✓ Medically reviewed by Dr Kudrat Jain – Consultant Psychiatrist, SSHIMOH, Noida.
Almost everything the public believes about electroconvulsive therapy comes from films made decades ago. The procedure those films depicted — awake, unmodified, used punitively — has not been practised in modern psychiatry for a very long time.
ECT today is done under general anaesthetic with a muscle relaxant, takes a few minutes, and is one of the most effective treatments available for severe depression. It also has real side effects that deserve honest discussion. This page covers both.
What modern ECT involves
You are given a general anaesthetic and a muscle relaxant. Once you are asleep, a carefully controlled electrical stimulus is applied through electrodes on the scalp, producing a brief seizure in the brain lasting under a minute. Because of the muscle relaxant, the body does not convulse — an observer would see very little.
The whole procedure takes around ten minutes, and you wake in a recovery area shortly afterwards. A course is typically six to twelve sessions, given two or three times a week, with response often beginning after the first few.
Consent is required and is reviewed throughout. You can withdraw at any point.
Who it is actually for
ECT is not a first-line treatment for ordinary depression, and no reputable psychiatrist would suggest it as one. It is considered when depression is severe and has not responded to medication and therapy, or when the situation is too urgent to wait weeks for a medicine to work.
That urgency matters. Where someone is not eating or drinking, is catatonic, has psychotic depression, or is at immediate and serious risk of suicide, ECT frequently works faster than anything else available. It is also used in severe mania and in some cases of schizophrenia that have not responded to medication.
It is sometimes the safest option in pregnancy, where medication choices are more constrained.
How effective is it?
For severe depression, ECT has among the highest response rates of any treatment in psychiatry — considerably higher than a further medication trial in people who have already failed several.
The honest caveat is relapse. Without continuation treatment afterwards — medication, sometimes maintenance ECT — relapse rates within a year are substantial. ECT is best understood as something that breaks a severe episode, after which the work of staying well continues.
The risks, stated plainly
Memory effects
This is the side effect that matters most and the one that is most often glossed over. Confusion immediately after each session is usual and clears within minutes to hours.
Two other effects are common: difficulty forming new memories during the course, which typically recovers over the weeks after treatment ends; and gaps in memory for events in the weeks or months around the treatment period, some of which may be permanent.
A minority of people report longer-lasting difficulties with autobiographical memory. That possibility should be part of the consent conversation, and it is one reason ECT is reserved for situations where the illness itself carries serious risk.
Anaesthetic and physical risks
The risks of ECT are largely the risks of a brief general anaesthetic, which are low but not zero, and higher in people with significant heart or lung disease. Headache, jaw ache and muscle soreness afterwards are common and usually mild.
Serious complications are rare. Mortality associated with ECT is comparable to that of minor surgery under general anaesthetic.
What about the alternatives?
If the concern is treatment-resistant depression specifically, ECT is not the only option. Repetitive transcranial magnetic stimulation is non-invasive, requires no anaesthetic, and has no effect on memory — though it is generally less powerful and slower than ECT, and is not appropriate for emergencies. We explain it in our guide to rTMS therapy.
Medication strategies — switching class, combining, augmenting — are usually tried first. So is structured psychotherapy. ECT enters the conversation when those have been given a fair trial, or when there is no time to give them one.
Questions to ask before consenting
Why is ECT being recommended for me specifically, and what has been tried already? Unilateral or bilateral placement, and why? How many sessions are anticipated? What happens to my current medication? What is the plan to prevent relapse afterwards? How will memory effects be monitored?
You are entitled to clear answers and to time to decide. Under India’s Mental Healthcare Act, 2017, ECT may not be given to a minor without additional safeguards, and unmodified ECT — without anaesthesia and muscle relaxant — is prohibited outright.
What a course actually looks like, week by week
Before starting, you will have a physical assessment including heart and lung review, blood tests, and an anaesthetic assessment. Current medications are reviewed — some, particularly certain anticonvulsants and benzodiazepines, interfere with treatment and may be adjusted.
Sessions are typically two or three times a week. You fast beforehand, as for any anaesthetic. Each visit takes a couple of hours in total, most of which is preparation and recovery rather than the procedure itself.
Improvement, where it happens, usually becomes apparent somewhere between the third and sixth session, though families often notice before the patient does. The number of sessions is decided by response, not fixed in advance.
Cognitive effects are monitored through the course, and electrode placement or frequency can be adjusted if memory problems are becoming prominent.
Preparing, practically
Arrange someone to accompany you to and from each session; you should not drive on treatment days. Expect to be tired afterwards and plan a light day.
Because memory for the treatment period can be patchy, it helps to keep a simple written record of important information and appointments during the course, and to postpone major financial or legal decisions until afterwards.
Tell the team about every medicine you take, including anything bought over the counter.
The myths worth correcting
That it is used as punishment or control. Modern ECT requires consent and is offered where it is the most effective option for a severe illness.
That it causes brain damage. Studies have not demonstrated structural brain damage from modern ECT. Memory effects are real, and are a separate issue from damage.
That it is a last resort only. It is often used where other treatments have failed, but it is sometimes chosen early precisely because it works faster than anything else — for example in severe depression with refusal to eat or drink.
That the effects are permanent and total. Most people recover cognitively over the weeks after a course, though gaps around the treatment period may remain.
How the decision is made at SSHIMOH
ECT is never the first thing suggested, and it is not offered without a clear clinical rationale that we will explain to you and your family in plain terms.
The discussion covers what has already been tried and for how long, how severe the current episode is, what the risks of waiting are, and what alternatives remain — including rTMS, a medication change, or intensive inpatient treatment without ECT.
If it is recommended, you receive information in writing, time to consider it, and the opportunity to ask questions with a family member present. Consent is documented and can be withdrawn at any stage, including after the course has started.
Physical fitness for anaesthesia is assessed before the first session, and cognitive function is monitored through the course so that placement or frequency can be adjusted if memory effects become prominent.
We also plan what happens afterwards at the outset, because ECT without a continuation strategy has a high relapse rate. That plan usually involves medication, ongoing therapy, and regular review rather than discharge on completion.
Frequently Asked Questions
Is ECT painful?
No. It is carried out under general anaesthetic, so you are asleep and feel nothing. Some people have a headache or muscle ache afterwards, usually mild and short-lived.
Will ECT erase my memories?
It can affect memory. Confusion right after a session is usual and brief. Difficulty forming new memories during the course usually recovers afterwards. Gaps for events around the treatment period can persist, and a minority report longer-term difficulties.
How many ECT sessions will I need?
A typical course is six to twelve sessions given two to three times per week, though this is individualised and reviewed as you respond.
Is unmodified ECT still used in India?
No. Unmodified ECT — without anaesthesia and muscle relaxant — is prohibited under the Mental Healthcare Act, 2017. Any ECT you are offered should be modified ECT.
Can ECT be given without consent?
Only within the narrow circumstances set out in the Mental Healthcare Act, with the safeguards it specifies. In ordinary practice, informed consent is obtained and can be withdrawn at any time.
Does ECT cure depression permanently?
It is highly effective at ending a severe episode, but without continuation treatment the relapse rate is significant. It is a way of breaking an episode, not a permanent cure.
References and further reading
A decision worth taking slowly, with good information
ECT provokes strong feelings, and people deserve accurate information rather than either reassurance or horror. If it has been suggested for you or a family member, ask every question on this page and as many more as you need.
To discuss it with a psychiatrist experienced in these treatments, call +91 72669 93399 or book a consultation.