Electroconvulsive Therapy Benefits
and Side-Effects

Electrical stock helps depression.

Does this statement surprise you? The shock treatment or electroconvulsive therapy is
helpful on patients suffered from major depressive disorder, manic episodes and other
serious mental disorders. [4, 7] Electroconvulsive therapy is usually regarded as a last
resort - after all attempts at medications therapy have failed.

Electroconvulsive therapy provokes a convulsion similar to a grand mal epileptic seizure via
an electric shock. No one knows exactly how electro-convulsive therapy makes a depression
lift, but it just works.

Back in 1960s or earlier, electroconvulsive therapy was over-prescribed. Fracture, tooth
loss, muscle contractions happened. Nowadays, patients are minor tranquillizers to minimize
such adverse events.

Immediately prior to the treatment, the patient is injected with a medication that prevents
abnormal heart rhythms, then the patient is given an intravenous barbiturate which is used
as the general anesthetic, and then the blocking agents. A rubber rod is usually placed into
patientÂ’s mouth, to prevent tongue biting. Electrodes are attached to the patient's scalp - a
switch is flipped for a few seconds, the convulsion itself lasts about 30 seconds, and several
minutes later the patient wakes up disoriented and groggy, and often with no recollection of
the events surrounding the treatment.

Electroconvulsive therapy was found to work very well patients suffered from major
depression regardless the age. [11] The effectiveness and side effects of electroconvulsive
therapy in adolescents are actually comparable with those in adults. However, there is a
pervasive reluctance to use electroconvulsive therapy in children and adolescents. [5]



When electroconvulsive therapy was given without tranquillization, the incidence and
severity of post-operative agitation and of side effects were significantly greater in those
patients with a high level of anxiety before treatment. Both diazepam and haloperidol were
found to be effective in subduing agitation and side effects in anxious, depressed patients,
but with diazepam recovery time was longer. [13]

For safe conduct of electro convulsive therapy, general anaesthesia, such as thiopentone
sodium, is administered to the patients. Zaidi NA et al found that Propofol offered a superior
haemodynamic stability during the procedure and a quick recovery from sleep from their
study. [9]


The actual mechanism for electroconvulsive therapy is not clear. But, scientists have found
some relevant information:

Involvement of NO is critical in the efficiency of Electroconvulsive therapy. [4]

Reductions in right prefrontal cerebral blood flow have been correlated with symptomatic
improvement in depressed individuals receiving electroconvulsive therapy. Non-invasive
near infrared spectroscopy has previously been shown to reliably measure changes in
cerebral hemoglobin concentrations and oxygen saturation. Fabbri F and his co-workers at
Tufts University found that the electrically induced seizure causes a strong cerebral
deoxygenation on the side ipsilateral to the electrical current, during the right unilateral
electroconvulsive therapy. A decrease in the total hemoglobin concentration was also
observed on the brain side ipsilateral to the electrical discharge of electroconvulsive
therapy. [2]

Chistyakov AV et al at The Technion, Israel Institute of Technology found the
antidepressant effect of electroconvulsive therapy associated with an enhancement of left
hemispheric excitability. In a study, they recruited 22 patients with major depression and
assigned them to receive electro-convulsive therapy and right prefrontal transcranial
magnetic stimulation or electro-convulsive therapy with sham transcranial magnetic
stimulation. They applied electro-convulsive therapy twice weekly and transcranial magnetic
stimulation on the remaining 4 days, throughout 3 weeks.

They observed a marked clinical improvement in 19 out of the 22 patients. And, these
patients was associated with a significant increase of the motor evoked potential P/M-wave
area ratio, decrease of the active motor threshold and reduction of the intra-cortical
inhibition in the left hemisphere. [1]


Electroconvulsive treatment (ECT) was therapeutically ineffective in 27 (20%) of 136
depressed patients. Failure to respond occurred in long-lasting depressions and in patients
with a history of long-lasting depressions. In these cases the depression lasted at least 6
months. The hypothesis is proposed that electro-convulsive therapy is effective only when
given within 6 months of the spontaneous end of the depression. [14]


Electroconvulsive therapy combined with pharmacotherapy is found to be safe and effective
with non-enduring subjective memory difficulty for the drug treatment resistant group of
psychotic patients. Electroconvulsive therapy facilitated recovery in this potentially drug
treatment resistant psychotic subjects. [10]


The most pronounced side effect is short-term memory loss in about two-thirds of the
patients. Some patients can also experience longer-term memory loss.

Complaints of muscle pain (31.4%), post- electroconvulsive therapy confusion (15.7%) and
post-ECT headache (20%) in the first week of treatment, were not evident at follow up. [10]

Transient hypertension (13%) and cardiac dysrhythmia (3.5%), which resolved in the
recovery period were the most frequent complications in a study of white female patients.

Bone injury while undergoing electroconvulsive therapy is rare. However, a case of hip
fracture during treatment was reported. Patients suffered from osteoporosis should get
doctorÂ’s advise before electro-convulsive therapy. [12]

Side effects, post-operative agitation and retrograde memory impairment were assessed in
each patient after each of several treatments. [13]


There was a trend for smaller frontal-temporal volumes in the treatment-resistant patients.
Impaired immediate working memory was linked with reduced frontal and parietal lobe
volume and impaired short-term memory functioning was associated with reduced temporal
lobe volume. Ventricular enlargement was associated with prior administration of
electroconvulsive therapy, poor physical health and later age at onset of first episode of
depression. [8]


Magnetic seizure therapy is the use of transcranial magnetic stimulation* to induce a
seizure. It is believed that magnetic seizure therapy can induce more targeted seizures. The
method is based on the principle that a time-varying magnetic field induces an electric field
which leads to activation of inhibitory and excitatory neurons in neural tissue. [6] This
magnetic field passes through tissue unimpeded, providing more control over the site and
extent of stimulation than can be achieved with Electroconvulsive Therapy. Preliminary
results suggest that magnetic seizure therapy may have some advantages over
Electroconvulsive Therapy in terms of subjective side effects and acute cognitive
functioning. [3]



[1] Effect of electroconvulsive therapy on cortical excitability in patients with major
depression: a transcranial magnetic stimulation study. Clin Neurophysiol. 2005 Feb;116(2):
[2] Bilateral near-infrared monitoring of the cerebral concentration and oxygen-saturation of
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