Electroconvulsive Therapy (ECT)

Honest, plain-language information about one of the most effective treatments we have for severe depression — including what it actually feels like, what the side effects are really like, and what the evidence says.

What is ECT?

ECT stands for electroconvulsive therapy. It's a medical treatment for severe depression and a few other psychiatric conditions, performed under general anesthesia. A brief, carefully-controlled electrical current is passed through the scalp to trigger a short seizure lasting about 30–60 seconds. You're completely asleep during the procedure and don't feel or remember it.

ECT has been used clinically since 1938, and the modern version looks nothing like what you may have seen in movies. Today's ECT is performed in a hospital procedure room with an anesthesiologist, a psychiatrist, and trained nursing staff. Muscle relaxants prevent any body movement during the seizure. The whole procedure, from IV placement to waking up, takes about an hour — the seizure itself is brief, and you typically go home the same day (for outpatient treatment) after a short recovery period.

The essentials: You're under general anesthesia. A brief seizure is triggered under careful medical control. You don't feel anything during the procedure. Most patients need 6–12 treatments spread over 2–4 weeks, typically 3 times a week (Monday/Wednesday/Friday). ECT is the most effective treatment available for severe, treatment-resistant depression.

Our ECT procedure area at Prisma Health.

What ECT is not

Most people's mental picture of ECT comes from old movies like One Flew Over the Cuckoo's Nest — a patient strapped to a table, visibly convulsing, clearly suffering. That scene was never an accurate depiction of clinical ECT, and it has nothing to do with how the treatment is delivered today. Modern ECT involves general anesthesia, muscle relaxation (which prevents any visible convulsing), and careful monitoring of your heart, blood pressure, and oxygen throughout the procedure. The seizure itself is electrical activity in the brain — it's not painful, and you're asleep for it.

ECT is also sometimes confused with transcranial magnetic stimulation (TMS). They're very different: TMS uses magnetic pulses at a low intensity, doesn't trigger a seizure, doesn't require anesthesia, and is done while you're fully awake. ECT uses electrical current to produce a therapeutic seizure under anesthesia. TMS is typically tried before ECT, though ECT is more effective for the most severe or urgent cases.

How does it work?

The honest answer is that researchers are still working out the details, but we know quite a bit about what ECT does to the brain.

Two electrode pads are placed on your temples. While you're under anesthesia, a brief, carefully-controlled electrical current passes between them, triggering a short seizure (about 30–60 seconds) that causes widespread changes in brain activity.

During an ECT treatment, while you're completely asleep under anesthesia, a brief electrical current is applied through two electrode pads placed on your scalp. The current triggers a short, controlled seizure in the brain — essentially, a large number of brain cells fire in synchrony for about 30–60 seconds. You don't feel this, and because muscle relaxants are given, your body doesn't visibly convulse.

The therapeutic benefit of ECT comes from this seizure activity, not from the electrical current itself. Researchers think the seizure triggers several downstream effects: changes in neurotransmitter systems (particularly glutamate, dopamine, and serotonin), release of growth factors that help brain cells form new connections, shifts in brain circuits involved in mood regulation, and changes in the brain's inflammatory signaling. What's clear is that these changes add up to a powerful antidepressant effect — one of the strongest we have.

Where is the current applied?

There are a few different electrode placements, and your treatment team will choose the one that best fits your situation:

Right unilateral (RUL): Both electrodes on the right side of the head. This placement tends to have fewer cognitive side effects but may work more slowly.
Bilateral (bitemporal or bifrontal): One electrode on each side of the head. This placement tends to be most effective, particularly for severe or urgent cases, but has a higher risk of temporary memory effects.

Modern protocols also use ultra-brief pulse width, which delivers the electrical current in very short bursts. This has been shown to reduce cognitive side effects while maintaining good efficacy. Your psychiatrist will discuss which placement and pulse width is right for you based on the urgency of your situation, your medical history, and your preferences.

Is ECT right for me?

ECT is considered when symptoms are severe, life-threatening, or haven't responded to other treatments. It's a legitimate and evidence-based option — not a treatment of last resort — and for many people, it's the treatment that finally works when nothing else has.

ECT might be a good fit if:

You have severe depression that hasn't responded to multiple antidepressant medications and therapy
You have active suicidal thoughts or are at high risk, and a rapid response is needed
You have depression with psychotic features (hallucinations, delusions), where ECT is often particularly effective
You have catatonia, where ECT is considered first-line treatment
You have severe bipolar depression or mania that hasn't responded to medications
You can't take antidepressants due to medical conditions, pregnancy, or severe side effects
You've responded to ECT before and need it again for a relapse

ECT may not be the right choice if:

Your depression is mild to moderate and hasn't been fully treated with other approaches yet
You have significant medical conditions that make anesthesia high-risk (these are evaluated carefully case-by-case)
You have recent stroke, brain tumor, or increased intracranial pressure — though even these are often relative rather than absolute contraindications
You're not ready for it emotionally — ECT is a big decision, and it's reasonable to take time to prepare

What about pregnancy?

ECT can be performed safely during all trimesters of pregnancy and is sometimes the preferred treatment for severe depression in pregnancy because it avoids exposing the developing baby to medications. Your psychiatrist, obstetrician, and the ECT team will coordinate care carefully.

What about older adults?

ECT is actually particularly effective in older adults with depression, often producing faster and more complete responses than in younger patients. Older patients may experience more cognitive side effects, but these are typically temporary. For severe depression in elderly patients — especially when medication side effects are intolerable — ECT is often the safest and most effective option.

What a typical visit looks like

From the time you arrive to the time you leave, a typical ECT treatment takes about 2 hours — though the procedure itself (anesthesia plus seizure) is only about 10–15 minutes.

Before your first treatment (evaluation)

Psychiatric consultation

A psychiatrist who specializes in ECT will meet with you to review your symptoms, treatment history, medications, and medical conditions. This is a thorough evaluation — we want to confirm ECT is the right choice for you, answer your questions, and make sure you have realistic expectations.
Medical evaluation and labs

Because ECT involves general anesthesia, you'll need a medical clearance. This typically includes blood work, an EKG, and sometimes additional tests depending on your medical history. You'll also meet with an anesthesiologist or nurse anesthetist to review your anesthesia plan.
Informed consent

You'll have the opportunity to ask every question you have. We'll walk through the benefits, risks, side effects, and alternatives in detail. You'll sign a consent form, but the consent is ongoing — you can stop treatment at any time for any reason.

On the day of each treatment

Fasting and medications

You'll be asked not to eat or drink after midnight before your treatment (some medications may be taken with a small sip of water). You'll need someone to drive you home afterward.
Check-in and IV

When you arrive, a nurse will check your vital signs, ask a few review questions, and place an IV in your arm for the anesthesia and other medications.
In the procedure room

You'll be connected to monitors for your heart rate, blood pressure, and oxygen levels. Small EEG electrodes will be placed on your head to monitor brain activity. Two stimulation electrode pads go on your scalp. An oxygen mask is placed over your face.
Anesthesia and the procedure

You'll receive general anesthesia through the IV — within seconds, you'll be asleep. A muscle relaxant is also given to prevent any body movement during the seizure. Once you're fully asleep, the brief electrical current is applied, triggering a 30–60 second seizure. You feel and remember nothing.
Waking up in recovery

You'll wake up 5–10 minutes later in a recovery area. You may feel groggy, confused, or have a headache — this is normal and usually fades within an hour or so. Nurses will monitor you until you're fully awake and your vital signs are stable.
Going home

Most outpatients go home within 1–2 hours of the procedure. You'll need someone to drive you. You shouldn't drive, make important decisions, or operate heavy machinery for the rest of the day.

Your full treatment course

ECT isn't a one-time procedure. It's a series of treatments spread over weeks. Here's what the full course typically looks like.

Standard course

Most patients receive 6 to 12 ECT treatments, typically delivered three times a week (Monday, Wednesday, Friday). Many patients start to feel noticeably better after 3–6 treatments, but the full effect usually requires the complete course. Your treatment team will assess your response after each treatment and adjust the plan as needed.

It's worth knowing that the exact number of treatments isn't set in stone. Some patients respond well after just 6 sessions; others may need more than 12 to reach their best response. Some research suggests that stopping ECT too early — before full remission — leads to higher relapse rates. We'll talk with you about what we're seeing in your response along the way and make these decisions together.

What a typical ECT schedule looks like

	Mon	Tue	Wed	Thu	Fri
Week 1	✓	—	✓	—	✓
Week 2	✓	—	✓	—	✓
Week 3	✓	—	✓	—	✓
Week 4	✓	—	✓	—	✓
Week 5	✓	—	—	—	✓
Week 6+	—	—	✓	—	—

Acute course (3×/week) Transition & maintenance No treatment

After the acute course: preventing relapse

ECT can produce a dramatic response, but preventing relapse is an important second step. Without some form of continuation treatment, relapse rates in the six months after ECT can be as high as 60–80%. There are two main strategies, often used together:

Continuation medications: A combination of an antidepressant (often lithium plus nortriptyline, based on the CORE study findings) started during or after the acute course. This approach can reduce six-month relapse rates from 84% on placebo to about 39% with the combination.
Maintenance ECT: Less frequent ECT treatments (e.g., once every 2–4 weeks, then less often) to maintain the benefit. This is particularly helpful for patients whose depression doesn't respond well to medications.

Your psychiatrist will work with you to create a continuation plan that fits your history and preferences.

Side effects and safety

ECT is safe when performed by a trained team, but it's not without side effects. Here's an honest, up-front account of what to expect.

Common short-term side effects

Most side effects occur in the hours or days right after a treatment and resolve quickly:

Headache (most common — typically mild and responsive to over-the-counter pain relievers)
Muscle aches (from the muscle relaxant)
Nausea (usually brief, often related to anesthesia)
Confusion or disorientation right after waking up (usually clears within an hour)
Fatigue on the day of treatment
Jaw soreness (from the bite block used during the procedure)

Memory effects — the honest version

Memory effects are the most-discussed side effect of ECT, and the one patients most want to understand. Here's a direct, honest accounting:

Short-term memory difficulties are common during and immediately after the treatment course. You may have trouble:

Remembering what happened right around the time of your treatments (the hours or days before and after each session)
Learning or retaining new information during the acute course
Recalling specific events from the weeks surrounding the treatment

For most people, these effects gradually improve over weeks to months after the course is complete. Most patients have fully recovered their memory function within 6 months, and often much sooner.

Longer-term memory effects are possible but uncommon. A smaller number of patients report persistent gaps in memory for specific events or periods (weeks to months surrounding the treatment). More rarely, some patients report more persistent difficulty with autobiographical memory — though studies have found that the objective memory of patients after ECT is typically the same or better than before, because severe depression itself causes significant cognitive impairment that improves with treatment.

The right electrode placement and pulse width matter: right unilateral with ultra-brief pulse causes substantially less memory disruption than bilateral with standard pulse, though it may work more slowly. Your psychiatrist will discuss which approach balances efficacy and cognitive side effects best for your situation.

What we tell patients honestly about memory

Memory side effects are real and not something we dismiss or minimize.
For most patients, the effects are temporary and mostly confined to the weeks around the treatment course.
A minority of patients experience longer-lasting memory gaps, and we can't predict perfectly who will.
Severe depression itself impairs memory and concentration — many patients find their overall cognitive function improves once the depression is treated.
If you're concerned about memory, we can choose placements and protocols that minimize cognitive side effects.
The benefit of ECT (lifting severe depression) typically far outweighs these side effects for patients who are appropriate candidates — but it's your call, based on an honest understanding of the tradeoffs.

Serious risks

ECT is among the safest procedures done under general anesthesia. The main risks are related to anesthesia itself (cardiovascular events, respiratory issues) rather than the seizure. The mortality rate is about 2 in 100,000 treatments — comparable to or lower than minor outpatient surgeries. Cardiovascular complications have been reported in about 2.2% of treatments but are typically minor and manageable. Serious adverse events are rare.

Does it actually work?

Yes — and the evidence is clearer for ECT than for almost any other treatment in psychiatry. Here's what the research actually shows.

Response and remission rates

ECT is the most effective treatment available for severe depression. Response rates (meaning at least a 50% reduction in symptoms) are typically 70–80%, and remission rates (meaning the depression is essentially gone) are 50–60% — even in patients whose depression has resisted multiple medications and therapy. These numbers are among the highest reported for any depression treatment.

In a large study called CORE (311 patients), remission rates reached 62% for melancholic depression and 79% for non-melancholic depression. Community clinics tend to report somewhat lower numbers (around 54% response and 31% remission), reflecting the harder-to-treat populations seen in routine practice — but ECT remains more effective than any other available intervention for these patients.

Saving lives

ECT doesn't just reduce symptoms. A 2024 meta-analysis of 11 studies involving over 43,000 patients found that ECT was associated with:

A 34% reduction in the odds of suicide compared to treatment as usual
A 30% reduction in death from all causes

For patients with severe depression — especially those with active suicidal thoughts — ECT can be genuinely life-saving.

How fast does it work?

ECT is one of the fastest-acting antidepressant treatments we have. Many patients notice improvement after just a few sessions, with full benefit usually seen by treatments 6–12. This speed matters enormously for people in crisis: when someone is acutely suicidal or has stopped eating due to severe depression, waiting weeks for a medication to work may not be safe. ECT can often produce meaningful improvement within days.

Being honest about the full picture

ECT is highly effective, but it isn't a cure. Without continuation treatment, relapse rates in the six months after ECT can be 60–80%. This is why the continuation plan (medications, maintenance ECT, or both) is so important. When continuation treatment is used properly, relapse rates drop substantially — to about 39% in the landmark Kellner study using lithium plus nortriptyline.

What we can say honestly about ECT

It is the most effective antidepressant treatment we have, with response rates of 70–80% and remission rates of 50–60% even in treatment-resistant cases.
It works fast — days to weeks, not months — which matters in urgent situations.
It saves lives: a 34% reduction in suicide risk is clinically meaningful and rare in psychiatry.
It has real side effects, especially memory effects, which for most patients are temporary but for some can be longer-lasting.
It is not a one-time cure — a continuation plan is essential to prevent relapse.
It is safe when performed by a trained team. Serious complications are uncommon.
It is stigmatized in a way that doesn't match its actual safety and efficacy. Many patients say they wish they'd tried it sooner.

Questions patients often ask

These are the questions we hear most often in our clinic. If yours isn't here, please ask — there's no such thing as a silly question when you're considering a major treatment.

Will I feel the shock?

No. You'll be under general anesthesia before the electrical current is ever applied. You won't feel anything, see anything, or remember anything about the procedure itself. From your perspective, you'll fall asleep, and the next thing you know, you're in recovery.

Is ECT anything like what I saw in movies?

No. Modern ECT bears essentially no resemblance to cinematic depictions. You're under general anesthesia with muscle relaxants, monitored continuously by an anesthesiologist and ECT team, and the procedure takes place in a hospital setting with all the safety equipment of any operating room. There's no visible convulsing, no pain, and no awareness of the procedure.

Will ECT change who I am?

No. ECT doesn't alter your personality, your values, or your sense of self. What it can change is your depression. Most patients describe feeling "like themselves again" after successful treatment — the depression lifts, and the person underneath re-emerges. Many patients say this is the most important thing ECT did for them.

Will I lose memories permanently?

For most patients, no. Memory effects during and shortly after treatment are common, but they typically resolve within weeks to months. A minority of patients experience longer-lasting memory gaps — usually for specific events or time periods around the treatment course rather than global memory loss. We use right unilateral and ultra-brief pulse techniques when appropriate to minimize these risks. We'll talk with you honestly about the balance of benefit and risk in your specific case.

How soon will I feel better?

Many patients notice improvement after 3–6 treatments. Full benefit usually requires the complete course of 6–12 treatments over 2–4 weeks. ECT is one of the fastest-acting depression treatments available — days to weeks, rather than the weeks to months typical of medications.

Do I need to stay in the hospital?

Not usually. Most ECT is done as an outpatient procedure: you arrive at the hospital procedure area in the morning, have the treatment, recover for an hour or two, and go home the same day. Inpatient ECT is typically reserved for patients whose depression is severe enough to require hospitalization for safety (for example, active suicidality or inability to care for themselves). At Prisma Health, your initial consultations and evaluations happen at our Grove Road office, and the ECT treatments themselves take place at a separate hospital-based facility — inpatient at Greenville Memorial Hospital, and outpatient at Baptist Hospital Columbia or Baptist Easley Hospital. Your care team will walk you through the logistics.

Can I drive myself home?

No. Because you'll have received general anesthesia, you cannot drive on the day of treatment. You'll need to arrange a ride home for every session. You also shouldn't make important decisions or operate heavy equipment for the rest of the day. By the next day, most patients feel back to their usual selves and can resume normal activities.

Will my insurance cover it?

Most major insurance plans, including Medicare, cover ECT when it's medically indicated. Coverage specifics vary, and there may be prior authorization requirements. Our team will help you navigate the insurance process and give you a clear picture of what your out-of-pocket costs may be.

What if ECT doesn't work for me?

First, it's worth noting that ECT has the highest response rate of any depression treatment we have — roughly 70–80% of patients respond. But if you're in the minority who don't respond, there are still options: different ECT protocols, medication combinations we haven't tried, ketamine-based treatments, TMS, or combinations of these. Severe depression is treatable for the vast majority of people, even when the first few treatments haven't been enough.

Can I keep taking my medications during ECT?

Usually yes. Most patients continue their psychiatric medications during ECT, though some medications (particularly benzodiazepines and certain anticonvulsants) may need to be adjusted because they can interfere with the seizure. Your psychiatrist and anesthesiologist will review your medication list carefully and give you specific instructions before starting treatment.

How is ECT different from TMS?

They're very different treatments. TMS uses magnetic pulses at low intensity, is done while you're awake, requires no anesthesia, and doesn't cause seizures — but it's typically used for more moderate depression and takes a longer course (about 6 weeks). ECT uses electrical current to produce a therapeutic seizure under anesthesia, is more effective for severe cases, works faster, and is often used when other treatments (including TMS) haven't worked. Many patients start with TMS and move to ECT if needed.

Helpful resources

If you want to learn more before or during treatment, these are organizations and materials we trust.

Patient organizations and education

Organization American Psychiatric Association (APA) — ECT information Plain-language patient-focused overview of ECT from the country's main psychiatric professional organization.
psychiatry.org/patients-families/ect
Organization NAMI (National Alliance on Mental Illness) — ECT fact sheet Written from a patient advocacy perspective, including patient stories.
nami.org
Government Mayo Clinic — Electroconvulsive Therapy overview Thorough patient-focused guide covering how ECT works, what to expect, side effects, and outcomes.
mayoclinic.org
Government NIMH (National Institute of Mental Health) — Brain stimulation therapies Overview of brain stimulation treatments including ECT, covering research and current evidence.
nimh.nih.gov

Patient perspectives

Testimonials Prisma Health ECT patient stories Hear from our own patients about what ECT was like for them and how it changed their lives.
prismahealth.org/services/behavioral-health-and-psychiatry/specialty-treatments/electroconvulsive-therapy
Book Shock: The Healing Power of Electroconvulsive Therapy by Kitty Dukakis and Larry Tye A candid, accessible account from Kitty Dukakis (former First Lady of Massachusetts) about her experience with ECT and its role in her recovery from severe depression.
Podcast The Carlat Psychiatry Podcast — ECT episodes In-depth conversations with experts about ECT, how it works, and its role in modern psychiatry. Aimed at clinicians but accessible to patients curious for more depth.
thecarlatreport.com/podcast

For families and caregivers

Guide Mayo Clinic guide for family members of ECT patients What to expect when a loved one is receiving ECT, how to support them, and how to recognize the signs that treatment is working.
mayoclinic.org
Organization NAMI Family Support Peer-led support groups and resources for families of people with serious mental illness, including those receiving ECT.
nami.org/Support-Education

Get in touch

If you think ECT might be right for you, or if you have more questions before making that decision, we're here to help. A referral from your current psychiatric provider is typically the fastest route, but you're also welcome to reach out directly to learn more.

ECT consultation at Prisma Health

To schedule a consultation or ask questions about ECT:

(864) 455-8813

Prisma Health Neuromodulation Program
Behavioral Health and Wellness Pavilion
725 Grove Road, Greenville, SC 29605

How care is organized: Initial consultations and evaluations take place at our Grove Road office (above). ECT treatments themselves are performed at dedicated hospital-based procedure facilities — inpatient care at Greenville Memorial Hospital and outpatient care at Baptist Hospital Columbia or Baptist Easley Hospital, depending on your needs. Your care team will walk you through exactly where and when to come for each step.

Adam Hart, MD — Medical Director for ECT Services
Our team also includes specialized nurses, anesthesiologists, and nurse anesthetists.

A consultation typically includes an in-depth discussion of your situation, your treatment history, and what ECT would look like for you. There's no commitment in having the conversation — it's a chance to get your questions answered by people who do this work every day.