Important

The information on this page is for educational purposes only. It is not medical advice and is not a substitute for evaluation, diagnosis, or treatment by a qualified healthcare professional. No physician-patient relationship is established through this website. If you are experiencing a medical or psychiatric emergency, call 911 or go to the nearest emergency room. If you are having thoughts of suicide or self-harm, call or text 988 to reach the Suicide and Crisis Lifeline.

Electroconvulsive Therapy (ECT)

ECT is the most effective acute treatment we have for severe depression and the one people fear most. Both of those things are true, and this page is written to explain why: what the trials show, what the side effects are, including the memory effects, and how the decision is made. Last reviewed October 26, 2026.

An ECT treatment room with the anesthesia and monitoring equipment used during a treatment

Overview

Electroconvulsive therapy (ECT) is the oldest treatment still in use for severe depression, and one of the most studied. It is also widely misunderstood, partly because of how it was given decades ago and how it has been portrayed since. This page describes modern ECT as it is actually practiced: what the trials show it can and cannot do, what the side effects are, including the memory effects that matter most to patients, and what to expect if you are considering it.

Where things stand on October 26, 2026:
  • In controlled trials ECT has outperformed sham (anesthesia without a seizure) and antidepressant medication for severe depression, with large effect sizes; most of those trials are decades old and the newer evidence is mainly comparisons between ECT techniques and against ketamine.1,2,29,30,31
  • In research trials, roughly 55–75% of patients reach remission; in routine practice the figure is lower, about 30–51%, and people whose depression has already failed adequate medication treatment do less well than those whose depression has not.6,4,9,10,13
  • Benefit does not last on its own: without continuation treatment, most people relapse within six months, so a plan for what comes after the course is part of the decision.24,26
  • Memory effects are real. Most test scores recover within about two weeks, but some loss of personal memories from around the time of treatment may not return, and FDA-required device labeling warns that some patients have reported permanent loss of such memories.40,41,42,73
  • The FDA classifies ECT devices as Class II (moderate risk, subject to “special controls” such as required labeling and cognitive monitoring) for catatonia and for severe depressive episodes, in major depression or bipolar disorder, in people aged 13 and older who have not responded to other treatment or need a rapid response. Other uses remain in the higher-risk Class III, which requires premarket approval.73

What ECT is

ECT uses a brief, carefully measured electrical stimulus, delivered through electrodes on the scalp, to produce a short generalized seizure while you are under general anesthesia. The first treatment was given in Rome in 1938.81 Modern ECT differs from that era in almost every practical respect: you are asleep under a short-acting anesthetic, a muscle relaxant prevents the body from convulsing, the stimulus is a brief-pulse or ultrabrief-pulse waveform rather than the older sine wave, electrode placement and dose are chosen deliberately, and the seizure is monitored on an EEG.62,41,73

Treatments are given two or three times a week, usually for six to twelve sessions, in a hospital procedure area with an anesthesia team present.75 Many people have ECT as outpatients and go home the same day with a responsible adult; others start treatment in hospital and continue as outpatients. Because of the anesthesia you cannot drive yourself home.75

ECT is one of several treatments that act on the brain directly rather than through daily medication. The others we offer or discuss on this site, transcranial magnetic stimulation, ketamine and esketamine, and vagus nerve stimulation, work differently and suit different situations; the How to Choose page compares them.

How it works

Nobody can yet say exactly why ECT relieves depression. What is known comes from two kinds of evidence. First, the seizure alone is not the whole story: in randomized trials, right unilateral ECT given just above the seizure threshold still produced a full seizure, yet helped only 17% of patients, while the same placement at a higher dose helped 43% and bilateral placement 63–65%. How the seizure is produced, where and at what dose, changes the result.16,17

Second, brain imaging shows that ECT changes the brain. In the largest pooled imaging study, the hippocampus (a memory structure) grew by about 0.28% per treatment, but larger growth did not go with greater improvement (if anything, the reverse), so it cannot be called the mechanism.53 A 1994 review of human autopsy, imaging and animal studies found no credible evidence that ECT damages brain tissue, and modern MRI studies have found temporary volume increases rather than tissue loss.54,53

The honest summary is that the clinical effect is well established and the mechanism is not. Theories involving brain chemistry, growth factors, inflammation and the brain’s own anti-seizure response each have some support and none has been proven.

Who it is for

ECT is usually considered when depression is severe and other treatments have not worked, or when the situation cannot wait for medication to take effect. The situations with the strongest evidence are:

  • Severe depression with psychotic features. In the CORE research trials, 95% of people with psychotic depression who completed a course remitted, compared with 83% without psychotic features; psychotic features and older age predict a better response.3,15
  • Bipolar depression. Remission rates are similar to those in unipolar depression (about half of patients in pooled cohort studies), and in the one randomized trial in treatment-resistant bipolar depression, 74% responded to ECT versus 35% to medication chosen by an algorithm, although full remission was uncommon with either (35% versus 30%).19,18
  • Catatonia. A benzodiazepine such as lorazepam is tried first; in one prospective series it resolved catatonia in about three quarters of patients (16 of 21), and those who did not respond improved with ECT. ECT is used when benzodiazepines fail or when catatonia is life-threatening. The evidence here is strong in clinical experience but comes mostly from case series and a few small, low-quality trials; no adequate randomized trial has been done.20,21,22
  • When speed matters. Among 131 patients with suicidal intent on their depression rating at baseline, intent scores fell to zero in 38% after one week of ECT, 61% after two weeks and 81% by the end of the course. This is not proof that ECT prevents suicide (see After the course), but it is a fast change in a dangerous symptom.23
  • When medication has failed. ECT still works for many of these patients, but less often: remission 48% after failed medication trials versus 65% without, and response 58% versus 70% (these are observational comparisons, so part of the gap may reflect other differences between the groups).13,14

ECT is also used for mania and for some people with schizophrenia, but the FDA left those uses in the higher-risk Class III in 2018 and they are less common in US practice.73 ECT is also used in adolescents (the FDA indication starts at age 13), in older adults, who are among the best responders, and occasionally in pregnancy; those situations are covered in the questions below.73,7

What ECT is not

It is not a first treatment for mild or moderate depression, it is not a cure that removes the need for follow-up care, and it is not something anyone can be given against their will outside narrow legal processes. In the United States, ECT is given only after informed consent: a discussion of the expected benefits, the risks and side effects, and the alternatives. Where a person cannot make treatment decisions, state law governs, usually through a legally authorized representative or a court. You can decide to stop treatment during a course; tell your treatment team and they will discuss it with you.75

What a treatment is like

Before

You will be asked not to eat or drink for a period before each treatment, following the anesthesia team’s instructions. You arrive with a companion, check in, and the nurses place an IV and attach heart, blood-pressure, oxygen and EEG monitors.

Anesthesia

A short-acting anesthetic (usually methohexital or propofol) puts you to sleep within a minute. A muscle relaxant, usually succinylcholine at about 1 mg per kilogram, prevents the body from moving during the seizure.62,63 A blood-pressure cuff inflated on one limb before the relaxant is given keeps that limb free of it, so the team can see the seizure.

The treatment

The stimulus lasts a few seconds. The seizure that follows is brief, usually well under a minute on the EEG (the team looks for an EEG seizure of at least about 40 seconds); a longer seizure is not a better one, and a seizure lasting more than three minutes (about 1 in 170 treatments) is stopped with medication.62,61

Recovery

You wake within minutes and are usually fully oriented in 20 to 30 minutes (median 19 minutes after right unilateral and 26 minutes after bitemporal ECT in one trial).46 In our program, most people are ready to leave within an hour or two of arriving.

You cannot drive yourself home, and you should not drive at all during a course of treatment (see the questions below). Headache is the most common complaint afterward, reported by about a third of patients at some point in a course and after roughly one session in ten; it is usually mild and treated with a simple pain reliever such as acetaminophen.59 Some people are briefly agitated or confused as they wake (about 14% of patients at least once); the team manages this with medication and a calm environment.60

The treatment course

An acute course is usually two or three treatments a week. In the CORE trials, 54% of patients had a first response by the third treatment, and remission had been reached by 34% after six treatments and 65% after ten; in the PRIDE trial of older adults the average number of treatments to remission was 7.3.4,7 Your psychiatrist rates your symptoms before each session and stops when you have remitted or clearly plateaued.

Choices your psychiatrist will discuss with you

  • Where the electrodes go. Right unilateral ECT at an adequate dose is as effective as bitemporal (both sides of the head) ECT in pooled trials, with faster reorientation and less loss of personal memories; bitemporal ECT may work a little faster in some patients. In a 230-patient randomized comparison, remission was 55% with right unilateral, 61% with bifrontal and 64% with bitemporal placement; the differences were not statistically significant.45,6
  • Pulse width. Ultrabrief pulses cause fewer memory effects but are somewhat less effective and take about one more session; across pooled studies (trials and clinical series), remission with ultrabrief high-dose right unilateral ECT was 32%, and 28% of patients were switched to the standard brief pulse. The best single-site result for ultrabrief right unilateral ECT, 73% remission, has not been reproduced at that level elsewhere.48,12,47
  • Dose. Right unilateral ECT works only when dosed well above the seizure threshold (six times threshold matched bilateral ECT in one trial); dose is set at the first treatment by measuring your threshold or from your age, and adjusted during the course.17
  • Medications. Most antidepressants are continued. Lithium is often reduced or held around treatments because of a possible increase in confusion afterward, although the most recent pooled analysis did not find a clear increase and supports cautious continuation when lithium is needed; benzodiazepines are minimized because they make seizures harder to produce and can reduce effectiveness. Your team will give you a specific plan.68,62

There is a trade-off in every one of these choices between effectiveness, speed and memory effects. We will tell you which we recommend and why, and the choice is yours.

How well it works

Two kinds of numbers matter: how ECT compares with doing something else, and how many people get well.

Against sham and against medication. The main systematic review pooled six trials in which patients received anesthesia with or without a real seizure (256 patients) and found a large advantage for real ECT (effect size −0.91), and eighteen trials against antidepressant medication (1,144 patients) with a large advantage for ECT (−0.80).1 A 2019 network meta-analysis of 113 brain-stimulation trials ranked bitemporal and high-dose right unilateral ECT as the most effective treatments against sham, while noting that only a third of trials were at low risk of bias (most of the rest were unclear) and that sham-controlled ECT trials are few.2 The sham-controlled trials in depression all date from the 1970s and 1980s, used older techniques, and none tested the ultrabrief pulse now in common use.1,12

Remission after a course of ECT in different settings Horizontal bars showing the share of patients in remission after a course of ECT: 87% of completers and 75% of all entrants in the CORE research trials, 62% of older adults in PRIDE, 51% in the Scottish national audit, 32% with ultrabrief high-dose right unilateral ECT across pooled studies, and 30 to 47% in US community hospitals. How many people are in remission after a course of ECT? Research trial, bilateral ECT, completers (CORE, 2001) 87% Research trial, bilateral ECT, everyone enrolled (CORE, 2004) 75% Older adults, right unilateral ultrabrief + venlafaxine (PRIDE, 2016) 62% National audit, Scotland, 2,074 episodes (2024) 51% Pooled studies, ultrabrief high-dose right unilateral ECT (2026) 32% US community hospitals, strict definition (2004) 30–47% Remission means depression scores fell to the normal range, by each study’s definition. Definitions, electrode placement and patient populations differ, which is why the numbers differ. Sources: Petrides 2001; Husain 2004; Kellner 2016; Semple 2024; Jelovac 2026; Prudic 2004.

Figure 1. Remission after a course of ECT. Research trials with bilateral electrodes and tightly selected patients report the highest rates; national audit and community data, and ultrabrief right unilateral ECT, report lower ones.3,4,7,9,12,10

In practice. Pooled across studies, about 74% of people with major depression respond and 52% remit.11 In a decade of Scottish national data covering 2,074 treatment episodes, 73% responded and 51% remitted.9 In seven US community hospitals, remission was 30–47% depending on the definition, and 64% of those remitters had relapsed within six months.10 The gap between research and community results is thought to reflect who is treated (longer episodes, more personality disorder), when courses are stopped, and how carefully outcomes are measured; it is the community numbers that are most relevant to a decision made in a clinic.10

Reading these numbers honestly

ECT’s advantage over sham and medication is large in the trials that exist, but those trials are old, small and conducted in an era of different techniques. Ultrabrief pulses, and right unilateral ECT at too low a dose, trade some efficacy for fewer memory effects, so quoted remission rates depend on the technique used. Prior medication failure lowers the odds of remission (and, in the CORE trials, melancholic features were associated with lower remission, 62% versus 79%), and relapse after a successful course is the rule rather than the exception without continuation treatment.2,48,16,17,13,5,24

Memory and thinking

This is the side effect patients ask about most, and the one on which older descriptions of ECT were least honest. The evidence falls into three parts.

  • Thinking and new learning recover. Across 84 studies (2,981 patients), most test scores for attention, processing speed and learning new material were lower in the first three days after a course and back to or above baseline within about two weeks.40 Treatment number does not accumulate harm: in 199 patients tested repeatedly, there was no cumulative decline with the number of lifetime treatments.49 In 109 older adults, average scores on a screening test improved during the course and stayed stable for six months afterward.50 Averages hide individuals: in a separate study of 65 patients of all ages, 26% were measurably worse one week after the course and 8% were still worse at six months.51
  • Some personal memories can be lost permanently. The studies above did not measure autobiographical memory. Studies that did find that memories for events around the time of treatment, and for some events before it, can be lost and not regained: in a 2026 meta-analysis the loss was moderate overall, smaller with right unilateral electrodes (effect size 0.32) than bilateral (0.82), and stable at follow-up.42,44 In a seven-hospital study of 347 patients, measurable deficits were still present six months after treatment, greatest with bilateral electrodes and with the older sine-wave stimulus.41 At least one third of patients in surveys report persistent memory loss.43
  • Technique changes the risk. Right unilateral placement reduces memory effects and, when dosed high enough, did not differ from bitemporal ECT in effectiveness in pooled trials.45 Ultrabrief pulses reduce memory effects further but at some cost in effectiveness and about one extra treatment (see the treatment course).48 Older age, female sex and lower estimated pre-illness intellectual ability are risk factors for more memory impairment.41

What the FDA requires us to tell you

Since 2018 the FDA has required ECT device labeling for patients to state that ECT may be associated with disorientation, confusion and memory problems; that the long-term safety and effectiveness of ECT have not been demonstrated; and that, although permanent memory loss is not supported by the clinical literature as a whole, some patients have reported permanent loss of memories of personal life events.73

What we do about it: we measure memory and orientation before and during the course, start with the technique that best fits your situation, and adjust if you or the people close to you notice problems. In a 2026 meta-analysis of six observational cohorts (about 287,000 patients), a later diagnosis of dementia was no more common after ECT (hazard ratio 0.98, 95% CI 0.79–1.21); the authors rated this evidence very low certainty and call for better-adjusted studies.52

Other side effects and risks

  • Common and short-lived: headache (about a third of patients during a course), muscle aches after the first treatments, nausea, and brief confusion or agitation on waking (about 14% of patients at least once).59,60,73
  • Heart and circulation. Heart rate and blood pressure rise sharply during the seizure and the anesthesia team treats this as needed. Major cardiac events occur in about 1 in 50 patients over a course (roughly 1 in 200–500 treatments). The risk is thought to be higher in people with existing heart disease, although the published series could not measure how much higher, which is why a medical and cardiac assessment comes first.56,62
  • Death. Across 766,180 treatments in published series, the ECT-related death rate was 2.1 per 100,000 treatments (95% CI 1.2–3.4), in the same range as the reported mortality of general anesthesia for surgical procedures (3.4 per 100,000); in the nine series published after 2001 (414,747 treatments) there was one reported ECT-related death.55 In a comparison of 5,008 matched pairs of psychiatric admissions in Ontario, serious medical events within 30 days were no more frequent after ECT than without it (hazard ratio 0.78, 95% CI 0.61–1.00).57
  • Prolonged seizure (longer than three minutes): about 1 per 167 treatments, treated immediately.61 Medical events of any kind in the week after a treatment occur at about 9 per 10,000 treatments; the most common are falls (about 3 per 10,000) and pneumonia (about 2 per 10,000).58
  • Teeth and mouth. A bite block protects the teeth during the stimulus; tell the team about loose teeth or dental work.

There are no absolute medical contraindications, but because ECT briefly raises heart rate, blood pressure and pressure inside the skull, conditions affecting the heart, blood vessels or brain raise the risk and need specialist review before treatment.62,73

After the course: relapse and staying well

ECT treats the current episode; it does not prevent the next one. In the landmark trial, 84% of patients who received placebo after a successful course relapsed within six months, compared with 60% on nortriptyline and 39% on nortriptyline plus lithium.24 With modern continuation medication, about 38% relapse by six months and 51% by one year; medication roughly halves the relapse risk compared with placebo.26

Continuation ECT, a tapering schedule of treatments over months, did about as well as lithium plus nortriptyline in the one randomized comparison (37% versus 32% relapsed by six months, a difference that was not statistically significant, and both arms had substantial dropout), and adding it to medication did better than medication alone (relapse reduced by about 40%; one relapse prevented for every seven patients treated, in four trials with 254 patients).25,27,8 Lithium after ECT was associated with roughly half the odds of relapse (one relapse prevented per seven patients), but the evidence is mostly observational and rated very low quality.28 The plan for after the course, which medication, whether to continue ECT, and how often you will be seen, is decided before the course begins.

Does ECT reduce suicide?

Large observational studies find lower suicide rates in the year after ECT: a hazard ratio of 0.72 in 5,525 matched pairs of Swedish inpatients (1.1% versus 1.6% died by suicide within a year), 0.53 in Ontario, and an odds ratio of 0.66 in a 2025 meta-analysis.35,36,37 These are associations, not randomized evidence, and they are not uniform: a US veterans study found no reduction, and a second 2025 meta-analysis found the suicide association only at three months and not at one, six or twelve months, while the all-cause mortality reduction (hazard ratio 0.70) was consistent at every time point.39,38 Patients who received ECT in hospital were readmitted within 30 days about half as often as similar patients who did not.72

How it compares with other options

  • Ketamine. In the largest head-to-head trial (403 patients with non-psychotic treatment-resistant depression referred to ECT clinics), intravenous ketamine was non-inferior to ECT: 55% responded to ketamine and 41% to ECT, and ECT caused more memory decline at three weeks.29 In a trial of 186 inpatients, ECT produced remission in 63% versus 46% with ketamine, and a meta-analysis of six trials favored ECT.30,31 One reading, which we share, is that ketamine is a credible alternative for non-psychotic patients well enough to be treated as outpatients, while ECT kept its advantage among hospitalized patients (63% versus 46% remission) and in the pooled trials. See the ketamine page.
  • TMS. In randomized comparisons ECT produced higher remission (52% versus 34%) and response (64% versus 49%) than repetitive TMS, with the largest difference in psychotic depression; the trials are small and older (seven trials with 294 patients through 2012). TMS needs no anesthesia and does not cause the memory side effects seen with ECT. See the TMS page.32,33
  • Magnetic seizure therapy induces a seizure with a magnetic field and may spare memory, but it remains investigational and is not FDA-cleared; in the most recent randomized trial, remission was 22.5% with MST and 27.8% with ultrabrief right unilateral ECT (non-inferior), with less autobiographical memory loss after MST; the trial stopped short of its planned size.34

Fewer than 1% of Americans with major depression receive ECT, and in a 2005 population survey in Switzerland 57% of respondents considered ECT harmful, so many people who might benefit never discuss it.69,70 Among patients who have had it, about a third describe feeling pressured into it and most describe it as helpful, which is a reminder that the decision has to be made freely and with full information.71

Common questions

Can I drive during treatment?

No. You will need a responsible adult to drive you home after every treatment, and because memory and reaction time can be affected across a course, you should not drive or make major decisions during the acute course. Guidance on resuming afterward varies; Mayo Clinic suggests one to two weeks after the last treatment of a series and at least 24 hours after each maintenance treatment. Your treating psychiatrist will tell you when it is safe for you.40,77

Will I feel the seizure or remember the treatment?

No. You are asleep under general anesthesia before the stimulus and the muscle relaxant prevents convulsive movement. In our experience most people remember arriving and waking up, with a gap in between. Most people reorient within about 20 to 30 minutes; some are hazy for a few hours, and occasionally longer, more often in older adults.62,46,77

Is it safe for older adults?

Older adults are among the best responders.9,15 In the PRIDE trial of 240 patients aged 60 and older, 62% remitted with right unilateral ultrabrief ECT plus venlafaxine (28% did not complete the trial).7 In a study of 109 patients aged 55 and older, average cognitive scores improved during ECT and were stable six months later; in a separate study of adults of all ages, 8% were individually worse at six months.50,51 Serious medical events are uncommon, but people with heart disease carry more risk, so the pre-treatment assessment is more extensive.56,57,77

Can ECT be used in pregnancy?

It has been, when severe depression, psychosis or catatonia threatens the mother or the pregnancy, but the evidence is entirely from case reports and the two systematic reviews disagree on how safe it is. One pooled 169 cases and found complications in 29%, with child mortality of 7.1% in those reports, and advised ECT in pregnancy only as a last resort; another pooled 339 cases and found at least partial remission in 78%, with 18 maternal and 11 fetal or neonatal complications judged likely related to ECT, including two fetal or neonatal deaths. If it is considered, obstetric and anesthesia planning is essential.64,65,66

What about teenagers?

The FDA indication starts at age 13. In a review of 41 mostly uncontrolled studies, response rates ranged from 51% to 92% (70–82% for depression and 87–90% for mania in the larger series), with no deaths reported. Treatment requires a parent’s or guardian’s consent and the young person’s assent; some states add extra review for minors.73,67

Will it change who I am?

The side effects that have been measured are the memory and thinking effects described above, which are real and are described honestly in the memory section. Personality change is not among the documented effects. People do often feel different after a severe depression lifts, and family members sometimes notice that before the patient does.40,41

Does insurance cover ECT?

Medicare has no exclusion for standard ECT and covers it as a medically necessary physician and hospital service; there is no national coverage policy specific to standard ECT (the only ECT national policy excludes the multiple-seizure technique, which we do not use), and South Carolina’s Medicare contractor has no separate ECT policy.74 Commercial plans cover ECT but, in our experience, usually require prior authorization. Our team handles the authorization and will give you an estimate of your expected out-of-pocket cost before treatment starts.

How many treatments will I need, and can it be repeated?

Most acute courses are six to twelve treatments.75,77 If depression returns later, a previous good response to ECT predicts a good response to another course, and some people do well on continuation or maintenance ECT at gradually longer intervals.9,27,8

Can I say no, or stop partway through?

Yes. ECT requires your informed consent, which we document in writing and which you can withdraw at any time. If a person cannot make treatment decisions, state law governs who may decide; in South Carolina a physician must first determine whether the patient can consent, and if not, the decision may be made by a guardian, an agent under a durable power of attorney, or family members in a set order of priority. We will explain how that works if it is relevant to you.75,79

Helpful resources

  • American Psychiatric Association, What is ECT? A clear patient and family overview.75
  • National Institute of Mental Health, Brain Stimulation Therapies. Government overview of ECT, TMS, VNS and newer approaches.76
  • Mayo Clinic, Electroconvulsive therapy. Practical description of preparation, the procedure and recovery.77
  • NAMI, ECT, TMS and Other Brain Stimulation Therapies. Written for patients and families.78
  • Kitty Dukakis and Larry Tye, Shock (2006). A first-person account of ECT for recurrent depression alongside a journalist’s history of the treatment.80

Get in touch

If you think ECT might be right for you, or you want to understand the alternatives before deciding, a consultation is the place to start. There is no commitment in having the conversation.

ECT consultation

Treatment is started by referral from a psychiatric provider. Please ask your psychiatrist to refer you; referring providers can call the Greenville ECT referral line.

(864) 455-8813

Prisma Health Psychiatry and Behavioral Medicine – Greenville
725 Grove Road, Greenville, SC 29605
Adam Hart, MD · Greenville, SC

Consultations take place at the Grove Road office. Treatments are given in hospital procedure areas, inpatient at Greenville Memorial Hospital and outpatient at Baptist Hospital in Columbia or Baptist Easley Hospital, depending on your needs; your care team will tell you exactly where and when to come for each step.

Sources

Every number on this page is linked to one of the sources below. PubMed entries were checked against the NCBI record on October 26, 2026; regulatory and institutional sources are dated in the entry.

  1. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003;361(9360):799-808. PubMed 12642045. Six sham-controlled trials (n=256): standardized effect size −0.91 (95% CI −1.27 to −0.54); 18 trials versus medication (n=1,144): −0.80 (95% CI −1.29 to −0.29).
  2. Mutz J, Vipulananthan V, Carter B, et al. Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis. BMJ. 2019;364:l1079. PubMed 30917990. Network meta-analysis of 113 trials (n=6,750); response versus sham: bitemporal ECT OR 8.91 (2.57–30.91), high-dose right unilateral ECT OR 7.27 (1.90–27.78); 34% of trials were rated at low risk of bias, 50% unclear and 17% high (the abstract gives 83% low or unclear); precision of the estimates varied considerably.
  3. Petrides G, Fink M, Husain MM, et al. ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT. 2001;17(4):244-53. PubMed 11731725. CORE: 253 patients entered; remission in 87% of completers; 95% with psychotic features versus 83% without.
  4. Husain MM, Rush AJ, Fink M, et al. Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. J Clin Psychiatry. 2004;65(4):485-91. PubMed 15119910. CORE: 75% of all entrants remitted; 54% had a first response by the third treatment; remission reached by 34% after 6 and 65% after 10 treatments.
  5. Fink M, Rush AJ, Knapp R, et al. DSM melancholic features are unreliable predictors of ECT response: a CORE publication. J ECT. 2007;23(3):139-46. PubMed 17804986. CORE, n=489; remission 62.1% with melancholic features versus 78.7% without.
  6. Kellner CH, Knapp R, Husain MM, et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. Br J Psychiatry. 2010;196(3):226-34. PubMed 20194546. Randomized comparison of placements (n=230): remission 55% right unilateral, 61% bifrontal, 64% bitemporal.
  7. Kellner CH, Husain MM, Knapp RG, et al. Right Unilateral Ultrabrief Pulse ECT in Geriatric Depression: Phase 1 of the PRIDE Study. Am J Psychiatry. 2016;173(11):1101-1109. PubMed 27418379. PRIDE phase 1: 240 patients aged 60 and older, right unilateral ultrabrief ECT plus venlafaxine; remission 61.7%, response 70%, mean 7.3 treatments to remission.
  8. Kellner CH, Husain MM, Knapp RG, et al. A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study. Am J Psychiatry. 2016;173(11):1110-1118. PubMed 27418381. PRIDE phase 2: continuation ECT plus medication versus medication alone after remission; HAM-D difference 4.2 points (95% CI 1.6–6.9) favoring continuation ECT at 24 weeks.
  9. Semple DM, Suveges S, Steele JD. Electroconvulsive therapy response and remission in moderate to severe depressive illness: a decade of national Scottish data. Br J Psychiatry. 2024;225(6):547-555. PubMed 39291460. Scottish national audit, n=2,074 episodes (2009–2018): response 73%, remission 51%; medication resistance predicted lower response.
  10. Prudic J, Olfson M, Marcus SC, et al. Effectiveness of electroconvulsive therapy in community settings. Biol Psychiatry. 2004;55(3):301-12. PubMed 14744473. Seven community hospitals, n=347: remission 30.3–46.7% depending on the definition; 64.3% of remitters relapsed within 24 weeks.
  11. Bahji A, Hawken ER, Sepehry AA, et al. ECT beyond unipolar major depression: systematic review and meta-analysis of electroconvulsive therapy in bipolar depression. Acta Psychiatr Scand. 2019;139(3):214-226. PubMed 30506992. Pooled response/remission: 74.2%/52.3% in major depression; 77.1%/52.3% in bipolar depression.
  12. Jelovac A, McLoughlin DM. Ultrabrief pulse electroconvulsive therapy for depression: a systematic review and meta-analysis. Mol Psychiatry. 2026;31(2):1132-1141. PubMed 41206419. Ultrabrief high-dose right unilateral ECT, 23 studies (n=1,478): remission 32.2% (95% CI 26.1–39.0), response 45.3%; 28.1% were switched to brief-pulse ECT.
  13. Heijnen WT, Birkenhäger TK, Wierdsma AI, et al. Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. J Clin Psychopharmacol. 2010;30(5):616-9. PubMed 20814336. Remission 48.0% after failed medication trials versus 64.9% without (OR 0.52, 95% CI 0.39–0.69).
  14. Haq AU, Sitzmann AF, Goldman ML, et al. Response of depression to electroconvulsive therapy: a meta-analysis of clinical predictors. J Clin Psychiatry. 2015;76(10):1374-84. PubMed 26528644. Eleven studies (n=1,175): response 58% after medication failure in the current episode versus 70% without; shorter episodes respond better.
  15. van Diermen L, van den Ameele S, Kamperman AM, et al. Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis. Br J Psychiatry. 2018;212(2):71-80. PubMed 29436330. Psychotic features (remission OR 1.47, response OR 1.69) and older age predicted better outcomes; severity predicted response but not remission; melancholic data inconclusive.
  16. Sackeim HA, Prudic J, Devanand DP, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med. 1993;328(12):839-46. PubMed 8441428. Response 17% with low-dose right unilateral ECT, 43% with higher-dose right unilateral, 63–65% with bilateral; bilateral ECT produced about three times the retrograde amnesia in the first week.
  17. Sackeim HA, Prudic J, Devanand DP, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000;57(5):425-34. PubMed 10807482. Right unilateral ECT at six times seizure threshold matched bilateral ECT at 2.5 times (65% response each); low-dose right unilateral 30–35%.
  18. Schoeyen HK, Kessler U, Andreassen OA, et al. Treatment-resistant bipolar depression: a randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment. Am J Psychiatry. 2015;172(1):41-51. PubMed 25219389. Randomized trial in treatment-resistant bipolar depression (n=73): response 73.9% with ECT versus 35.0% with algorithm-based pharmacotherapy; remission did not differ (34.8% versus 30.0%).
  19. Dierckx B, Heijnen WT, van den Broek WW, et al. Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis. Bipolar Disord. 2012;14(2):146-50. PubMed 22420590. Meta-analysis: remission 50.9% in unipolar and 53.2% in bipolar depression, no significant difference.
  20. Bush G, Fink M, Petrides G, et al. Catatonia. II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatr Scand. 1996;93(2):137-43. PubMed 8686484. Catatonia, prospective series: lorazepam resolved catatonic signs in 16 of 21 patients (76%) who completed a trial; four who did not respond improved promptly with ECT.
  21. Sienaert P, Dhossche DM, Vancampfort D, et al. A clinical review of the treatment of catatonia. Front Psychiatry. 2014;5:181. PubMed 25538636. Review of catatonia treatment: research is scarce but clinical evidence for benzodiazepines and ECT is described as overwhelming; ECT when benzodiazepines fail or in malignant catatonia.
  22. Leroy A, Naudet F, Vaiva G, et al. Is electroconvulsive therapy an evidence-based treatment for catatonia? A systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2018;268(7):675-687. PubMed 28639007. Catatonia: pre-post effect size −3.14 across 10 studies; evidence from randomized trials rated low quality.
  23. Kellner CH, Fink M, Knapp R, et al. Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am J Psychiatry. 2005;162(5):977-82. PubMed 15863801. In 131 patients with expressed suicidal intent at baseline, intent scores fell to zero in 38.2% after one week, 61.1% after two weeks and 80.9% by the end of the course.
  24. Sackeim HA, Haskett RF, Mulsant BH, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001;285(10):1299-307. PubMed 11255384. Relapse within 24 weeks after a successful course: 84% on placebo, 60% on nortriptyline, 39% on nortriptyline plus lithium (n=84).
  25. Kellner CH, Knapp RG, Petrides G, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry. 2006;63(12):1337-44. PubMed 17146008. Continuation ECT versus lithium plus nortriptyline (n=201): relapse 37.1% versus 31.6% at six months, not significantly different.
  26. Jelovac A, Kolshus E, McLoughlin DM. Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology. 2013;38(12):2467-74. PubMed 23774532. Meta-analysis: with modern continuation medication, relapse 37.7% by 6 months and 51.1% by 12 months; antidepressant versus placebo RR 0.49, NNT 3.3.
  27. Jelovac A, Braithwaite R, Kellner CH, et al. Continuation electroconvulsive therapy combined with pharmacotherapy for depression relapse prevention: A systematic review and meta-analysis. Psychol Med. 2025;55:e251. PubMed 40874256. Continuation ECT plus medication versus medication alone (4 randomized trials, n=254): relapse RR 0.57 (95% CI 0.37–0.88), NNT 7.
  28. Lambrichts S, Detraux J, Vansteelandt K, et al. Does lithium prevent relapse following successful electroconvulsive therapy for major depression? A systematic review and meta-analysis. Acta Psychiatr Scand. 2021;143(4):294-306. PubMed 33506961. Lithium after ECT: relapse OR 0.53 (95% CI 0.34–0.82), NNT 7; very-low-quality evidence.
  29. Anand A, Mathew SJ, Sanacora G, et al. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. N Engl J Med. 2023;388(25):2315-2325. PubMed 37224232. ELEKT-D (n=403, non-psychotic treatment-resistant depression referred to ECT clinics): response 55.4% with ketamine versus 41.2% with ECT; ketamine non-inferior; ECT produced more memory decline at three weeks.
  30. Ekstrand J, Fattah C, Persson M, et al. Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT). Int J Neuropsychopharmacol. 2022;25(5):339-349. PubMed 35020871. KetECT (n=186 inpatients): remission 63% with ECT versus 46% with ketamine.
  31. Rhee TG, Shim SR, Forester BP, et al. Efficacy and Safety of Ketamine vs Electroconvulsive Therapy Among Patients With Major Depressive Episode: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022;79(12):1162-1172. PubMed 36260324. Six trials (n=340): standardized mean difference −0.69 (95% CI −0.89 to −0.48) favoring ECT over ketamine.
  32. Berlim MT, Van den Eynde F, Daskalakis ZJ. Efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (rTMS) versus electroconvulsive therapy (ECT) for major depression: a systematic review and meta-analysis of randomized trials. Depress Anxiety. 2013;30(7):614-23. PubMed 23349112. Seven randomized trials (n=294): remission 52% with ECT versus 33.6% with high-frequency rTMS; NNT 6.
  33. Ren J, Li H, Palaniyappan L, et al. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: a systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2014;51:181-9. PubMed 24556538. Nine trials (n=425): response 64.4% with ECT versus 48.7% with rTMS; the difference was clearest in psychotic depression.
  34. Blumberger DM, McClintock SM, Thorpe KE, et al. Confirmatory efficacy and safety trial of magnetic seizure therapy versus right unilateral ultra-brief electroconvulsive therapy in depression (CREST-MST): a randomised, double-blind, non-inferiority trial in Canada and the USA. Lancet Psychiatry. 2026;13(5):376-386. PubMed 41997695. CREST-MST randomized trial: remission 22.5% with magnetic seizure therapy versus 27.8% with ultrabrief right unilateral ECT (non-inferior); autobiographical memory worsened in 2.7% versus 17.3%; enrolment stopped before the planned sample size.
  35. Rönnqvist I, Nilsson FK, Nordenskjöld A. Electroconvulsive Therapy and the Risk of Suicide in Hospitalized Patients With Major Depressive Disorder. JAMA Netw Open. 2021;4(7):e2116589. PubMed 34287633. Swedish inpatients, 5,525 matched pairs: suicide within 12 months HR 0.72 (95% CI 0.52–0.99).
  36. Kaster TS, Blumberger DM, Gomes T, et al. Risk of suicide death following electroconvulsive therapy treatment for depression: a propensity score-weighted, retrospective cohort study in Canada. Lancet Psychiatry. 2022;9(6):435-446. PubMed 35487236. Ontario inpatients (67,327 admissions): suicide within one year cause-specific HR 0.53 (0.31–0.92).
  37. Odermatt J, Sarlon J, Schaefer N, et al. Electroconvulsive therapy reduces suicidality and all-cause mortality in refractory depression: A systematic review and meta-analysis of neurostimulation studies. Neurosci Appl. 2025;4:105520. PubMed 41323432. Meta-analysis of 11 ECT studies (43,257 patients): suicide OR 0.66 (0.50–0.88); all-cause mortality OR 0.70; observational.
  38. Rhee TG, Shim S, Nasir M, et al. Longitudinal associations of electroconvulsive therapy with all-cause mortality and suicide deaths in severe unipolar or bipolar depression: a systematic review and meta-analysis. BMJ Ment Health. 2025;28(1):e302083. PubMed 41407487. Meta-analysis: all-cause mortality HR 0.70 (0.61–0.81); the suicide association (HR 0.53) was significant only at three months, not at 1, 6 or 12 months.
  39. Peltzman T, Shiner B, Watts BV. Effects of Electroconvulsive Therapy on Short-Term Suicide Mortality in a Risk-Matched Patient Population. J ECT. 2020;36(3):187-192. PubMed 32205732. US veterans: suicide OR 1.31 (0.94–1.96) after ECT, not significant; an example of a null result.
  40. Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010;68(6):568-77. PubMed 20673880. 84 studies (n=2,981): cognitive test deficits in the first three days after a course, none remaining after 15 days on the tests used; the review did not include measures of autobiographical (retrograde) memory.
  41. Sackeim HA, Prudic J, Fuller R, et al. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007;32(1):244-54. PubMed 16936712. Seven community hospitals, n=347: measurable deficits six months after ECT, greatest with bilateral electrodes and sine-wave stimulation; older age, female sex and lower estimated pre-illness intellectual function were risk factors.
  42. Mathiassen AB, Semkovska M, Lundsgaard CC, et al. Autobiographical memory after electroconvulsive therapy: systematic review and meta-analysis. Br J Psychiatry. 2026;228(3):263-273. PubMed 40357797. Meta-analysis: loss of autobiographical memory after ECT versus controls, SMD 0.55 (0.35–0.75); right unilateral 0.32 versus bilateral 0.82; lost memories were not regained at follow-up.
  43. Rose D, Fleischmann P, Wykes T, et al. Patients' perspectives on electroconvulsive therapy: systematic review. BMJ. 2003;326(7403):1363. PubMed 12816822. Systematic review of patient-reported outcomes: at least one third of patients report persistent memory loss.
  44. Lisanby SH, Maddox JH, Prudic J, et al. The effects of electroconvulsive therapy on memory of autobiographical and public events. Arch Gen Psychiatry. 2000;57(6):581-90. PubMed 10839336. Retrograde amnesia after ECT affects memory for impersonal more than personal events and recent more than remote events; greater with bilateral electrodes; some impersonal-event deficits persist at two months.
  45. Kolshus E, Jelovac A, McLoughlin DM. Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2017;47(3):518-530. PubMed 27780482. Meta-analysis: bitemporal versus high-dose right unilateral ECT, efficacy g −0.03 (no difference); right unilateral patients reoriented 8.3 minutes sooner and had less autobiographical memory loss (g −0.46).
  46. Semkovska M, Landau S, Dunne R, et al. Bitemporal Versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial. Am J Psychiatry. 2016;173(4):408-17. PubMed 26892939. EFFECT-Dep (n=138): twice-weekly high-dose right unilateral ECT non-inferior to bitemporal; median reorientation 19.1 versus 26.4 minutes.
  47. Sackeim HA, Prudic J, Nobler MS, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul. 2008;1(2):71-83. PubMed 19756236. Single-site trial (n=90): remission 73% with ultrabrief right unilateral, 65% brief-pulse bilateral, 59% brief-pulse right unilateral, 35% ultrabrief bilateral; ultrabrief right unilateral had the fewest cognitive effects.
  48. Tor PC, Bautovich A, Wang MJ, et al. A Systematic Review and Meta-Analysis of Brief Versus Ultrabrief Right Unilateral Electroconvulsive Therapy for Depression. J Clin Psychiatry. 2015;76(9):e1092-8. PubMed 26213985. Meta-analysis: brief pulse more effective than ultrabrief (SMD 0.25; remission OR 0.71 for ultrabrief), ultrabrief fewer cognitive effects and about one more session.
  49. Kirov GG, Owen L, Ballard H, et al. Evaluation of cumulative cognitive deficits from electroconvulsive therapy. Br J Psychiatry. 2016;208(3):266-70. PubMed 26585101. 199 patients, 498 assessments: no cumulative cognitive deficit with increasing number of lifetime treatments.
  50. Obbels J, Vansteelandt K, Verwijk E, et al. MMSE Changes During and After ECT in Late-Life Depression: A Prospective Study. Am J Geriatr Psychiatry. 2019;27(9):934-944. PubMed 31104967. 109 patients aged 55 and older: screening-test (MMSE) scores improved during ECT and stayed stable for six months, including in those with low baseline scores.
  51. Hebbrecht K, Giltay EJ, Birkenhäger TK, et al. Cognitive change after electroconvulsive therapy in mood disorders measured with the Montreal Cognitive Assessment. Acta Psychiatr Scand. 2020;142(5):413-422. PubMed 32895922. 65 patients of all ages, individual-level change on the MoCA: 26% worse one week after ECT, 8% at six months.
  52. Kassar O, Makhlouf HA, Mansour MEM, et al. Long-term dementia risk following electroconvulsive therapy: A GRADE-assessed systematic review and meta-analysis. Int Psychogeriatr. 2026;38(3):100159. PubMed 41176476. Meta-analysis of six observational cohorts (286,995 patients): dementia diagnosis after ECT, HR 0.98 (95% CI 0.79–1.21), rated very low certainty.
  53. Oltedal L, Narr KL, Abbott C, et al. Volume of the Human Hippocampus and Clinical Response Following Electroconvulsive Therapy. Biol Psychiatry. 2018;84(8):574-581. PubMed 30006199. GEMRIC consortium (n=281): hippocampal volume increased about 0.28% per treatment, but the increase was not positively associated with clinical improvement.
  54. Devanand DP, Dwork AJ, Hutchinson ER, et al. Does ECT alter brain structure?. Am J Psychiatry. 1994;151(7):957-70. PubMed 8010381. 1994 review of human and animal data: no credible evidence that ECT causes structural brain damage.
  55. Tørring N, Sanghani SN, Petrides G, et al. The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis. Acta Psychiatr Scand. 2017;135(5):388-397. PubMed 28332236. Meta-analysis of 766,180 treatments: 2.1 ECT-related deaths per 100,000 treatments (95% CI 1.2–3.4); one reported ECT-related death in the nine series published after 2001 (414,747 treatments); the paper compares this with 3.4 per 100,000 for general anesthesia in surgery.
  56. Duma A, Maleczek M, Panjikaran B, et al. Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy: A Systematic Review and Meta-analysis. Anesthesiology. 2019;130(1):83-91. PubMed 30557212. Major adverse cardiac events in about 1 in 50 patients (roughly 1 in 200–500 treatments); death 0.06 per 1,000 treatments.
  57. Kaster TS, Vigod SN, Gomes T, et al. Risk of serious medical events in patients with depression treated with electroconvulsive therapy: a propensity score-matched, retrospective cohort study. Lancet Psychiatry. 2021;8(8):686-695. PubMed 34265274. Ontario, 5,008 matched pairs of psychiatric admissions: serious medical events within 30 days were not more frequent after ECT than in matched inpatients who did not receive it (HR 0.78, 95% CI 0.61–1.00).
  58. Blumberger DM, Seitz DP, Herrmann N, et al. Low medical morbidity and mortality after acute courses of electroconvulsive therapy in a population-based sample. Acta Psychiatr Scand. 2017;136(6):583-593. PubMed 28922451. 135,831 treatments: medical events within 7 days 9.1 per 10,000 treatments; falls 2.7 and pneumonia 1.8 per 10,000 were the most common.
  59. Mulder LAC, Grootens KP. The Incidence of Post-Electroconvulsive Therapy Headache: A Systematic Review. J ECT. 2020;36(3):e22-e28. PubMed 32205737. Headache after ECT in 32.8% of patients and 9.4–12.1% of sessions.
  60. Ertman M, van der Valk Bouman ES, Clephas PRD, et al. Prognostic Factors and Incidence for Postictal Agitation After Electroconvulsive Therapy: A Systematic Review and Meta-analysis. J ECT. 2025;41(1):17-26. PubMed 39105589. Post-treatment agitation in 13.9% of patients.
  61. Isenberg K, Dinwiddie SH, Song J, et al. A Retrospective Matched Comparison Study of Prolonged Seizures in ECT. J ECT. 2024;40(1):37-40. PubMed 37530874. Prolonged seizures (over 180 seconds) in about 1 per 167 treatments.
  62. Kadiyala PK, Kadiyala LD. Anaesthesia for electroconvulsive therapy: An overview with an update on its role in potentiating electroconvulsive therapy. Indian J Anaesth. 2017;61(5):373-380. PubMed 28584345. Review of ECT anesthesia: methohexital, propofol, etomidate and ketamine as induction agents; succinylcholine as the usual muscle relaxant; cardiovascular changes and their management.
  63. Mirzakhani H, Guchelaar HJ, Welch CA, et al. Minimum Effective Doses of Succinylcholine and Rocuronium During Electroconvulsive Therapy: A Prospective, Randomized, Crossover Trial. Anesth Analg. 2016;123(3):587-96. PubMed 26967896. Dose-finding study: succinylcholine 1.06 mg/kg (90% effective dose) and rocuronium 0.57 mg/kg for ECT.
  64. Leiknes KA, Cooke MJ, Jarosch-von Schweder L, et al. Electroconvulsive therapy during pregnancy: a systematic review of case studies. Arch Womens Ment Health. 2015;18(1):1-39. PubMed 24271084. Systematic review of 169 reported pregnancies: adverse events in 29%, child mortality 7.1% in case reports; authors advise ECT in pregnancy only as a last resort.
  65. Anderson EL, Reti IM. ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosom Med. 2009;71(2):235-42. PubMed 19073751. Review of 339 reported cases: at least partial remission in 78%; 18 maternal and 11 fetal or neonatal complications judged likely related to ECT, including two fetal or neonatal deaths.
  66. Rose S, Dotters-Katz SK, Kuller JA. Electroconvulsive Therapy in Pregnancy: Safety, Best Practices, and Barriers to Care. Obstet Gynecol Surv. 2020;75(3):199-203. PubMed 32232498. Practice review: ECT can be used in pregnancy with obstetric and anesthesia planning; the evidence is case-based.
  67. Castaneda-Ramirez S, Becker TD, Bruges-Boude A, et al. Systematic review: Electroconvulsive therapy for treatment-resistant mood disorders in children and adolescents. Eur Child Adolesc Psychiatry. 2023;32(9):1529-1560. PubMed 34999973. Adolescents, 41 mostly uncontrolled studies: response 51–92% overall (70–82% in depression and 87–90% in mania in studies with more than 30 patients); no fatalities reported.
  68. Van den Eynde L, Takamiya A, Vansteelandt K, et al. Lithium, Electroconvulsive Therapy and Cognition: A Systematic Review and Meta-Analysis. Acta Psychiatr Scand. 2026;154(2):116-130. PubMed 41949408. Lithium continued during ECT: confusional states OR 2.09 (0.94–4.66) in the primary analysis, OR 2.38 (1.20–4.74) in a sensitivity analysis; no difference on cognitive tests (five studies, n=341); authors support cautious continuation.
  69. Wilkinson ST, Kitay BM, Harper A, et al. Barriers to the Implementation of Electroconvulsive Therapy (ECT): Results From a Nationwide Survey of ECT Practitioners. Psychiatr Serv. 2021;72(7):752-757. PubMed 33971727. Fewer than 1% of US patients with major depression receive ECT.
  70. Lauber C, Nordt C, Falcato L, et al. Can a seizure help? The public's attitude toward electroconvulsive therapy. Psychiatry Res. 2005;134(2):205-9. PubMed 15840423. Population survey: 57% of the public viewed ECT as harmful.
  71. Chakrabarti S, Grover S, Rajagopal R. Electroconvulsive therapy: a review of knowledge, experience and attitudes of patients concerning the treatment. World J Biol Psychiatry. 2010;11(3):525-37. PubMed 20128713. Review of patient attitudes: about one third of patients felt coerced; most found treatment helpful.
  72. Slade EP, Jahn DR, Regenold WT, et al. Association of Electroconvulsive Therapy With Psychiatric Readmissions in US Hospitals. JAMA Psychiatry. 2017;74(8):798-804. PubMed 28658489. Inpatients who received ECT: 30-day psychiatric readmission 6.6% versus 12.3% without.
  73. U.S. Food and Drug Administration. Neurological devices; reclassification of electroconvulsive therapy devices. Final order, 83 FR 66103 (December 26, 2018); codified at 21 CFR 882.5940. Class II with special controls for catatonia or a severe major depressive episode associated with major depressive disorder or bipolar disorder in patients aged 13 and older who are treatment-resistant or require a rapid response; all other uses remain Class III. Required patient labeling warns of disorientation, confusion and memory problems, states that long-term safety and effectiveness have not been demonstrated, and notes patient reports of permanent loss of autobiographical memories. Federal Register; eCFR.
  74. Centers for Medicare & Medicaid Services. National Coverage Determination 160.25, Multiple Electroconvulsive Therapy (MECT), effective April 1, 2003 (multiple-seizure ECT not covered). There is no national coverage determination and, as of October 2026, no Palmetto GBA local coverage determination for standard single-seizure ECT. CMS Medicare Coverage Database.
  75. American Psychiatric Association. What is Electroconvulsive Therapy (ECT)? Patient and family information page. psychiatry.org.
  76. National Institute of Mental Health. Brain Stimulation Therapies. nimh.nih.gov.
  77. Mayo Clinic. Electroconvulsive therapy (ECT). mayoclinic.org.
  78. National Alliance on Mental Illness. ECT, TMS and Other Brain Stimulation Therapies. nami.org.
  79. South Carolina Code of Laws, Title 44, Chapter 22, Section 44-22-40: consent to electro-convulsive therapy; who may give consent when a patient is unable to. scstatehouse.gov (read October 26, 2026).
  80. Dukakis K, Tye L. Shock: The Healing Power of Electroconvulsive Therapy. New York: Avery; 2006. ISBN 9781583332658.
  81. Endler NS. The Origins of Electroconvulsive Therapy (ECT). Convuls Ther. 1988;4(1):5-23. PubMed 11940939. First treatment given by Cerletti and Bini in Rome in 1938.

Last reviewed: October 26, 2026 · Information on this page is educational and does not substitute for a conversation with your clinician. Treatment decisions should be made individually, based on your history and circumstances.