Deciding whether or not to have ECT may be very difficult. Usually you will only be offered it if you are very depressed, which in itself makes it difficult to take in information and make decisions based on what you have been told. But you have the right to full information about the treatment, and to decide for yourself whether or not you wish to receive it.
Generally, unless you are unable to make a decision for yourself, it is your decision 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. You can contact POhWER or Rethink Mental Illness to find out about advocacy services in your area.
Advantages of ECT:
- When it works, it works quickly.
- It can prevent death if you are so depressed you are unable to talk, and you have stopped eating and drinking and looking after yourself.
- If you have depression after childbirth, it can lift these feelings quickly so that you are able to care for and enjoy your baby.
- It may lift suicidal feelings (but there is no evidence that it prevents suicide).
Disadvantages of ECT:
- Even if it has worked, often the effects don’t last long, and it can’t address any underlying despair or life problems you may have, or prevent future depression.
- Some people find it overwhelmingly negative and may feel worse after treatment, especially if they regret having consented to it, or were given it without consent.
- Side-effects, especially memory loss, which is usually short lived, but may be very significant in some cases.
It is important that you are offered other types of treatments in the period following ECT so that you can make the most of any improvement it has given you. These might include talking treatments or arts therapies which you may have been too depressed to make use of before, as well as medication.
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.
When should I avoid having ECT?
Before a course of ECT treatments, you will need a full medical examination. You will be asked about:
- your medical history – if you have any physical problems, these should be treated, as far as possible, before you have ECT. If you have heart or circulation problems, or breathing problems, both the ECT itself and the anaesthetic may be more dangerous for you.
- whether you are pregnant – ECT may be used in pregnancy, but the anaesthetist may not be happy about giving a general anaesthetic to a pregnant woman, except in a medical emergency.
- any medicine you are taking – some prescribed drugs affect your response to ECT:
- some antidepressants (such as fluoxetine) may cause the seizure to last longer than normal
- some drugs, including benzodiazepine tranquillisers, make it more difficult to induce a seizure so that a higher dose of electric current has to be used.
- any drug allergies.
NICE guidance
The National Institute for Health and Care Excellence (NICE) says that before you are offered ECT, doctors should consider the risks of the treatment. These include:
- the risk of general anaesthetic
- other medical conditions you might have
- possible adverse effects, especially memory loss
- the risks of not having treatment
Extra caution should be used as the risks of ECT may be higher in the following groups, for:
- pregnant women
- older people
- children and young people (it should not be used for depression in children under the age of 12)
After each ECT session, you should be assessed, and you should not receive any more ECT if you:
- have had a positive response so that more treatment is unnecessary
- show signs of serious adverse effects, such as memory loss
If you have had ECT for depression before and it did not 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 the doctor and also with a friend or family member, if you want them to be included
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This information was published in June 2016. We will revise it in 2019.
