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Electroconvulsive therapy (ECT)

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

How do I decide whether to have ECT?

Deciding whether or not to have ECT can be difficult. Usually you will only be offered it if you are very unwell, so you might find it harder to take in information and make decisions.

You should be given full information about the treatment so you can make an informed decision. Unless you are unable to make the decision for yourself, it is your choice whether you accept the treatment or not.

You may find it helpful to discuss it with a trusted friend or family member, or a mental health advocate. See our information on advocacy in mental health, or contact POhWER or Rethink Mental Illness to find out about advocacy services in your area.

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Why might I consider having ECT?

  • If ECT improves your mental health, the effects are usually felt quickly.
  • ECT could be helpful if you have stopped eating and drinking or looking after yourself due to severe depression.
  • If you have depression after having a baby (also known as postnatal depression), ECT might make it easier to care for and bond with your baby.
  • ECT may reduce suicidal feelings, although there is no evidence that it prevents suicide.

Why might I decide against ECT?

  • Any helpful effects are likely to be short-term. ECT can’t prevent future depression, or fix any ongoing stresses or problems that are contributing to how you’re feeling.
  • Some people have very bad experiences of ECT, for example because they feel worse after treatment or are given it without consent.
  • You might not want to risk the possibility of getting side effects.

"It was suggested by my psychiatrist as a last resort since my depression was resistive to multiple medications that had been tried and multiple types of talking therapies."

Who should avoid having ECT?

Before a course of ECT treatments, you will need a full medical examination to make sure the treatment is safe for you. You will be asked about:

  • your medical history – in case you have other health problems that should be treated first, or which mean you shouldn’t have the treatment
  • whether you are pregnant – ECT can be used in pregnancy, but there may be concerns about giving you anaesthetic while pregnant
  • any medicine you are taking – some prescribed drugs can affect your response to ECT, meaning the treatment needs to be adjusted
  • any allergies you have.

NICE guidance

NICE recommends in its guidance on ECT that, before you are offered ECT, doctors should consider:

  • the risks of general anaesthetic
  • other medical conditions you might have
  • possible adverse effects, especially memory loss
  • the risks of not having treatment.

Doctors should take extra caution about recommending ECT if you are at higher risk of adverse effects. This includes if you are:

  • currently pregnant
  • an older person
  • a child or young person.

You should be assessed after each ECT session, and you should not receive any more ECT if you:

  • have already been helped by the treatment so you don't need any more
  • show signs of serious adverse effects, such as memory loss.

If you have had ECT for depression before and it didn't help, you should only be given it again if:

  • you and your doctors are sure that all other possible treatments have been tried
  • you have discussed the possible benefits and harms with your doctor and also with a friend or family member, if you want them to be included.

This information was published in July 2019. We will revise it in 2022.

References and bibliography available on request.

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