Electroconvulsive therapy (ECT) has long been associated with a history of cruelty, fear, and stigmatisation, despite evidence of its efficacy for many people with severe mood and psychotic disorders. Although the exact mechanisms as to why ECT is effective are not well understood, contemporary ECT remains a safe and effective approach, that does not need to be a treatment of last resort [799]. During ECT treatment, an electric current stimulates seizure activity in the brain via electrodes applied to the scalp. Throughout treatment, the person receiving treatment is anaesthetised and given muscle relaxants to prevent body spasms [800]. There are notable adverse effects associated with ECT, which are most commonly related to executive function, attention, and memory [799]. Memory loss (including forgetting past information, or retrograde amnesia, as well as difficulty retaining new information, or anterograde amnesia) is typically greater with longer courses of ECT. There is evidence that the majority of adverse cognitive effects are temporary, although there is variability in how different people respond and recover [799]. Other adverse effects are associated with general anaesthesia and are less common (e.g., cardiac events), or other neurological events (e.g., stroke) [801]. More contemporary approaches to ECT, including electrode placement, have substantially reduced these risks [799]. The number of ECT sessions depends on a client’s progress but is usually between six and twelve sessions [800]. Clinicians may wish to refer to patient accounts and experiences with ECT for more information; for example, Wells and colleagues [802], where patients describe both positive and negative experiences.
The effectiveness of ECT in the treatment of depression, catatonia, mania, and schizophrenia is well documented [799, 803–806], but ECT remains underutilised [807]. There is evidence supporting the use of ECT for treatment resistant depression, mania, and schizophrenia [799], as well as a potential first-line treatment when rapid improvement in clinical symptoms is required (e.g., for clients at high risk of medical complications or suicide risk) [808].