Electroconvulsive Therapy

ECT stands for Electroconvulsive therapy. It is a safe and effective treatment for various illnesses. During ECT, a small amount of electrical current is passed through the brain using two electrodes. This triggers a brief seizure, similar to an epileptic fit.
 The patient is under general anaesthesia and receives medication to prevent muscle spasms.

While films and TV shows sometimes portray ECT in a dramatic or frightening way, the reality is that it is a calm, well-controlled medical procedure. It is a safe treatment that can even save lives.

ECT is used for various conditions. In the Netherlands, it is mainly applied in cases of moderate to severe depression, severe psychotic symptoms, severe suicidal thoughts and some forms of mania in people with bipolar disorder.

ECT often brings improvement quickly, while medication and other therapies take more time. That’s why ECT is a good alternative for people who urgently need relief —for example, when there is a risk of suicide or when someone is unable to eat or drink due to severe mental illness.

ECT is also an important treatment for people with treatment-resistant depression. This means that other treatments, such as various medications and psychotherapy, have not been effective.

ECT aims to reduce or eliminate the symptoms of the illness. People with depression, psychosis or mania often experience significant distress. Their symptoms can vary from person to person,  but in every case,  these problems make daily life challenging or even impossible. By easing these symptoms, ECT can help people regain their ability to function and resume their daily routines.

During ECT, a carefully controlled electrical current is passed through the brain via two electrodes placed on the head. The current flows from one electrode to the other.

The procedure is performed under general anaesthesia, making it completely painless. General anaesthesia means you are fully unconscious and will not notice the treatment. The electrical stimulus lasts no more than 8 seconds and triggers a short reaction of 20 to 60 seconds, similar to an epileptic seizure.

Muscle relaxant medication is given during anaesthesia to prevent muscle spasms. This is done via an IV in the arm. Throughout the procedure, a team of doctors and nurses monitors the patient’s heart rate, breathing and brain activity.

The most common electrode placement in the Netherlands is called right unilateral (RUL),  where one electrode is placed on the right side of the head and the other on the top of the head. The current flows from the top electrode to the one at the temple.

If RUL does not provide enough improvement, bilateral placement may be used. However, this carries a higher risk of memory problems.

An ECT treatment course typically involves between 6 and 15 sessions, though the exact number varies from person to person. It’s not unusual for someone to require more treatments than the average. Most people receive two sessions per week. If discomfort or side effects occur, the treatment settings can be adjusted.

More than two out of three people with depression who receive ECT experience a significant reduction in depressive symptoms after treatment. The figures below are based on data from 1,444 patients who underwent ECT in the Netherlands during a specific period. For more information see Frequently Asked Questions.

Some people experience a return of symptoms after treatment ends  —this is true for many therapies, including ECT.  Among people with depression who responded well to ECT, about half will relapse if no preventive measures are taken. Medication after ECT—often an antidepressant combined with lithium —can reduce the risk of relapse. However, it is difficult to predict who will relapse  and the follow-up treatment needed varies from person to person. Your healthcare provider can advise you on the best approach.

Overall, ECT is well tolerated, but like any medical treatment, it can have side effects. These may include short-term effects such as headache, nausea or muscle aches shortly after treatment. Some people also experience temporary memory issues, which may last for a time after ECT. The extent of these memory issues varies from person to person. This side effect is important and is explained in more detail here.

ECT is a voluntary procedure. In all cases, informed consent must be given before starting treatment. The patient (and their loved ones) will receive a clear explanation of what the procedure involves. In rare emergencies, ECT may be performed without prior consent—for example, if the patient’s life is in immediate danger.