Electroconvulsive therapy, also known as ECT, often elicits fearful associations and skepticism in the popular imagination. Its portrayal in the media certainly has a role to play. In the movie One Flew Over the Cuckoo's Nest, ECT was depicted as a coercive treatment to punish the main character and change his personality. Ernest Hemingway, the famous American writer known for his masculine writing style, received ECT for severe depression and paranoia before he tragically ended his life.
In reality, working as a mental health nurse, I have seen many patients benefit from ECT and regain functioning as a result. Usually, they had failed repeated trials of psychotropic medications until ECT was suggested as a last resort. Given the climbing rates of mental illness and its dire consequences if left untreated, this article is aimed at dispelling common myths about ECT and introducing it as a safe, effective treatment.
History of ECT
In the early 20th century, ECT was first used on patients with schizophrenia who subsequently showed resolution of their symptoms. During this period, some patients suffered bone fractures, prolonged memory loss, and extreme anxiety related to the procedure, which caused its popularity to dwindle in the 1970s.
Nowadays, however, ECT is highly safe with few reports of major complications.
It can be used for a variety of psychiatric and neurological conditions, including but not limited to major depression, dementia, delusional disorders, and acute mania. In addition, ECT may be considered for pregnant women and older adults who are unable to tolerate psychotropic medications. Most patients need 6-12 treatments to achieve symptom relief. Some patients need maintenance ECT for the rest of their lives to prevent recurrence of symptoms and deterioration.
How does ECT work and how to prepare for it?
ECT works by inducing a controlled seizure to stimulate the brain. Although the exact mechanism of action remains unclear, several theories have been proposed to explain ECT’s therapeutic effects. It is suggested that seizure activity increases the release of certain neurotransmitters and hormones, enhances transmission of these chemicals in the brain, promotes the generation of new neurons, and alters connectivity between different parts of the brain.
Prior to each ECT session, the patient will hold medications with anti-seizure effects. They will remove any assistive device they wear – such as dentures, glasses, and hearing aids – to prevent injuries during treatment. In addition, the patient needs to abstain from food and liquids (except for a sip of water with necessary medications) to avoid aspiration under general anesthesia.
What to expect during and after ECT?
During ECT, the patient will go to sleep and not feel anything. Electrodes are placed on their head to deliver a small electric current that generates a brief seizure. A muscle relaxant is given into the patient’s vein to control the degree of seizure and reduce the intensity of bodily movement. A mouth guard is placed in the patient’s mouth to keep them from involuntarily biting their teeth or tongue. After the treatment, which typically takes about 20 minutes, the patient is transferred to a recovery area until they become awake and stable. When ECT is performed as an outpatient procedure, the patient is picked up by their family member or support worker who will monitor them for 24 hours to ensure safety.
Although generally safe and well-tolerated, ECT can cause certain side effects. The most common ones are nausea, headache, confusion, muscle stiffness, and memory loss. Some of these side effects are short-lived and resolve on their own. Others may persist for weeks after the patient finishes a course of ECT. One such example is detailed by Terri Cheney, a mental health advocate and former lawyer, in her blog The Bipolar Lens - she suffered severe memory loss after 3 months of ECT, which forced her to quit her practice in law but eventually paved the way for her finding a new career in writing. At our ECT clinic, we advise patients to avoid driving, traveling alone, or making important life decisions immediately after ECT.
Conclusion
Working in psychiatry has made me acutely aware of the heavy toll a serious mental illness can take on a person’s life, impacting their self-identity, career, and social relations. Thus, it is my hope that with information provided in this article, readers now have a better grasp of what ECT involves and see it as a potentially lifesaving treatment for people with debilitating mental health symptoms. I envision a future where stereotypical, outdated views of ECT are replaced by increased awareness of its efficacy and safety, leading to wider acceptance and accessibility to benefit those in need.
If you or someone you love is having thoughts of suicide, please call 988 in the U.S. and Canada for immediate support that is available 24/7.
Sources
Payne, N. A., & Prudic, J. (2009). Electroconvulsive therapy: Part I. A perspective on the evolution and current practice of ECT. Journal of Psychiatric Practice, 15(5), 346–368. https://doi.org/10.1097/01.pra.0000361277.65468.ef
Suleman, R. (2020). A Brief History of Electroconvulsive Therapy. American Journal of Psychiatry Residents’ Journal, 16(1), 6–6. https://doi.org/10.1176/appi.ajp-rj.2020.160103
Kellner, C. (2022). Overview of electroconvulsive therapy (ECT) for adults. In UpToDate.
Cheney, T. (2023). How Electroshock Therapy Changed My Life. Psychology Today.
Markel, H. (2020, July 21). How mental health struggles wrote Ernest Hemingway’s final chapter. PBS News Hour. Retrieved from https://www.pbs.org/newshour/health/how-mental-health-struggles-wrote-ernest-hemingways-final-chapter Assessed and Endorsed by the MedReport Medical Review Board