According to the American Psychiatry Association (APA) task force guidelines report, the majority of patients who undergo electroconvulsive therapy (ECT) rate the experience as no more unpleasant than visiting the dentist.

The report states that many patients actually found ECT less distressing than a dental visit and that the majority would be willing to receive ECT again, if required.

According to the NICE guidelines report on ECT, most patients undergoing the therapy have found it beneficial and even life saving. By contrast, other patients felt ashamed, distressed, scared and described the treatment as invasive and abusive, particularly when treatment proceeded without their consent being given.

Informed consent means that the patient is made aware of the benefits and risks associated with the therapy prior to the procedure going 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.

The NICE report stresses that most people who experience negative feelings associated with ECT are those who have been given ECT without their consent.

One of the main reasons ECT is considered a controversial therapy concerns the purported effects of the therapy on memory. ECT may cause both retrograde amnesia (the loss of memories that existed prior to treatment) and anterograde amnesia (loss of memories formed after treatment).

However, patients may feel that the memory loss associated with ECT is an acceptable price to pay in return for the relief from depression symptoms the therapy can provide. As consent may be withdrawn at any point during the treatment schedule, many patients may well discontinue ECT if they find it uncomfortable or become concerned about the side effects.