August 30, 2022

Q&A: All about ECT for treatment-resistant depression

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What to know about electroconvulsive therapy (ECT) for depression.


There are many treatments for depression, but they don’t have the same effects for all people. Electroconvulsive therapy can be used to treat several types of depression. It is often given as an option for people whose depression has not been helped by medication or other treatments.

ECT uses brief, controlled electrical stimulation to the brain. It can produce chemical changes in the brain that lessen symptoms of depression. ECT is done under general anesthesia.

The possible benefits of ECT were first recognized by accident. Doctors noticed that some patients experiencing psychosis (such as hallucinations or severe paranoia) who developed epilepsy showed improvement in psychotic symptoms after a seizure. Eventually, researchers developed methods of inducing a seizure, which in turn led to using ECT to treat depression.

Elizabeth K. Shultz, D.O., medical director of Neuromodulation at Vanderbilt University Medical Center, answers some questions about this therapy and its use for people who have depression that’s difficult to treat.

What ECT can treat

Question: When is ECT typically used for people with depression?

Answer: ECT can be used for several types of depression, yet it is often a third-line treatment for patients who did not see any change after using medications or participating in psychotherapy.

Q: Does ECT also help with chronic anxiety?

A: If the anxiety is a symptom of a depressive episode, then ECT can be very effective for the anxiety. If the anxiety is due to generalized anxiety disorder or panic disorder, then ECT is not very effective.

Q: Who is a good candidate for this therapy?

A: Generally, a good candidate for ECT is a person experiencing severe depressive symptoms that have not responded well or consistently after trying at least two or three antidepressants and psychotherapy. People with unstable heart or lung disease may not be appropriate for ECT due to the stress the anesthesia and seizure can cause on these systems. People having a depressed episode with psychotic features (hallucinations, delusions, severe paranoia, etc.) and geriatric (elderly) patients experiencing depression both respond very well to ECT.

ECT can be use in children and adolescents all the way to adults in their 90s or older.

Q: What would disqualify someone from receiving ECT?

A: There are no absolute contraindications to ECT. However, we have to carefully weigh the risks and benefits of undergoing the treatment vs. other options for each individual patient.

How ECT works for depression

Q: Why does it seem to help reduce depression symptoms?

A: The exact way ECT works is still somewhat unknown. It does appear to help with the release of neurotransmitters (chemicals in the brain involved in mental health), the receptors these chemicals attach to, and the pathways they travel in the brain.

Q: What’s the typical timeframe for ECT? How many sessions does a person need?

A: On average, it takes four to six treatments to start to notice a difference, and it may take 10 to 20 treatments to see a full response. Often those around the person may notice changes first — for example, they have better facial expression, and more interest and better functioning in daily activities.

Typically, sessions are two to three times per week to start. After the patient feels a sustained improvement in their depression, then we taper off the treatments.

Q: Can ECT cure depression, or do its effects wear off? Do patients need to undergo more ECT eventually?

A: About 80% to 90% of patients report that ECT created a “remission” of their depressed episode. ECT will not cure depression. Its results may last anywhere from a few months to several years. 

Q: Is this an outpatient therapy (meaning patients do not have to spend a night in the hospital)?

A: Treatment can be done inpatient (with a hospital stay) or outpatient, but patients doing this on an outpatient basis need appropriate transportation after each treatment.

More to know about ECT

Q: What do you tell people who have negative ideas about “shock treatments” they’ve seen in the movies?

A: There continues to be a great deal of stigma, due to pop culture portrayals and people’s experiences of how ECT used to be done in the past. I openly acknowledge this history. Deciding to do any sort of procedure is a big decision, especially for the person undergoing the procedure. Additionally, I refer patients to references in pop culture and from medical sources for more accurate information and descriptions of modern ECT. It is likely a more common treatment today than many people realize.

Q: Can ECT treat other conditions besides depression?

A: Yes. It is sometimes used to treat bipolar disorder; catatonia; some symptoms of Parkinson’s disease, especially if medication has not helped; certain forms of psychosis; and severe or refractory behavioral dysregulation in autism spectrum disorder or due to neurocognitive illness such as dementia.

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Vanderbilt University Medical Center treats a range of mental health conditions for which medication or psychotherapy have not been helpful. The Behavioral Health team combines advanced technology with personalized care to create a plan individualized to each patient, with the ability to treat more medically complex patients than most hospitals. A referral is needed to receive electroconvulsive therapy at Vanderbilt. A coordinator will walk the referring doctor and the patient through the information needed to schedule a consultation. Call 615-875-1890 for appointments.

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