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Understanding the Risks of ECT

Although ECT is generally safe, there are known risks and side effects. Among them:

• Cognitive impairment. Immediately after an ECT treatment, you may experience a period of confusion. You may not know where you are or why you're there. Impairment generally lasts from a few minutes to several hours. The duration of confusion often gets longer with each succeeding treatment. Occasionally, the confusion may last several days. It typically goes away when the course of treatment is over.
• Memory loss. ECT can affect memory in several ways. You may have trouble remembering events that occurred before treatment began, a condition known as retrograde amnesia. For most, retrograde amnesia obscures memory of the weeks or months leading up to treatment, although some people do have problems with longer-term memories from years previous, as well. You may also have trouble recalling events that occurred during the course of your treatment. And some people have trouble with memory of events that occur even after ECT has stopped. These memory problems usually improve within a couple months, but for some, the memory loss is permanent.
• Medical complications. As with any type of medical procedure, especially one in which anesthesia is used, there are risks of medical complications. The pre-ECT medical evaluation helps identify medical conditions that may put you at increased risk of complications, enabling doctors to take special precautions. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. ECT also carries a very small risk of death, about the same as with other procedures in which anesthesia is used.
• Physical issues. On the days you have an ECT treatment, you may experience nausea, vomiting, headache, muscle ache or jaw pain. These are common and generally can be treated effectively with medications.

Deciding if it's right for you

Some 100,000 Americans have ECT treatments each year. But how do you know if it's right for you? Talking to your doctors, family members and others who've had ECT can help you make an informed decision.

Here are some issues to consider:

• You need quick relief of symptoms. Perhaps your symptoms are severe enough that there's a fear you may attempt suicide. In some cases of severe depression, people refuse food and fluids to the point where their physical health is at risk. Occasionally, people with severe depression experience delusions or hallucinations that put them at risk of hurting themselves or others. In these situations, when you may not have time to wait for antidepressants to take effect, ECT may offer faster benefits.
• Other treatments aren't effective. When you've tried antidepressants, and possibly psychotherapy, to no avail, ECT may be your next best option.
• You can't take antidepressants. Some people are extremely sensitive to antidepressants and experience significant side effects even with the lowest possible doses. In addition, women who are pregnant may not want to risk exposing their unborn baby to psychiatric medications.
• You didn't respond well to other treatments in the past. If you've had depression or other mental illnesses in the past and treatment wasn't effective, it may be time to consider ECT for the latest recurrence.
• You've already done well with ECT. If you were treated with ECT in the past and it worked well, you may decide that it makes sense to stick with a proven treatment if your condition recurs.

Despite its dark past, ECT is now a relatively safe and effective procedure. ECT can often work faster than psychiatric medications or psychotherapy can, and it can help when other treatments have failed. The risks are real but usually small.

next: Electroconvulsive Therapy (ECT): One Woman's Journey

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Reviewed: 03/2006