Electroconvulsive Therapy
Definition: By definition, Electroconvulsive Therapy is a psychiatric treatment that is non-surgical and performed under general anesthesia. During this procedure, small electric currents are passed throughout the brain, aiming to cause brief and controlled seizures. Based on previous evidence, this practice has been shown to change brain chemistry. The alteration in brain chemistry can lead to improvements in certain symptoms of mental health conditions. (Mayo Clinic Staff)
History: The history of electroconvulsive therapy (ECT) is extremely long, dating back almost 100 years and branching from multiple different therapies before it. The history behind ECT was originally aimed at curing schizophrenia, but due to a lack of success, it was considered a failure. Diverging from the failure of schizophrenia treatment was the realization of the positive impacts that electroconvulsive therapy had on patients with extreme depression, and it is now mainly used for this, along with other mental health conditions.
To begin today's history lesson, we have to start around 100 years ago. Although ECT wasn’t theorized during this time, similar therapies were developed, which led to the development of ECT. Deep sleep therapy was used to treat schizophrenia by inducing a coma between 5-11 days with the use of barbiturate chemicals. This therapy led to some reduction of symptoms, but death was still seen in these trials, causing researchers to move on from this therapy.
Then, researchers moved to insulin shock therapy, which gave patients a large dose of insulin to cause the blood sugar levels to fall enough to induce a coma. This was theorized with the belief that schizophrenia was caused by weak neurotransmitters, which was proven not to be accurate. This therapy led to short-term improvement but also permanent brain damage in some patients and death from the procedures.
Soon after, convulsive therapy was developed in the 1930s. This was backed by the theory that a patient couldn't have both seizures and schizophrenia, which has been proven to be incorrect. This practice induced seizures in patients with a drug called metazol. Some patients came out with fewer symptoms, while others suffered serious injuries due to this practice.
In the early developmental stages of ECT, around 120 volts of electricity were sent throughout the patient’s brain to cure schizophrenia. It did not help with this, but it did help with extreme depression and became a common treatment for depression. An issue arose when doctors realized that some patients couldn’t remember their treatments and faced jarring side effects of cognitive impairment.
Today, after more research and studies, there are now practices of using electrodes on one side of the head, instead of both sides, which might decrease the chance of memory loss due to treatment. Additionally, patients are now given muscle relaxants and anesthesia to reduce the possibility of dangerous side effects from uncontrolled convulsions. But there is still a chance of memory loss with ECT, and this therapy is only used on patients who are conscious of those risks and are still considered a last resort treatment option for extreme depression.
Pros vs Cons
Pros:
Highly effective for severe depression
Useful in last resort situations
It could be helpful for other mental health conditions
Cons:
Memory loss and cognitive side effects
General anesthesia is used
Multiple treatments are required
This isn't considered a cure
What is going on now?
Currently, one of the developments in electroconvulsive therapy is focusing on the side effects, mainly memory and cognitive issues, which arise from this therapy. One study uses different treatment methods, including pharmacological and non-pharmacological interventions, which have been proven to help some side effects. A recent meta-analysis found statistically significant improvement in cognitive function with the use of memantine and liothyronine, ranging from moderate to large effects.
The issue with this analysis was the poor collection methods. This meta-analysis had generally poor evidence due to a lack of studies and a large amount of conflicting evidence. But to further exploration on this topic, a randomized controlled trial is active to explore the link between cognitive control therapy and enhancing working memory in ECT patients. Additionally, researchers have also recently found that dexmedetomidine has been found ot reduce some of the body's immediate reactions to ECT, such as raised blood pressure and quickened heart rate, which can benefit the patient's comfort and general health.
Why is it used?
ECT is used to treat severe mental health conditions when medications aren’t working and as a last resort option.
Ethical Considerations?
Here are some important ethics to consider when thinking about Electroconvulsive therapy.
Does the recommendation for ECT by a physician or clinician constitute coercion?
What degree of a patient’s wishes should be incorporated in the decision-making process when they lack complete mental capacity?
Should people still use this therapy with the risk of myocardial infarctions, stroke, and even death?
Did you know?
The first ECT was conducted in 1938 by Dr.Ugo Cerletti on an Italian engineer who was hallucinating and having delusions. After 11 high-voltage treatments with anesthesia, he made a full recovery.
Work Cited
Mayo Clinic Staff. “Electroconvulsive Therapy (ECT).” Mayo Clinic, 29 Mar. 2018, https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894.
Mukhtar, Fahad, et al. “Recent Advances in Electroconvulsive Therapy in Clinical Practice and Research.” Faculty Reviews, vol. 12, June 2023, https://doi.org/10.12703/r/12-13.
professional, Cleveland Clinic medical. “Electroconvulsive Therapy (ECT).” Cleveland Clinic, 25 Apr. 2017, https://my.clevelandclinic.org/health/treatments/9302-ect-electroconvulsive-therapy.
Puzantian, Talia. “Medication Fact Book for Psychiatric Practice, 7th Edition.” Carlat Publishing. Accessed 26 May 2025.
SciShow Psych. - YouTube. 29 Mar. 2018, https://www.youtube.com/watch?v=xOF9B2NcpLU.
Weiner, Richard D. “Ethical Considerations with Electroconvulsive Therapy.” AMA Journal of Ethics, vol. 5, no. 10, pp. 467–69, https://doi.org/10.1001/virtualmentor.2003.5.10.oped2-0310. Accessed 26 May 2025.
