
- an electrode
- an extensible wire
- an implantable pulse generator (IPG) the size of a stopwatch
The surgeon inserts the lead through a small opening in the skull and positions the tip within the specific area of the brain responsible for schizophrenia symptoms.
The surgeon passes the wire under the head, neck, and shoulder skin to connect the lead to the IPG. They then implant the IPG under the skin near the collarbone.
The IPG will constantly send electrical impulses to deep areas of the brain, block abnormal electrical signals, and improve symptoms.
Vagus nerve stimulation (VNS)
VNS transmits regular, mild electrical impulses to the brain through the vagus nerve, the longest of the 12 cranial nerves.
Research from 2015 suggests that VNS may be a promising method for targeting hippocampal hyperactivity and improving cognition in schizophrenia.
The surgeon will make two small incisions. The first incision, on the upper left side of the chest, will accommodate the pulse generator.
A second incision on the left side of the lower neck contains the wires that connect the pulse generator to the vagus nerve. The procedure takes 45–90 minutes.
Magnetic seizure therapy (MST)
Research from 2021 found that MST was as effective as ECT in improving psychotic symptoms but caused fewer cognitive impairments.
Doctors recommend ECT for treatment-resistant schizophrenia, which is schizophrenia that fails to respond to
Up to 30% of people with schizophrenia may not respond well to standard antipsychotic medications.
Research from 2019 found that
A 2021 review of studies conducted between 2000–2021 reported that 18 out of 35 studies found a positive effect of ECT on negative symptoms, such as lack of motivation, desire, and emotion.
Doctors may recommend ECT if medications and psychosocial therapies do not effectively treat a person’s schizophrenia.
Research suggests that ECT is successful for many people living with schizophrenia.
While ECT sessions are usually short, the doctor may recommend 2–3 sessions per week to produce the desired effect.
The doctor may recommend other brain stimulation therapies, such as TMS, DBS, VNS, and MST, for people who cannot tolerate ECT.