Electroconvulsive Therapy (ECT)

The Electroconvulsive Therapy Program at Massachusetts General Hospital treats hundreds of patients annually on an inpatient and outpatient basis. We use Electroconvulsive Therapy (ECT) to treat a number of psychiatric conditions, including depression. Given Mass General’s superior anesthesia and medical support, we serve as a tertiary referral center for seriously ill patients requiring ECT treatment.

About Electroconvulsive Therapy

ECT provides a minor modification in brain activity (small seizure) when a brief electric pulse is applied to the scalp. The procedure is performed under anesthesia and is administered with precise, careful calculation for each individual patient. During the procedure, patients do not experience any pain or discomfort.

ECT is a safe and very effective treatment for certain psychiatric disorders. It is most commonly used to treat patients with depression, which can be a painful and disabling illness. It may also be used to treat patients with psychotic or manic symptoms.

How ECT Works

During ECT, the brain is stimulated by a small amount of electrical current. The electrical current produces a modified seizure, which affects the entire brain, including centers that control mood, appetite and sleep. Researchers believe that ECT corrects the biological abnormalities that underlie severe depression.

More than one treatment is needed to achieve these positive effects. An average of six to ten repeated treatments (also referred to as a "series") is needed for sustained improvement. More than 80% of depressed patients who receive ECT respond favorably. Following a course of treatment, patients feel more like themselves again and are able to work and lead productive lives. Often, family members, doctors, or nurses may notice improvement before the patient.

After completing a successful ECT course with significant resolution of depressive symptoms, patients must continue taking an antidepressant or receive maintenance ECT to remain well.

Our Research

The members of the ECT service are engaged in a range of research activities. These include research into:

• N-methyl-D-aspartate Antagonist (Ketamine) Augmentation of Electroconvulsive Treatment for severe Major Depression
• Comparison of propofol and methohexital anesthesia during ECT in Major Depression Clinical Efficacy and cognitive side effects.
• A Pilot Study of the Use of IV Scopolamine to Augment the Efficacy of Electroconvulsive Therapy
• Optimal dose of succinylcholine and rocuronium for electroconvulsive treatment
• Retrospective chart review for patients with bipolar disorder who have been treated with electroconvulsive therapy
• Retrospective Chart Review for Child and Adolescent Patients Who Have Been Treated with Electroconvulsive Therapy

Referrals

Internal Referrals: New patient referrals from MGB providers can be submitted via EPIC order - Ambulatory referral to MGH Electroconvulsive Therapy (ECT) (REF21010).

Outside Referrals: Please complete a referral form so that we can determine whether the program is a good fit for the individual and gather relevant information. A completed referral form is required prior to consultation.

Our Staff

Oscar Mercado

• Program Coordinator

Frequently Asked Questions About ECT

Q: Who will benefit from ECT?

A: Many patients get relief from ECT when other options fail to address their pain and suffering.

ECT is used most often for patients who:

• Have depression, mania, some schizophrenic disorders or are severely suicidal
• Have not responded to/improved from other treatments, such as medication or psychotherapy
• Are medically cleared to have the procedure
• Have appropriately consented to the procedure

Q: Is ECT safe?

A: Like any other medical procedure, there are risks associated with ECT. These risks are related to the body’s response to the procedure rather than the electrical current itself.

To minimize these risks, patients undergo a complete medical exam performed by one of our specially trained anesthesiologists and routine tests are done prior to treatment including blood work, chest x-ray and an electrocardiogram. The procedure is conducted in the Post-Anesthesia Care Unit, which is equipped with all elements required to manage any complications.

There is continuous monitoring of vital signs and cardiac function during the procedure and in the recovery room

Q: Does ECT have any side effects?

A: Most people who have ECT report very few side effects, and these usually subside after completing the ECT course.

Most commonly reported ECT side effects:

• Memory problems (the great majority of patients experience only mild, short-term memory loss, if any)
• Headache
• Jaw pain
• Muscle aches
• Nausea and vomiting (occur very rarely)

Of these side effects, perhaps the most feared is memory difficulty. Typically, mild short-term memory loss accompanies the treatment and resolves in the hours post-treatment. In rare cases, long-term memory may also be affected. If any long-term memory problems occur, they almost always resolve a few weeks after the completion of an entire course of ECT. Within a few weeks after ECT, your ability to learn and remember new information usually returns to normal.

Q: Does ECT cause permanent brain damage?

A: No. Studies have demonstrated that ECT does not cause brain damage, nor does it cause permanent brain dysfunction. In fact, ECT often improves the cerebral functioning of patients with severe depression. By treating the depression, patients often report that they are able to concentrate better and think more clearly.

During the course of ECT, we recommend that important decisions be delayed or postponed until after recovery. If any important decisions must be made while receiving ECT, we suggest that family, friends and the treatment team be consulted.

Q: What medical risks are associated with ECT?

A: As with any other medical procedure, ECT does pose some risks. Overall, ECT is one of the safest procedures done under anesthesia. Both the risks and benefits of this procedure are fully explained at the time that the patient signs a statement of informed consent. With advances in anesthesia and delivery of electricity, ECT is a safe and relatively comfortable experience.

Q: What can I expect at an ECT appointment?

A: Before the procedure
You will have at least one required appointment to meet medical clearance guidelines

The day of the procedure
You will arrive at 7 am at the Same Day Surgery Unit located in 3rd floor in the Wang building. Before your treatment, you will meet with the psychiatrist and the anesthesiologist to address safety protocols and any other concerns

During the procedure
You will undergo general anesthesia just before receiving the procedure. The procedure itself is rather short (only about 30 seconds). You will be asleep during this time and will not experience any discomfort.

After the procedure
You will be transported to the recovery room where monitoring will continue until you completely recover from anesthesia--this usually takes about 15 – 30 minutes. 

If you are an outpatient, you will then be taken back to Same Day Surgery, and your designated escort can take you home. When you return home, you should contact us if you have any concerns or questions.

If you are an inpatient, you will return to the ward to rest and continue with your normal daily activities. If you have any concerns or questions while back on the unit, notify the staff on the unit and they can contact your provider as necessary.

Q: Why are so many people afraid of ECT?

A: Although it is estimated that as many as 100,000 patients a year receive ECT and 80% of patients improve with this treatment, negative images still remain in the public domain. Some reasons for this include:

• When ECT was first introduced, it did not have the safety and comfort measures that are required today
• Historically, movies which portrayed early, dramatic and inhumane experiences with ECT have increased stigma and fear around ECT
• In the earlier decades of the 1900s, some patients were given this treatment against their will as the strict, legally required consent procedures we have today did not exist
• All procedures which are new to a patient/family can be anxiety-provoking