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Understanding the ECT Procedure

The procedure takes about 10 or 15 minutes, with added time for preparation and recovery. ECT may be performed while you're hospitalized or as an outpatient procedure. In either case, it's done under brief general anesthesia. Your health care team will tell you how long you must avoid food and drinks before the procedure.

When it's time for the procedure, you may have a brief physical exam to check your heart and lungs. An intravenous (IV) catheter is inserted in your arm or hand through which medications or fluids can be given. During the procedure, monitors constantly check your heart, blood pressure and oxygen use. Oxygen may be given through an oxygen mask.

Doctors place electrode pads, each about the size of a silver dollar, on your head. ECT can be unilateral, in which only one side of the brain is subject to electricity, or bilateral, in which both sides of the brain receive electrical currents.

An anesthetic is injected in the IV to make you unconscious and unaware of the procedure. A muscle relaxant is also injected to help prevent your body from convulsing violently during the seizure. A blood pressure cuff is placed around a forearm or ankle area, preventing the muscle relaxant from paralyzing those particular muscles. When the procedure begins, the doctor can make sure you're actually having a seizure by watching for movement in that one hand or foot.

In addition to the anesthetic and muscle relaxant, you may also be given other medications, depending on any health conditions you have or your previous reactions to ECT. You also may be given a mouth guard to help protect your teeth and tongue from injury.

When you're asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electrical current to pass through the electrodes to your brain, producing a seizure that usually lasts 30 to 60 seconds.

Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you're experiencing a seizure may be a rhythmic movement of a foot or a hand. But internally, activity in your brain increases dramatically — recorded by an electroencephalogram (EEG) in much the same way as an ECG measures your heart activity. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.

A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You're taken to a recovery area, where you'll continue to be monitored. Upon awakening, you may experience a period of confusion lasting from a few minutes to a few hours or more.

Seeing the Benefits of ECT

No one knows for certain how ECT helps treat depression. What is known, though, is that many chemical aspects of brain functioning are altered during and after seizure activity. Researchers theorize that when ECT is administered on a regular basis, these chemical changes build upon one another, somehow reducing symptoms of depression or other mental illnesses.

That's why it's important to have multiple treatments. Most people who receive ECT have treatments three times a week, usually for two to four weeks. ECT is effective in about 80 percent of people who receive the full course.

Its beneficial effects often aren't immediate, but many people begin to notice an improvement in their symptoms after two or three treatments. Response to medications, on the other hand, can take several weeks.

Even after your symptoms improve, though, you likely will need ongoing treatment to prevent a recurrence. Options include antidepressants or other psychiatric medications, psychotherapy and even periodic ECT, known as maintenance treatment, for a year or more.

continue: The Risks of ECT

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Reviewed: 03/2006