Electroconvulsive Therapy: Breaking the Stigma

The modern form of electroconvulsive therapy is a potent weapon against severe depression.

“Electroconvulsive therapy is the most effective treatment for major depression that we have in psychiatry, bar none,” says Robert Greenberg, MD, Electroconvulsive Therapy (ECT) Medical Director, RWJBarnabas Health Behavioral Health Network. “It works far more quickly and gets a far higher response than any medication.”

Robert M. Greenberg, MD
Robert Greenberg, MD

Although major depression is one of the most common mental disorders in the U.S., ECT isn’t widely available.

“There’ are a lot of stigmas that stem from early forms of the treatment, which have no relation to the modern way ECT is done,” says Dr. Greenberg, an internationally recognized expert in the field who offers ECT at Clara Maass Medical Center.

“If ECT were developed and introduced today, it would be heralded as a miraculous treatment.”

Here, he explains how it works.

What happens during ECT?

Small pulses of electric currents are passed through the brain of a patient who is briefly under general anesthesia. The currents result in synchronized brain wave activity, which, over a series of treatments, brings about changes in brain chemistry and/or connections that can reverse symptoms of some mental health conditions.

It is a safe treatment and does not hurt. Temporary side effects may include some memory impairment, but they are usually mild and last a short time.

What conditions is ECT used to treat?

ECT is not for the “worried well” or for mild forms of depression. It’s for major depression, mixed bipolar states, catatonia and acute psychotic disorders. For people with severe autism, who may show self-injurious behaviors, it can be a life-changing treatment.

When should physicians and patients consider using ECT?

Contrary to what many believe, ECT should not be considered a last resort. In fact, it may be a first resort when a rapid, definitive response is needed—for example, when a patient is actively suicidal or has a serious medical disability that precludes waiting for months to see if an antidepressant will be effective. ECT may also be used when a patient has failed to respond to, or can’t tolerate, antidepressants or other mood-altering medications. At least a third of patients who have serious depression do not respond adequately to antidepressants.

Does ECT work better for older or younger people?

The treatment is highly effective for all populations, but there seems to be a modestly greater rate of success for older people. We don’t really know why, but one theory is that depression in older people tends to be a biologically based form of true melancholic depression that responds better to ECT.

What should people do to find out whether they are a candidate for ECT? If a patient is already in the hospital, we can see whether it’s appropriate to transfer him or her to the Inpatient Psychiatry Unit for evaluation. In other cases, ideally, a psychiatrist should be involved and make a referral. However, a patient can also call our office and request a consultation on his or her own. ECT is covered by most private insurances and also by Medicare and Medicaid.

Learn more about mental and behavioral health services. For more information about electroconvulsive therapy or to schedule an appointment with Robert Greenberg, MD, call (973) 322-0220.