What is ECT Really?

10/18/2017 03:57 pm ET Updated Oct 19, 2017

By Paula Bolton, MS, APRN-BC

Unfortunately, because of the way it has been portrayed in books, films, and other media, many people have a mistaken impression of electroconvulsive therapy (ECT). Once known as “electroshock therapy,” ECT has frequently been represented as barbaric and violent, a process that produces memory loss or leads to mind control. Many people remember the dramatic depiction of the therapy in the 1975 movie “One Flew Over the Cuckoo’s Nest.”

What people rarely hear are the many stories of success and recovery for those who undergo ECT treatment. At McLean Hospital’s ECT Service, we know that ECT is one of the most effective treatments we have for treating resistant mental illness like severe depression. After having ECT, many patients relate that “I feel like myself again” or “I’m getting my life back.”

Despite its effectiveness, there are still a lot of misconceptions about ECT. Perhaps that’s understandable because of the way electroshock therapy was performed in its early days, without the use of anesthesia or muscle relaxants. From a psychiatric point of view, patients got better, but the procedure often resulted in physical side effects.

Today, ECT is administered in a far more controlled and safe manner than it was in years past. Surrounded by a skilled team of anesthesia, psychiatric, and nursing staff, the patient is given a short-acting anesthetic that puts them to sleep. They also receive a muscle relaxant that paralyzes their muscles for a short period to prevent movement during the treatment. Heart rhythm, oxygen saturation, and blood pressure are closely monitored. Electrical stimulation is delivered to produce a seizure, but the seizure happens in the brain only, not the body. While no one knows exactly how ECT works, it may “reboot” the brain—much like resetting your computer when it’s acting funky.

ECT is an effective treatment for patients with certain types of mental illness, including severe depression, severe mania, a
McLean Hospital
ECT is an effective treatment for patients with certain types of mental illness, including severe depression, severe mania, and catatonia

With ECT, we follow principles similar to when someone is put on a medication. We start low and go slow, using the minimum amount of electricity we can. Everything possible is done to minimize the risk of memory loss or cognitive issues. The ECT team works with the patient and family to give enough treatment to be effective without causing unwanted side effects.

In general, ECT has been a last resort for people suffering with treatment-resistant conditions, like severe depression. These are people who don’t get better after trying other forms of treatment, like taking medications or engaging in talk therapy. Sometimes, however, ECT may be used as a first line of treatment for people who have a severe or debilitating illness.

Whether used early or late in a person’s treatment, however, we know that ECT can be extremely effective in helping people with serious depression and other forms of mental illness. ECT success stories are being experienced every day at clinics like ours at McLean. While they might not be as dramatic as those old horror stories, these stories have happy endings. And these are the stories we should be telling.

Paula Bolton, MS, APRN-BC, has been a nurse practitioner in the Internal Medicine Department at McLean Hospital for over 25 years. She serves as the program director for the Psychiatric Neurotherapeutics Program and was instrumental in both the expansion of the inpatient and outpatient ECT Service and the development of the Transcranial Magnetic Stimulation (TMS) Service.

McLean’s ECT Service performs over 7,000 treatments a year, making it one of the largest ECT centers in the country. To learn more about ECT, visit McLean’s Guide to ECT Treatment.

If you are concerned about your own well-being or that of a loved one, you can take an anonymous and confidential mental health screening online.

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