[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Behavioral science](https://durgical.com/en/behavioral-science/) › [Somatic treatments and levels of care](https://durgical.com/en/behavioral-science/areas/care/) › Electroconvulsive therapy

# Electroconvulsive therapy

- Technique

Under anaesthesia and a muscle relaxant, a brief electrical stimulus causes a short, controlled seizure; a rapid-acting treatment for severe depression.

Updated Nov 13, 2026

## Key points

- Indications: severe or treatment-resistant depression, bipolar depression, suicidality, catatonia, refusal to eat or drink (malnutrition), and some cases of mania, schizophrenia and schizoaffective disorder.
- Catatonia responds well to ECT, which can be combined with benzodiazepines.
- It is usually safe and effective in pregnancy, with joint obstetric care and frequent fetal monitoring, and it is often useful in older adults who do not tolerate medicines.
- Few conditions rule ECT out; a recent heart attack, a brain aneurysm and intracranial lesions call for caution and specialist assessment.
- Main side effects: headache, upset stomach, muscle aches and confusion, and memory loss for events around the treatment, which usually improves over days to weeks.
- Unilateral electrode placement carries a lower risk of memory loss than bilateral placement.

## What it is

Electroconvulsive therapy (ECT) induces a brief generalized seizure under a short-acting anaesthetic and a muscle relaxant, so the body hardly moves. A course is usually about three sessions a week, typically 6 to 12 treatments, and many patients need maintenance sessions to prevent relapse. It is used for severe or treatment-resistant depression and bipolar depression, and when a rapid response is needed because of catatonia, suicidality or malnutrition; it is also used in some cases of mania, schizophrenia and schizoaffective disorder. Its main side effects are headache, muscle aches, confusion and memory loss around the time of treatment.

## Key facts

- The stimulus first causes a brief parasympathetic (vagal) slowing of the heart, then the seizure brings a catecholamine surge with a rise in heart rate and blood pressure.
- Death directly caused by ECT is extremely rare; most serious risks come from the heart and the anaesthesia.
- Neither dementia nor delirium is a contraindication; ECT is often useful in older adults.
- Relapse after a successful course is common without continuation treatment; maintenance ECT ranges from weekly to every few months.

## How it is done

- Discuss benefits, risks and alternatives and obtain informed consent (or the legal substitute process if the patient lacks capacity).
- Pre-treatment workup: medical history, examination, review of medicines that alter seizures, and anaesthetic assessment.
- Fasting before the session; monitoring of heart rhythm, blood pressure and oxygen.
- A short-acting intravenous anaesthetic is given, then a muscle relaxant so the seizure causes almost no movement.
- Electrodes are placed on the scalp, on one side (unilateral) or both sides (bilateral).
- A brief electrical stimulus produces a short generalized seizure.
- The patient wakes and recovers under observation; headache, muscle aches, upset stomach and confusion are treated.
- Sessions run about three times a week, typically 6 to 12 in all; mood and memory are tracked and maintenance is planned to prevent relapse.

## When ECT is chosen, and why

| Situation | Why ECT |
| --- | --- |
| [Severe depression, refusal to eat or drink](https://durgical.com/en/conditions/major-depressive-disorder/) | Rapid response when life or health is at risk |
| [Suicidality in depression](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/) | Used when a rapid response is needed |
| [Catatonia](https://durgical.com/en/conditions/catatonia/) | Effective; can be combined with benzodiazepines |
| [Treatment-resistant depression](https://durgical.com/en/conditions/major-depressive-disorder/) | When medicines and psychotherapy have not helped |
| [Mania, schizophrenia, schizoaffective disorder](https://durgical.com/en/conditions/bipolar-disorder/) | Used in some cases |

## Test yourself

Think of the answer, then tap the question to see it.

## Why is a muscle relaxant given during ECT?

So the induced seizure causes almost no body movement, preventing fractures and injury; anaesthesia keeps the patient asleep.

## What is the main side effect of ECT?

Headache, muscle aches and confusion after sessions, and memory loss for events around the treatment, which usually improves over days to weeks.

## What happens to the heart rate during an ECT session?

The stimulus first causes a brief vagal slowing of the heart; the seizure then brings a catecholamine surge with a faster heart rate and higher blood pressure.

## What are three indications for ECT?

Severe or treatment-resistant depression, suicidality and catatonia (also malnutrition from refusal to eat and some cases of mania or schizophrenia).

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/behavioral-science/electroconvulsive-therapy/)

## Elsewhere in DurgiPedia

- [Respect for autonomy](https://durgical.com/en/medical-ethics/respect-for-autonomy/)

## Connections

## Related 3

- [Neuromodulation: TMS, vagus nerve stimulation, deep brain stimulation and light therapy](https://durgical.com/en/behavioral-science/neuromodulation-tms-vagus-nerve-stimulation-deep-brain-stimulation-and-light-the/)
- [Psychiatric emergencies: agitation, violence risk and the suicidal patient](https://durgical.com/en/behavioral-science/psychiatric-emergencies-agitation-violence-risk-and-the-suicidal-patient/)
- [A short history of psychiatry](https://durgical.com/en/behavioral-science/a-short-history-of-psychiatry/)

## Related conditions 5

- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Catatonia](https://durgical.com/en/conditions/catatonia/)
- [Bipolar disorder](https://durgical.com/en/conditions/bipolar-disorder/)
- [Schizophrenia](https://durgical.com/en/conditions/schizophrenia/)
- [Suicidal behaviour and suicide risk](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/)

## In Pharmacology 2

- [Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/)
- [Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Brain Stimulation Therapies](https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies) (National Institute of Mental Health (NIMH), 2024); [Safety of electroconvulsive therapy in the context of physiological and medical complexity: A state-of-the art review](https://pmc.ncbi.nlm.nih.gov/articles/PMC11695668/) (PCN Reports (PubMed Central), 2025).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/electroconvulsive-therapy/