Electroconvulsive therapy (ECT)

Explains what electroconvulsive therapy (ECT) is, when it might be used and what happens during the treatment.

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What are ECT treatment sessions like?

This page covers:

Do I have to be an inpatient to have ECT?

It’s more common to have ECT as an inpatient in a hospital, which means you will stay in hospital overnight. But outpatient treatment is sometimes possible – this means you won’t have to stay overnight.

If you’re staying in a hospital that doesn’t offer ECT, you’ll need to visit another hospital with an ECT clinic to have the treatment.

If you are an outpatient, you will need to have someone with you to accompany you home, as it’s important that you aren’t alone when leaving hospital. You, or your friend or family member who is with you, should be asked at the hospital to confirm that:

you will be accompanied home and have someone with you for 24 hours after treatment
you will not drive during your course of treatment, or until the psychiatrist has told you it’s ok
you will not drink alcohol for at least 24 hours after treatment, or until you have been told it’s ok
you will not sign any legal documents for at least 24 hours after treatment, or until you have been told it’s ok.

What is the ECT clinic like?

The ECT clinic should have three rooms:

a waiting area, which should be comfortable and provide a relaxing environment
a treatment room, which should have the equipment required for monitoring and for resuscitation in an emergency, as well as the ECT machine
a recovery room.

The clinic should be organised so that the rooms are separate and you can move easily from one room to the next, without people observing you from other rooms. Staff at the clinic will usually include nurses, psychiatrists and anaesthetists.

Where can I find out about the clinic I'm visiting?

ECTAS provides standards for the use of ECT in the UK, including how the clinic is set up and how treatment is administered. It also has a list of clinics which meet these standards across different areas of the country.

"I was so surprised after my first treatment that it was nowhere near as bad as I had anticipated it being."

How can I prepare for ECT?

To prepare for ECT, you should:

wear loose, comfortable clothing
tell the team if you have had cosmetic dentistry such as veneers or implants, or any piercings.

And you should not:

eat or drink anything (except a few sips of water) for at least six hours before treatment, because of the anaesthetic given just before treatment
wear any hairspray, creams, make-up, nail polish, metal hair slides or grips, or piercings.

What happens during ECT?

Before the treatment starts, you will lie on a bed and your jewellery, shoes and any dentures will be removed and kept safe for you.
You will be given a general anaesthetic injection, once you are comfortable.
Once the anaesthetic takes effect and you are unconscious, you will be given an injection of muscle relaxant to stop your body from convulsing during the treatment. You will also be given oxygen through a face mask or tube. This is needed because of the muscle relaxant.
Two padded electrodes will be placed on your temples. You will either have one placed on each side of your head (bilateral ECT), or both placed on the same side of your head (unilateral ECT) – there is more information about this below.
A mouth guard will be placed in your mouth, to stop you biting your tongue.
The ECT machine will deliver a series of brief, high-voltage electrical pulses. This will cause you to stiffen slightly, and there may be some twitching movements in the muscles of your face, hands and feet. The seizure should last for 20 to 50 seconds.

"The actual treatment was disorientating and overwhelming... I was overwhelmed by how quickly it was happening."

What are bilateral and unilateral ECT?

Bilateral ECT means that two electrodes are placed on your temples, one on each side of your head, so the electric current passes across your whole brain.
Unilateral ECT means that two electrodes are placed together on one temple, so only one side of your brain is stimulated.

Both types cause a seizure of the whole brain. Bilateral ECT is more commonly used and is believed to be more effective, but may also be more likely to cause memory problems. Unilateral ECT can have fewer side effects, but may also be less effective. You may be given unilateral ECT if it has helped you in the past, or if you have had unpleasant side effects after bilateral ECT.

What happens after ECT?

After the seizure, the mouth guard is removed and you will be turned on your side. The anaesthetist will provide oxygen until the muscle relaxant wears off (after a few minutes) and you start breathing on your own again.

You will slowly come round, although you may feel very groggy. You may sleep for a while after treatment.

You will need to recover from the general anaesthetic as well as the ECT treatment itself.

How many treatment sessions might I have?

ECT is usually given twice a week for 3-6 weeks, meaning you might have around 6-12 sessions. You should be assessed after each treatment to see if another one is necessary, or isn’t advisable.

ECT tends to provide short-term improvements, so it can be helpful to try other types of treatments after having it. This could help you make the most of any improvement you have experienced from ECT.