The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you’re hospitalized or as an outpatient procedure.
Before the procedure
To get ready for the ECT procedure:
•You’ll have general anesthesia, which means you may have dietary restrictions before the procedure. Your health care team will tell you how long to avoid food and drinks before ECT treatment. Typically, this might mean no food or water after midnight and only a sip of water to take any morning medications.
•You may have a brief physical exam to check your heart and lungs.
•You’ll have an intravenous (IV) line inserted. Your nurse or another health care team member inserts an IV tube into your arm or hand through which medications or fluids can be given.
•Your nurse places electrode pads on your head. Each pad is about the size of a silver dollar. ECT can be unilateral, in which electrical currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electrical currents.
Anesthesia and medications
At the start of the procedure, you’ll receive these medications through your IV:
•An anesthetic to make you unconscious and unaware of the procedure
•A muscle relaxant to help minimize the seizure and prevent injury
You also may receive other medications, depending on any health conditions you have or your previous reactions to ECT.
A blood pressure cuff placed around your ankle stops the muscle relaxant medication from entering the foot and affecting the muscles there. When the procedure begins, your doctor can monitor seizure activity by watching for movement in that foot.
During the procedure, monitors constantly check your heart, blood pressure and oxygen use. You may be given oxygen through an oxygen mask. You may also be given a mouth guard to help protect your teeth and tongue from injury
Inducing a seizure
When you’re asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electrical current to pass through the electrodes to your brain, producing a seizure that usually lasts less than 60 seconds.
Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you’re having a seizure may be a rhythmic movement of your foot if there’s a blood pressure cuff around your ankle. But internally, activity in your brain increases dramatically. A test called an electroencephalogram (EEG) records the electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.
A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You’re taken to a recovery area, where you’re monitored for problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.
Series of treatments
In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments. The number of treatments you’ll need depends on the severity of your symptoms and how rapidly they improve.
Some people may be advised not to return to work until one to two weeks after the last ECT in a series or for at least 24 hours after the last treatment.