Electroconvulsive Therapy — or ECT as it’s commonly known — is a brief medical procedure that involves applying short electrical bursts to the brain through external electrode pads on your head. These electrical bursts create a seizure, which has been shown to help relieve symptoms associated with severe depression. The entire procedure lasts about 15 minutes, although you may be in the hospital for about an hour to include time for prep and recovery from the treatment. ECT treatments are usually grouped together in 6 to 12 treatments at a time, generally given three times a week for 2 to 4 weeks. The number of treatments you will need depends on the severity of your symptoms and how rapidly they improve.
Before your first ECT treatment, your doctor needs to make sure the procedure is safe for you. Your psychiatrist will likely refer you to a physician for a physical examination, an electrocardiogram (ECG) to check your heart’s health, and laboratory tests (basic blood tests), to ensure there are no medical conditions that would preclude you from receiving ECT treatment. You may also be referred to an anesthesiologist to go over the risks associated with having anesthesia.
Modern electroconvulsive therapy is administered under general anesthesia, to ensure it is a safe and pain-free experience. You will therefore be unconscious during the treatment. As with any medical procedure involving general anesthesia, your doctor will talk to you about the associated risks and things to avoid before coming in for treatment.
Before ECT is administered, you’ll be given an IV (intravenous catheter), which is inserted in your arm or hand through which medications and fluids can be given. Sometimes you will be provided with a mouth guard to help ensure you don’t accidentally bite your tongue and help protect your teeth during the seizure. Some doctors also may administer oxygen through an oxygen mask.
Electrode pads will be placed on your head, which will be the pads that actually administer the small electrical impulse that will trigger a seizure in your brain. ECT can either be administered unilateral, in which only one side of the brain is subject to electricity, or bilateral, in which both sides of the brain receive electrical currents. An electroencephalogram (EEG) is also connected, which measures your brain activity. The EEG lets the doctor knows when a seizure is occurring, which can be confirmed by watching for movement in your hand or foot.
Short-acting, general anesthesia is injected in the IV to bring about unconsciousness, as well as a muscle relaxant to help prevent your body from convulsing during the seizure. A blood pressure cuff is placed around your forearm or ankle area, preventing the muscle relaxant from paralyzing those particular muscles.
After the general anesthesia has taken effect and you are fully unconscious — the doctor will test to make certain you are — the ECT procedure then begins. ECT is administered through an ECT machine, which allows the doctor to prescribe an exact amount of electrical impulse and duration that may differ somewhat from patient to patient depending upon the severity of their symptoms and other factors. The doctor presses a button on the machine which starts the ECT treatment cycle. The machine sends a small amount of electricity through the electrodes on your head, which then passes into your brain through your skull. This electricity produces a short seizure that lasts no more than 60 seconds.
You are unconscious during this process, so you don’t feel a thing. However, your brain is thought to be resetting itself because of the seizure, clearing its neuropathways and lifting the common symptoms of depression. Sudden, increased activity on the EEG lets the doctor know the start of a seizure, followed by a leveling off that shows the seizure is over.
A few minutes later, the effects of the anesthesia and muscle relaxant will begin to wear off. You’ll be taken to a recovery area, where you’re monitored and given time to recover from the anesthesia and procedure. Upon awakening, you may experience a period of confusion lasting from a few minutes to a few hours or more.