ECT is a treatment for a small number of severe mental illnesses. It was originally developed in the 1930s and was used widely during the 1950s and 1960s for a variety of conditions. It is now clear that ECT should only be used in a smaller number of more serious conditions.

ECT consists of passing an electrical current through the brain to produce an epileptic fit – hence the name, electro-convulsive. On the face of it, this sounds bizarre. Why should anyone ever have thought that this was a sensible way to treat a mental disorder? The idea developed from the observation that, in the days before there was any kind of effective medication, some people with depression or schizophrenia, and who also had epilepsy, seemed to feel better after having a fit. Research suggests that the effect is due to the fit rather than the electrical current.

Q     How often is it used? It is now used less often. Between 1985 and 2002 its use in England more than halved, possibly because of better psychological and drug treatments for depression.

Q     How does ECT work? No-one is certain how ECT works, and there are a number of theories.

Many doctors believe that severe depression is caused by problems with certain brain chemicals.  It is thought that ECT causes the release of these chemicals and, probably more importantly, makes the chemicals more likely to work and so help recovery. 

Recent research has suggested that ECT can stimulate the growth of new blood vessels in certain areas of the brain.

Q       Does ECT really work? It has been suggested that ECT works not because of the fit, but because of all the other things – like the extra attention and support and the anaesthetic – that happen to someone having it.

Several studies have compared standard ECT with "sham" or placebo ECT. In placebo ECT, the patient has exactly the same things done to them – including going to the ECT rooms and having the anaesthetic and muscle relaxant – but no electrical current is passed and there is no fit. In these studies, those patients who had standard ECT were much more likely to recover, and did so more quickly than those who had the placebo treatment. Those who didn't have adequate fits did less well than those who did.

Interestingly, a number of the patients having "sham" treatment recovered too, even though they were very unwell; it's clear that the extra support does have a benefit as might be expected. However, ECT has been shown to have an extra effect in severe depression – it seems, in the short term, to be more helpful than medication.

Pros & Cons of ECT Q     Who is ECT likely to help? The National Institute of Health and Clinical Excellence (NICE) have looked in detail at the use of ECT and have said that it should be used only in severe depression, severe mania or catatonia.  ECT is most often used for severe depression, usually only when other treatments have failed.

Q     Who is ECT unlikely to help? ECT is unlikely to help those with mild to moderate depression or most other psychiatric conditions. It has no role in the general treatment of schizophrenia.

Q     Why is it given when there are other treatments available? It would normally be offered if:

  • several different medications have been tried but have not helped
  • the side-effects of antidepressants are too severe
  • you have found ECT helpful in the past
  • your life is in danger because you are not eating or drinking enough
  • you are seriously considering suicide.
Q     What are the side effects of ECT? ECT is a major procedure involving, over a few weeks, several epileptic seizures and several anaesthetics.  It is used for people with severe illness who are very unwell and whose life may be in danger.  As with any treatment, ECT can cause a number of side-effects. Some of these are mild and some are more severe. 

Short-term

Many people complain of a headache immediately after ECT and of aching in their muscles. They may feel muzzy-headed and generally out of sorts, or even a bit sick. Some become distressed after the treatment and may be tearful or frightened during recovery.  For most people, however, these effects settle within a few hours, particularly with help and support from nursing staff, simple pain killers and some light refreshment.

There may be some temporary loss of memory for the time immediately before and after the ECT.

Older people may be quite confused for two or three hours after a treatment.  This can be reduced by changing the way the ECT is given (such as passing the current over only one side of the brain rather than across the whole brain). 

There is a small physical risk from having a general anaesthetic – death or serious injury occurs in about 1 in 50,000 treatments, around the same level of risk in dental aneasthesia.

Long-term

The greater concern is that of the long-term side effects, particularly memory problems. Surveys conducted by scientists and clinical staff usually find a low level of severe side-effects, maybe around 1 in 10.  User-led surveys have found much more, maybe in half of those having ECT. Some surveys conducted by those strongly against ECT say there are severe side-effects in everyone. 

Some difficulties with memory are probably present in everyone receiving ECT.  Most people find these memories return when the course of ECT has finished and a few weeks have passed. However, some people do complain that their memory has been permanently affected, that their memories never come back. It is not clear how much of this is due to the ECT and how much is due to the depressive illness or other factors. 

Some people have complained of more distressing experiences, such as feeling that their personalities have changed, that they have lost skills or that they are no longer the person they were before ECT. They say that they have never got over the experience and feel permanently harmed.

What seems to be generally agreed is that the more ECT someone is given, the more it is likely to affect their memory.

Q     What if ECT is not given?
  • You may take longer to recover.
  • If you are very depressed and are not eating or drinking enough, you may become physically ill or die.
  • There is an increased risk of suicide if your depression is severe and has not been helped by other treatments.
Q       What are the alternatives? If someone with severe depression declines ECT there are a number of possibilities.  The medication may be changed, new medication added or intensive psychotherapy offered, although this should already have been tried. Given time, some episodes of severe depression will get better on their own, although being severely depressed carries a significant risk of suicide.

 


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