What is ECT?

Electroconvulsive therapy ('ECT' for short) involves giving a brief electric current to the brain to produce an epileptic fit. The electric current can be given to one side of the brain (unilateral ECT) or to both sides (bilateral ECT). ECT is given under a general anesthetic and with a muscular relaxant, so that the person receiving the treatment does not show any of the body jerks normally seen in an epileptic fit. ECT is only used for people who are severely depressed.

How does ECT work?

It is not known how ECT works. It is thought to increase the level of certain neurotransmitters (chemical messengers) in the brain. These neurotransmitters are in short supply in depression.

Is ECT effective?

ECT has been studied extensively in severely depressed hospitalized patients. In research studies, it produces better results than sham ECT (that is, when a general anesthetic only given). ECT is more effective than antidepressant drugs. It is even effective for many severely depressed people who have not responded to antidepressant drugs. Bilateral ECT is more effective than unilateral ECT and a stronger electric current also produces more improvement. There has been little research on ECT for people with mild or moderate depression.

Are there any disadvantages to ECT?

ECT can produce memory problems, but these tend to improve after a couple of months. The memory problems are greater with bilateral ECT and with a stronger electric current. Unfortunately, these are the types of ECT that are also most effective in treating depression. ECT requires having a general anesthetic which involves some small risk of death. Because of the bad public image of ECT, a person who receives it may feel some shame.

Where do you get ECT?

ECT is given by a psychiatrist in a hospital.

Recommendation

ECT is an effective treatment for severe depression. Given its disadvantages, it is only appropriate in extreme circumstances such as:

• when all other treatments have failed
• where there is a persistent risk that a person will harm themselves
• where the depression is life-threatening because the person has stopped eating or drinking.

Key references UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799-808.

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Reviewed: 03/2006