Electroconvulsive therapy (ECT): facts, myths and when doctors use it

What is electroconvulsive therapy today?

Electroconvulsive therapy (ECT), known in Egypt simply as "electricity sessions" (galasat el-kahraba), is a medical treatment for some severe mental illnesses. The person is given a short-acting general anesthetic and a muscle relaxant, then a brief, carefully measured electric current causes a controlled seizure in the brain that lasts less than a minute. Because the person is asleep under anesthesia, they feel no pain and do not feel the electrical pulses, as the US National Institute of Mental Health explains (2024).

Cleveland Clinic (2025) points out that what films and TV series show about this treatment is often inaccurate and exaggerated, and rarely shows the anesthesia and safety steps that are actually used. In reality, it is more like a short medical procedure in an equipped room:

• Before starting: a mental health and physical assessment, meetings with the psychiatry and anesthesia teams, a review of medicines, and not eating or drinking for several hours as the team instructs.
• During the session: a trained medical team includes a psychiatrist and an anesthetist, and the anesthetist monitors breathing, heart rate and blood pressure throughout. Thanks to the muscle relaxant, the body moves very little.
• After the session: the person starts to wake up within minutes, may feel confused for usually around half an hour, and stays under observation until settled.
• Number of sessions: usually given two or three times a week. The Royal College of Psychiatrists in the UK (2026) says the average is about 10 sessions, and the plan is reviewed if there is no improvement after 6.

Nobody yet knows exactly how the treatment works. The American Psychiatric Association says the controlled seizure may boost "neuroplasticity", the brain's ability to change and adapt, but no single mechanism has been proven to explain its full effect.

When do doctors use ECT?

ECT is usually used when other treatments have not helped enough, but a doctor may turn to it early when someone is severely unwell and needs to improve quickly. It is not used for anxiety or most mental health problems. According to the medical sources this article relies on, a doctor considers it in a limited number of situations:

• Severe depression that has not improved with medicines and talking therapy, or when the person could not tolerate their side effects, whether recurrent depression or depression as part of bipolar disorder, sometimes with psychotic symptoms.
• Situations that need fast improvement because life is at risk: such as severe suicidal thoughts, or a person refusing to eat and drink until their body deteriorates.
• Catatonia: when a person freezes or stops speaking and moving. The American Psychiatric Association notes that many studies have found response rates of 80% or more in this condition.
• Selected cases of severe mania or schizophrenia that have not improved with other treatments.
• People who responded well to it before and whose illness has returned just as severely.

The Royal College of Psychiatrists says it is rarely used for people under 18, and that in this case it always needs an independent second opinion.

Does ECT work for depression?

It is one of the fastest-acting treatments for severe depression. The US National Institute of Mental Health (2024) says its effect often shows within the first week, sooner than antidepressants. The American Psychiatric Association's patient page (2026) says about 70 to 80% of people with severe depression improve clearly, and about half of them become free of symptoms, with results varying by how severe the illness is and which treatments came before.

In UK data on ECT services for 2023, presented by the Royal College of Psychiatrists (2026), 67% of patients were described as "much improved" or "very much improved" at the end of treatment, compared with 1% who became much worse.

But improvement does not mean treatment is over. The Royal College says about half of those who improve stay well for at least a year, and the chance is higher with continued treatment afterward, such as medicine, talking therapy or spaced-out maintenance sessions.

ECT side effects and memory: what does the evidence say?

This is what worries patients and families most, and the worry is understandable. The honest picture holds both things together: most memory problems are temporary, but some may last.

• During the course of sessions: difficulty remembering new things is common, such as forgetting a conversation from a short while ago. According to the Royal College of Psychiatrists, it is more likely when the electrodes are placed on both sides of the head and with higher current strength.
• After treatment ends: a systematic review published in 2010 in the journal Biological Psychiatry pooled 84 studies including 2,981 patients with depression. It found that the drop in thinking and memory tests was concentrated in the first three days after sessions, then performance returned to its earlier level, and some of it even improved after two weeks. However, the researchers noted that the studies did not measure forgetting of past events in the same way.
• Gaps in memories of the past: some people forget events from during the course of treatment or shortly before it. The Royal College of Psychiatrists considers this the most serious long-term effect and says these memories often do not come back, while the American Psychiatric Association says these effects improve a lot after treatment ends, and Cleveland Clinic describes permanent memory loss as very rare. The risk is usually lower when the electrodes are placed on one side of the head.

The Royal College of Psychiatrists says there is no evidence that this treatment damages the brain, or that it raises the risk of stroke or dementia. The most common other effects are headache, muscle aches and temporary confusion on waking; nausea is less common, and blood pressure may rise for a short time. Death linked to this treatment is very rare, around one in every 50,000 to 100,000 sessions according to the Royal College (2026), and the anesthetist checks before starting whether anesthesia is safe for the person.

Who decides? Informed consent and the family's role

The basic rule is that a person who is able to make the decision is only given this treatment with their full consent, after it has been explained what will happen, its benefits, its risks and the alternatives. The Royal College of Psychiatrists explains that the person is given at least 24 hours to think before signing, except in emergencies, and that they have the right to withdraw consent and refuse treatment at any time, even just before the first session.

If the illness is so severe that the person has lost the ability to understand and decide, the law determines who decides and with what safeguards, and this differs from country to country, so ask the treating doctor about the procedures where you live. In the UK, for example, the person's capacity is reassessed before each session, and their consent is sought again if they regain it.

The family has an important role in asking questions, offering support and coming along, and can join the discussion with the person's permission. If the person refuses mental health treatment in general, you may find our article when someone refuses psychiatric treatment helpful.

What are the treatment-resistant depression options?

"Treatment-resistant depression" usually means depression that has not improved despite trying more than one suitable treatment. It does not mean hope is gone. Before ECT or instead of it, the doctor may discuss other options depending on the situation:

• Reviewing the diagnosis and medicines: making sure the diagnosis is right and the medicine was taken regularly for long enough, or changing it or adding another one, as the doctor decides. Our guide to psychiatric medicines explains the different classes. Never change or stop a medicine on your own.
• Talking therapy such as cognitive behavioral therapy, on its own or alongside medicine.
• Repetitive transcranial magnetic stimulation (rTMS): magnetic pulses directed at specific areas of the brain, without anesthesia and without causing a seizure. The US National Institute of Mental Health notes that the US Food and Drug Administration has approved it for treatment-resistant depression.
• Ketamine in a specialized clinic under direct medical supervision: a trial published in 2023 in the New England Journal of Medicine compared ketamine with ECT in 403 patients with treatment-resistant depression without psychotic symptoms. 55.4% responded in the ketamine group compared with 41.2% in the ECT group, and the researchers concluded that ketamine was not less effective than ECT in this group. ECT was linked to a temporary drop in memory that gradually improved, and ketamine to a feeling of detachment from reality while it was being given. This result does not apply to psychotic or emergency cases, and the availability of these options varies between countries. These findings never mean that taking ketamine outside this medical setting is safe or helpful; it is not a treatment to take at home or without a doctor's supervision.

Questions to ask the treating doctor before deciding

1. Why do you think ECT is right for my situation now, and what have we tried before it?
2. What alternatives are available, and what can we expect if we do not start this treatment?
3. Roughly how many sessions do you expect, and when will we review the plan if there is no improvement?
4. Will the electrodes be placed on one side of the head or both, and what does that mean for my memory?
5. What is the anesthetist's assessment of my health, and which medicines will I continue or stop under your guidance?
6. What is the plan to prevent relapse after the sessions end?

When to get help, and how treatment starts

Do not wait until things reach the point of needing ECT. Ask a psychiatrist for an assessment if sadness or loss of interest lasts most days, if depression has not improved despite treatment, or if it starts to affect eating, sleep and work. Our article on depression symptoms can help you understand the signs.

Treatment usually starts with an appointment with a psychiatrist to assess the situation and build a plan that fits, which may include medicine, therapy sessions and regular follow-up. In severe cases that need constant monitoring, the doctor may recommend inpatient psychiatric treatment; inpatient stays at Oxygen Center are available for males aged 15 and over. With the right treatment, many people improve, even after long periods of suffering.