Smiley Australia

Information on ECT (Electroconvulsive Therapy)

ECT (shock treatment) is still used today for the treatment of severe forms of depression and some other illnesses. It is usually implemented when the patient does not respond to medication, in conjunction with medication or where the patient has such severe side effects that medication is not an option.

ECT can only be given after 'informed consent' is obtained from the patient, unless the patient is so ill that they are incapable or giving informed consent and are (in the opinion of the treating psychiatrist) a danger to themselves and/or others.

ECT is usually given in blocks of 6 treatments over a two week period with up to 12 treatments given if the first 6 do not have the desired effect.

Further treatment called 'maintenance ECT' may be recommended dependant on the circumstances of the patients recovery and to prevent relapse. There is no evidence that maintenance ECT is of any benefit in preventing relapse.

ECT is performed under a general anaesthetic so the patient is not conscious during the treatment.

It is usually 'unilateral' which means the electrodes are applied to one side of the brain, the non-dominant side.

A low voltage is applied to the brain which causes the patient to convulse for a short period of time.

It is basically described as a means of 're-wiring' the brain. It's a bit like deleting files off the hard drive of your computer - the ones you don't need anymore. In the case of ECT the doctors are attempting to wipe the thought processes that are causing you trouble.

While the patient has no memory of the treatment, it is usual to suffer a terrible headache for the remainder of the day of treatment, and some people feel nausea.

There is usually little improvement in the patient's condition until after the 3rd treatment where hopefully the positive results will start to become apparent.

The side effect of ECT is memory loss. Not usually long held memories, but short term memories of some things that you did for the days while undergoing the treatment. This short term memory loss should resolve within a few weeks.

There are proponents and oponents of ECT as a treatment. Some patients respond well to ECT, others appear to receive no noticable benefit. Some patients report ongoing memory problems and loss of some abilities after undergoing treatment.

Informed Consent:

You will be provided with videos and other material prior to undergoing any treatment. ECT is a personal choice and patient consent must be fully informed before treatment starts. You will be required to sign a release document stating that you understand the nature of the treatment and that you are giving your informed consent.

If the patient is heavily medicated they may have difficulty understanding what they are being 'informed' about. It is preferable that a patient has someone they trust (i.e. a family member) explain and assist with this important decision.

Given the condition of some patients under the influence of medication it is difficult to understand how these people could be construed to have provided 'informed consent'. Where a treating practitioner has suggested the treatment is necessary because of failure of medication to correct the underlying condition one could suggest the patient remains incapable of providing 'informed consent'.

It is stated that you may withdraw your consent at any time during the treatment if you wish to, however in reality this may be difficult.

If you are in an 'in-patient' situation in a government mental health institution the above also applies to you. Be aware that there are patient reports of coercive techniques applied in these situations to 'encourage' you to undergo the treatment. If you refuse treatment after a time you may be placed in a 'quiet room' until you reconsider. This type of practice is an abomination however it may occur when patients show a reluctance to undergo 'recommended' treatment.

The Royal Australian and New Zealand College of Psychiatrists has produced a Clinical Memorandum with information on the practice of treating patients with ECT.

You can visit the RANZCP website by accessing the link on our 'Helpful Links' page.

This Memorandum (PDF format) is also available for you to download here.
(Right-click the Link below and choose Save As):

RANZCP Guidelines for ECT
Royal Australian and New Zealand College of Psychiatrists Clinical Memorandum on ECT

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