Obtaining informed consent
The patient is informed about the benefits and risks of the therapy before they provide their consent that the procedure goes ahead. The doctor treating the patient is under a legal obligation to ensure that the patient is informed of the following points prior to treatment with ECT:

• The reason for the treatment
• The risks associated with ECT
• The treatment plan
• The risks and benefits of alternative treatments at the stage of disease concerned
• The risks and benefits of not receiving any ECT therapy versus receiving therapy

Once these facts are explained, the patient is given the opportunity to reject or accept the treatment. At any time during the course of the treatment plan, the patient retains the right to refuse the treatment and revoke his or her informed consent.

Prior to treatment
Before treatment, the patient is administered a short-acting anesthetic to render them unconscious. Examples of the anesthetics used include methohexital, etomidate and thiopental. A muscle relaxant such as succinylcholine may also be used and sometimes atropine is administered to prevent salivation.

Electrode placement
For unilateral ECT, two electrodes are placed on one side of the patient’s head. The unilateral therapy may be used initially, to limit memory loss. When electrodes are placed on either side of the head, the therapy is called bilateral ECT. Patients in the UK usually receive bilateral ECT.

The ECT treatment
The electrodes deliver an electrical stimulus to the brain that is over the individual’s seizure threshold, usually about one and a half times the threshold in the case of bilateral ECT and up to 12 times the threshold when unilateral ECT is used.

Monitoring
The patient’s blood oxygen level, ECG and EEG are carefully monitored throughout the therapy.