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Electroconvulsive Therapy (ECT)

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Electroconvulsive therapy (ECT) is used to treat some people with bipolar disorder (BPD). It is rare, but it can be very effective in specific situations. It may be used alone or combined with prescription medicines and therapy.1

While ECT often works well, it does not prevent bipolar symptoms from returning. For this reason, most people will need maintenance treatment that includes medicines, therapy, and sometimes additional ECT treatments.2

ECT may be considered as a bipolar disorder treatment option for:1-3

  • People who have not responded to other treatments
  • People with very severe mania
  • Pregnant people with severe mania
  • People who are catatonic (have unusual or no movement) and are at risk for severe dehydration from not eating or drinking
  • People in need of rapid treatment due to risk of suicide
  • Older people who cannot take bipolar medicines
  • People for whom ECT has worked in the past

ECT was once called shock therapy. It also may be used to treat severe depression.2

How does ECT work?

ECT sends short electrical pulses to a person’s brain through electrodes placed in specific spots on their scalp. The procedure is performed in a hospital by a team that includes a psychiatrist, anesthesiologist, and a nurse or physician assistant.2

Before giving ECT, a doctor conducts a psychiatric assessment and a medical exam. This exam may include a blood test and electrocardiogram (EKG) to check the person’s heart health.2

During the procedure, the person is sedated with general anesthesia and a muscle relaxant. The electrical pulses cause a seizure in their brain that lasts for about 1 minute. The person then wakes up after 5 to 10 minutes, similar to having a minor surgery.2

The person may receive ECT treatments 2 to 3 times per week for a total of 6 to 12 sessions. But the number of sessions will depend on how severe their symptoms are and how quickly their symptoms improve.2

ECT of the past

There is some stigma around ECT because early use of the treatment was much different. People received high doses of electricity without any anesthesia. This led to memory loss, broken bones, and other serious side effects. Modern ECT is much safer, though it does still come with side effects.3

Side effects of ECT

Like any medical procedure, electroconvulsive therapy comes with side effects. The most common side effects are temporary memory loss or trouble learning. Some people may have trouble remembering events that occurred before their treatment. This may last for up to 2 months after the treatment. But some people have long-term memory loss or permanent gaps in their memory.2

There are also side effects to receiving anesthesia. The most common side effects of anesthesia occur on the day of treatment and include nausea, headache, fatigue, confusion, and memory loss. These symptoms may last for a few minutes to a few hours.2

These are not all of the side effects of ECT and anesthesia. Talk to your doctor about what to expect with electroconvulsive treatment. You also should call your doctor if you have any changes that concern you after receiving ECT treatments.

Before beginning treatment for BPD, tell your doctor about all of your health conditions and any drugs, vitamins, or supplements you take. This includes over-the-counter and recreational drugs.

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