Electroconvulsive therapy (ECT) is an effective treatment for clinical depression (or major depression), as well as in some forms of recurrent or chronic clinical depression with one big caveat — nearly everyone who receives this treatment has some sort of memory loss.
During ECT, a person is placed under general anesthesia so that they will not feel anything from the procedure. Electrodes are then placed on the person’s head and an electrical current is applied to the brain. This results in the creation of a brief seizure that lasts for several seconds. The number of ECT sessions necessary for a therapeutic effect varies by person and severity of the depression. However, most people undergo between six and 12 sessions.
Electroconvulsive therapy can be sometimes considered as an initial treatment when a person’s depression has resulted in psychosis (such as a person having hallucinations), catatonic stupor (e.g., severe reduction in movement and speech), or extreme suicidality. ECT is also offered to depressed patients who do not respond to psychiatric medication after many different medications have been tried over the course of some time — usually years. An alternative to ECT in the psychotically depressed patient is a combination of an antidepressant with an antipsychotic medication, along with psychotherapy.
There remains considerable confusion about electroconvulsive therapy, resulting in many patients being frightened of the procedure. Part of this is based on portrayals of ECT, including in the movie “One Flew Over the Cuckoo’s Nest,” as inhumane. The earliest uses of electroconvulsive therapy used much higher doses of electricity and were administered without anesthesia. This led to physical harm in the patient and other serious side effects. ECT as it is practiced today is a much safer treatment for depression. Because of the anesthesia, patients do not experience any pain associated with the procedure.
As with medication, ECT does have some side effects. The most prominent is an impairment in memory functioning, or memory loss. Persons undergoing ECT frequently do not remember the procedures, or events leading up to the procedure. Additionally, they may become confused, and not remember events surrounding their hospitalization.
Others have more serious memory problems, losing significant portions of their memory of the past. While this memory impairment can be quite dramatic, it is generally transient, with many people having full memory functioning several weeks after the last session. However, some people never fully recover from this memory loss. At this time, professionals cannot tell a person ahead of time what kind of memory impairment they will suffer from this procedure, how severe it will be, and whether it will be temporary or permanent in nature. Nearly everybody who undergoes the ECT procedure will suffer from sort of memory loss.
Following ECT, many patients are given an antidepressant to help prevent a relapse of depression. Other patients receive maintenance ECT. This treatment consists of periodic ECT sessions. Because of the limited number of sessions in maintenance therapy, it is usually conducted on an outpatient basis.
Other physical treatments that have been employed in the treatment of depression, include bright light therapy, sleep deprivation, and rTMS (repetitive transcranial magnetic stimulation). Bright light therapy utilizing special lighting in a person’s home or office has an important role in Seasonal Affective Disorder (SAD).
Electroconvulsive therapy is generally considered the treatment of last resort for people who are experiencing severe, debilitating and chronic depression (also known as treatment-resistant depression) that doesn’t appear to be helped by medications and psychotherapy. Many people each year find relief from their depression because of the procedure, but at the cost of some memory loss. ECT maintenance treatments — going in for annual ECT treatment — is nearly always needed for most people, as the effects of ECT appear not to be long-lasting.