Since the Italian neurologist Ugo Cerletti introduced electroconvulsive therapy in 1938 as a treatment for various mental disorders, this technique has been the subject of powerful criticism, sometimes based on misinformation.

Today, after more than 80 years of use, this therapeutic method continues to generate doubts regarding its efficacy and safety. But what is the reason for this controversy? Is electroconvulsive therapy dangerous? First of all, let’s see what this type of intervention consists of.

What is electroconvulsive therapy?

Electroconvulsive therapy (ECT) is a procedure performed under general anesthesia and involves introducing small electrical currents through the brain to intentionally trigger a brief seizure.

This technique consists of placing several electrodes on the patient’s forehead and a rubber band around it where the wires are connected to the machine that controls and executes the electrical mechanism.

During the procedure, the electrical current passes from the electrodes to the brain in just a few seconds. This is what causes the seizure, which usually lasts less than 1 minute. Because the patient is anesthetized and his or her muscles are relaxed, there is little or no sign that he or she is having a seizure and his or her body is usually completely immobile.

The final objective of this therapeutic technique is to provoke changes in brain neurochemistry, so that some of the symptoms of the serious mental disorders and illnesses it seeks to alleviate can be quickly reversed.

For what type of disorders is therapy indicated

The main indication for electroconvulsive therapy (ECT) is severe major depression that threatens life or significantly impairs an individual’s functioning. Because of its speed of action and effectiveness, it may be the treatment of choice in severe psychiatric disorders such as catatonia, depression, bipolar disorder and psychosis .

This technique is considered the most effective and fastest acute treatment for major depression. According to the randomised trials conducted, remission occurs in 70-90% of patients receiving the therapy.

Other specific indications for ECT are unipolar psychotic depression, people with suicidal tendencies and malnutrition secondary to refusal of food, severe catatonia, as well as people with episodes of recurrent depression and treated with this therapy after numerous medication failures.

It is considered that there are no absolute contraindications for ECT , regardless of the type of population and its clinical situation, except for at-risk populations that should be attended to with closer supervision.

Main side effects

Like any therapeutic procedure, electroconvulsive therapy is not exempt from possible side effects . These are the most common:

  • Memory loss or amnesia
  • Muscle aches
  • Nausea
  • Headache
  • Confusion

Headaches, nausea and muscle aches are usually mild and can be prevented or alleviated with medication. The most unpleasant side effect is usually memory loss , although this is reversed and disappears after a few weeks.

It should be clarified, however, that this type of side effect depends on the patient’s previous conditions, such as their age, their susceptibility to this type of treatment, the technique used or the frequency of administration.

Is electroconvulsive therapy really dangerous?

There is evidence that electroconvulsive therapy is one of the psychiatric treatments with the highest efficacy and safety rates for the treatment of some serious mental disorders.

Research concludes that the most common side effect is memory loss or amnesia. However, this therapy appears to have fewer side effects than some antidepressant and antipsychotic drugs in frail elderly patients.

The effects that this technique can have on the developing brain are still unknown . In pregnant and breastfeeding women who are concerned about possible teratogenic sequelae (birth defects during pregnancy of the fetus) and other side effects of the medication, it can also be effective and can be treated safely with this therapy.

A review of 300 cases of ECT during pregnancy found five cases of congenital abnormalities (hypertelorism, clubfoot, optic atrophy, anencephaly and lung cysts). The review concluded that these malformations were not the result of therapy, and that there was no evidence of postnatal developmental effects.

Clinical research also supports the efficacy and safety of electroconvulsive therapy as a therapeutic tool for the prevention of relapses in major depressive disorder, including in adolescents.

It seems therefore that, in view of the studies and research carried out, the question of whether electroconvulsive therapy is dangerous must be answered with an unequivocal no, at least until the opposite is proved.

Effectiveness in disorder intervention

Research indicates that electroconvulsive therapy (ECT) is effective in the short term for the treatment of depression, and is probably more effective than drug therapy , with bilateral ECT (with electrodes on both sides of the head) being moderately more effective than unilateral ECT.

Studies further conclude that high doses of ECT appear to be more effective than low doses in the treatment of serious mental illnesses such as depression and bipolar disorder. In addition, ECT is also shown to be effective in severe bipolar depression.

ECT would also be indicated in children and adolescents with severe and persistent major depression , with life-threatening symptoms or who do not respond to other treatments. However, in this type of younger population, ECT should be used exceptionally and always carried out by a qualified professional.

However, ECT is a therapy reserved solely and mainly for patients with severe and persistent symptoms, especially when they have not responded to other types of treatment or when there is a real serious threat to their life.

Bibliographic references:

  • Gallegos J.; Vaidya P.; D’Agati D.; et al. Decreasing adverse outcomes of unmodified electroconvulsive therapy: suggestions and possibilities. The Journal of Electroconvulsive Therapy. 28 (2): 77 – 81.
  • Fitzgerald, P.B. (2013). Non-pharmacological biological treatment approaches to difficult-to-treat depression. The Medical Journal of Australia. 199(6): 48 – 51.