Electroconvulsive therapy (ECT)

Domain IX · Biomedical, neuro & digital · Ugo Cerletti, Lucio Bini · 1938 · Rome, Italy

What it is

What it is: under a general anaesthetic and a muscle-relaxing medicine, a brief electrical stimulus is passed through electrodes on the head to bring on a short generalised seizure. The types named in the field are bilateral, unilateral and ultrabrief-pulse variants. The idea of how change happens…

Format

• Phase B: Assessment, information and consent. Goal: a documented risk-benefit assessment (anaesthetic risk, other illnesses, expected adverse effects, especially cognitive impairment, and the risks of not treating), with particular care in pregnancy, older people, children and young people; valid…
• Phase C: The acute course. Format: treatments in a hospital ECT suite, as an inpatient or outpatient, under general anaesthesia given by an anaesthetist; relatives usually wait outside the treatment room. Clinical status is assessed after each treatment, and cognitive function is monitored…

Who practises it, and how they are trained or regulated

• USA (FDA, final order 26 December 2018): ECT devices are Class II (special controls) for catatonia or a severe major depressive episode in major depressive disorder or bipolar disorder, in people aged 13 and over who are treatment-resistant or need a rapid response because of the severity of their condition. All other uses (for example schizophrenia, mania, under-13s, people not meeting those criteria) remain Class…
• Mental Health Act 1983 s58A applies to ECT. For detained patients and for young people under 18 (detained or not), ECT may not be given unless one of these applies: (3) a patient aged 18 or over consents, and the approved clinician in charge or a second-opinion appointed doctor (SOAD) certifies in writing that the patient understands the nature, purpose and likely effects and consents; (4) a patient under 18…
• Mental Health Act 2025 (Royal Assent, enacted text dated 18 December 2025): replaces the "capable of understanding" test with a capacity test (competence for under-16s); adds a duty (new s56A) to consider alternatives and involve the patient in decisions; requires certificates to confirm that duty was met; renames the role "second opinion appointed doctor"; and replaces the urgent-treatment rule for ECT with a new…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• carer views overriding the client's.
• a young person's views being sidelined.
• no cognitive review at the end of a course.
• your own views about ECT shaping how you respond.
• starting demanding work while concentration is still poor.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.