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ECT General Information

History of ECT

Formerly known as "shock therapy," modern day electroconvulsive therapy (ECT) bears little resemblance to its frightening presentations in the media. The topic of ECT has sparked feelings of fear and barbaric machinations since its introduction in 1938. Bad press and an inaccurate portrayal in the media have fueled this misconception. In fact, ECT is an extremely safe and effective treatment for certain psychiatric disorders. Today ECT is most commonly used to treat patients with very severe depression. ECT is often the safest, fastest and most effective treatment available to treat this illness. ECT is also occasionally used in the treatment of patients with manic illness, schizophrenia, catatonia and severe symptoms of Parkinson's disease.

When it was first introduced, ECT was the only effective treatment available for severe psychiatric disorders. Hence, it was at times given to patients in the hope that "something that might work is better than doing nothing." While today many of these patients are treated differently, there were no other options available at that time. The techniques of administering the treatment have also changed very much since its introduction.

Before Receiving ECT

Most ECT in the United States of America is given only with the consent of the patient. If you do not want to have ECT, it is highly unlikely that you will receive it against your will. You must sign an informed consent form that specifically conforms to requirements set out by this state. In addition, another psychiatrist or neurologist must see you in consultation and agree that ECT is the best treatment for you and that you are capable of giving informed consent.

ECT is given as a course of treatments. The average number needed to successfully treat severe depression is between six and 12. It is highly unusual to feel better after only one treatment. In fact, most people do not begin to notice any change until they have had at least four treatments.

If you agree to have ECT, the treatments are usually given three times a week - usually Monday, Wednesday and Friday. You must not eat or drink anything after midnight prior to your scheduled treatment. Do not take your usual morning medicine before ECT unless your doctor tells you to do so. Please try to refrain from smoking on the morning prior to your treatment.

The Procedure

Although you are asleep during the treatment, preparations are necessary while you are still awake. An intravenous line is started shortly before you are treated. Electrodes are placed on your head for administering the treatment and also for recording your EEG (electrical measure of brain activity). Electrodes are placed on your chest for monitoring your EKG (cardiogram). A blood pressure cuff is wrapped around your arm for monitoring your blood pressure during the treatment. A monitor is placed on your finger to measure the oxygen in your blood. When everything is connected, the machine is tested to ensure that it is set properly for you.

Much of what is described above is not remembered by the patient. Next, a medicine (e.g., Brevital®, methohexital) is injected through the intravenous line, which induces sleep for five to 10 minutes. When you are asleep, a muscle relaxant (Anectine®, succinylcholine) is injected to prevent movement during the treatment. It may cause a mild amount of muscle soreness, but it will pass. During this time, you are being assisted in your breathing with 100% oxygen. When you are completely asleep and your muscles are completely relaxed, the treatment is given.

A small amount of electrical energy is applied to your head for a few seconds. It is off more than it is on. If you were watching the treatment instead of receiving it, you would notice your toes wiggling but little else. You continue to receive oxygen until you awaken.

After Treatment

When you awaken, you will be very confused. This is partially due to the anesthesia and partially due to the treatment. With most people the confusion passes in a few hours. Occasionally, someone may be confused for the entire day. The duration of the confusion cannot be predicted. You may have a headache from the treatment, generally caused by the muscles of your forehead contracting very tightly - like a tension headache. Tylenol® or aspirin usually relieves the headache.

You will also most likely experience some memory loss following the completion of the treatments. Recent events, dates, names of friends, public events, addresses, telephone numbers and computer passwords may be forgotten. This memory loss should gradually reverse itself over the course of several weeks or months, but you may never remember many things that happened to you during your hospitalization. A very few people report some memory problems for years. "Exercising your memory" is the best way for you to help your memory return. You may have read about brain damage with ECT. The scientific evidence concerning ECT as it is done today has not demonstrated evidence of brain damage.

ECT is an extremely effective form of treatment. It is often safer and more effective than the available medications for the treatment of depression. It is without a doubt safer than no treatment at all. If you have any questions about ECT, please discuss them with your physician.

For More Information

For general information about ECT Services at Cedars-Sinai, click here.

For more information about ECT services at Cedars-Sinai, please contact: