Electroshock therapy, also known as electroconvulsive therapy (ECT), is a treatment for severe major depression, bipolar depression, and other mental health conditions.

Psychiatrists may recommend ECT when a person does not respond well to other treatments. ECT uses electric currents to stimulate a person’s brain to induce a controlled seizure. Researchers do not exactly know how ECT works, but one theory is that it could regulate neurotransmitter activity.

This article looks at how ECT works, whether it is an effective treatment, and its controversial history. It also discusses some alternative neuromodulation treatments.

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When a person receives ECT treatment, a doctor will first administer general anesthesia and a muscle relaxant. The doctor will then wait for the anesthesia to take effect before they begin the electrical stimulation. They will also place a bite block in the person’s mouth to stop them from biting their tongue.

The stimulus usually consists of a brief electrical pulse, which is one in the range of 0.5–2.0 milliseconds (ms). Doctors may sometimes use ultra-brief pulses, which are under 0.5 ms. The pulse reaches the brain through electrodes on the head and induces a controlled seizure. The ECT team monitors the person’s seizure throughout the procedure with electroencephalography (EEG).

An ECT session may last for about 1 hour, which includes 15–20 minutes for the procedure and 20–30 minutes of recovery time. A person may receive ECT two or three times a week for a total of between six and 12 sessions.

The frequency and number of sessions will differ among individuals depending on the severity of the condition and the effectiveness of treatment.

After the session, a person must not drive for 24 hours. They should also try to arrange for someone to stay with them until they go to sleep.

Although ECT is an effective treatment, a person will need to continue their medication and receive more ECT sessions to prevent a relapse.

Researchers do not fully understand how ECT works, but they have observed several changes in people’s brains after this treatment.

Their observations suggest that ECT may have several effects, including:

  • changing brain blood flow
  • briefly altering the permeability of the blood-brain barrier
  • modifying the electrical profile of the brain
  • promoting the action of genes that play a role in certain brain cell growth
  • stimulating the release of hormones
  • stimulating the release of neurotransmitters, particularly serotonin and dopamine

Doctors may recommend ECT for people with various mental health conditions, including:

People with heart, lung, or nervous system problems usually cannot receive ECT.

The reason for this is that an ECT-induced seizure can elevate blood pressure, intracranial pressure, and oxygen consumption, affecting heart and breathing rate.

People respond differently to ECT, and some individuals may experience more serious side effects than others.

Common side effects of ECT include:

  • nausea
  • fatigue
  • headaches
  • confusion
  • minor memory loss of events before ECT session

More serious but rare side effects include irregular heart and breathing rate. Some people may also experience more memory loss than others.

ECT is one of the oldest and most controversial psychiatric treatments. While some countries ban its use, others use it widely.

The negative perceptions of ECT originate from previous misuse and the historical lack of consistent administration of general anesthetics or muscle relaxants. Furthermore, when healthcare professionals first introduced ECT, many people did not consent to the therapy. As a result, they often received ECT against their will or did not know the full extent of its side effects.

The media has tended to portray ECT in a negative light — for example, in the film version of “One Flew over the Cuckoo’s Nest.” However, attitudes toward ECT are changing, and people are beginning to view it as an effective treatment for those with mental health conditions that are resistant to medication and therapy.

Newer neuromodulation techniques, including transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS), can also be effective treatments for severe depression and other mental health conditions. However, TMS is the only technique that researchers have directly compared with ECT, and ECT produced better outcomes for people with depression.

ECT is an effective treatment option for people who do not feel better after taking medication or going through therapy. For most people, it is a low risk procedure that has a powerful antidepressant effect, which could last for years.

When people live with suicidal ideation, or suicidal thoughts and feelings, ECT can provide relief. Researchers found that 38% of people completely stopped having suicidal thoughts after 1 week of ECT. After treatment completion, 81% of people reported no longer thinking about suicide.

This procedure also results in good outcomes for pregnant or older people who cannot take psychotropic medications, such as mood stabilizers.

TMS and VNS are two neuromodulation techniques that are an alternative to ECT.

TMS

TMS utilizes magnetic fields that rapidly alternate. It stimulates the brain without inducing a seizure, and the person is awake during the procedure. People can expect to receive TMS four to five times a week, for a total of 4–6 weeks.

The side effects of TMS, which tend to be mild, may include:

  • headaches
  • twitching muscles
  • pain at the site of stimulation

VNS

Researchers originally developed VNS to treat seizure conditions. However, they realized that it was also an effective treatment for depression. Before stimulating the vagus nerve, a doctor places an electrode under the skin of a person’s chest.

VNS causes complications in approximately 2% of cases. The possible complications include:

ECT can be an effective therapy for treatment-resistant mental health conditions, including depression, schizophrenia, and catatonia.

It is a very old psychiatric treatment and has a controversial history. However, doctors recommend ECT for some people because it is low risk and carries few side effects.

Researchers are still not sure how ECT works, but they understand that it has many effects on the brain, including increasing blood flow and triggering the release of neurotransmitters and hormones.

Newer neuromodulation techniques include TMS, which uses alternating magnetic fields to stimulate the brain, and VNS, which stimulates the vagus nerve with electrical pulses.