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Treatment terms

ECT

Shariq Refai, MD, MBA, board-certified psychiatrist and the reviewer of this article.

Reviewed by Shariq Refai, MD, MBA·Updated September 23, 2026·About 3 minutes

About this term

Quick definition
Electroconvulsive therapy. A procedure done under brief general anesthesia that produces a controlled, monitored seizure to treat severe depression. Has the strongest evidence base among acute treatments in selected patients.
Full clinical definition
ECT delivers a brief electrical stimulus through electrodes on the scalp to induce a generalized seizure lasting roughly 20 to 60 seconds, with the patient under general anesthesia and a muscle relaxant. Modern protocols use brief-pulse or ultrabrief-pulse stimulation and either right unilateral or bifrontal/bitemporal electrode placement, balancing efficacy and cognitive side effects. A typical acute course is 6 to 12 sessions delivered two to three times per week.
Epidemiology and evidence base
ECT has the strongest evidence base among acute treatments for severe depression, with response rates of roughly 60 to 80 percent in carefully selected patients, including many who haven't responded to multiple medications (UK ECT Review Group, Lancet, 2003). It has evidence for use in depression with psychotic features, catatonia, acute suicidality, and depression with refusal to eat or drink. APA and NICE both endorse ECT as a treatment option for severe and treatment-resistant depression.
What a course can look like
A patient with severe depression and active suicidal ideation who hasn't responded to multiple medication trials is admitted to a hospital. Over two to three weeks, they receive 8 to 10 ECT sessions. Family and clinical staff often see meaningful change after the first three to five sessions: less psychomotor slowing, more food intake, reengagement with conversation. After the acute course, the patient continues an antidepressant and sometimes receives maintenance ECT (a single session every two to six weeks) to reduce relapse risk.
Why the careful framing
Public perception of ECT lags decades behind current practice. Modern ECT is done under anesthesia, with oxygenation and muscle relaxation, in a controlled setting with a psychiatrist and an anesthesiologist. The visible convulsions of older techniques are blocked by the muscle relaxant. The procedure itself takes only a few minutes; the full visit, including recovery, lasts about an hour.
How clinicians assess it
A pre-ECT workup includes a full psychiatric and medical history, anesthesia evaluation, basic labs, and an EKG. The decision to proceed is made jointly by the patient (or their surrogate decision-maker), a psychiatrist, and an anesthesiologist. Informed consent covers expected benefits, alternatives, and the cognitive side-effect profile.
Treatment implications
ECT is considered when depression is severe, life-threatening, or hasn't responded to medication; when speed of response matters (acute suicidality, catatonia, refusal to eat); when psychotic features are present; in pregnancy when medication carries risk; and in older adults who don't tolerate medications. Side effects include short-term confusion in the first hour after a treatment, headache, and memory effects (most prominent for events around the treatment course; long-term retrograde amnesia is uncommon with right unilateral and ultrabrief-pulse techniques).
Related terms
Treatment-resistant depression. TMS. Ketamine and esketamine. Major depressive disorder.
Related articles
Depression treatment, explained.

Sources

  • UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003.
  • American Psychiatric Association. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging, 2nd edition. APA, 2001.
  • Kellner CH, et al. ECT in treatment-resistant depression. Am J Psychiatry. 2012.
  • Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010.

Primary source: NIMH: Brain stimulation therapies.

Frequently asked questions

What's electroconvulsive therapy (ECT)?
ECT is a procedure done under brief general anesthesia in which a controlled electrical current is applied to the scalp to produce a brief, monitored seizure. It has been used since the 1940s and has evolved substantially. Modern ECT uses muscle relaxants, oxygenation, and brief-pulse or ultrabrief-pulse stimulation, which makes it much better tolerated than the techniques portrayed in older media.
How effective is ECT for depression?
ECT is the most effective acute treatment available for severe depression, with response rates of roughly 60 to 80 percent in carefully selected patients, including many who haven't responded to multiple medications (UK ECT Review Group, Lancet, 2003). It's particularly effective for severe depression with psychotic features, catatonia, acute suicidality, and depression in pregnancy where medication carries risk.
When is ECT considered?
ECT is considered when depression is severe, life-threatening, or hasn't responded to multiple medication trials; when speed of response matters (acute suicidality, refusal to eat or drink, catatonia); when psychotic features are present; or when the patient prefers it after informed discussion. It's also a reasonable option in pregnancy and in older adults who don't tolerate medications well.
What are the side effects of ECT?
The most common side effects are headache, muscle aches, and nausea on treatment days, which usually resolve within hours. Short-term confusion in the first hour after a treatment is common. Memory effects are the most discussed side effect: short-term memory of events around the treatment course can be patchy, and some patients report longer-lasting gaps for autobiographical events from the weeks before treatment. Right unilateral and ultrabrief-pulse techniques reduce cognitive side effects compared with older bilateral approaches.
How is ECT delivered?
A typical acute course is 6 to 12 sessions given two to three times per week, in a hospital or specialty ECT suite under the care of a psychiatrist and an anesthesiologist. Each session lasts about an hour from arrival to discharge, with the procedure itself taking only a few minutes. After remission, some patients receive maintenance ECT (a single session every two to six weeks) to reduce relapse risk, often alongside medication.

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Last reviewed September 23, 2026.

Cite this page (APA)

Refai, S. (2026). ECT. DepressionResource.org. https://depressionresource.org/glossary/ect

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