Electroconvulsive therapy (ECT)
Modern ECT (electroconvulsive therapy) is a common, routine, carefully monitored medical procedure done under anesthesia: you are asleep and feel nothing during it. We turn to it for severe depression that has not improved after an adequate trial of medication and therapy (often called treatment-resistant depression), and for severe mania or catatonia, as well as psychosis that has not responded to medication. It can have time-limited effects on memory which we will discuss with you; see more about that below.
Is ECT covered by insurance?
Most major insurers cover ECT for severe or treatment-resistant depression. Many plans require a prior authorization documenting the treatments you have already tried; we verify your plan and handle that authorization. Our team will let you know what costs to expect ahead of time.
Who is ECT a good fit for, and who is it not for?
ECT is most often considered for adults whose symptoms are severe and have not responded to adequate treatment, or when a faster response is medically important. You may be a candidate if any of these apply:
- Your depression has not responded to antidepressants and therapy (treatment-resistant depression).
- You have severe mania, or catatonia (a state of immobility or unresponsiveness that can occur in severe psychiatric illness).
- You have psychotic symptoms that have not responded sufficiently to medication.
- Your symptoms are life-threatening and a faster response is medically necessary.
- You responded well to ECT in a previous episode.
ECT is not a first-line option for milder depression that has not yet had a reasonable course of standard treatment, and it is used with extra caution in people with certain cardiac, neurological, or anesthesia-related risks.
Whether ECT is appropriate and safe for you depends on a full evaluation, including a medical and anesthesia assessment, and your psychiatrist reviews your history and other options with you thoroughly before anything is scheduled.
What happens during ECT, step by step?
Evaluation and workup. A psychiatrist reviews your diagnosis, prior treatments, current medications, and goals. Because ECT involves general anesthesia, you also have a medical workup, usually including a review of your heart and general health and coordination with an anesthesia clinician.
The treatment itself. You are given a short-acting general anesthetic and a muscle relaxant. Once you are asleep, a carefully controlled electrical stimulus produces a brief, monitored seizure while the team manages your breathing and vital signs. That seizure is the intended therapeutic event, not a complication. The procedure itself takes about ten minutes. It is a painless procedure and you will be asleep for the duration with no experience or memory of the treatment itself.
Recovery and the ride home. You do not eat or drink for the morning beforehand, and you wake under monitoring as the anesthesia wears off. Because of the anesthesia and any short-term confusion, you cannot drive for 48 hours after treatment, so someone needs to take you home.
The series. A common course is 2 to 3 treatments a week for several weeks, often 6 to 12 in total, sometimes followed by a tapering and less frequent maintenance schedule. Because you cannot drive on treatment days, plan on arranging a ride each time for the length of the course.
What about memory and other side effects?
The most important risk to understand is the effect on memory. Many people have temporary confusion right after a treatment and some difficulty remembering events from around the treatment period. For most people this improves over days to weeks once the course is finished, though some report longer-lasting gaps in memory, especially for the weeks surrounding treatment.
Other common, usually short-lived effects include headache, jaw or muscle soreness, and nausea. There are also the general risks of brief general anesthesia, which is why the medical workup and on-site monitoring matter. Your psychiatrist and the anesthesia team discuss the risks and benefits specific to your situation before you decide.
How does ECT compare to your other options?
ECT has one of the highest response rates of any treatment for severe depression, which is why it is considered when stronger or faster help is needed. Relapse is common without follow-up care, so ECT is usually paired with ongoing medication to help hold the response after the acute course.
For some people, medication adjustments, psychotherapy, or other interventional treatments such as TMS or ketamine-based care are more appropriate. Choosing among these options, and deciding when to move toward or away from ECT, is an individualized decision made with your psychiatrist, not a fixed pathway.
Where is ECT done?
ECT needs anesthesia, monitoring equipment, and a treatment team, so it is handled through the Herrick Campus hospital-based site, not any of our outpatient offices. Herrick Campus is a Sutter hospital campus where BPA physicians provide care; it is separate from our outpatient offices.
Physicians who provide ECT
Common questions
Is ECT painful?
No. The treatment is done under brief general anesthesia, so you are asleep and feel nothing. Some people have a headache, jaw or muscle soreness, or nausea afterward; these are usually mild, short-lived, and manageable.
Will ECT affect my memory?
Memory is the most important risk to understand. Many people have some confusion right after a treatment and gaps in memory for events around the treatment period. For most, this improves over days to weeks after the course ends, though some report longer-lasting gaps, especially for the weeks surrounding treatment. We review this with you before starting and monitor it throughout.
How many treatments will I need?
An initial course is commonly 6 to 12 treatments, given 2 to 3 times a week, but the exact number depends on how you respond. Some people then move to a less frequent maintenance schedule. The plan is individualized and adjusted as you go.
Where is ECT performed?
Through the Herrick Campus hospital-based site, not any of our outpatient offices, because ECT needs anesthesia, monitoring equipment, and a treatment team. Herrick Campus is a Sutter hospital campus where BPA physicians provide hospital-based psychiatric services.
Is ECT covered by insurance?
ECT for severe or treatment-resistant depression is covered by most major insurers, though many plans require a prior authorization documenting earlier treatment trials. Coverage and your expected responsibility vary by plan. We verify your plan and handle the authorization.
How to get started with ECT
Request an appointment. We’ll check your insurance and help you get started.