For severe depression or treatment-resistant depression, ECT may be the answer.

For some people, electroconvulsive therapy (ECT) conjures up frightening images of pain, suffering and even broken bones. Indeed, although it's much safer today, its use in treating depression and other mental illnesses remains controversial, 70 years after it was first introduced.

In certain cases, though, ECT may be the best treatment option, sometimes offering fast and dramatic benefits. In severe depression, for instance, the risk of suicide may be high, requiring treatment that can quickly alleviate symptoms. And for some people, antidepressant medications aren't effective.

But deciding whether ECT is a good option for you or a family member can be a struggle. Should ECT be your first treatment choice? Should you try medications and psychotherapy instead? And what about the risks to memory? Understanding more about the potential benefits and risks can help in your decision.

ECT's Prior Bad Reputation

Electroconvulsive therapy is a procedure in which electrical currents are passed through the brain to trigger a seizure. Although researchers don't fully understand just how ECT works, it's thought that the seizure causes changes in the brain chemistry. Given in a series over several weeks, ECT can help alleviate the symptoms of certain mental illnesses.

ECT is most commonly recommended for these conditions:

• Severe depression, with psychosis, suicidal intent or refusal to eat
• Mania, in cases where there hasn't been a good response to medications
• Schizophrenia, when symptoms are severe or medications aren't sufficient

Today, although the procedure isn't risk-free, it's a far cry from the old methods that helped give ECT a bad reputation — one that lingers on. Its use began in the early 1930s, when researchers injected chemicals to induce seizures in people with mental illnesses. The chemicals were soon replaced by electrical currents. The success of ECT propelled it into widespread and sometimes indiscriminate use over the next few decades, before the advent in the 1950s of medications to treat depression.

In those early years, ECT could be painful and downright dangerous. It was administered with neither anesthesia nor muscle relaxants, and the electrical current was much higher. Powerful seizures racked the body with a force that could break bones. The images of doctors and nurses holding people down as they endured violent seizures were captured in books and films and have become nearly indelible.

ECT is different today, although it still does pose a risk of side effects and complications, such as memory loss and confusion. The procedure has become refined, with precisely calculated electrical currents administered in a controlled medical setting.

Preparing for ECT

Before having your first ECT treatment, you need a complete physical examination, in addition to a psychiatric evaluation. You may also have a consultation with an anesthesiologist to assess the risks of anesthesia. These exams help make sure that ECT is safe for you.

A pre-ECT evaluation usually includes:

• A medical history
• A physical examination
• Basic blood tests
• An electrocardiogram (ECG) to check for certain types of heart disease

You must also sign informed consent documents authorizing the use of ECT. Consent means that you understand the procedure and its risks and benefits. If you're unable to provide written consent, state or local laws may allow the appointment of a legal guardian who can approve the procedure on your behalf if deemed medically necessary.

continue: How ECT Works

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Reviewed: 03/2006