What is ECT?
Electroconvulsive Therapy, more commonly known as “ECT”, is a medical treatment for severe mental illnesses that can only be carried out by trained health professionals.
How does it work?
The brain works through complex electrochemical processes. These processes may be affected by certain types of mental illnesses. It is believed that ECT works by causing the brain to have a seizure(a short period of irregular brain activity) when an electrical current is given. This seizure releases many chemicals in the brain. The release of these chemicals makes the brain cells work better and improves the patient’s mood.
Who is it used for?
ECT is generally used for severely depressed patients when other forms of therapy such as medications or psychotherapy:
- have not been effective
- cannot be tolerated
- cannot help patient quickly enough in life threatening situations
ECT is also used for :
- most forms of mania(a mood disorder associated with grandiose, hyperactive irrational and destructive behaviour)
- schizophrenia
- a few other mental and neurological disorders
ECT is safe for pregnant women who suffer from depression or mania.
Does it actually work?
Many studies have shown that ECT is effective. The Singapore Psychiatric Association, the American Psychiatric Association, the American Medical Association, the National Institute of Mental Health and similar organizations in USA, Canada, Great Britain and many other countries have recognized that ECT is effective in treating severe mental illness.
ECT has been found to be successful in patients with:
- severe depression(70% to 80% success rate, higher than any other forms of treatment)
- depression who do not respond to other forms of treatment
- mania who do not respond to other forms of treatment
- psychotic depression or strong suicide thoughts
ECT can be life saving and produce dramatic results.
What is involved?
A course of treatment with ECT usually consists of three to twelve treatments given three times a week(Monday, Wednesday and Friday).
Before each treatment, anaesthesia(to put the patient to sleep-like state) and a muscle relaxant (to relax the muscles) will be given to the patient through an intravenous (IV) line. The heart rate, blood pressure and breathing will be watched closely. When the medications are fully working, electrodes will be placed at exact locations on the patient’s head and the brain stimulated with a series of short controlled electrical pulses.
This stimulation causes a controlled seizure within the brain which lasts for a bout a minute. The patient will not feel any pain because of the anaesthesia and muscle relaxant, the patient wakes up after five to ten minutes.

What are the risks and side effects?
Any medical procedure including ECT will have a certain amount of risk and side effects. However, ECT is not more dangerous than minor surgery done under general anaesthesia. In fact, it may at times be less dangerous than treatment with anti-depressant medications. It is safe for use in elderly patients and those with existing medical illnesses although a small number of other medical disorders increase the risks associated with ECT.
These risks include:
Minor side effects that are common:
- headache
- muscle soreness
- nausea
- confusion
These side effects get better with simple treatment.
- Memory effects:
- difficulty in remembering newly learned information (disappears over the following days and weeks)
- Partial loss of memory for events that happened days, weeks or months before the ECT (most of these memories return over a period of days to months, rarely, some patients report longer lasting problems)
- Improved memory in some (because the forgetfulness and poor concentration associated with severe depression have been removed)
More serious but rare side effects:
- heartbeat problems (usually mild and short lasing, in some cases can be life threatening)
- mania or hypomania (in patients with previously diagnosed or undiagnosed bipolar disorders) – uncommon
- dental complications (with modern ECT methods, this is not frequent)
- serious medical problems such as heart attack, stroke, breathing problems, continuous seizures (very rare, confined to those with pre-existing diseases)
- death is possible although very unlikely (about one in 10,000 patients, higher in patients with serious medical problems and greater anaesthesia risks)
To reduce the risks of these major side effects, patients are carefully screened before they are recommended for ECT. If these side effects do happen, the medical care that is needed will be given quickly.
What about brain damage?
There has been no evidence that ECT damages the brain. A recent study using magnetic resonance imaging (MRI) equipment to measure very sensitive scans of the brain showed no changes in the brain structure with ECT. Other studies showed that only a small percentage of the electricity that is applied to the head actually enters the brain. This amount of electricity is much lower in intensity and shorter in duration than that which would be necessary to damage brain tissue.
Can ECT be refused?
No psychiatrist simply “decides” to treat a patient with ECT. Before ECT can be given, written consent must be taken from the patient. If the patient is too ill to make decisions, one of the patient’s family members will have to assist in the decision making process. The person consenting to the treatment will be kept informed of the progress as the treatment continues, and may withdraw consent at any time.
What happens after ECT?
As many as 20% to 50% of the people who respond well to a course of ECT relapse within six months without maintenance treatment. Anti-depressants and/or mood stabilizers are therefore necessary. Sometimes, the patient may have to go for maintenance ECT at intervals of one month to six weeks.
How to prepare for ECT?
Patients could ask their family or friends ahead of time for support in case of memory problems
- to coach them after the ECT to help them remember events
- to help them prepare summaries of important events from the recent past
- to develop lists of things they may need to remember
Patients should not make any important personal or business decisions during or immediately after the ECT (this may mean postponing decisions about financial or family matters). Patients should not drive, do business or other activities which are likely to be affected by memory problems.