At a glance
Electroconvulsive therapy (ECT) is a psychiatric treatment in which a brief, controlled electrical current is passed through the brain to produce a short seizure (a temporary surge of electrical activity in the brain) while the patient is under general anaesthesia.
The seizure causes a cascade of chemical and hormonal changes inside the brain. Neurotransmitters (chemical messengers that carry signals between brain cells) shift in ways that appear to lift severe mood disturbances, reduce psychotic symptoms, and, in some cases, ease life-threatening conditions very quickly. The exact mechanism is still studied, but the clinical effect in suitable patients can be substantial.
Medical Condition
ECT is used when severe psychiatric conditions have not responded adequately to medication and psychotherapy, or when a patient's life is at immediate risk and a faster response is needed than drugs can provide.
- Major depressive disorder (deep, persistent depression) that has not improved with antidepressants
- Severe depression with psychotic features, such as hallucinations or delusions
- Bipolar disorder (a condition with extreme mood swings between mania and depression) during a severe episode of either pole
- Catatonia (a state where a person becomes unresponsive or rigid, unable to speak or move normally), whether linked to depression, schizophrenia, or a medical cause
- Schizophrenia with acute, disabling symptoms that have not responded to medication
- Treatment-resistant mania (extreme highs that do not improve with mood stabilisers)
- Suicidal crisis so severe that waiting weeks for a medication to work is unsafe
ECT is generally not recommended in certain situations, even if symptoms are severe.
- A space-occupying lesion in the brain (a tumour or abscess that raises pressure inside the skull), because the seizure can worsen pressure
- Unstable heart disease or very recent heart attack, because the procedure stresses the cardiovascular system
- Inability to tolerate general anaesthesia due to serious medical conditions
- Very recent stroke, unless the clinical team judges the benefit to outweigh the risk
Risks & Complications
ECT has real but manageable risks; most are short-lived and resolve without treatment.
- Confusion and disorientation immediately after the session, which usually clears within minutes to an hour
- Short-term memory loss around the time of treatment, such as difficulty recalling recent events or the sessions themselves
- Longer-lasting gaps in memory in some patients, particularly for events around the treatment period; this is the most discussed concern
- Headache or muscle aches after the session, which are usually mild
- Nausea from the general anaesthesia
- Cardiovascular changes during the procedure, including brief rises in heart rate and blood pressure; these are monitored and managed in real time
- Rare risks of general anaesthesia, such as breathing difficulties or allergic reaction
- Risk of prolonged seizure (a seizure that does not stop on its own), which the anaesthesia team is trained to manage immediately
Preparation & Procedure
Before ECT begins, the team carries out a full medical and psychiatric evaluation to confirm the diagnosis, review all current medications, and assess the heart and lungs to ensure general anaesthesia is safe.
Common pre-treatment tests include a blood panel (full blood count, kidney and liver function), an EKG (a recording of the heart's electrical activity), a chest X-ray in some cases, and cognitive (memory and thinking) tests that act as a baseline so any changes after treatment can be measured fairly.
Some medications interact with ECT. The treating psychiatrist and anaesthetist will review every drug the patient takes; some blood thinners, sedatives, or specific psychiatric medications may be adjusted in timing, though this decision is made individually and never abruptly.
Patients stop eating solid food and drinking for at least six hours before each session, as required for safe general anaesthesia. Smoking and alcohol should be avoided in the days leading up to treatment, as both affect how the body responds to anaesthesia.
A typical ECT course involves multiple sessions, most often given three times a week over several weeks, though the exact number depends on the patient's response. Each session follows a similar sequence.
- The patient arrives, fasting confirmed, and a small intravenous (IV) line is placed in the arm.
- The anaesthetist gives a general anaesthetic and a muscle relaxant so the body does not convulse visibly during the seizure.
- Small electrode pads are placed on specific areas of the scalp.
- The psychiatrist delivers a brief electrical pulse; the brain produces a controlled seizure lasting roughly 20 to 60 seconds.
- The patient breathes through a mask while the anaesthetist manages the airway throughout.
- The patient wakes in a recovery area, usually within minutes, and is monitored until alert and stable.
Aftercare
After each session, the patient rests in a monitored recovery area until the anaesthetic has fully worn off and they are oriented and comfortable. Some confusion in the first hour is expected, which is why a responsible adult must accompany the patient home after every outpatient session.
- Driving is not permitted on any day a session is given; transport must be arranged in advance.
- Light activity is generally fine on the same day, but physically demanding work or exercise is usually avoided until the treating team advises otherwise.
- Headaches or muscle aches after a session can be managed with simple pain relief as directed by the doctor.
- Memory concerns should be reported to the psychiatrist at each visit; the team tracks cognitive function throughout the course.
- Psychiatric medications are often continued alongside ECT and will be reviewed regularly by the psychiatrist.
- Follow-up appointments are scheduled after the acute course ends; some patients need maintenance ECT (less frequent sessions over months) to prevent relapse.
- Psychotherapy and social support are usually encouraged alongside and after ECT to build on the improvement.
- The patient and family are given clear written instructions about warning signs, such as prolonged confusion, chest pain, or difficulty breathing, that require immediate medical attention.
Cost & What Determines It
The cost of ECT varies widely because pricing reflects not just one procedure but an entire course of treatment, the setting in which it is delivered, and the complexity of each patient's situation.
- Number of sessions required: a shorter course for a patient who responds early costs far less than a prolonged course or ongoing maintenance sessions.
- Hospital class and country: a public hospital, a private psychiatric facility, and an internationally accredited hospital in different countries each have different fee structures.
- Anaesthesia fees: each session requires a trained anaesthetist, and their fee is usually charged separately per session.
- Pre-treatment investigations: blood tests, EKG, cognitive assessments, and specialist consultations add to the baseline cost.
- Type of electrode placement: bilateral (both sides of the head) and unilateral (one side) placements may be priced differently because they use different equipment settings.
- Inpatient versus outpatient setting: patients admitted to a psychiatric ward for the duration of the course pay ward fees on top of the procedure fees.
- Psychiatric consultations: the treating psychiatrist typically charges for each review visit throughout the course.
- Medication during the course: anaesthetic agents, any medications adjusted for ECT, and post-session pain relief all contribute to the total bill.
A hospital package for ECT, when one is offered, usually covers the session itself, the anaesthesia administered during it, basic monitoring, and the immediate recovery room stay. Fees typically billed separately include the initial psychiatric assessment, pre-treatment tests, each post-session consultation, medications taken at home, and any additional specialist reviews requested during the course.
BPJS Kesehatan does not cover treatment received abroad, and most Indonesian private health insurance policies also exclude overseas care. Patients who travel for ECT generally pay the full cost themselves or rely on international health insurance that explicitly covers treatment outside Indonesia. Before travelling, ask the hospital for a written cost estimate that lists every component of the course, not just the per-session fee, so that the total outlay is clear before any commitment is made.
Frequently Asked Questions
How many ECT sessions will I need?
Most people receive between 6 and 12 sessions, though the exact number depends on how you respond to treatment. Sessions are usually given three times a week, so a full course typically takes three to four weeks. Your psychiatrist will review your progress after each session and adjust the plan if needed.
What does ECT feel like? Is it painful?
You are under general anaesthesia (fully asleep) during each ECT session, so you feel nothing while the treatment is happening. Afterwards, some people wake up with a headache, sore muscles, or brief confusion, but these effects usually pass within an hour or two. Memory around the time of treatment can feel fuzzy for some patients, and your care team will monitor this throughout your course.
How soon will I start to feel better after ECT?
Many patients notice a lift in mood after just a few sessions, though for others improvement builds gradually over the full course of treatment. ECT tends to work faster than medication for severe depression or certain other psychiatric conditions, but individual responses vary. Your psychiatrist will track your symptoms closely to judge how well the treatment is working for you.
How much does ECT cost?
The cost of ECT depends on several factors: the total number of sessions prescribed, whether the hospital charges per session or as a package, the class of hospital or facility you choose, and any additional fees for anaesthesia and psychiatric monitoring. Because these factors combine differently for each patient, a written estimate from the hospital is the most reliable way to understand what you would pay.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
