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By Mayo Clinic staffThe ECT procedure takes about 10 or 15 minutes, with added time for preparation and recovery. ECT may be performed while you're hospitalized or as an outpatient procedure. In either case, it's done under general anesthesia, which means you'll be unconscious during the procedure. Your health care team will tell you how long you must avoid food and drinks before ECT treatment.
When it's time for the procedure, you may have a brief physical exam to check your heart and lungs. An intravenous (IV) catheter is inserted in your arm or hand through which medications or fluids can be given. During the procedure, monitors constantly check your heart, blood pressure and oxygen use. You may be given oxygen through an oxygen mask.
Doctors place electrode pads, each about the size of a silver dollar, on your head. ECT can be 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.
Anesthesia and medications
An anesthetic is injected in the IV to make you unconscious and unaware of the procedure. A muscle relaxant also is injected to help prevent your body from convulsing violently during the seizure. A blood pressure cuff is placed around your forearm or ankle area, preventing the muscle relaxant from paralyzing those particular muscles. When the procedure begins, the doctor can make sure you're actually having a seizure by watching for movement in that one hand or foot.
In addition to the anesthetic and muscle relaxant, you may be given other medications, depending on any health conditions you have or your previous reactions to ECT. You may also be given a mouth guard to help protect your teeth and tongue from injury.
Inducing a seizure
When you're asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electrical current to pass through the electrodes to your brain, producing a seizure that usually lasts 30 to 60 seconds.
Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you're experiencing a seizure may be a rhythmic movement of a foot or a hand. But internally, activity in your brain increases dramatically. This is recorded by an electroencephalogram (EEG) in much the same way as an ECG measures your heart's activity. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.
A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You're taken to a recovery area, where you're monitored for problems. Upon awakening, you may experience a period of confusion lasting from a few minutes to a few hours or more.
Series of treatments
In the United States, ECT treatments are generally given three times weekly for two to four weeks — for a total of six to twelve treatments. The number of treatments you will need depends on the severity of your symptoms and how rapidly they improve.
- Baghai TC, et al. Electroconvulsive therapy and its different indications. Dialogues in Clinical Neuroscience. 2008;10:105.
- George MS, et al. Nompharmacological somatic treatments. In: Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Publishing; 2008. http://www.psychiatryonline.com/content.aspx?aID=338950. Accessed May 25, 2010.
- Payne N, et al. Electroconvulsive therapy: Part I. A perspective on the evolution and current practice of ECT. Journal of Psychiatric Practice. 2009;15:346.
- Fact sheet: Electroconvulsive therapy (ECT). Mental Health America. http://www.nmha.org/go/information/get-info/treatment/electroconvulsive-therapy-ect. Accessed May 26, 2010.
- Depression: Electroconvulsive therapy. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/common/mentalhealth/treatment/058.html. Accessed May 26, 2010.
- Doughrerty DD, et al. Somatic therapies for treatment-resistant depression: New neurotherapeutic interventions. Psychiatric Clinics of North America. 2007;30:31.
- Lisanby SH. Electroconvulsive therapy for depression. New England Journal of Medicine. 2007;298:330.
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