How Shock Therapy Is Used and How to Prepare for It

Shock therapy, known medically as electroconvulsive therapy (ECT), is a treatment for major depressive disorder (MDD), bipolar disorder, and other psychiatric conditions. ECT is generally offered when other treatments are ineffective or there is a need for rapid response.

ECT has a stigma attached to it from the early days of shock therapy, but the ECT that is available today is very different from what it was like when first administered in 1938.

Here is an overview of how shock therapy is used today, including what to expect from an ECT session.

What Is Shock Therapy?

Shock therapy—also known as electroconvulsive therapy (ECT)—is a medical treatment involving electrical stimulation of the brain. It is done under general anesthesia. Even though ECT has been around for nearly 90 years, scientists still are not sure why or how it works. There are a few theories, however.

Neurons send electrical signals back and forth. These signals tell the brain to release specific chemicals. When the brain undergoes ECT, an increase in beneficial neurochemicals like serotonin or dopamine may be released.

ECT may also impact the neurons in other ways, such as by stimulating the development of new brain cells or connections, or by affecting the electrical activity in the parts of the brain that are associated with mood regulation.

Shock therapy is typically used to treat people with severe major depression or bipolar disorder. It is generally only done in people who haven't had a good response to first-line treatments, or in those who need a faster relief of symptoms, such as people at high risk of harming themselves or others.

Benefits of Shock Therapy

Most people who undergo ECT will see a noticeable change in their symptoms. Some people will notice an immediate improvement after one session. However, it is more common to not see or feel a significant difference in symptoms for several sessions.

Some people only need to undergo a series of shock therapy treatments once, while other people may need additional treatments to maintain the benefits.

Severe Major Depression

Shock treatment is sometimes used in people who have severe major depression but have not responded to antidepressants. It may also be used in people who are at risk for suicide and need more immediate symptom relief than is usually possible with antidepressants.

One study found that shock therapy was most effective for people with major depression who were also experiencing psychotic symptoms such as delusions and hallucinations. Around 79% of this group responded to shock therapy, while the response rate was around 71% for those without psychotic symptoms. The treatment also seemed to work better in older people.

Bipolar Disorder

In bipolar disorder, shock therapy may be used to treat severe depressive or manic states. Because severe bipolar disorder is associated with suicidal ideation and risk-taking behavior, some healthcare providers may try shock therapy before medication.

In one study, shock treatment was found to be effective for around 68% of those with bipolar depression and around 75% for those in a manic state. It was also effective for around 73% of those in a mixed state.

Schizophrenia

Around 30% of those diagnosed with schizophrenia do not respond well to the medications used to treat the disease. Research has found that shock therapy combined with medication may be effective in this group of people. One study found that 50% of those receiving combined ECT and clozapine experienced an improvement in symptoms, compared to none of those taking only clozapine.

Though shock therapy is generally considered safe, the temporary cognitive side effects that shock therapy can cause may be more of a problem for someone with schizophrenia, since the condition itself can also cause cognitive problems.

Catatonia

Catatonia is a syndrome that occurs in around 10% of those diagnosed with a psychiatric condition. There are two types. In the first, a person may be immobile, unable to speak, and may stare unresponsively. In the second less common form of catatonia, a person may develop agitation. Catatonia can be dangerous since a person who is catatonic may not eat or drink or may develop problems like blood clots or pressure ulcers.  

Because of the high-risk catatonia poses to a person's health, some healthcare providers consider shock therapy as the definitive treatment for the condition. Studies have found that between 80% and 100% of those with catatonia who receive shock therapy will respond to the treatment.

Dementia

Dementia can cause aggression and agitation in some people. These symptoms can be life-threatening and potentially dangerous for the person's caretakers. Healthcare providers may consider shock therapy when medication isn't enough to relieve these symptoms.

Studies have found that when people with dementia-related aggression and agitation are treated with shock therapy, around 88% experience significant improvement in symptoms.

How Shock Therapy Is Administered

An ECT treatment regimen will typically include sessions two to three days a week for a total of six to 12 treatments. The schedule works out to about one month of treatment, although the course may continue for longer.

During ECT, you will be under general anesthesia. You will not be aware of what is going on while you are undergoing the treatment.

Once you are under anesthesia, electrodes will be attached to your scalp in specific locations. The brain is then stimulated with a brief amount of electricity to induce a seizure that will last less than a minute.

Your healthcare provider will closely monitor you to make sure that the anesthesia and a muscle relaxant are working and that you are not experiencing any complications.

The entire process lasts about one minute. When the procedure is finished, you will rest in a recovery room until you wake up from the anesthesia, which typically only takes a few minutes. You should be able to go home within an hour.

For the most part, you can go about the rest of your day, although because you had anesthesia, you will need someone to accompany you home since you will be advised not to drive.

How to Prepare for Shock Therapy

ECT sessions generally do not require much preparation, though you will need to go over the specifics with your healthcare provider. You will be asked to arrive with a clean, dry head, for example. Your healthcare provider may also give you orders to follow based on other health conditions you have.

Since you will be put under anesthesia, your healthcare provider will ask you to fast before the procedure, which typically means that you do not eat after midnight the night before your treatment.

If you smoke, you may be asked to refrain from smoking on the day of your treatment. You may also have to reduce or stop medication prior to the procedure, with a few exceptions. Discuss any medications you may be taking with your healthcare provider.

Risks and Side Effects

ECT is much safer than it used to be. However, it is still a medical procedure that can have side effects. Most of the side effects are temporary. For example:

• Difficulty remembering recent events
• Temporary problems learning

Although most cognitive problems resolve over a period of months, some people will experience permanent gaps in memory.

ECT is performed under anesthesia, which comes with risks of its own. Anesthesia-related side effects may include:

• Headache
• Nausea
• Fatigue or grogginess
• Confusion
• Temporary, minor memory loss
  

Who Should Not Get Shock Therapy

Shock therapy is typically only used in people who meet specific criteria. A person who is experiencing depression related to another condition such as anxiety or a personality disorder is not a good candidate for shock therapy.

Unless the person is at immediate risk for harming themselves or others, most healthcare providers will only consider shock therapy if the person hasn't responded to medication.

People with certain conditions may be at greater risk of serious complications when receiving shock therapy. These include:

• Present or past heart conditions like heart failure, heart attack, and problems with heart rhythm
• A history of aneurysms
• Pheochromocytoma, a type of neuroendocrine tumor
• Broken or fractured bones

The use of ECT in children is controversial. While some studies support its effectiveness, the procedure raises ethical questions related to the ability of a child to participate in the decision-making process and give informed consent. 

Summary

Electroconvulsive therapy (ECT) can be used to treat major depressive disorder, bipolar disorder, and other psychiatric conditions. It is often considered when other treatments have not helped.

During ECT, electrodes are attached to the scalp, and the brain is briefly stimulated to induce a short seizure (lasting less than a minute). A person is under anesthesia and has been given medications to relax their muscles, so they do not feel any discomfort during the session.

A person might need just a few sessions of ECT to start feeling its effects, while others require more treatments to maintain the therapeutic benefits ECT can offer.