Electroconvulsive Therapy and Other Brain Stimulation Therapies

For cases in which medication and/or psychotherapy does not help relieve symptoms of depression (or, in other words, when the depression appears to be resistant to treatment), electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.

How ECT Works

Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. He or she sleeps through the treatment and does not consciously feel the electrical impulses. Within an hour after the treatment session which takes only a few minutes, the patient is awake and alert.

A person typically will undergo ECT several times a week, and often will need to take an antidepressant or other medication along with the ECT treatments. Although some people will need only a few courses of ECT, others may need maintenance ECT--usually once a week at first, then gradually decreasing to monthly treatments. Ongoing ECT research is aimed at developing personalized maintenance ECT schedules.

Side Effects of ECT

ECT may cause some side effects, including confusion, disorientation and memory loss. Usually these side effects are short-term, but sometimes they can linger. Newer methods of administering the treatment have reduced the memory loss and other cognitive difficulties associated with ECT. A patient always provides informed consent before receiving ECT, ensuring that they understand the potential benefits and risks of the treatment.

Other Brain Stimulation Therapies

Other, more recently introduced types of brain stimulation therapies used to treat severe depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). The non-invasive approach (TMS) and the surgical approach (VNS) have FDA approval for use in depression that does not respond to medication. However, these methods have not achieved widespread use.

A more invasive approach called deep brain stimulation (DBS), in which electrodes are implanted at specific locations in the brain, is now approved for the treatment of Parkinson’s disease. Researchers are studying DBS is as a possible treatment for depression that does not respond to more conventional approaches.