Understanding Electroconvulsive Therapy (ECT)
What is Electroconvulsive Therapy (ECT)?
Electroconvulsive Therapy (ECT) is a very safe and effective medical treatment for certain psychiatric disorders. It is considered a form of brain neuromodulation. The treatment involves delivery of a small amount of electrical energy to your brain to induce a short seizure. Most people, on average, receive between 6 to 12 treatments for their illness to improve. While ECT will be helpful for many patients, ECT is not a panacea or cure. A response to ECT is never guaranteed.
What indications or diagnoses might benefit from ECT?
- Major Depression including acute depression, moderate to severe depression, treatment-resistant depression, suicidal depression, and psychotic depression
- Bipolar Depression
- Bipolar Mania
- Schizoaffective Disorder
- Other illnesses may also benefit
Who can get ECT in California?
Any adult age 18 or older with an appropriate clinical diagnosis and who is capable of giving voluntary informed consent can receive ECT. Others, including adolescents between 13 and 17 years of age, may receive ECT after special reviews and legal procedures are followed. Nobody capable of providing informed consent can be given ECT against their will.
Where is ECT performed?
ECT is performed at the UCLA Resnick Neuropsychiatric Hospital in the ECT Treatment Suite.
Is ECT an Inpatient (in hospital) or Outpatient procedure?
Most patients who undergo ECT are outpatients. However, for severely ill patients, ECT can be done or started in the hospital. There is no requirement to be hospitalized. However, for outpatients, there are driving and other restrictions.
What is needed to be considered for ECT?
Patients cannot self-refer. A patient must be under the care of a Psychiatrist or Physician who makes a referral for a consultation with an ECT Psychiatrist.
What happens during the ECT consultation?
The patient's current medical and psychiatric history are reviewed. The ECT procedure is explained. The patient's ability to understand their illness, the procedure and possible risks and benefits are evaluated. If a person is considered a candidate for treatment, further work-up and preparation are discussed. The ECT team will coordinate care and treatment with the patient's doctors. Involvement, with patient permission, of family, friends, or significant others is encouraged.
How does ECT work?
During ECT, the brain is stimulated by a small amount of electrical current. The electrical current produces a modified seizure, which affects the entire brain, including centers that control mood, appetite and sleep. ECT is done under medical monitoring and with general anesthesia. Researchers believe that ECT corrects the biological abnormalities that underlie severe psychiatric disorders. More than one treatment, however, is needed to achieve these positive effects. An average of 6 to 12 repeated treatments (also referred to as an "index series") is needed in order to achieve sustained improvement. However, there is no set number and treatments are individualized to the person. Response rates vary depending on the type of illness and other factors. Following a course of treatment, patients feel more like themselves again and are able to work and lead productive lives. Often, family members, doctors, or nurses may notice improvement before the patient.
What happens after ECT?
After completing a successful ECT course with significant resolution of depressive symptoms, a person will need to continue a form of treatment to remain well. These options to prevent relapse would be tailored to the individual's goals, tolerance and needs. Options for relapse prevention include combination medications, maintenance ECT (which is ECT at the lowest frequency needed to stay well), a combination of medications and ECT, and/or other forms of talk therapy.
What are the side-effects from ECT?
In general, the most common side effects are headache, muscle soreness, nausea and difficulties with short-term memory. Of these side effects, perhaps the most feared side effect is memory difficulty. Typically, mild short-term memory loss accompanies the treatment and resolves in the hours post-treatment. In rare cases, long-term memory may also be affected. If any long-term memory problems occur, they almost always resolve a few weeks after the completion of an entire course of ECT. Within a few weeks after ECT, your ability to learn and remember new information usually returns to normal.
What are the medical risks from ECT?
As with any other medical procedure, ECT may pose some risks. Overall, ECT is one of the safest procedures done under general anesthesia. The ECT procedure is also brief. Time asleep is about 5-10 minutes and the usual duration of a seizure is between 30 to 60 seconds, on average. Both the risks and benefits of this procedure are explained during the ECT consultation by the ECT Psychiatrist and at treatment by the Anesthesiologist. With advances in anesthesia and modern delivery of electrical energy, ECT is a safe and relatively comfortable experience.
For more information about ECT or referral to UCLA Resnick Neuropsychiatric Hospital Services, please call us at 1-800-825-9989.