Electroconvulsive therapy (ECT) is one of the most controversial treatments used in medical practice. While some psychiatrists believe that ECT is an effective life-saving psychiatric treatment, others have grave concerns about its effectiveness and the associated side effects.

The ECT that is practiced today is very different to the procedure that has been performed historically (often referred to as electroshock treatment). In today’s therapeutic arena, ECT is mostly a painless, effective and safe measure taken to combat severe depression.

ECT is used to treat refractory clinical depression or depression that has been non-responsive to other methods of treatment such as counselling, cognitive behavioural therapy and medication.

In most cases, attempts to improve the patients symptoms using these methods have failed before ECT is advocated. Aside from severe clinical depression, other conditions that may improve with the use of ECT include bipolar disorder and catatonia.

ECT was first introduced in the 1930s and became a popular treatment for a variety of conditions throughout the 50s and 60s.

Today, use of the procedure is only limited to a small number of very serious conditions. In most cases, the treatment is usually scheduled for three times a week on alternate days for a period of two to four weeks.

Method of application

The application of ECT can differ in the following ways:

• How the electrodes are placed
• How frequent the treatments are
• Which electrical waveform is used

These three factors significantly influence patient outcomes and side effects. In most cases, drug treatment is usually continued after treatment and some patients receive further ECT as a maintenance therapy.

The patient’s informed consent is obtained before the treatment is administered, as part of the standard ECT protocol. In the United States, for example, ECT is only administered without consent when all other treatment options have been exhausted and ECT is believed to be lifesaving.