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I was so surprised after my first treatment that it was nowhere near as bad as I had anticipated it being.
Do I have to be an inpatient?
Not necessarily. You usually receive ECT as an inpatient in a hospital, but outpatient treatment is possible.
If you are an outpatient, you will need to have someone with you to accompany you home - you should not return alone to an empty house. You (or your friend or family member who is with you) should be asked 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, or until you have been told it’s ok
- you will not sign any legal documents for at least 24 hours or until you have been told it’s ok.
What is the ECT clinic like?
The ECT Accreditation Service sets standards for the administration of ECT, and there is a list of participating clinics, and the standards they have met, on the Royal College of Psychiatrists website.
The ECT treatment centre should consist of a suite of 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 resuscitation in addition to the ECT machine
- a recovery room.
The suite should be organised so that the rooms are separate and you are able to move easily from one room to the next, and cannot observe other people in adjacent rooms.
Clinic staff
The staff should consist of:
- nurses, including:
a trained nurse manager in overall charge of the ECT session
a nurse, who you know and trust, who is with you during all stages of treatment
a nurse trained in resuscitation
- a medical team including:
a senior psychiatrist
a senior anaesthetist
an assistant to the anaesthetist.
What happens during the procedure?
ECT is carried out under a general anaesthetic and with a muscle relaxant. Because of the anaesthetic, you must not eat or drink anything (except a few sips of water) for at least six hours beforehand.
- You should wear loose, comfortable clothing
- You should not be wearing any hairspray, creams, make-up or nail polish, or have any metal slides or grips in your hair, or piercings.
- Let the team know if you have had cosmetic dentistry such as veneers, implants or piercings
- You will lie on a bed, and your jewellery, shoes and any dentures will be removed and kept safe for you.
- Once you are comfortable, you will be given a general anaesthetic, via an injection.
- While you are unconscious, you will receive an injection of muscle relaxant to minimise the convulsions caused by the electric current. Because of the muscle relaxant, you will be given oxygen, and the anaesthetist will look after your breathing, using a face mask and a pressure bag.
- Two padded electrodes will be placed on your temples, either one on each side of your head (bilateral ECT), or both on the same side (unilateral ECT) (see below for more information).
- 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 – about 60 to 70 pulses a second, for three to five seconds, causing you to have a seizure, or fit. This will cause you to stiffen slightly, and there may be twitching movements in the muscles of your face, hands and feet. The seizure should last 20 to 50 seconds.
The actual treatment was disorientating and overwhelming... I was overwhelmed by how quickly it was happening.
What is bilateral or unilateral ECT?
- Bilateral means that one electrode is placed on each temple so that the whole brain is stimulated
- Unilateral means that both electrodes are place on one temple, so that only one side of the brain is stimulated.
Both types cause a seizure of the whole brain.
Bilateral ECT may be more effective, but unilateral is sometimes thought to cause fewer memory problems. However, with unilateral you may need a higher dose of electricity to cause the seizure, and this may increase the likelihood of memory loss with this method, so that it is not in fact very different from bilateral.
Bilateral placement is more commonly used. You may receive unilateral ECT if you have had unpleasant side effects after bilateral, or if you have responded well to unilateral ECT in the past.
How strong is the electric current?
The strength of electric current needed to produce a fit is called the seizure threshold. This varies from person to person:
- it is higher in men than in women
- it may be affected by medication you may recently have taken
- it increases with age, meaning that older people need a stronger electric current
- it depends on the exact position of the electrodes on your head
- it depends on the amount of anaesthetic you have been given
The ‘dose’ of electric current given to you will be adjusted to take all of these things into account.
- if the dose is too low (below the threshold), there will be no benefit from the ECT
- the higher the dose, the greater the risk of unpleasant side effects, so it’s important that the dose is kept as close as possible to the threshold.
What happens immediately after?
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 treatments will I have?
You should not normally be prescribed more than two treatments at one time, although a maximum number (usually 12) may be prescribed beforehand. You should be assessed after each treatment to see if another one is necessary, or is inadvisable.
The treatments should normally take place twice a week, although three treatments may be given in one week if you have a severe or life-threatening illness.
After a course of treatment you should be seen by the mental health team at least once a month for three months.
This information was published in June 2016. We will revise it in 2019.
