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Electroconvulsive therapy: preparation, recovery and memory effects

  • Procedure

ECT is given under general anaesthesia; the nurse teaches, checks consent and fasting, prepares the person and monitors recovery, confusion and memory.

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What it is

Electroconvulsive therapy (ECT) uses a brief, controlled electrical stimulus to cause a seizure in the brain while the person is under general anaesthesia and a muscle relaxant. It is used mainly for severe depression that has not responded to other treatment, or when a fast response is needed (suicide risk, psychotic depression, catatonia), and sometimes for mania. A course is usually several sessions over some weeks. The team includes a psychiatrist, an anaesthesiologist and a nurse. The nurse prepares the person as for minor surgery, supports them, and monitors airway, vital signs, confusion and memory after each session.

Indications

  • Severe major depression not responding to medicines or psychotherapy.
  • When a rapid response is needed: high suicide risk, depression with psychotic features, catatonia.
  • Severe depression in a person who cannot take antidepressants, including during pregnancy, as the team decides.
  • Less often: mania or psychosis that does not improve enough with other treatment.

Contraindications and precautions

  • No ECT without valid written informed consent; the person and family receive full information on benefits, risks and alternatives.
  • Some medical conditions raise the risk of complications: the team assesses them before the course.
  • General anaesthesia: fasting and pre-anaesthesia checks follow the institutional protocol.
  • Usual morning medicines: give only those the team confirms.

Equipment

  • Signed consent form and the pre-procedure checklist of the institution.
  • Equipment for IV access.
  • Vital-sign and oxygen-saturation monitoring for the procedure and recovery, as the protocol lists.
  • Airway equipment and the recovery area of the anaesthesia service, as the protocol lists.
  • A memory and orientation screening tool chosen by the service.

Step by step (and why)

  1. Teach the person and family what ECT is, how a session goes and its common effects — clear information lowers fear and supports consent.
  2. Confirm written informed consent is signed and valid before each course — ECT is never given without it.
  3. Check fasting as ordered and ask the team which usual medicines to give that morning — general anaesthesia requires an empty stomach.
  4. Record baseline vital signs and orientation and memory with the service's tool — a baseline lets later changes be measured.
  5. Remove jewellery, metal objects and dental pieces as the service instructs — this prepares for anaesthesia and the scalp electrodes.
  6. Place the IV line as ordered and stay with the person until anaesthesia — presence reduces anxiety.
  7. In recovery, monitor airway, breathing, circulation and vital signs until fully awake — anaesthesia and the seizure affect them.
  8. Reorient the person calmly, keep fall precautions and help with the first walk — short-term confusion is common after waking.
  9. Repeat orientation and memory checks and record headache, nausea or muscle pain — effects guide the team's plan for the next session.

Complications

  • Short-lasting confusion after waking.
  • Headache, muscle soreness and nausea.
  • High or low blood pressure, fast heart rate or other heart effects.
  • Memory problems: difficulty learning new things and gaps for events around the treatment period; most improve within a couple of months, but some gaps can last.

Next step: when to call for help

  • Notify the anaesthesiologist or nurse in charge at once if breathing, saturation or consciousness do not recover as expected.
  • Report confusion that lasts longer than usual, or chest pain, palpitations or a marked change in blood pressure.
  • Report memory complaints that worsen from session to session so the team can review the plan.
  • After the course, report early signs of relapse: the team plans maintenance treatment.

Test yourself

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

Why does a person fast before ECT?

ECT is given under general anaesthesia with a muscle relaxant, which requires preparation as for minor surgery, including fasting as ordered.

What does the nurse monitor right after an ECT session?

Airway, breathing, circulation and vital signs until fully awake, orientation, and fall risk after anaesthesia.

Which memory effects can ECT cause?

Difficulty forming new memories and gaps for events around the treatment period; most improve within months, but some gaps can last.

When may ECT be chosen because a rapid response is needed?

With high suicide risk, depression with psychotic features or catatonia, as the team decides.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing: Mental Health and Community Concepts, 7.4: Treatments for depression (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Electroconvulsive therapy (Medical Encyclopedia) (MedlinePlus, U.S. National Library of Medicine, 2026); Nursing: Mental Health and Community Concepts, 8.3: Treatments for bipolar disorders (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022).

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