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How Electroconvulsive Therapy Works

Welcome to Your ECT Appointment
1998: Doctors at a New York hospital perform ECT on a patient to treat depression.
1998: Doctors at a New York hospital perform ECT on a patient to treat depression.
© Najlah Feanny/Corbis

ECT has come a very long way since it was first used as a form of therapy. No longer does a patient need to worry that her bones will break from violent jarring or that she'll be awake the whole time her brain is being shocked.

So let's walk through a modern ECT treatment and see what the actual event looks like, as well as what's happening to the brain. First off, you'll have already gone through a battery of blood tests, an electrocardiogram, psychological assessment and a physical exam to make sure that you're physically and mentally fit for ECT.

Unlike the old days, you'll be put under general anesthesia for the procedure, so an IV will be inserted into your arm for the medicine to knock you out. Medical staff will also include a muscle relaxant in the IV to ensure a less profound physical reaction to the seizure. However, a blood pressure cuff around one ankle will prevent the relaxant from entering the foot. The doctor will watch that foot to monitor the physical activity of the seizure. A mouth guard might also be provided to prevent you from chomping your tongue.

Most important, electrode pads are placed on your head. A bit larger than a quarter, these pads might be placed on just one side of the head (unilateral), or both (bilateral). After you're completely unconscious, the doctor will press a button on the ECT machine. An electric current travels through the machine to the electrodes, where they will then pass through to your brain. For about 60 seconds or less, you will undergo a seizure. But keep in mind that you won't appear to be doing so; the muscle relaxant should function so that only your non-medicated foot will move. An electroencephalogram (EEG) monitor will show sudden spikes in activity, of course, as it measures the electrical activity of your brain. While traditional ECT uses pulses administered for one millisecond, there's now a growing trend to use ultra-brief pulses -- 0.25-0.37 milliseconds -- which still cause the seizure but lead to less side effects after the treatment [source: John Hopkins Medicine].

And that's pretty much it; the whole thing usually lasts five or 10 minutes [source: Mayo Clinic]. After the meds wear off, you might show some confusion for a few hours. And according to Mayo Clinic, most ECT treatments in the United States are given two to three times weekly, for three to four weeks.