Reprinted from "Treatments: What Works?" issue of Visions Journal, 2015, 11 (1), p. 22
Electroconvulsive therapy (ECT) has been, and continues to be, among the most effective treatments in psychiatry. Over 80% of those patients receiving ECT can expect significant improvement or recovery from their depressive symptoms.1 In comparison, improvement rate with either antidepressant medication or a course of cognitive psychotherapy is 55% to 60%.1
It’s unfortunate that ECT remains so misunderstood—so shrouded in fear. ECT is nothing like the frightening experience depicted in the movies! It’s a modern medical procedure. It is administered under the supervision of a psychiatrist and anesthesiologist, with other health care professionals (e.g., nurses) available and present. ECT can be an inpatient or outpatient procedure.
The effectiveness of ECT is based on inducing a brain electrical seizure. Brain electrical seizures result in a number of neurochemical and hormonal changes in the brain. These chemical and hormonal brain changes from the ECT treatments are the likely cause in the improvement or resolution of depressive symptoms.
The procedure is quite safe and painless.1 The patient is anesthetized and given muscle relaxants. With the use of anesthetic, the brain seizure doesn’t cause the body to convulse.2 Less electricity is used, and it’s administered as a very quick pulse (up to 8 seconds) rather than a steady stream.2-3 The equipment is computerized and has much improved control over the administration of the electrical current.3
In many ways ECT is very similar to the electrical stimulation given to restabilize the heart rate in people with heart rhythm irregularities. Indeed, the same anesthesiologist typically administers both ECT and the heart-stimulating versions on the same day in the same area of the hospital.
ECT should not be considered as a last resort in the treatment of depression. Rather, it is a treatment option for any patient with a chronic depression that is not improving.
About the author
Ron is Medical Director of the Mood Disorders Association of BC Psychiatric Urgent Care Program
Kennedy, S.H., Milev, R., Giacobbe, P. et al. (2009). Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies [research report]. Journal of Affective Disorders, 117, S44-S53. www.canmat.org/resources/CANMAT%20Depression%20Guidelines%202009.pdf
HealthLinkBC. (2013). Electroconvulsive therapy (ECT). www.healthlinkbc.ca/healthtopics/content.asp?hwid=ty1541
Minnesota National Alliance on Mental Health. (2011). Electroconvulsive therapy (ECT) [fact sheet]. www.namihelps.org/Electroconvulsive-Therapy.pdf