There is no guarantee that ECT will work for all people or for all kinds of mental illness. The National Institute for Health and Care Excellence (NICE - an organisation that provides guidance on the best ways to treat ill health in the UK) says that:
“It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with:
- catatonia
- a prolonged or severe manic episode” (guidance TA59 last updated 1 October 2009)
There are variations in both the dosage of electricity that can be given during ECT, and the way ECT can be given (to one side, or both sides of the head). In any course of ECT that is given the number of treatments received and the gaps between these treatments varied.
The people we spoke to had differing views about how effective ECT actually was. Some people responded extremely positively to ECT, e.g. their mood lifted, they got a “sort of a buzz”, they felt calmer or they had less invasive thoughts about self-harm. For some, it was the only thing that worked. For instance, David Z had had depression since he was a teenager but had managed it. When it got worse in his forties, he found that anti-depressant medication didn’t work and that ECT was the only thing that lifted his mood. Although Enid had felt depressed a lot during her life, she only had ECT after she retired when she found that she couldn’t do anything and was crying all the time. She now has maintenance ECT from time to time and finds it helps her a lot - she had a “big dip” in her mood when she stopped it. Tania found ECT “absolutely incredible”, although she had regular relapses and overall recovery has been up and down. After taking advice she had a tailored course of maintenance ECT which helped her stop taking a medication that was disturbing her sleep and her appetite returned and physical strength improved.
Sunil’s wife knew that anti-depressants didn’t work well for her husband and “begged” for him to have ECT. He says it is the only treatment that helps him when he is severely depressed.
Sunil’s wife knew that anti-depressants didn’t work well for her husband and “begged” for him to have ECT. He says it is the only treatment that helps him when he is severely depressed.
Age at interview: 56
Sex: Male
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Now when I had the episode in 2007, again it was a rather prolonged episode and I was off work for nearly a year. And during that time I was initially treated with anti-depressant for many, many months, and because my wife knew my illness very well by then, she knew that I don’t respond very well to anti-depressants, or I only either respond initially and then relapse, or the response is not ideal. It’s a partial response.
So she really begged the psychiatrist looking after me repeatedly to give me ECT. But the psychiatrist was very reluctant and we went for many months without having any ECT. And me, just lingering and struggling along, until eventually I was given ECT again as a day patient, and again that was the only thing that finally got me better.
And after nearly a year off work, I was able to go back and resume my work.
John Z was catatonic when he had ECT and it was the only answer. Although he went “on a high” after the treatments he found it very effective and nothing like the film ‘One flew over the cuckoo’s nest’.
John Z was catatonic when he had ECT and it was the only answer. Although he went “on a high” after the treatments he found it very effective and nothing like the film ‘One flew over the cuckoo’s nest’.
Age at interview: 63
Sex: Male
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I was clinically depressed, almost catatonic when I went into hospital, about twelve years ago, and basically ECT was the only answer. And it provided the answer within eight sessions. I saw, out of the depression, but unknown to the psychiatrist at the time until my wife told them, I was bipolar and not a depressive. And therefore of course by coming out of the deep depression I shot into a high, which means I went off the scale. And it was good fun being high on bipolar is better than any drug I’m sure, because you just can take on the world. You’re very creative, you suffer fools not very gladly and you tell them so. And so basically that’s what happened.
And I can tell you the process of ECT is not at all frightening.
How much did you know about ECT before that?
I’d never heard of it.
So you’d never heard of ‘One flew over the cuckoo’s nest’ or?
I’d seen the film, but you didn’t always relate ‘One flew over the cuckoo’s nest which is highly destructive in my view in terms of mental health treatments these days because it’s informed a lot of, or misinformed a lot of people over the years about what ECT is. And I’ve heard terms such as its barbaric and all this sort of nonsense. Nothing like it. It’s like having a cataract operation.
Enid had ECT as an inpatient and now has maintenance ECT as an outpatient. Along with dialectical behavioural therapy ECT has helped her improve her mood enormously.
Enid had ECT as an inpatient and now has maintenance ECT as an outpatient. Along with dialectical behavioural therapy ECT has helped her improve her mood enormously.
Age at interview: 74
Sex: Female
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And I had a course of twelve sessions then, and then once a week and once a fortnight and kind of, they tailed it off, and it helped me enormously and that really did make a lot of difference to how I was and I came home, and started, I was on tablets and various other bits and pieces and for quite some time, because my moods were, were swinging but I didn’t get to a, you know, very low patch for a while and then I did and had another lot of ECT. But stayed home this time. I wasn’t in hospital for it. I had another session of twelve and then it… Initially it went to once a month and then the sessions got wider and wider apart and at the beginning of this year, I was very poorly and wanted to do myself harm. I wanted to end it all, and ended up with another set of twelve sessions.
But during that, during the last eighteen months, well it’s a bit more than that now, but I did a dialectic behaviour therapy course as well. I had to stop part way through that, because of the ECT. I couldn’t get to the sessions because I couldn’t drive myself. But I have completed that now. And I actually think that that is helping me to stay much better than I have been in the past. But I am still having monthly sessions of ECT at the moment. My doctor currently is reluctant to space it out any wider, because last time I did a big dip again, so this is early days yet you know, it’s only a few months since the last set of twelve ECTs, so I will have to see how things go.
When people were involved in the care of others who had experienced severe mental health problems, the sense of relief in finding a treatment like ECT that worked could be immense. People talked to us about how the people they cared for had often been unwell for a long period of time before ECT was offered as a treatment. Some, like Catherine Z, thought ECT should have been offered much sooner and not as a last resort. Annie and Lorraine felt that ECT had given their elderly mother her life back and couldn’t speak highly enough about the effect that ECT had had on her quality of life.
However, other people felt that there was no improvement in their symptoms from ECT. Some of the people we spoke to found that ECT didn’t help them at all, or the immediate effect soon wore off, and they needed medication to manage their symptoms. For others, while ECT was effective on some occasions, it was not effective at other times. Tracy suffered from post-natal depression as well as depression at other times of her life. She does not think ECT had any effect on her except to wipe her memory.
Even when ECT did not lead to a positive change in mood or wellbeing, it could still sometimes have distressing side effects (see for more ‘
Side effects of having ECT’). Some people described ECT itself as a distressing treatment to have (for more see ‘
Experience of having ECT’) and said self-help and medication worked better for them. Where the ECT didn’t work, some carers felt desperate and like they had “let down” their loved one. Carys said ECT had not helped her daughter and “it was almost like another way of hurting her”, “quite cruel”.
Tristan felt huge relief when ECT appeared to work dramatically for his wife. However, his wife had a relapse 6 to ten weeks after the treatment and he thought that antidepressant medication helped improve her well-being in the longer term.
Tristan felt huge relief when ECT appeared to work dramatically for his wife. However, his wife had a relapse 6 to ten weeks after the treatment and he thought that antidepressant medication helped improve her well-being in the longer term.
Age at interview: 38
Sex: Male
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She had a course of six treatments over six weeks which is about the shortest course I think that you can have. It worked dramatically well but everyone said at the time that you have to be careful I think there’s a theory that if you have a long course of treatment it’s less likely that you’ll relapse, but there is a high likelihood of relapse anyway if there’s a problem with the treatment. And but she was quite well for a little while after the ECT. And it did feel like a huge relief at the time and up until that point I had no real strong idea as to when or if [name of wife] was going to get better so just to see the possibility of her being better for the first time since [name of daughter] was born was huge relief and I was immensely grateful for it and felt very positive about it in many ways despite some previous reservations. but then unfortunately she did relapse I think it was probably six to ten weeks later, she had that window of being better and then she got worse again which was quite crushing at the time.
And at, but at that time I then felt that this wasn’t the solution that just going back to ECT for various reasons I’ll go into in a minute wasn’t going to be the long-term solution and that we would, actually she went back into a psychiatric unit and she tried a different drug and this drug suited her much better, it was a drug she hadn’t been on before and she was able to get, she started to get better on the drug and we decided that we would stick with that, persevere with that and that was what, you never know conclusively but I’m sure that was what got her better, and got her better properly in the long term.
Tracy felt that ECT didn’t help with her depression and she would recommend people pursue other avenues. She lost a lot of memories and doesn’t think enough research has been done on the after effects.
Tracy felt that ECT didn’t help with her depression and she would recommend people pursue other avenues. She lost a lot of memories and doesn’t think enough research has been done on the after effects.
Age at interview: 49
Sex: Female
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Well perhaps it does work for some people. It must do otherwise they wouldn’t continue to do it. I hope that that’s why they continue to do it. But I would never have it again no matter how bad I was, because the worst thing for me was the memory loss. And I know I’m not the only person that’s suffered with that, that’s quite a normal thing. But I don’t think enough research is done into the after effects either. No. My recommendation is “stay well clear”, and pursue other avenues first. But like me they are desperate, you try anything. Don’t.
I don’t think it helped with the depression at all. I can’t even remember what my ex thought about it. Whether he thought it did or not. I can’t even remember my parents visiting me. I know they would have. But no it definitely didn’t do any help, unless it’s wiped off a memory that was bad that I wanted to get rid of. I don’t know, because I can’t remember, but that would have been the only positive thing that might have come from it. But if it is I’m unaware. I don’t like it at all.
How quickly did it work and what was the effect?
Many of the people we spoke to had 8-12 treatments of ECT before they experienced any effect. Recovery was a very individual process (see ‘
Managing mental illness and recovery’ for more). But some people who had had ECT when they were suicidal or catatonic described a sudden or striking change after their treatment. Tania said, “It was as if I’d switched back on and I’d come back to life again, and the screen had kind of gone”. Steve described his wife as having a “positive response” within days of having ECT - showing signs of a “strong recovery” within weeks. Catherine Z had 4 treatments over a short period and within a week was well enough for “home-leave’ and was discharged with weekly outpatient appointments after that. She describes ECT as the best thing that could have happened to her and she has not had a recurrence of her mental health problems in twenty three years.
But people said the treatment could have unexpected results and lead to other mental health problems. For John Z, who was later diagnosed as bipolar, after 8 treatments of ECT, he went from being catatonic to being high and "off the scale". Sunil who had had dozens of ECT treatments says he now gets hypomania and can be quite argumentative, though he is not sure if that is from the ECT or the two anti-depressants he is taking.
Suzanne and her husband felt that ECT saved Suzanne’s life as before she had the ECT she had stopped eating and drinking. After having ECT, she got better quite quickly and was able to return to work.
Suzanne and her husband felt that ECT saved Suzanne’s life as before she had the ECT she had stopped eating and drinking. After having ECT, she got better quite quickly and was able to return to work.
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I lost a lot of weight when I wasn’t eating and the ECT was kind of life saving really, because I don’t think I would have recovered otherwise. My parents think I would have, they think it would just would have taken a lot longer. And I have heard other psychiatrists talk about when ECT is used in those circumstances and so that people do recover, but I don’t see how it can happen when you’re not eating and not responding to anything.
Yes, I remember the last course of ECT treatment, but I’ve no recollections of the others, because I think I would have had about five or six treatments.
So different sets of treatments or …?
No like they give you a series of treatments and electric shocks and through for which you’re receiving anaesthetic for, as part of a package kind of … it’s a sad story. I don’t know how to describe it. But it’s like a course of treatment.
Yeah yeah.
Yes. But for me I think it was lifesaving and I became well again very, very quickly and within a couple of weeks of being in hospital I had got myself a Sunday job and I was back functioning normally. You know, when I had a few days in hospital of feeling really well and then I was discharged and I continued to feel well after that.
Tania had been very ill and in and out of hospital and it took a while to come to terms with her depression. She describes the effect of the ECT as ‘quite incredible’: She ‘just woke up and the whole thing had lifted’.
Tania had been very ill and in and out of hospital and it took a while to come to terms with her depression. She describes the effect of the ECT as ‘quite incredible’: She ‘just woke up and the whole thing had lifted’.
Age at interview: 41
Sex: Female
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And I had been, you know, over a year of being in and out of hospital and very dangerously ill. And I gave the ECT a try and I had seven or eight, I had eight treatments ultimately, but I think after the seventh one I just woke up and the whole thing had lifted and it was quite incredible. I can’t, you know, I could never put it into words. It was as if I’d switched back on and I’d come back to life again, and the screen had kind of gone.
And after that, I mean, it took some time, it took some time to make a full recovery, because, you know, after the experiences of the previous year and I was, I was really in pieces and I, you know, took a while, over the course of the next few months I needed to get my sleep sorted out and I just needed to come to terms with the anxiety that whole, the whole episode had produced for me. And I had some cognitive behaviour which really helped me, like, get sort of relaxed and face kind of getting back to life again and just kind of get over what happened. And I also, it helped, I managed to come off the sleeping pills and get back to sleeping again, and you know, that just took a couple of months because I wasn’t, I wouldn’t say I was really ill then, I just, it was more like the after effects of just having the sort of the trauma of the whole, the whole year, and then following that I went back to university the next year and I went back and did my final year at university and it was, you know, it was tough going back, a lot of my friends had left by then and I was pretty shaken about what had happened, but my department were lovely and really supportive and I went back to university and I, and it went really well and I ended up, yeah, I ended up getting a First, which is what I’d really hoped for all along and staying in academia.
For many others the effect was much more gradual, and it was only some time after the treatment that they, or those who cared for them, thought that ECT had had an effect. It was sometimes difficult for people to identify at what point any change had happened. People we spoke to talked about subtle changes such as becoming aware what year and day it was, becoming more active, or taking an interest in what was happening around them. Some remember feeling better only after they left hospital, for example, when they noticed they relaxed during a holiday with their family.
Jane suffered anxiety and paranoia before having ECT and had 19 sessions of ECT. She remembers going on holiday after the treatments and planning the next day and realising “there was a point in living”, but it was only much later she made the connection that having the ECT had made her better. After her first treatment, Kathleen reported a bad headache and jaw ache and so they lowered the dose and she believes they switched the ECT from both to only one side of the scalp, which she thought needed a longer course to work. She had twenty four treatments and, although she says it “saved my life”, her overall recovery was gradual.
The effect of ECT for Matt’s wife after the initial 7 treatments was hard to measure, but he noticed a definite change. It was not a change in her mood but in her energy level, returning to her talkative active self.
The effect of ECT for Matt’s wife after the initial 7 treatments was hard to measure, but he noticed a definite change. It was not a change in her mood but in her energy level, returning to her talkative active self.
Age at interview: 36
Sex: Male
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I mean she had it twice a week for three or four weeks, and then each time I’d try and get over there after dropping the kids off at the school. And the… it was really weird is really I kind of hard to measure what effect it was having, but by about the fifth or the sixth treatment, she… her mood hasn’t changed very much, but her energy level had changed really dramatically. It really, really picked up. She was much more talkative, you know, she was doing. There was all sorts of stuff going on in the ward which she’d been ignoring, you know, art classes, and drama classes, and badminton and table tennis and she was kind of, she was signing up for everything and doing all these things and it felt really positive. Because that was what she had been like ordinarily, kind of get involved in everything.
But the really odd thing was that her, it was like her energy had recovered ahead of her actual mood and her actual thinking. It was like, she was kind of cheerful, but she would be cheerfully saying really kind of dark things you know, so it was, it was like her thinking was the last thing to recover, but it felt. It felt really encouraging, it felt really positive and it felt really kind of exciting. That this… this thing was going to work. Especially because everybody had been talking about it as the kind of last option.
For Kathleen ECT had a more gradual effect. She found that she began to not have so many suicidal thoughts and that they were less intrusive.
For Kathleen ECT had a more gradual effect. She found that she began to not have so many suicidal thoughts and that they were less intrusive.
Age at interview: 51
Sex: Female
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What was the effect? Well it’s not like a light switch. It wasn’t a sudden thing I would say. I remember some of the things that I did on the ward, like sort of the occupational therapy type things. But for the length of time that I was there, there’s so much that I don’t remember. That’s why I don’t know whether it was unilateral or bilateral. It certainly must have been a lower dose and although you come round very quickly from it. You’re sort of sleepy. Sometimes I would sleep afterwards for a while, sometimes I would be wide awake and just be able to carry on. Other times I was totally disorientated and not, not know where I am or where my room is or whatever for a while. But from a mood point of view, well it just, things must have improved because I didn’t have the thoughts so much or I’d have the thoughts but they weren’t so intrusive. And I was able to do other things like these other activities that we did on the ward.
If it worked once did it always work?
Many people we spoke to reported a return of their illness after having had effective ECT. While the effect of the ECT was only short-term, it had got them through a real crisis. However, not everyone who had an initial good response to ECT responded the same way after every treatment. When Kathleen had ECT after an attempted suicide she improved dramatically with few side effects. But when she went back for ‘maintenance’ ECT she had a bad experience. She was disoriented and didn’t remember walking home alone, or anything that happened during the three days following the treatment. She had to be admitted to hospital to recover (for more see ‘
Side effects of having ECT’).
Steve’s wife first had ECT in the 1970s and has had several courses of ECT treatments over the years. Steve thinks that although ECT does work, she now seems to need more treatments before she responds.
Steve’s wife first had ECT in the 1970s and has had several courses of ECT treatments over the years. Steve thinks that although ECT does work, she now seems to need more treatments before she responds.
Age at interview: 60
Sex: Male
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And my own recollections of when she came out of hospital and how she was and, and generally how she improved, and she always seemed to have, it seemed to have a positive effect on her. It may have taken longer sometimes. She tends to get a little bit anxious when she has ECT, that she feels it’s not working. You know, after two or three sessions she’s start to get anxious thinking by now it should have had an effect, but obviously her psychiatrist will say, “Well we’re going to give you ten sessions, you just have to be patient.” I guess she’s just been measuring it against her past history. But she has recently when she’s had it the last five years noticed that she needs the frequencies to be increased, and she gets a little bit alarmed that she doesn’t notice anything herself and to be quite honest I haven’t really noticed anything positive in the last in the first three or four sessions, but over a period of time, and sometimes you know, even though she’s had ten sessions of ECT she’ll come home after her tenth treatment and there’s no distinct positive effect, but it tends to slowly work its way into her system and that after a few weeks then we start to have the benefits of it.
But I guess in the early days when she was younger, she noticed it almost immediately, and she would tell you sometimes, even after one treatment of ECT she would definitely get a sort of buzz, a positive effect from it and I guess that’s what she looks back to, and she measures that by what she’s having, had recently, but yes.
For some, interruptions in treatment (for example due to a change of consultant) made ECT less effective. Jane had had her treatment stopped and restarted when her consultant changed, and this affected how well the ECT had worked.
Matt felt that because his wife had had her ECT stopped and restarted it wasn’t as effective as it could have been. He found it very frustrating that a change in consultant had led to inconsistent treatment.
Matt felt that because his wife had had her ECT stopped and restarted it wasn’t as effective as it could have been. He found it very frustrating that a change in consultant had led to inconsistent treatment.
Age at interview: 36
Sex: Male
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Yes, so then after the… I think it was the 7th treatment it was stopped quite suddenly, because the consultant changed. And there was this weird set up where the consultant who had wanted her to come into hospital was running the admissions ward. So he brought her into the admissions ward, but then you were only supposed to stay there for a few days, and she ended up being there for two weeks while they were finding her a bed in the kind of, in the more long term ward. During which time the treatment started. But then she got moved quite, quite suddenly into the new ward, and that meant that the original consultant wasn’t in charge of her care anymore, even though it had been that who had set up the ECT. And the new consultant just had a completely different opinion about the diagnosis, the problem, the history, and the use of ECT.
That was incredibly frustrating because you know, just the whole structure just seemed really absurd, because while she was at home there was one consultant, and then he had to hand over to this other consultant who was only in charge of the admissions ward, who then had to hand over to this third one. Who, you know, he spoke to her for about twenty minutes, read her notes, and decided to stop the ECT, which you know, it had been building up. Lots of people had been involved. The team that was looking after her in the community, those two consultants had discussed it, and you know, everybody in the admissions ward and I’d discussed with [name of wife], you know, it had just been this really kind of long, involved, decision making process. And this new consultant was able to just, just stop it.
And it got to the point, I think, I… something happened, somebody, I think one of the nurses, one of the nurses on the ward spoke to me, and said something and she was kind of being a bit cagey, but she said something to me about the way the consultant had been, the new consultant had been speaking and kind of suggested that she thought there was a problem, and maybe I, it would be helpful for me to speak to him to give him more information or something like that. And so I phoned him up and then he offered to meet me, and so I went and spoke to him for about an hour. I mean he was quite generous with his time, but you know, it was, it was awful. He just, he had a really clear idea about what was wrong with her, and just completely disagreed with what other people thought, and it was to do with the depression and the psychosis. And, the fact that… ECT’s for treating depression. And it’s no good for treating psychosis, and… and he was saying, she was only exhibiting symptoms of depression because of the psychosis and so she had to have, just have a stronger anti-psychotic and everything would be fixed.
Whereas my experience, having seen her virtually get ill was that no, she had been gradually getting more and more depressed, until it got to the point, you know, where she had tipped over into psychosis but because he, you know, and I think he just generally didn’t agree with ECT full stop. So he was just able to come in and say he was going to stop it.
Last reviewed January 2018.
Last updated January 2018.
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