Electroconvulsive therapy (ECT) is a medical treatment in which a controlled electrical stimulus is given under anaesthesia to produce a brief therapeutic seizure. It is not a routine treatment for all mental-health conditions and is considered only after specialist assessment.

When ECT may be considered

For severe depression, current NICE guidance recommends considering ECT when a person prefers it based on previous response, when a rapid response is clinically necessary—for example because illness is life-threatening—or when other treatments have been unsuccessful. Other psychiatric indications require individual specialist assessment.

Before treatment

• Confirm the diagnosis, severity, indication and reasonable alternatives.
• Review physical health, anaesthetic risk, medicines and relevant investigations.
• Discuss expected benefits, uncertainties and important adverse effects, including memory and cognitive effects.
• Document consent, capacity and the treatment decision in accordance with applicable law and clinical circumstances.

What happens during ECT

ECT is performed in a clinical setting with anaesthesia, muscle relaxation and physiological monitoring. The treatment team monitors recovery after each session. The number and frequency of treatments are individualised according to response, adverse effects and the treatment plan.

Possible adverse effects

Short-term headache, muscle discomfort, nausea or temporary confusion can occur. Memory difficulties are an important potential adverse effect and should be discussed before treatment and monitored during the course. Anaesthetic and medical risks are considered separately for each person.

ECT is part of a broader care plan

ECT addresses an acute episode; ongoing treatment is usually required to reduce relapse risk. Depending on the condition, this may include medication, psychological treatment, rehabilitation, follow-up and relapse-prevention planning.

Questions to discuss before ECT

• Why is ECT being considered now?
• What alternatives are reasonable in this clinical situation?
• What benefits are expected and how will response be measured?
• What memory, cognitive, anaesthetic and medical risks are relevant to this person?
• What is the plan after the acute ECT course to reduce relapse risk?

Frequently asked questions

Is ECT given while a person is awake?

No. Modern ECT is given with anaesthesia and a muscle relaxant, with monitoring before, during and after the procedure.

Does ECT always cause permanent memory loss?

Memory effects vary. Temporary confusion and memory difficulty can occur, and some people report longer-lasting gaps around the treatment period. This risk should be discussed individually and monitored during treatment.

Depression · Inpatient Care · Adult Psychiatry · Editorial Policy

Clinical and regulatory sources

Mental Healthcare Act, 2017 — Section 95
NICE NG222: Depression in adults — ECT recommendations

This information is for general education. Suitability for treatment requires individual assessment, informed discussion and consideration of alternatives, risks and current clinical circumstances.