Electroconvulsive Therapy Provides Hope for Treatment-Resistant Depression

If you or a loved one lives with treatment-resistant depression (TRD), you’re not alone. At least 30 percent of people with depression have TRD, which means they can’t find relief with antidepressants or therapy alone. 

TRD can be a particularly debilitating form of depression — it may be hard for those who have it to get out of bed in the morning or even eat regular meals. 

But there’s hope for people with TRD: a treatment called electroconvulsive therapy (ECT), which has an impressive 90 percent success rate. 

“ECT is the gold standard for treatment-resistant depression, despite being highly stigmatized,” says Muhammad Ali Abbas, M.D., director of Electroconvulsive Therapy and Neuromodulation at Raritan Bay Medical Center in Perth Amboy. 

He says the procedure has been refined a lot since the 1950s. The way it is performed today is painless and generally safe. “There is no other treatment available in psychiatry that helps the patient that quickly,” says Dr. Abbas. “More and more, people are using it as a first resort.”

In fact, Carrier Behavioral Health at Carrier Clinic & Raritan Bay Medical Centerand Jersey Shore University Medical Center perform more than 5,000 ECT treatments each year, the most in the entire state.

Here’s what you need to know about electroconvulsive therapy for TRD, including what to expect if you decide to try it. 

What Is Electroconvulsive Therapy (ECT)?

ECT delivers a brief, targeted dose of electrical current to the brain, triggering what is called a therapeutic seizure or convulsion. Experts believe ECT “resets” the brain cells responsible for producing mood-regulating hormones, like serotonin and dopamine. 

“Over time, ECT actually improves the functions of the neurons in the brain,” says Dr. Abbas. “It fixes the underlying pathology.”

Hackensack Meridian Health uses ECT to treat several other conditions in addition to TRD, including bipolar depression, catatonia, schizophrenia and some severe forms of autism.

When to Consider ECT forDepression

“Electroconvulsive therapy has a major role as a first-line treatment for TRD, especially in certain situations,” Dr. Abbas says. Those situations include any time a delay in recovery could potentially be harmful, such as in cases of depression with catatonia (unsafe behaviors), suicidal ideation, severe weight loss or psychotic features. 

ECT can also be useful if you can’t tolerate the side effects of antidepressant medications or have other conditions that prevent you from using them. 

What to Expect During ECT for Depression Treatment

ECT can be performed as an outpatient procedure, but most people opt to stay overnight for the first few sessions. You can’t eat for eight hours before the procedure, and you are given a muscle relaxer before it begins.

“It’s a very brief procedure, less than 20 minutes in the actual operating room,” says Dr. Abbas. 

Once you’re fully sedated, a short burst of electricity is delivered via electrodes placed on your head. Throughout the procedure, your vital signs and brainwaves are monitored. Afterward, you’re taken to the recovery area where you get back to your baseline senses after about 30 minutes. 

Initially, people typically receive three sessions of ECT a week for several weeks. “Usually after three to five sessions they start to see improvement,” says Dr. Abbas. 

Every person responds differently, so a full course could be up to 15 sessions. Your doctor evaluates your depressive symptoms and compares them to the baseline taken before treatment. 

When you show more than 50 percent improvement, you’re recommended to move on to maintenance treatments. When you have an improvement of 80 percent or more over baseline, you are considered to be in remission. 

But it’s important to note that ECT for depression is not a permanent fix, says Dr. Abbas. Even if you achieve remission, you will need occasional maintenance treatments (or an alternative, like antidepressant medications) for a long period of time. 

Are There Any Side Effects of ECT for Depression?

Not only is ECT for depression largely effective and faster working than most other treatments, it also has few side effects. “Short term, patients may experience headache or nausea,” says Dr. Abbas. 

In patients who are prone to these side effects, he says, they are easily preventable during future treatments. Some people may experience short or long-term memory loss. But in general, side effects are minor and reversible over time, especially when compared to those of antidepressant medications. 

Is ECT for Depression Safe? 

It’s true that ECT, formerly known as “shock therapy,” was not always administered as carefully as it is today. Now, Dr. Abbas says, patients are fully anesthetized and monitored throughout the procedure. The use of muscle relaxers and bite blocks helps prevent injuries. 

“There is lots of safety and efficacy data on ECT,” says Dr. Abbas. “We modified the electricity intensity and frequency to make it more tolerable and decrease the negative side effects.” 

The Future of ECT Therapy for Treatment-Resistant Depression

As the rates of depression rise and cases become more urgent and complex, it’s important to let go of outdated beliefs about ECT, says Dr. Abbas. He sees ECT as a “more natural way of treating patients with depression.” 

Evidence shows that ECT reduces the cost of inpatient stays and readmission rates and that it reduces suicide risk by 50 percent, literally saving lives.

For people who undergo the procedure at Hackensack Meridian Health, “the prognosis is pretty good,” Dr. Abbas says. “We are a medical hospital. We get a lot of very complicated cases — severe catatonia, suicide attempts. We have used ECT when patients are not responding to other treatments, and we get very good results. I witness that every single day.”

Next Steps & Resources:

• Meet our source: Muhammad Ali Abbas, M.D.
• Make an appointment online with a behavioral health physician, or call 800-822-8905.
• Learn more about electroconvulsive therapy at Hackensack Meridian Health. 

The material provided through Healthier You is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.