Depression: Electroconvulsive Therapy

What conditions does electroconvulsive therapy treat?

Electroconvulsive therapy (also called ECT) may help people who have the following conditions:

• Severe depression with insomnia (trouble sleeping), weight change, feelings of hopelessness or guilt, and thoughts of suicide (hurting or killing yourself) or homicide (hurting or killing someone else).
• Severe depression that does not respond to antidepressants (medicines used to treat depression) or counseling.
• Severe depression in patients who can't take antidepressants.
• Severe mania that does not respond to medicines. Symptoms of severe mania may include talking too much, insomnia, weight loss or impulsive behavior.

How does ECT work? It is believed that ECT works by using an electrical shock to cause a seizure (a short period of irregular brain activity). This seizure releases many chemicals in the brain. These chemicals, called neurotransmitters, deliver messages from one brain cell to another. The release of these chemicals makes the brain cells work better. A person's mood will improve when his or her brain cells and chemical messengers work better.

What steps are taken to prepare a person for ECT treatment?

First, a doctor will do a physical exam to make sure you're physically able to handle the treatment. If you are, you will meet with an anesthesiologist, a doctor who specializes in giving anesthesia. Anesthesia is when medicine is used to put you in a sleep-like state. The anesthesiologist will examine your heart and lungs to see if it is safe for you to have anesthesia. You may need to have some blood tests and an electrocardiogram (a test showing the rhythm of your heart) before your first ECT treatment.

How are the ECT treatments given?

ECT may be given during a hospital stay, or a person can go to a hospital just for the treatment and then go home. ECT is given up to 3 times a week. Usually no more than 12 treatments are needed. Treatment is given by a psychiatrist.

Before each treatment, an intravenous (IV) line will be started so medicine can be put directly into your blood. You will be given an anesthetic (medicine to put you into a sleep-like state) and a medicine to relax your muscles. Your heart rate, blood pressure and breathing will be watched closely. After you are asleep, an electrical shock will be applied to your head. The shock will last only 1 or 2 seconds and will make your brain have a seizure. This seizure is controlled by medicines so that your body doesn't move when you have the seizure.

You will wake up within 5 to 10 minutes after the treatment and will be taken to a recovery room to be watched. When you are fully awake, you can eat and drink, get dressed, and return to your hospital room or go home.