Electroconvulsive therapy (ECT) is a treatment for severe symptoms of depression, mania, and catatonia. This section explains what ECT is, when it is used and your rights to refuse this treatment. This information is for people affected by mental illness in England who are 18 or over. It’s also for their carers, friends and relatives and anyone interested in this subject.
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The Royal College of Psychiatrists have produced a 3-minute British Sign Language video on Electroconvulsive therapy (ECT). You can view it by clicking on this link and scrolling down to the bottom of the page: www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/ect
Electroconvulsive therapy (ECT) is a treatment for some mental illnesses.
ECT is when electrical currents are passed through your brain to cause seizures or fits.
National Institute for Health and Care Excellence (NICE) say there is still no generally agreed theory that explains how ECT works. But the most accepted theory is that it causes changes to your central nervous system neurotransmitters.
The Royal College of Psychiatrists say ECT.
Researchers are trying to find out more about how ECT works.
There are 2 types of ECT.
Before you get ECT:
Doctors will give you muscle-relaxing medicine and a mouth guard will be put in your mouth to protect your teeth.
Staff will place 2 metal discs will on your head. If you are having unilateral ECT both will be placed on the same side of your head. If you are having bilateral ECT one disc will be placed on each side of your head.
You will be given several brief electrical currents to your head to bring on a fit or seizure.
The number of electric pulses you will be given depends on how much is needed to make you have a fit. Medical professionals will look at how you respond to the electric pulses. They will try to give you just enough electric pulses to make you have a fit.
The seizures or fits can be very small and minor. They usually last for an average of 40 seconds but can last up to 2 minutes.
You often get short courses of ECT treatment of about 6-12 sessions.
ECT is usually given twice a week.
Sometimes it is given once every 2 weeks or once a month to stop symptoms from coming back.
Electroconvulsive therapy (ECT) can be used to gain fast and short-term improvement of severe symptoms:
It can be used for the following mental health conditions.
Doctors should offer you other treatments like medication and talking therapy, before ECT.
The National Institute of Health and Clinical Excellence (NICE) recommends that ECT should only be used when:
But NICE say ECT should not be used:
ECT is occasionally offered as a treatment to people who live with schizophrenia. But it is not recommended by NICE. NICE think that more research is needed about its effectiveness to treat the condition.
Research suggests that ECT may be effective to treat acute episodes of certain types of schizophrenia and reduce relapse. And that ECT used with antipsychotic medication may be more effective than medication alone. But NICE say the design of many of the studies did not reflect current practice and results are not conclusive.
You can find the NICE ‘Guidance on the use of electroconvulsive therapy’ by clicking here: www.nice.org.uk/guidance/ta59
You can find more information about NICE in the Further reading section at the bottom of this page.
NICE have guidelines on ‘Depression in adults: Treatment and management.’ The guidelines say when ECT can be considered for treatment for depression. See point 1.13.1 in the guidelines here:
www.nice.org.uk/guidance/ng222/chapter/recommendations#further-line-treatment
The guidelines say medical professionals can consider using ECT for the treatment of severe depression if:
If you are having ECT for treatment for depression, it should be stopped immediately if:
For more information see our webpages on the following:
The NHS say that ECT is generally safe.
There is no evidence that having ECT is more dangerous than any other procedure needing a general anaesthetic.
An anaesthetist will assess you before your ECT treatment starts. If they think it’s not safe for you to have an anaesthetic, you won’t have ECT.
Death from general anaesthetic is rare, with a rate of about 1 in every 100,000 who have it. This means that about 99,999 people who have a general anaesthetic will not die from it. But the risk is higher if:
Do ECT clinics need to be accredited?
The National Institute of Health and Clinical Excellence (NICE) say that clinics should only provide ECT if they:
You can ask if the clinic you are referred to meets the above standards.
Electroconvulsive therapy (ECT) can cause some side-effects. You can ask your doctor about possible side-effects before you have ECT.
Straight after ECT, you might experience some or all the following:
You might experience memory problems after ECT. For most people the problems end within 2 months and they are not too distressing.
ECT may cause short or long-term memory problems for current and past events.
About 1 in 5 people say that their memory was already causing them problems before having ETC. Often because of their mental illness. So, it can be hard to say whether the problems were caused by the ETC, their illness, or both.
ECT can trigger a long seizure, but this is very rare.
Some report longer-term side-effects after having ECT treatment.
ECT is only used when you are severely ill or other treatments haven’t worked. So, it can be difficult to know whether side-effects that people report are caused by ECT or the illness it’s treating.
Scientific research hasn’t found any evidence of increased risk of brain damage, epilepsy, stroke, or dementia after ECT.
Some people say they experience:
Healthcare professionals should assess you after each session of ECT. This assessment will check if:
Your ETC sessions should stop if:
The way that you deal with information should also be monitored regularly. This is called your cognition. As a minimum, it should be assessed at the end of each course of treatment.
There can be increased risks if some people have ECT.
Doctors need to think carefully before they give you the treatment if you’re:
Your doctor should offer you ECT if they think that it is a good option for you.
They should explain the risks and benefits of the treatment. Your relatives, carers or an advocate can be involved in the discussion too if you want.
You should be medically examined to make sure you’re well enough to have ECT.
Mostly, you don’t have to have ECT if you don’t want to. The following sections on this page below will explain when you can be given ECT without your agreement.
Your doctor should not pressure you to have ECT if you do not want it.
You can withdraw your agreement to have ECT at any time.
Your doctor can consider offering you a repeat course of ECT if:
If you have had ECT before and you didn’t respond well, it should only be offered to you again if:
In some limited situations, doctors can give you ECT without you agreeing to it. These are if you:
Mental capacity means you can make your own decisions by being able to:
Doctors might think ECT is the right option for you. You might not be able to do all the things in the 4 bullet points above to make your own decision. This means you would lack mental capacity to decide whether you agree to ECT.
Doctors might consult with other people, such as your relatives, attorneys, or professionals in your mental health team. They might do this to see if they think if ECT is the right option for you. A law called the Mental Capacity Act gives doctors the right to then make a decision in your ‘best interests.’
They might think it is in your best interests to have ECT if you are very unwell.
A best interest’s decision to give you ECT can be made, even if you are not detained under the Mental Health Act.
But ECT shouldn’t be given if you have a valid advance decision in place to refuse ECT. See the following sections for more information.
There might be a disagreement about if ECT would be in your best interests. The Court of Protection can decide if the treatment is right for you. Their contact details are:
Court of Protection
Make decisions on financial or welfare matters for people who lack mental capacity.
Phone: 0300 456 4600
Address: PO Box 70185, First Avenue House, 42-49 High Holborn,
London, WC1A 9JA
Email: courtofprotectionenquiries@justice.gov.uk
Website: www.gov.uk/courts-tribunals/court-of-protection
You might not have anyone who can give their opinion about your treatment. You should have an independent mental capacity advocate (IMCA) to help you. An IMCA is free to use, and they do not work for the NHS.
For more information see our webpages on the following:
You might be detained in hospital under the Mental Health Act. You can decide if you want ECT if you are offered it.
A medical professional will certify that:
You might be offered other types of treatment if you are detained under the Mental Health Act. You can decline treatment, but if you do you can be forced to have it under the Act.
You might be in hospital under the Mental Health Act and doctors might think you need urgent ECT treatment. Whether you have mental capacity or not, you can be given ECT without your consent if:
You might be in hospital under the Mental Health Act. Your doctor might think it’s in your best interests to have ECT, but you lack mental capacity.
A second opinion appointed doctor (SOAD) must agree with your doctor that it is in your best interests to have ECT.
The SOAD must write down if they think you should have ECT or not.
Their decision doesn’t have to be shared with you if they think it would cause mental or physical harm to you or anyone else. But in most cases, you should be able to see the SOAD’s decision.
But you still should not have ECT if:
See the following section for more information on advanced decisions.
People who can make legal decisions on your behalf are:
You have the right to see an independent mental health advocate (IMHA) for free, independent advice.
If you want to see an IMHA you can ask staff on the ward about this.
For more information see our webpages on the following:
You can find more information about ‘Can someone else manage my money for me?’ at: www.mentalhealthandmoneyadvice.org/en
Under an advance decision you can say what specific medical treatment you do not want to have. The purpose is to have a record, so medical professionals know in case you become mentally incapable in the future.
Advanced decisions are legally binding.
An advanced decision cannot be used for anything else.
To make a valid advance decision you must:
You can make an advance decision if you don’t want ECT in the future.
We advise you to put your advance decision in writing and share it with people like:
It is your responsibility to make people aware of your advance decision.
Doctors can still give you ECT in an emergency. See the previous section for more information. But the Care Quality Commission (CQC) says this only happens in exceptional cases.
Your doctor should tell you about the risks and possible benefits of having electroconvulsive therapy (ECT).
The National Institute of Clinical Excellence (NICE) recommends that your doctor should give you an information leaflet. It is to help you decide if you want ECT.
The leaflet should:
You can ask your doctor for information on ECT.
Your doctor should document both the risks and benefits of you having ECT. As part of the assessment the doctor will think about:
NICE (National Institute of Health and Clinical Excellence)
NICE guidelines are evidence-based recommendations for health and care in England. They set out the care and services suitable for most people with a specific condition or need, and people in particular circumstances or settings. Health professionals should use them to help them to make decisions about patient health, care and wellbeing.
NICE has written a booklet on ECT for patients, carers, advocates and the general public. You can get this booklet from:
You can read the full NICE Guidance on the use of electroconvulsive therapy here: www.nice.org.uk/guidance/ta59.
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© Rethink Mental Illness 2024
Last updated August 2023
Next update August 2026
