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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Electroconvulsive Therapy

April 25, 2011

What Kind Of Treatment Is Available?
Electroconvulsive Therapy
Electroconvulsive Therapy
Electroconvulsive therapy (also called electroshock therapy or shock therapy) can be a life-saving treatment. It is the most effective treatment for depression and has better results than antidepressants do.
InteliHealth/Harvard Medical Content

Reviewed by the Faculty of Harvard Medical School

Electroconvulsive Therapy
Electroconvulsive therapy (also called electroshock therapy or shock therapy) can be a life-saving treatment. Contrary to popular belief, electroconvulsive therapy is veryrelatively safe, and it works faster than any other treatment for depression.
It is the most effective treatment for severe depression and gets better results than antidepressants do. About 80% to 90% of depressed people receiving electroconvulsive therapy get some relief.
Electroconvulsive therapy is usually offered when drugs and/or psychotherapy haven't worked. It is also a very good option for the following people:
  • People who have severe symptoms
  • People who are completely unable to meet their daily needs (such as eating and drinking)
  • People who are at the greatest risk of suicide
Electroconvulsive therapy has been misrepresented and is misunderstood. People who have received the treatment are often very satisfied with the results. Most would be willing to have the treatment again if they needed it.
What To Expect
If you choose to be treated with electroconvulsive therapy, you will be given a short-acting anesthetic to prevent awareness of the procedure and reduce discomfort. Other drugs are given to relax your muscles to prevent any outward signs of convulsions.
While you are sleeping, your doctor will carefully monitor you. You will receive an electrical impulse to stimulate your brain, which causes a seizure. There are no outward signs of this seizure, but your doctor can see it on a monitor (similar to an electroencephalogram or EEG) that measures electrical activity of the brain. The seizure seems to restore the brain's ability to regulate mood and decreases the symptoms of severe mental illness. It is the seizure (not the electricity) that generates improvement.
The seizure lasts less than three minutes, after which your doctor will wake you. The entire procedure from beginning to end takes about 15 minutes.
Electroconvulsive therapy must be repeated to be effective. You will need treatment usually two to three times a week to relieve your symptoms. Most people require six to 12 treatments over three to four weeks. Improvement is gradual, over days to weeks, rather than all at once. On average, improvement is faster with electroconvulsive therapy than with drugs.
Be aware that before you have electroconvulsive therapy, you will need to have a comprehensive evaluation, including psychiatric, medical and neurological assessment. Expect to be educated about electroconvulsive therapy, with explanations of how it is done and what the potential benefits and risks are compared with other treatments. Some excellent videos are available that show the procedure in detail and demystify the treatment. It may be useful to speak with other people who have had the treatment. They can explain what the experience is like, demystifying it further.

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Side Effects
The discomfort of electroconvulsive therapy is about equivalent to that of a minor surgical procedure.
The most common side effect is memory loss, particularly for events that occurred just before and soon after treatment. But this memory loss is temporary. Relatively few people have long-lasting problems with memory, although electroconvulsive therapy can worsen existing memory problems. To date, no study has shown that electroconvulsive therapy causes brain damage.
Other side effects are short-lived. Some people feel a bit sedated or fatigued on the day of the procedure. There may also be a transient mild headache or nausea. Some of these symptoms may be related to the anesthesia rather than to the electroconvulsive therapy.
Electroconvulsive therapy temporarily increases the heart rate and blood pressure. Thus, if you have heart disease, speak with your health-care provider about your risk.

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Electroconvulsive therapy involves a great number of resources: a psychiatrist, an anesthesiologist, nursing staff and a facility with available equipment. And the relapse rate after electroconvulsive therapy is significant. Use of an antidepressant or mood stabilizer after successful treatment helps prevent relapse, but you may need additional "maintenance" electroconvulsive therapy. Many people find the stigma of electroconvulsive therapy too much to overcome and simply choose not to investigate the option.

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