Pros and Cons of Electroconvulsive Therapy (ECT)
The pros and cons of electroconvulsive therapy (ECT) are actually quite numerous but in this post I will try to, unbiasedly, lay out the basic pros and cons for anyone considering ECT as a treatment. I am likely uniquely qualified to do this as I am very educated about ECT (Yes, I still have that book in the works. Did I mention I’m really busy?) and I’ve also had ECT. This does not mean it’s right for everyone, however. Do consider the pros and cons of electroconvulsive therapy carefully before you make your own mind up with the help of a doctor.
[Note: I am running a survey on real patients’ experiences with, and perspectives on, electroconvulsive therapy (ECT). If you’ve had ECT and want your voice heard, please take the survey here. More detailed information on the ECT survey can be found here.]
Are There Actually Pros to ECT?
Some people will tell you that ECT is evil and there are no benefits worth the side effects. Some people will tell you that ECT is inhumane and should be banned. Some people say that anyone who gets ECT is submitting to some form of assault.
All of this is poppycock.
Now, back in 2009, before I had ECT, I felt, very strongly, that it was barbaric and I couldn’t believe that anyone could possibly get that treatment in this day and age. At one point I swore to myself that I would suicide before I allowed someone to induce a seizure in me.
These statements, while accurate in feeling, were dramatically inaccurate in knowledge. I was speaking and feeling out of ignorance. Most people do, on the subject of ECT. The very notion of it is unbelievably scary (to everyone) and people have a right to feel that fear. It’s pretty normal.
But, mark my words, ECT can have great benefits. ECT is nothing like sticking your finger in a light socket (as some people would crudely say). ECT is a medical procedure, nothing more and nothing less.
The Pros of ECT
We’ll start with the pros for ECT.
- ECT can act extremely quickly altering a person’s mood in as little as one treatment (although, on average, taking about 9-12).
- ECT is the most effective known treatment for depression with remission rates of 50-80% (give or take depending on the study), even for treatment-resistant depression. Studies consistently show it to be much higher than any medication.
- ECT does not require medication alteration (for the vast majority).
- ECT does not have the same kind of side effects as medication so it’s safe to use in situations where a patient can’t take medication like when they are elderly, pregnant or breast-feeding.
- ECT seems unbelievably effective in treating catatonia with a success rate of over 90% in those, severe cases.
- ECT is typically covered by insurance (I wish that weren’t a factor for people but, let’s face it, it is).
- Ketamine can actually be used as the anaesthetic during ECT and this may improve effectiveness even more (this is a controversial point and while I suspect it’s true, there isn’t enough research to fully support that conclusion).
All that being said, let’s not forget no treatment works for everyone and, for the record, ECT didn’t work for me. I’d also like to note that some people actually prefer ECT over all other treatments. Yes, it’s that successful and painless for some.
One other factor that is an ECT pro and con is that typically, unilateral ECT is tried first (there are fewer side effects) but if that isn’t effective, a stronger form of ECT (bilateral) can be tried. It’s a pro because it’s an option but it’s a con because of the increased side effects.
The Cons of ECT
Coming with the pros of ECT, there are cons, however.
- ECT can produce physical pain during the treatment. This is muscular and has to do with the invoked seizure, the anaesthesia or both. Headaches are common. This pain is typically easily treated with over the counter medications or, in some cases, prescribed medication like acetaminophen with codeine.
- ECT tends to cause memory loss from the time around the procedure. You may not remember weeks around the procedure. (Note that overall, memory may actually improve when depression improves.)
- ECT tends to create some cognitive deficits during treatment. These cognitive deficits have been shown to go away between 1-6 months after treatment ends.
- You have all the risks of undergoing anaesthesia, just like with any other minor procedure in which it is used.
- The more ECT you do and the more bilateral ECT you do, the greater your risk of side effects like memory loss.
- The positive effects of ECT may be short-lived leaving you with the choice as to whether to have ECT again. (Doctors try to prevent this by selecting medication for you when you get better that will keep you better.) Some people do choose to receive maintenance ECT.
Your chances of dying during ECT are the same as that for any procedure using anaesthesia – in other words, extremely, extremely small. I’ve never even heard of a case of this but I’m sure it happens. Your risk of death is actually less, by an order of magnitude, during ECT than it is when you’re just walking around your apartment in everyday life (presumably because in everyday life you don’t have qualified professionals ready to help you if something goes wrong).
I must also say that some people claim to have lost large chunks of memory from ECT. According to the research I’ve done this is virtually never seen but I do feel compelled to mention it. Keep in mind that these people have typically had many, many rounds of ECT and many of them were decades ago when we weren’t nearly as educated about how to minimize the side effects of ECT.
Weighing the Pros and Cons of ECT
When you weigh the pros and cons of ECT please try to do so without listening to fringe hate groups. Anyone who tells you that ECT is always good or always bad is wrong – don’t listen to them.
Instead, try to weigh ECT pros and cons for yourself and consider your own life, illness and situation. Get advice from a doctor who performs ECT that you like and is reputable (get a referral from your current psychiatrist). (I say that because not all psychiatrists know all the facts about ECT. Talking to someone with clinical experience is very important).
Make sure you ask lots of questions about every, single thing you are worried about. Don’t go into this procedure with unasked questions. Feel free to question everything I’ve said. I don’t mind. Your question-asking is very, very healthy.
And finally, know that ECT is infinitely superior to death. I’ve had it, it didn’t work, it hurt and I can still say that. So while I would never push anyone into a treatment like ECT, if it’s that or suicide, pick ECT. There is always time for death later.
More on electroconvulsive therapy can be found in the links I’ve provided above and in this Medscape section.
* I shouldn’t have to say this, but I will: I have no financial stake in anything to do with ECT. I have no conflict of interest here. My opinions are my own.