Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is a psychiatric treatment in which carefully controlled electrical pulses are passed through the brain to produce a brief, controlled seizure (a temporary surge of electrical activity in the brain) under general anaesthesia.

During ECT, the electrical pulse lasts only a few seconds and triggers changes in brain chemistry — including the release of neurotransmitters (chemical messengers such as serotonin and dopamine) — that can rapidly reduce severe psychiatric symptoms. The patient is fully asleep and given muscle relaxants (medicines that prevent the body from convulsing visibly), so the physical signs of the seizure are very slight. A full course of ECT usually involves several sessions spread over a few weeks.

ECT is generally considered when a severe mental health condition has not responded well to medications and talking therapies, or when the situation is so urgent that a rapid response is needed. It is used across several psychiatric diagnoses.

• Severe major depression (profound low mood that does not improve with antidepressants), especially when the patient refuses food or is at immediate risk of self-harm
• Bipolar disorder — particularly a severe depressive episode or a prolonged manic episode (a state of extreme overactivity and elevated mood) that has not responded to other treatments
• Catatonia (a state in which a person becomes unresponsive or stuck in fixed positions) associated with various psychiatric or medical conditions
• Schizophrenia (a condition affecting how a person thinks, feels, and behaves) when symptoms are acute and severe and have not responded to antipsychotic medicines
• Postpartum psychosis (a rare but serious mental health crisis after childbirth) when rapid improvement is essential for the safety of mother and baby

ECT is not suitable for everyone. Doctors will carefully weigh the risks before recommending it in certain situations.

• Patients with a recent heart attack or unstable heart condition, because general anaesthesia carries added risk
• Patients with raised intracranial pressure (increased pressure inside the skull), such as from a brain tumour, because ECT can temporarily raise this pressure further
• Patients who cannot safely receive general anaesthesia for other medical reasons
• Pregnancy is not an absolute reason to avoid ECT — in some cases it is still considered — but extra precautions are taken and the decision is made very carefully

ECT is considered safe for most patients when carried out by a trained team, but like any procedure involving anaesthesia and a triggered seizure, it does carry recognised risks.

• Memory problems — the most commonly reported side effect; patients often notice difficulty remembering events around the time of treatment (short-term memory loss) and, less often, gaps in older memories; for most people this improves gradually after the course ends
• Confusion and disorientation immediately after waking from anaesthesia, usually clearing within minutes to hours
• Headache and muscle aches in the hours following a session, related to the anaesthetic and the muscle relaxant
• Nausea (feeling sick), also linked to the anaesthetic
• Brief rise in blood pressure and heart rate during and just after the seizure, which is closely monitored by the anaesthesia team
• Rare cardiac (heart-related) complications, most likely in patients who already have a heart condition
• Risks common to any general anaesthesia: allergic reaction, breathing difficulties, or other anaesthetic-related complications — these are uncommon but are monitored for throughout the procedure
• Very rarely, a prolonged seizure (one that lasts longer than intended); the medical team has medicines ready to stop this immediately

Because each ECT session requires general anaesthesia, preparation follows the standard rules for anaesthesia safety. Your care team will give specific instructions before the first session and again before each subsequent session.

Before the procedure, the care team typically asks the patient to:

• Fast (not eat or drink, including water) for a set number of hours before each session — usually from midnight for a morning appointment, or as directed; the exact fasting window is set by the anaesthesia team
• Inform the team of all medications currently being taken; some medicines (including certain blood thinners, mood stabilisers, and anticonvulsants — medicines used to prevent seizures) may need to be adjusted or temporarily paused, but only on a doctor's instruction
• Avoid smoking and alcohol in the hours before each session, as both can affect the anaesthetic and the seizure threshold (the level of stimulation needed to produce a seizure)
• Remove jewellery, nail polish, contact lenses, and hairpins before arriving, as these can interfere with monitoring equipment or electrode (small pad) placement
• Arrange for a trusted person to accompany them home after each session, since driving is not permitted on treatment days

Before starting the course, doctors usually arrange a set of assessments to confirm the patient is fit for both anaesthesia and ECT itself.

• A physical examination and full review of medical history
• Blood tests to check kidney function, liver function, electrolytes (salts in the blood), and blood count
• An ECG (electrocardiogram — a recording of the heart's electrical activity) to screen for heart conditions
• Occasionally a chest X-ray or brain imaging (CT or MRI) if the clinical picture suggests it is needed
• An anaesthesia assessment to identify any personal risk factors

On the day of each session, the following steps typically occur — though the exact order and details can vary between hospitals and individual patients:

• 1. The patient arrives and fasting and consent are confirmed by the nursing team.
• 2. An intravenous (IV) line — a thin tube placed into a vein — is inserted, usually in the arm, to allow medicines to be given.
• 3. Monitoring equipment is attached: sticky pads on the chest for heart monitoring, a blood pressure cuff, and a pulse oximeter (a small clip on the finger that measures oxygen in the blood).
• 4. EEG (electroencephalogram — brainwave recording) electrodes and ECT electrodes (small pads that deliver the electrical pulse) are positioned on the scalp.
• 5. The anaesthesia team gives medicines through the IV line to make the patient fully asleep and to relax the muscles.
• 6. Once the patient is asleep, the psychiatrist delivers a brief, precisely measured electrical pulse through the ECT electrodes.
• 7. The EEG confirms that a seizure has occurred in the brain; the body shows very little movement because of the muscle relaxant.
• 8. The patient wakes up in a recovery area with nurses present, usually within a few minutes.

After each ECT session, the patient is monitored in a recovery area until the anaesthesia has fully worn off, breathing is stable, and the person is alert enough to interact. Because ECT is given as a course — usually several sessions per week over a few weeks — the aftercare routine is repeated after each session, with a longer review at the end of the full course.

• Monitoring: vital signs (blood pressure, heart rate, breathing, oxygen levels) are checked regularly in the recovery room until the team is satisfied the patient is stable
• Confusion and memory: mild confusion immediately after waking is expected; patients are advised not to make important decisions, sign documents, or operate machinery on treatment days
• No driving: patients must not drive on any day they receive ECT; a responsible adult should accompany them home each time
• Diet: once the patient is fully awake and the gag reflex (the throat's protective swallowing response) has returned — confirmed by the nursing team — eating and drinking can resume
• Headache and muscle aches: these usually settle within a few hours; the care team will advise on suitable pain relief
• Medications: the psychiatrist reviews all ongoing medications throughout the course and adjusts them as needed, particularly mood stabilisers and antidepressants
• Ongoing mental health monitoring: between sessions and after the course ends, the psychiatric team assesses mood, cognition (thinking and memory), and overall wellbeing at regular intervals
• Memory follow-up: any memory difficulties are discussed openly with the psychiatrist; in most cases they improve after the course ends, but the timeline varies between individuals
• Maintenance therapy: for some patients, the psychiatrist may recommend occasional maintenance ECT sessions (spaced weeks or months apart) to help prevent relapse (the return of symptoms) — this decision is made case by case
• Lifestyle: adequate sleep, avoiding alcohol, and keeping follow-up appointments are generally encouraged to support recovery