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id="toc-Effects_and_adverse_effects-sublist" class="vector-toc-list"> <li id="toc-Risk_of_death" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Risk_of_death"> <div class="vector-toc-text"> 3.1 Risk of death </div> </a> <ul id="toc-Risk_of_death-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cognitive_impairment" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cognitive_impairment"> <div class="vector-toc-text"> 3.2 Cognitive impairment </div> </a> <ul id="toc-Cognitive_impairment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Effects_on_brain_structure" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Effects_on_brain_structure"> <div class="vector-toc-text"> 3.3 Effects on brain structure </div> </a> <ul id="toc-Effects_on_brain_structure-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Effects_in_pregnancy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Effects_in_pregnancy"> <div class="vector-toc-text"> 3.4 Effects in pregnancy </div> </a> <ul id="toc-Effects_in_pregnancy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Effects_on_the_heart" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Effects_on_the_heart"> <div class="vector-toc-text"> 3.5 Effects on the heart </div> </a> <ul id="toc-Effects_on_the_heart-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Procedure" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Procedure"> <div class="vector-toc-text"> 4 Procedure </div> </a> <button aria-controls="toc-Procedure-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Procedure subsection </button> <ul id="toc-Procedure-sublist" class="vector-toc-list"> <li id="toc-Neuroimaging_prior_to_ECT" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Neuroimaging_prior_to_ECT"> <div class="vector-toc-text"> 4.1 Neuroimaging prior to ECT </div> </a> <ul id="toc-Neuroimaging_prior_to_ECT-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Concurrent_pharmacotherapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Concurrent_pharmacotherapy"> <div class="vector-toc-text"> 4.2 Concurrent pharmacotherapy </div> </a> <ul id="toc-Concurrent_pharmacotherapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Course" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Course"> <div class="vector-toc-text"> 4.3 Course </div> </a> <ul id="toc-Course-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment_team" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Treatment_team"> <div class="vector-toc-text"> 4.4 Treatment team </div> </a> <ul id="toc-Treatment_team-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Devices" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Devices"> <div class="vector-toc-text"> 4.5 Devices </div> </a> <ul id="toc-Devices-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Mechanism_of_action" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Mechanism_of_action"> <div class="vector-toc-text"> 5 Mechanism of action </div> </a> <ul id="toc-Mechanism_of_action-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Use" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Use"> <div class="vector-toc-text"> 6 Use </div> </a> <button aria-controls="toc-Use-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Use subsection </button> <ul id="toc-Use-sublist" class="vector-toc-list"> <li id="toc-United_States" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#United_States"> <div class="vector-toc-text"> 6.1 United States </div> </a> <ul id="toc-United_States-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-United_Kingdom" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#United_Kingdom"> <div class="vector-toc-text"> 6.2 United Kingdom </div> </a> <ul id="toc-United_Kingdom-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-China" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#China"> <div class="vector-toc-text"> 6.3 China </div> </a> <ul id="toc-China-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> 7 Society and culture </div> </a> <button aria-controls="toc-Society_and_culture-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Society and culture subsection </button> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> <li id="toc-Controversy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Controversy"> <div class="vector-toc-text"> 7.1 Controversy </div> </a> <ul id="toc-Controversy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Legal_status" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Legal_status"> <div class="vector-toc-text"> 7.2 Legal status </div> </a> <ul id="toc-Legal_status-sublist" class="vector-toc-list"> <li id="toc-Informed_consent" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Informed_consent"> <div class="vector-toc-text"> 7.2.1 Informed consent </div> </a> <ul id="toc-Informed_consent-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Involuntary_ECT" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Involuntary_ECT"> <div class="vector-toc-text"> 7.2.2 Involuntary ECT </div> </a> <ul id="toc-Involuntary_ECT-sublist" class="vector-toc-list"> <li id="toc-United_States_2" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#United_States_2"> <div class="vector-toc-text"> 7.2.2.1 United States </div> </a> <ul id="toc-United_States_2-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-United_Kingdom_2" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#United_Kingdom_2"> <div class="vector-toc-text"> 7.2.2.2 United Kingdom </div> </a> <ul id="toc-United_Kingdom_2-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Regulation" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Regulation"> <div class="vector-toc-text"> 7.2.3 Regulation </div> </a> <ul id="toc-Regulation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-By_country" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#By_country"> <div class="vector-toc-text"> 7.2.4 By country </div> </a> <ul id="toc-By_country-sublist" class="vector-toc-list"> <li id="toc-Australia" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Australia"> <div class="vector-toc-text"> 7.2.4.1 Australia </div> </a> <ul id="toc-Australia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-United_States_3" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#United_States_3"> <div class="vector-toc-text"> 7.2.4.2 United States </div> </a> <ul id="toc-United_States_3-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Public_perception" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Public_perception"> <div class="vector-toc-text"> 7.3 Public perception </div> </a> <ul id="toc-Public_perception-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Famous_cases" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Famous_cases"> <div class="vector-toc-text"> 7.4 Famous cases </div> </a> <ul id="toc-Famous_cases-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Fictional_examples" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Fictional_examples"> <div class="vector-toc-text"> 7.5 Fictional examples </div> </a> <ul id="toc-Fictional_examples-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 8 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 9 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 10 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Electroconvulsive therapy</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 43 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-43" aria-hidden="true" > 43 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%85%D8%B9%D8%A7%D9%84%D8%AC%D8%A9_%D8%A8%D8%A7%D9%84%D8%AA%D8%AE%D9%84%D9%8A%D8%AC_%D8%A7%D9%84%D9%83%D9%87%D8%B1%D8%A8%D8%A7%D8%A6%D9%8A" title="معالجة بالتخليج الكهربائي – Arabic" lang="ar" hreflang="ar" data-title="معالجة بالتخليج الكهربائي" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Elektrokonvulsiv_terapiya" title="Elektrokonvulsiv terapiya – Azerbaijani" lang="az" hreflang="az" data-title="Elektrokonvulsiv terapiya" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target">Azərbaycanca</a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%95%D0%BB%D0%B5%D0%BA%D1%82%D1%80%D0%BE%D0%BA%D0%BE%D0%BD%D0%B2%D1%83%D0%BB%D1%81%D0%B8%D0%B2%D0%BD%D0%B0_%D1%82%D0%B5%D1%80%D0%B0%D0%BF%D0%B8%D1%8F" title="Електроконвулсивна терапия – Bulgarian" lang="bg" hreflang="bg" data-title="Електроконвулсивна терапия" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target">Български</a></li><li class="interlanguage-link interwiki-bar mw-list-item"><a href="https://bar.wikipedia.org/wiki/Elektrokrampftherapie" title="Elektrokrampftherapie – Bavarian" lang="bar" hreflang="bar" data-title="Elektrokrampftherapie" data-language-autonym="Boarisch" data-language-local-name="Bavarian" class="interlanguage-link-target">Boarisch</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Ter%C3%A0pia_electroconvulsiva" title="Teràpia electroconvulsiva – Catalan" lang="ca" hreflang="ca" data-title="Teràpia electroconvulsiva" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Elektrokonvulzivn%C3%AD_terapie" title="Elektrokonvulzivní terapie – Czech" lang="cs" hreflang="cs" data-title="Elektrokonvulzivní terapie" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Elektrochokbehandling" title="Elektrochokbehandling – Danish" lang="da" hreflang="da" data-title="Elektrochokbehandling" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Elektrokonvulsionstherapie" title="Elektrokonvulsionstherapie – German" lang="de" hreflang="de" data-title="Elektrokonvulsionstherapie" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Elekterkrampravi" title="Elekterkrampravi – Estonian" lang="et" hreflang="et" data-title="Elekterkrampravi" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target">Eesti</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%97%CE%BB%CE%B5%CE%BA%CF%84%CF%81%CE%BF%CF%83%CF%80%CE%B1%CF%83%CE%BC%CE%BF%CE%B8%CE%B5%CF%81%CE%B1%CF%80%CE%B5%CE%AF%CE%B1" title="Ηλεκτροσπασμοθεραπεία – Greek" lang="el" hreflang="el" data-title="Ηλεκτροσπασμοθεραπεία" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Terapia_electroconvulsiva" title="Terapia electroconvulsiva – Spanish" lang="es" hreflang="es" data-title="Terapia electroconvulsiva" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Elektroshock" title="Elektroshock – Basque" lang="eu" hreflang="eu" data-title="Elektroshock" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%AF%D8%B1%D9%85%D8%A7%D9%86_%D8%A8%D8%A7_%D8%B6%D8%B1%D8%A8%D9%87_%D8%A7%D9%84%DA%A9%D8%AA%D8%B1%DB%8C%DA%A9%DB%8C_%D8%AA%D8%B4%D9%86%D8%AC%E2%80%8C%D8%A2%D9%88%D8%B1" title="درمان با ضربه الکتریکی تشنج‌آور – Persian" lang="fa" hreflang="fa" data-title="درمان با ضربه الکتریکی تشنج‌آور" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/%C3%89lectroconvulsivoth%C3%A9rapie" title="Électroconvulsivothérapie – French" lang="fr" hreflang="fr" data-title="Électroconvulsivothérapie" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-fy mw-list-item"><a href="https://fy.wikipedia.org/wiki/Elektrokonvulsyterapy" title="Elektrokonvulsyterapy – Western Frisian" lang="fy" hreflang="fy" data-title="Elektrokonvulsyterapy" data-language-autonym="Frysk" data-language-local-name="Western Frisian" class="interlanguage-link-target">Frysk</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%A0%84%EA%B8%B0_%EA%B2%BD%EB%A0%A8_%EC%9A%94%EB%B2%95" title="전기 경련 요법 – Korean" lang="ko" hreflang="ko" data-title="전기 경련 요법" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B5%E0%A4%BF%E0%A4%A6%E0%A5%8D%E0%A4%AF%E0%A5%81%E0%A4%A4%E0%A5%8D-%E0%A4%86%E0%A4%95%E0%A5%8D%E0%A4%B7%E0%A5%87%E0%A4%AA%E0%A5%80_%E0%A4%9A%E0%A4%BF%E0%A4%95%E0%A4%BF%E0%A4%A4%E0%A5%8D%E0%A4%B8%E0%A4%BE" title="विद्युत्-आक्षेपी चिकित्सा – Hindi" lang="hi" hreflang="hi" data-title="विद्युत्-आक्षेपी चिकित्सा" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target">हिन्दी</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Terapi_elektrokonvulsif" title="Terapi elektrokonvulsif – Indonesian" lang="id" hreflang="id" data-title="Terapi elektrokonvulsif" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/Rafl%C3%A6kningar" title="Raflækningar – Icelandic" lang="is" hreflang="is" data-title="Raflækningar" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target">Íslenska</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Terapia_elettroconvulsivante" title="Terapia elettroconvulsivante – Italian" lang="it" hreflang="it" data-title="Terapia elettroconvulsivante" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A0%D7%96%D7%A2%D7%99_%D7%97%D7%A9%D7%9E%D7%9C" title="נזעי חשמל – Hebrew" lang="he" hreflang="he" data-title="נזעי חשמל" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-ku mw-list-item"><a href="https://ku.wikipedia.org/wiki/Terapiya_elektrokomp%C3%BBls%C3%AEv" title="Terapiya elektrokompûlsîv – Kurdish" lang="ku" hreflang="ku" data-title="Terapiya elektrokompûlsîv" data-language-autonym="Kurdî" data-language-local-name="Kurdish" class="interlanguage-link-target">Kurdî</a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Elektrokonvulsin%C4%97_terapija" title="Elektrokonvulsinė terapija – Lithuanian" lang="lt" hreflang="lt" data-title="Elektrokonvulsinė terapija" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target">Lietuvių</a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Elektrosokk-ter%C3%A1pia" title="Elektrosokk-terápia – Hungarian" lang="hu" hreflang="hu" data-title="Elektrosokk-terápia" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target">Magyar</a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%87%E0%B4%B2%E0%B4%95%E0%B5%8D%E0%B4%9F%E0%B5%8D%E0%B4%B0%E0%B5%8B%E0%B4%95%E0%B5%BA%E0%B4%B5%E0%B5%BE%E0%B4%B8%E0%B5%80%E0%B4%B5%E0%B5%8D_%E0%B4%A4%E0%B5%86%E0%B4%B1%E0%B4%BE%E0%B4%AA%E0%B5%8D%E0%B4%AA%E0%B4%BF" title="ഇലക്ട്രോകൺവൾസീവ് തെറാപ്പി – Malayalam" lang="ml" hreflang="ml" data-title="ഇലക്ട്രോകൺവൾസീവ് തെറാപ്പി" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target">മലയാളം</a></li><li class="interlanguage-link interwiki-arz mw-list-item"><a href="https://arz.wikipedia.org/wiki/%D8%B9%D9%84%D8%A7%D8%AC_%D8%A8%D8%A7%D9%84%D8%B5%D8%AF%D9%85%D8%A7%D8%AA" title="علاج بالصدمات – Egyptian Arabic" lang="arz" hreflang="arz" data-title="علاج بالصدمات" data-language-autonym="مصرى" data-language-local-name="Egyptian Arabic" class="interlanguage-link-target">مصرى</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Elektroconvulsietherapie" title="Elektroconvulsietherapie – Dutch" lang="nl" hreflang="nl" data-title="Elektroconvulsietherapie" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a 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برېښنايي شاک باندې درملنه" data-language-autonym="پښتو" data-language-local-name="Pashto" class="interlanguage-link-target">پښتو</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Terapia_elektrowstrz%C4%85sowa" title="Terapia elektrowstrząsowa – Polish" lang="pl" hreflang="pl" data-title="Terapia elektrowstrząsowa" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Eletroconvulsoterapia" title="Eletroconvulsoterapia – Portuguese" lang="pt" hreflang="pt" data-title="Eletroconvulsoterapia" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%AD%D0%BB%D0%B5%D0%BA%D1%82%D1%80%D0%BE%D1%81%D1%83%D0%B4%D0%BE%D1%80%D0%BE%D0%B6%D0%BD%D0%B0%D1%8F_%D1%82%D0%B5%D1%80%D0%B0%D0%BF%D0%B8%D1%8F" title="Электросудорожная терапия – Russian" lang="ru" hreflang="ru" data-title="Электросудорожная терапия" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-sah mw-list-item"><a href="https://sah.wikipedia.org/wiki/%D0%AD%D0%BB%D0%B5%D0%BA%D1%82%D1%80%D0%BE%D1%81%D1%83%D0%B4%D0%BE%D1%80%D0%BE%D0%B6%D0%BD%D0%B0%D0%B9_%D1%82%D0%B5%D1%80%D0%B0%D0%BF%D0%B8%D1%8F" title="Электросудорожнай терапия – Yakut" lang="sah" hreflang="sah" data-title="Электросудорожнай терапия" data-language-autonym="Саха тыла" data-language-local-name="Yakut" class="interlanguage-link-target">Саха тыла</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Electroconvulsive_therapy" title="Electroconvulsive therapy – Simple English" lang="en-simple" hreflang="en-simple" data-title="Electroconvulsive therapy" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target">Simple English</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%95%D0%BB%D0%B5%D0%BA%D1%82%D1%80%D0%BE%D0%BA%D0%BE%D0%BD%D0%B2%D1%83%D0%BB%D0%B7%D0%B8%D0%B2%D0%BD%D0%B0_%D1%82%D0%B5%D1%80%D0%B0%D0%BF%D0%B8%D1%98%D0%B0" title="Електроконвулзивна терапија – Serbian" lang="sr" hreflang="sr" data-title="Електроконвулзивна терапија" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Elektrokonvulzivna_terapija" title="Elektrokonvulzivna terapija – 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href="https://th.wikipedia.org/wiki/%E0%B8%81%E0%B8%B2%E0%B8%A3%E0%B8%A3%E0%B8%B1%E0%B8%81%E0%B8%A9%E0%B8%B2%E0%B8%97%E0%B8%B2%E0%B8%87%E0%B8%88%E0%B8%B4%E0%B8%95%E0%B9%80%E0%B8%A7%E0%B8%8A%E0%B8%94%E0%B9%89%E0%B8%A7%E0%B8%A2%E0%B9%84%E0%B8%9F%E0%B8%9F%E0%B9%89%E0%B8%B2" title="การรักษาทางจิตเวชด้วยไฟฟ้า – Thai" lang="th" hreflang="th" data-title="การรักษาทางจิตเวชด้วยไฟฟ้า" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target">ไทย</a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Elektrokonv%C3%BClsif_terapi" title="Elektrokonvülsif terapi – Turkish" lang="tr" hreflang="tr" data-title="Elektrokonvülsif terapi" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target">Türkçe</a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a 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div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"Electroshock" redirects here. For other uses, see <a href="/wiki/Electroshock_(disambiguation)" class="mw-disambig" title="Electroshock (disambiguation)">Electroshock (disambiguation)</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical intervention</div> <style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: lightblue">Electroconvulsive therapy</th></tr><tr><td colspan="2" class="infobox-image"><a href="/wiki/File:MECTA_spECTrum_ECT.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e6/MECTA_spECTrum_ECT.jpg/280px-MECTA_spECTrum_ECT.jpg" decoding="async" width="280" height="212" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e6/MECTA_spECTrum_ECT.jpg/420px-MECTA_spECTrum_ECT.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e6/MECTA_spECTrum_ECT.jpg/560px-MECTA_spECTrum_ECT.jpg 2x" data-file-width="1231" data-file-height="934" /></a><div class="infobox-caption">MECTA spECTrum 5000Q with <a href="/wiki/Electroencephalogram" class="mw-redirect" title="Electroencephalogram">electroencephalography</a> (EEG) in a modern ECT suite</div></td></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Electroshock therapy</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/ICD-10_Procedure_Coding_System" title="ICD-10 Procedure Coding System">ICD-10-PCS</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="http://www.icd10data.com/ICD10PCS/Codes/G/Z/B/GZB">GZB</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/ICD-9-CM_Volume_3" title="ICD-9-CM Volume 3">ICD-9-CM</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="http://icd9cm.chrisendres.com/index.php?srchtype=procs&srchtext=94.27&Submit=Search&action=search">94.27</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D004565">D004565</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/OPS-301" title="OPS-301">OPS-301 code</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="http://www.icd-code.de/ops/code/8-630.html">8-630</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="https://medlineplus.gov/ency/article/007474.htm">007474</a></td></tr><tr class="noprint"><td colspan="2" class="infobox-full-data"><div style="text-align: right;">[<a href="https://www.wikidata.org/wiki/Q131543" class="extiw" title="d:Q131543">edit on Wikidata</a>]</div></td></tr></tbody></table> Electroconvulsive therapy (ECT) or electroshock therapy (EST) is a <a href="/wiki/Psychiatry" title="Psychiatry">psychiatric</a> treatment during which a generalized <a href="/wiki/Seizure" title="Seizure">seizure</a> (without muscular <a href="/wiki/Convulsion" title="Convulsion">convulsions</a>) is electrically induced to manage refractory <a href="/wiki/Mental_disorder" title="Mental disorder">mental disorders</a>.<a href="#cite_note-Rudorfer-1">[1]</a> Typically, 70 to 120 <a href="/wiki/Volt" title="Volt">volts</a> are applied externally to the patient's head, resulting in approximately 800 <a href="/wiki/Amperes" class="mw-redirect" title="Amperes">milliamperes</a> of direct current passing between the electrodes, for a duration of 100 <a href="/wiki/Millisecond" title="Millisecond">milliseconds</a> to 6 seconds, either from temple to temple (bilateral ECT) or from front to back of one side of the head (unilateral ECT). However, only about 1% of the electrical current crosses the bony skull into the brain because skull <a href="/wiki/Electrical_impedance" title="Electrical impedance">impedance</a> is about 100 times higher than skin impedance.<a href="#cite_note-2">[2]</a> Aside from effects on the brain, the general physical risks of ECT are similar to those of brief <a href="/wiki/General_anesthesia" class="mw-redirect" title="General anesthesia">general anesthesia</a>.<a href="#cite_note-SG-3">[3]</a>: 259  Immediately following treatment, the most common adverse effects are confusion and transient memory loss.<a href="#cite_note-FDA2011rev-4">[4]</a><a href="#cite_note-APA2001guideline-5">[5]</a> Among treatments for severely depressed pregnant women, ECT is one of the least harmful to the <a href="/wiki/Fetus" title="Fetus">fetus</a>.<a href="#cite_note-Pompili2014Rev-6">[6]</a> ECT is often used as an intervention for <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a>, <a href="/wiki/Mania" title="Mania">mania</a>, <a href="/wiki/Autism" title="Autism">autism</a>, and <a href="/wiki/Catatonia" title="Catatonia">catatonia</a>.<a href="#cite_note-FDA2011rev-4">[4]</a> The usual course of ECT involves multiple administrations, typically given two or three times per week until the patient no longer has symptoms. ECT is administered under anesthesia with a <a href="/wiki/Muscle_relaxant" title="Muscle relaxant">muscle relaxant</a>.<a href="#cite_note-7">[7]</a> ECT can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. These treatment parameters can pose significant differences in both adverse side effects and symptom remission in the treated patient. Placement can be bilateral, where the electric current is passed from one side of the brain to the other, or unilateral, in which the current is solely passed across one <a href="/wiki/Brain_hemisphere" class="mw-redirect" title="Brain hemisphere">hemisphere</a> of the brain. High-dose unilateral ECT has some cognitive advantages compared to moderate-dose bilateral ECT while showing no difference in antidepressant efficacy.<a href="#cite_note-pmid27780482-8">[8]</a> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="History">History</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=1" title="Edit section: History">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Bergonic_chair.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/6b/Bergonic_chair.jpg/220px-Bergonic_chair.jpg" decoding="async" width="220" height="153" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/6b/Bergonic_chair.jpg/330px-Bergonic_chair.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/6b/Bergonic_chair.jpg/440px-Bergonic_chair.jpg 2x" data-file-width="1848" data-file-height="1288" /></a><figcaption>A Bergonic chair, a device "for giving general electric treatment for psychological effect, in psycho-neurotic cases", according to original photo description. World War I era.</figcaption></figure> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/History_of_electroconvulsive_therapy_in_the_United_Kingdom" title="History of electroconvulsive therapy in the United Kingdom">History of electroconvulsive therapy in the United Kingdom</a> and <a href="/wiki/History_of_electroconvulsive_therapy_in_the_United_States" title="History of electroconvulsive therapy in the United States">History of electroconvulsive therapy in the United States</a></div> As early as the 16th century, agents to induce seizures were used to treat psychiatric conditions. In 1785, the therapeutic use of seizure induction was documented in the <a href="/wiki/London_Medical_and_Surgical_Journal" title="London Medical and Surgical Journal">London Medical and Surgical Journal</a>.<a href="#cite_note-Rudorfer-1">[1]</a><a href="#cite_note-9">[9]</a> As to its earliest antecedents one doctor claims 1744 as the dawn of electricity's therapeutic use, as documented in the first issue of Electricity and Medicine. Treatment and cure of <a href="/wiki/Conversion_disorder" title="Conversion disorder">hysterical blindness</a> was documented eleven years later. <a href="/wiki/Benjamin_Franklin" title="Benjamin Franklin">Benjamin Franklin</a> wrote that an electrostatic machine cured "a woman of hysterical fits." By 1801, <a href="/wiki/James_Lind_(physician,_born_1736)" class="mw-redirect" title="James Lind (physician, born 1736)">James Lind</a><a href="#cite_note-10">[10]</a> as well as <a href="/wiki/Giovanni_Aldini" title="Giovanni Aldini">Giovanni Aldini</a> had used <a href="/wiki/Galvanism" title="Galvanism">galvanism</a> to treat patients with various mental disorders.<a href="#cite_note-11">[11]</a> G.B.C. Duchenne, the mid-19th century "Father of Electrotherapy", said its use was integral to a neurological practice.<a href="#cite_note-12">[12]</a> In the second half of the 19th century, such efforts were frequent enough in British asylums as to make it notable.<a href="#cite_note-13">[13]</a> Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist <a href="/wiki/Ladislas_J._Meduna" title="Ladislas J. Meduna">Ladislas J. Meduna</a> who, believing mistakenly that <a href="/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a> and <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a> were antagonistic disorders, induced seizures first with <a href="/wiki/Camphor" title="Camphor">camphor</a> and then <a href="/wiki/Metrazol" class="mw-redirect" title="Metrazol">metrazol</a> (cardiazol).<a href="#cite_note-14">[14]</a><a href="#cite_note-Fink-history-15">[15]</a> Meduna is thought to be the father of convulsive therapy.<a href="#cite_note-Bolwig-16">[16]</a> In 1937, the first international meeting on <a href="/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a> and <a href="/wiki/Convulsive_therapy" class="mw-redirect" title="Convulsive therapy">convulsive therapy</a> was held in Switzerland by the Swiss psychiatrist Max Müller.<a href="#cite_note-17">[17]</a> The proceedings were published in the <a href="/wiki/American_Journal_of_Psychiatry" class="mw-redirect" title="American Journal of Psychiatry">American Journal of Psychiatry</a> and, within three years, cardiazol convulsive therapy was being used worldwide.<a href="#cite_note-Fink-history-15">[15]</a> The ECT procedure was first conducted in 1938 by Italian neuro-psychiatrist <a href="/wiki/Ugo_Cerletti" title="Ugo Cerletti">Ugo Cerletti</a><a href="#cite_note-18">[18]</a> and rapidly replaced less safe and effective forms of <a href="/wiki/Shock_therapy_(psychiatry)" title="Shock therapy (psychiatry)">biological treatments</a> in use at the time. Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his assistant <a href="/wiki/Lucio_Bini" title="Lucio Bini">Lucio Bini</a> at Sapienza University of Rome developed the idea of using electricity as a substitute for <a href="/wiki/Metrazol" class="mw-redirect" title="Metrazol">metrazol</a> in convulsive therapy and, in 1938, experimented for the first time on a person affected by <a href="/wiki/Delusion" title="Delusion">delusions</a>. It was believed early on that inducing convulsions aided in helping those with severe <a href="/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a> but later found to be most useful with <a href="/wiki/Affective_disorder" class="mw-redirect" title="Affective disorder">affective disorders</a> such as <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>. Cerletti had noted a shock to the head produced convulsions in dogs. The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state.<a href="#cite_note-Sabbatini-19">[19]</a> Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial. Once they started trials on patients, they found that after 10–20 treatments the results were significant. Patients had much improved. A positive side effect to the treatment was <a href="/wiki/Retrograde_amnesia" title="Retrograde amnesia">retrograde amnesia</a>. It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it.<a href="#cite_note-Sabbatini-19">[19]</a> ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient.<a href="#cite_note-20">[20]</a> Cerletti and Bini were nominated for a <a href="/wiki/Nobel_Prize" title="Nobel Prize">Nobel Prize</a> but did not receive one. By 1940, the procedure was introduced to both England and the US. In Germany and Austria, it was promoted by <a href="/wiki/Friedrich_Meggendorfer" title="Friedrich Meggendorfer">Friedrich Meggendorfer</a>. Through the 1940s and 1950s, the use of ECT became widespread. At the time the ECT device was patented and commercialized abroad, the two Italian inventors had competitive tensions that damaged their relationship.<a href="#cite_note-21">[21]</a> In the 1960s, despite a climate of condemnation, the original Cerletti-Bini ECT apparatus prototype was contended by scientific museums between Italy and the US.<a href="#cite_note-:2-22">[22]</a> The ECT apparatus prototype is now owned and displayed by the Sapienza <a href="https://it.wikipedia.org/wiki/Museo_di_storia_della_medicina" class="extiw" title="it:Museo di storia della medicina">Museum of the History of Medicine</a> in Rome.<a href="#cite_note-:2-22">[22]</a> In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of <a href="/wiki/Sinusoidal_current" class="mw-redirect" title="Sinusoidal current">sinusoidal current</a> with brief pulse. It took many years for brief-pulse equipment to be widely adopted.<a href="#cite_note-Kiloh-23">[23]</a> In the 1940s and early 1950s, ECT was usually given in an "unmodified" form, without muscle relaxants, and the seizure resulted in a full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s, psychiatrists began to experiment with <a href="/wiki/Curare" title="Curare">curare</a>, the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of <a href="/wiki/Suxamethonium" class="mw-redirect" title="Suxamethonium">suxamethonium</a> (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. A short-acting anesthetic was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants.<a href="#cite_note-Kiloh-23">[23]</a> The steady growth of <a href="/wiki/Antidepressant" title="Antidepressant">antidepressant</a> use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 1950s to the 1970s. The <a href="/wiki/Surgeon_General_of_the_United_States" title="Surgeon General of the United States">Surgeon General</a> stated there were problems with electroshock therapy in the initial years before <a href="/wiki/Anesthesia" title="Anesthesia">anesthesia</a> was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media."<a href="#cite_note-erica_goode-24">[24]</a> The New York Times described the public's negative perception of ECT as being caused mainly by one movie: "For Big Nurse in <a href="/wiki/One_Flew_Over_the_Cuckoo%27s_Nest_(film)" title="One Flew Over the Cuckoo's Nest (film)">One Flew Over the Cuckoo's Nest</a>, it was a tool of terror, and, in the public mind, shock therapy has retained the tarnished image given it by <a href="/wiki/Ken_Kesey" title="Ken Kesey">Ken Kesey</a>'s novel: dangerous, inhumane and overused".<a href="#cite_note-Goleman_1990-25">[25]</a> In 1976, Dr. Blatchley demonstrated the effectiveness of his constant current, brief pulse device ECT. This device eventually largely replaced earlier devices because of the reduction in cognitive side effects, although as of 2012 some ECT clinics still were using sine-wave devices.<a href="#cite_note-LeiknesWWrev2012-26">[26]</a> The 1970s saw the publication of the first <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> (APA) task force report on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). The report endorsed the use of ECT in the treatment of depression. The decade also saw criticism of ECT.<a href="#cite_note-27">[27]</a> Specifically, critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT. The use of ECT declined until the 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression".<a href="#cite_note-erica_goode-24">[24]</a> In 1985, the <a href="/wiki/National_Institute_of_Mental_Health" title="National Institute of Mental Health">National Institute of Mental Health</a> and <a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a> convened a consensus development conference on ECT and concluded that, while ECT was the most controversial treatment in psychiatry and had significant side-effects, it had been shown to be effective for a narrow range of severe psychiatric disorders.<a href="#cite_note-28">[28]</a> Because of the backlash noted previously, national institutions reviewed past practices and set new standards. In 1978, the American Psychiatric Association released its first task force report in which new standards for <a href="/wiki/Consent" title="Consent">consent</a> were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances. The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented. Finally, in 2001 the American Psychiatric Association released its latest task force report.<a href="#cite_note-APA2001guideline-5">[5]</a> This report emphasizes the importance of <a href="/wiki/Informed_consent" title="Informed consent">informed consent</a>, and the expanded role that the procedure has in modern medicine. By 2017, ECT was routinely covered by insurance companies for providing the "biggest bang for the buck" for otherwise intractable cases of severe <a href="/wiki/Mental_illness" class="mw-redirect" title="Mental illness">mental illness</a>, was receiving favorable media coverage, and was being provided in regional medical centers.<a href="#cite_note-ECT_Provided_in_Boise-29">[29]</a> Though ECT use declined with the advent of modern antidepressants, there has been a resurgence of ECT with new modern technologies and techniques.<a href="#cite_note-30">[30]</a> Modern shock voltage is given for a shorter duration of 0.5 milliseconds where conventional brief pulse is 1.5 milliseconds.<a href="#cite_note-31">[31]</a> In a review from 2022 of <a href="/wiki/Neuroimaging" title="Neuroimaging">neuroimaging</a> studies based on a global data collaboration ECT was suggested to work via a temporary disruption of neural circuits followed by augmented <a href="/wiki/Neuroplasticity" title="Neuroplasticity">neuroplasticity</a> and rewiring.<a href="#cite_note-Ousdal_2022-32">[32]</a> <div class="mw-heading mw-heading2"><h2 id="Modern_use">Modern use</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=2" title="Edit section: Modern use">edit</a>]</div> ECT is used, where possible, with <a href="/wiki/Informed_consent" title="Informed consent">informed consent</a><a href="#cite_note-Beloucif-33">[33]</a> in treatment-resistant <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a>, <a href="/wiki/Bipolar_depression" class="mw-redirect" title="Bipolar depression">bipolar depression</a>, treatment-resistant <a href="/wiki/Catatonia" title="Catatonia">catatonia</a>, prolonged or severe <a href="/wiki/Mania" title="Mania">mania</a>, and in conditions where "there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by <a href="/wiki/Suicidality" class="mw-redirect" title="Suicidality">suicidality</a>, <a href="/wiki/Psychosis" title="Psychosis">psychosis</a>, <a href="/wiki/Stupor" title="Stupor">stupor</a>, marked <a href="/wiki/Psychomotor_retardation" title="Psychomotor retardation">psychomotor retardation</a>, depressive <a href="/wiki/Delusion" title="Delusion">delusions</a> or <a href="/wiki/Hallucination" title="Hallucination">hallucinations</a>, or life-threatening physical exhaustion associated with mania)."<a href="#cite_note-FDA2011rev-4">[4]</a><a href="#cite_note-who.int-34">[34]</a><a href="#cite_note-Espinoza_2022-35">[35]</a> It has also been used to treat <a href="/wiki/Autism" title="Autism">autism</a> in adults with an intellectual disability, yet findings from a systematic review found this an unestablished intervention.<a href="#cite_note-36">[36]</a> <div class="mw-heading mw-heading3"><h3 id="Major_depressive_disorder">Major depressive disorder</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=3" title="Edit section: Major depressive disorder">edit</a>]</div> For <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a>, despite a Canadian guideline and some experts arguing for using ECT as a first line treatment,<a href="#cite_note-37">[37]</a><a href="#cite_note-Psychiatry_p.-38">[38]</a><a href="#cite_note-Bolwig_2005_p=51-39">[39]</a> ECT is generally used only when one or other treatments have failed, or in emergencies, such as imminent suicide.<a href="#cite_note-FDA2011rev-4">[4]</a><a href="#cite_note-40">[40]</a><a href="#cite_note-NICE2009-41">[41]</a> ECT has also been used in selected cases of depression occurring in the setting of <a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a>, <a href="/wiki/Parkinson%27s_disease" title="Parkinson's disease">Parkinson's disease</a>, <a href="/wiki/Huntington%27s_chorea" class="mw-redirect" title="Huntington's chorea">Huntington's chorea</a>, <a href="/wiki/Intellectual_disability" title="Intellectual disability">developmental delay</a>, brain <a href="/wiki/Arteriovenous_malformations" class="mw-redirect" title="Arteriovenous malformations">arteriovenous malformations</a>, and <a href="/wiki/Hydrocephalus" title="Hydrocephalus">hydrocephalus</a>.<a href="#cite_note-42">[42]</a> <div class="mw-heading mw-heading4"><h4 id="Efficacy">Efficacy</h4>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=4" title="Edit section: Efficacy">edit</a>]</div> A <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> on the effectiveness of ECT in unipolar and bipolar depression indicated that although patients with <a href="/wiki/Unipolar_depression" class="mw-redirect" title="Unipolar depression">unipolar depression</a> and <a href="/wiki/Bipolar_depression" class="mw-redirect" title="Bipolar depression">bipolar depression</a> responded to other medical treatments very differently, both groups responded equally well to ECT. Overall <a href="/wiki/Remission_(medicine)" title="Remission (medicine)">remission</a> rate for patients given a round of ECT treatment was 50.9% for those with unipolar depression and 53.2% for those with bipolar depression. Most severely depressed patients respond to ECT.<a href="#cite_note-Dierckx_Heijnen_van_den_Broek_Birkenhäger_2012_pp._146–150-43">[43]</a> In 2004, a meta-analysis found in terms of efficacy, "a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus <a href="/wiki/Placebo" title="Placebo">placebo</a>, ECT versus antidepressants in general, ECT versus tricyclics and ECT versus <a href="/wiki/Monoamine_oxidase_inhibitor" title="Monoamine oxidase inhibitor">monoamine oxidase inhibitors</a>."<a href="#cite_note-pmid15087991-44">[44]</a> In 2003, The UK ECT Review Group published a <a href="/wiki/Systematic_review" title="Systematic review">systematic review</a> and meta-analysis comparing ECT to <a href="/wiki/Placebo" title="Placebo">placebo</a> and antidepressant drugs. This meta-analysis demonstrated a large effect size (high efficacy relative to the mean in terms of the <a href="/wiki/Standard_deviation" title="Standard deviation">standard deviation</a>) for ECT versus placebo, and versus antidepressant drugs.<a href="#cite_note-:0-45">[45]</a> Compared with <a href="/wiki/Repetitive_transcranial_magnetic_stimulation" class="mw-redirect" title="Repetitive transcranial magnetic stimulation">repetitive transcranial magnetic stimulation</a> (rTMS) for people with treatment-resistant major depressive disorder, ECT relieves depression as shown by reducing the score on the <a href="/wiki/Hamilton_Rating_Scale_for_Depression" title="Hamilton Rating Scale for Depression">Hamilton Rating Scale for Depression</a> by about 15 points, while rTMS reduced it by 9 points.<a href="#cite_note-46">[46]</a> Other estimates regarding the response rate in treatment resistant depression vary between 60–80%, with a remission rate of 50–60%.<a href="#cite_note-Espinoza_2022-35">[35]</a> In addition to reducing symptoms of depression and inducing relapse, ECT has also been shown to reduce the risk of suicide, improve functional outcomes and quality of life as well as reduce the risk of re-hospitalization.<a href="#cite_note-Espinoza_2022-35">[35]</a> Efficacy does not depend on depression subtype.<a href="#cite_note-Psychiatry_p.-38">[38]</a> With regards to treatment resistant schizophrenia, the response rate is 40–70%.<a href="#cite_note-Espinoza_2022-35">[35]</a> <div class="mw-heading mw-heading4"><h4 id="Follow-up">Follow-up</h4>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=5" title="Edit section: Follow-up">edit</a>]</div> There is little agreement on the most appropriate follow-up to ECT for people with major depressive disorder.<a href="#cite_note-Jelovac2013Rev-47">[47]</a> The initial course of ECT is then transitioned to maintenance ECT, pharmacotherapy or both. When ECT is stopped abruptly, without a bridge to maintenance ECT or medications (usually antidepressants and <a href="/wiki/Lithium_(medication)" title="Lithium (medication)">Lithium</a>), it is associated with a relapse rate of 84%.<a href="#cite_note-Espinoza_2022-35">[35]</a> There is no defined schedule for maintenance ECT, however it is usually started weekly with intervals extended permissibly with the goal of maintaining remission.<a href="#cite_note-Espinoza_2022-35">[35]</a> When ECT is followed by treatment with <a href="/wiki/Antidepressants" class="mw-redirect" title="Antidepressants">antidepressants</a>, about 50% of people relapsed by 12 months following successful initial treatment with ECT, with about 37% relapsing within the first 6 months. About twice as many relapsed with no antidepressants. Most of the evidence for continuation therapy is with <a href="/wiki/Tricyclic_antidepressants" class="mw-redirect" title="Tricyclic antidepressants">tricyclic antidepressants</a>; evidence for relapse prevention with newer antidepressants is lacking.<a href="#cite_note-Jelovac2013Rev-47">[47]</a> Adjunct maintenance ECT paired with <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a> has also been shown to reduce relapse rates.<a href="#cite_note-Espinoza_2022-35">[35]</a> Maintenance ECT may safely continue indefinitely, with no set maximum treatment interval established.<a href="#cite_note-Espinoza_2022-35">[35]</a> <a href="/wiki/Lithium_(medication)" title="Lithium (medication)">Lithium</a> has also been found to reduce the risk of relapse, especially in younger patients.<a href="#cite_note-Lambrichts_Detraux_Vansteelandt_Nordenskjöld_2021_pp._294–306-48">[48]</a> <div class="mw-heading mw-heading3"><h3 id="Catatonia">Catatonia</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=6" title="Edit section: Catatonia">edit</a>]</div> ECT is generally a second-line treatment for people with <a href="/wiki/Catatonia" title="Catatonia">catatonia</a> who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia.<a href="#cite_note-FDA2011rev-4">[4]</a><a href="#cite_note-catatoniaRev-49">[49]</a><a href="#cite_note-50">[50]</a> There is a plethora of evidence for its efficacy, notwithstanding a lack of randomised controlled trials, such that "the excellent efficacy of ECT in catatonia is generally acknowledged".<a href="#cite_note-catatoniaRev-49">[49]</a> For people with <a href="/wiki/Autism_Spectrum_Disorders" class="mw-redirect" title="Autism Spectrum Disorders">autism spectrum disorders</a> who have catatonia, there is little published evidence about the efficacy of ECT.<a href="#cite_note-51">[51]</a> <div class="mw-heading mw-heading3"><h3 id="Mania">Mania</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=7" title="Edit section: Mania">edit</a>]</div> ECT is used to treat people who have severe or prolonged <a href="/wiki/Mania" title="Mania">mania</a>;<a href="#cite_note-FDA2011rev-4">[4]</a> <a href="/wiki/NICE" class="mw-redirect" title="NICE">NICE</a> recommends it only in life-threatening situations or when other treatments have failed<a href="#cite_note-NICEtech2003-52">[52]</a> and as a second-line treatment for <a href="/wiki/Bipolar_disorder" title="Bipolar disorder">bipolar mania</a>.<a href="#cite_note-53">[53]</a><a href="#cite_note-54">[54]</a> <div class="mw-heading mw-heading3"><h3 id="Schizophrenia">Schizophrenia</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=8" title="Edit section: Schizophrenia">edit</a>]</div> ECT is widely used worldwide in the treatment of <a href="/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a>, but in North America and Western Europe it is invariably used only in <a href="/wiki/Treatment_resistant_schizophrenia" class="mw-redirect" title="Treatment resistant schizophrenia">treatment resistant schizophrenia</a> when symptoms show little response to <a href="/wiki/Antipsychotic" title="Antipsychotic">antipsychotics</a>; there is comprehensive research evidence for such practice.<a href="#cite_note-55">[55]</a> It is useful in the case of severe exacerbations of <a href="/wiki/Catatonic_schizophrenia" class="mw-redirect" title="Catatonic schizophrenia">catatonic schizophrenia</a>, whether excited or stuporous.<a href="#cite_note-FDA2011rev-4">[4]</a><a href="#cite_note-NICEtech2003-52">[52]</a> There are also case reports of ECT improving persistent psychotic symptoms associated with <a href="/wiki/Stimulant_psychosis" title="Stimulant psychosis">stimulant-induced psychosis</a>.<a href="#cite_note-56">[56]</a><a href="#cite_note-57">[57]</a> <div class="mw-heading mw-heading2"><h2 id="Effects_and_adverse_effects">Effects and adverse effects</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=9" title="Edit section: Effects and adverse effects">edit</a>]</div> Aside from effects in the brain, the general physical risks of ECT are similar to those of brief <a href="/wiki/General_anesthesia" class="mw-redirect" title="General anesthesia">general anesthesia</a>; the <a href="/wiki/Surgeon_General_of_the_United_States" title="Surgeon General of the United States">US Surgeon General</a>'s report says that there are "no absolute health <a href="/wiki/Contraindications" class="mw-redirect" title="Contraindications">contraindications</a>" to its use.<a href="#cite_note-SG-3">[3]</a>: 259  Immediately following treatment, the most common adverse effects are confusion and memory loss. Some patients experience <a href="/wiki/Myalgia" title="Myalgia">muscle soreness</a> after ECT. Other common adverse effects after ECT include headache, jaw soreness, nausea, vomiting and fatigue. These side effects are transient and respond to treatment.<a href="#cite_note-Espinoza_2022-35">[35]</a> There is evidence and rationale to support giving low doses of <a href="/wiki/Benzodiazepine" title="Benzodiazepine">benzodiazepines</a> or otherwise low doses of <a href="/wiki/General_anesthetic" class="mw-redirect" title="General anesthetic">general anesthetics</a>, which induce <a href="/wiki/Sedation" title="Sedation">sedation</a> but not <a href="/wiki/Anesthesia" title="Anesthesia">anesthesia</a>, to patients to reduce adverse effects of ECT.<a href="#cite_note-pmid22531198-58">[58]</a> While there are no absolute contraindications for ECT, there is increased risk for patients who have unstable or severe cardiovascular conditions or <a href="/wiki/Aneurysms" class="mw-redirect" title="Aneurysms">aneurysms</a>; who have recently had a <a href="/wiki/Stroke" title="Stroke">stroke</a>; who have increased <a href="/wiki/Intracranial_pressure" title="Intracranial pressure">intracranial pressure</a> (for instance, due to a solid <a href="/wiki/Brain_tumor" title="Brain tumor">brain tumor</a>), or who have severe pulmonary conditions, or who are generally at high risk for receiving anesthesia.<a href="#cite_note-APA2001guideline-5">[5]</a>: 30  In adolescents, ECT is highly efficient for several psychiatric disorders, with few and relatively benign adverse effects.<a href="#cite_note-59">[59]</a><a href="#cite_note-LimaNascimento2013-60">[60]</a><a href="#cite_note-pmid31714466-61">[61]</a> <div class="mw-heading mw-heading3"><h3 id="Risk_of_death">Risk of death</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=10" title="Edit section: Risk of death">edit</a>]</div> A meta-analysis from 2017 found that the death rate of ECT was around 2.1 per 100,000 procedures.<a href="#cite_note-62">[62]</a> A review from 2011 reported an estimate of the mortality rate associated with ECT as less than 1 death per 73,440 treatments.<a href="#cite_note-pmid20966769-63">[63]</a> <div class="mw-heading mw-heading3"><h3 id="Cognitive_impairment">Cognitive impairment</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=11" title="Edit section: Cognitive impairment">edit</a>]</div> Cognitive impairment sometimes occurs after ECT.<a href="#cite_note-64">[64]</a><a href="#cite_note-65">[65]</a><a href="#cite_note-66">[66]</a><a href="#cite_note-67">[67]</a> The <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> (APA) report in 2001 acknowledges: "In some patients the recovery from <a href="/wiki/Retrograde_amnesia" title="Retrograde amnesia">retrograde amnesia</a> will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss".<a href="#cite_note-APA2001guideline-5">[5]</a> It is the purported effects of ECT on long-term memory that give rise to much of the concern surrounding its use.<a href="#cite_note-Lisanby_2000-68">[68]</a> However, the methods used to measure memory loss are non-specific, and their application to people with depressive disorders, who have <a href="/wiki/Cognitive_deficits" class="mw-redirect" title="Cognitive deficits">cognitive deficits</a> related to the depression, including problems with memory, may further limit their utility.<a href="#cite_note-SemkovskaRev2013-69">[69]</a> The acute effects of ECT can include <a href="/wiki/Amnesia" title="Amnesia">amnesia</a>, both retrograde (for events occurring before the treatment) and anterograde (for events occurring after the treatment).<a href="#cite_note-Benbow-70">[70]</a> Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with outdated sine-wave rather than brief-pulse currents. The use of either constant or pulsing electrical impulses also varied the memory loss results in patients. Patients who received pulsing electrical impulses, as opposed to a steady flow, seemed to incur less memory loss. The vast majority of modern treatment uses brief pulse currents.<a href="#cite_note-Benbow-70">[70]</a> A greater number of treatments and higher electrical charges (stimulus charges) have also been associated with a greater risk of memory impairment.<a href="#cite_note-Espinoza_2022-35">[35]</a> Retrograde amnesia is most marked for events occurring in the weeks or months before treatment. <a href="/wiki/Anterograde_amnesia" title="Anterograde amnesia">Anterograde memory loss</a> usually resolves 2–4 weeks after treatment, whereas retrograde amnesia (which develops gradually after repeated treatments in the initial course) usually takes weeks to months to resolve, and amnesia rarely persist for more than 1 year.<a href="#cite_note-Espinoza_2022-35">[35]</a> Retrograde amnesia after ECT usually affects autobiographical memory, rather than <a href="/wiki/Semantic_memory" title="Semantic memory">semantic memory</a>.<a href="#cite_note-Espinoza_2022-35">[35]</a> One published review summarizing the results of questionnaires about subjective memory loss found that between 29% and 55% of respondents believed they experienced long-lasting or permanent memory changes.<a href="#cite_note-bmj_rose-71">[71]</a> In 2000, American psychiatrist <a href="/wiki/Sarah_Lisanby" title="Sarah Lisanby">Sarah Lisanby</a> and colleagues found that bilateral ECT left patients with more persistently impaired memory of public events as compared to right unilateral ECT.<a href="#cite_note-Lisanby_2000-68">[68]</a> However, bilateral ECT may be more efficacious than unilateral in the treatment of mood disorders.<a href="#cite_note-Espinoza_2022-35">[35]</a> ECT has not been found to increase the risk of dementia nor cause structural brain damage.<a href="#cite_note-Osler_2018-72">[72]</a><a href="#cite_note-Espinoza_2022-35">[35]</a> <div class="mw-heading mw-heading3"><h3 id="Effects_on_brain_structure">Effects on brain structure</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=12" title="Edit section: Effects on brain structure">edit</a>]</div> Considerable controversy exists over the effects of ECT on brain tissue, although a number of mental health associations—including the APA—have concluded that there is no evidence that ECT causes structural brain damage.<a href="#cite_note-APA2001guideline-5">[5]</a><a href="#cite_note-NICE2009-41">[41]</a> A 1999 report by the US Surgeon General states: "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals."<a href="#cite_note-surgeon-73">[73]</a> Many expert proponents of ECT maintain that the procedure is safe and does not cause brain damage. Dr. Charles Kellner, a prominent ECT researcher and former chief editor of the Journal of ECT, stated in a 2007 interview that, "There are a number of well-designed studies that show ECT does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to ECT."<a href="#cite_note-kellner_interview-74">[74]</a> Kellner cites a study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime ECT treatments.<a href="#cite_note-100_lifetime-75">[75]</a> Kellner stated "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness." Two meta-analyses find that ECT is associated with brain matter growth.<a href="#cite_note-76">[76]</a><a href="#cite_note-77">[77]</a> <div class="mw-heading mw-heading3"><h3 id="Effects_in_pregnancy">Effects in pregnancy</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=13" title="Edit section: Effects in pregnancy">edit</a>]</div> If steps are taken to decrease potential risks, ECT is generally accepted to be relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments.<a href="#cite_note-Pompili2014Rev-6">[6]</a><a href="#cite_note-78">[78]</a> Suggested preparation for ECT during pregnancy includes a <a href="/wiki/Pelvic_examination" title="Pelvic examination">pelvic examination</a>, discontinuation of nonessential <a href="/wiki/Anticholinergic" title="Anticholinergic">anticholinergic</a> medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate <a href="/wiki/Antacid" title="Antacid">antacid</a>. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, <a href="/wiki/Intubation" title="Intubation">intubation</a>, and avoidance of excessive <a href="/wiki/Hyperventilation" title="Hyperventilation">hyperventilation</a> are recommended.<a href="#cite_note-Pompili2014Rev-6">[6]</a> In many instances of active mood disorder during pregnancy, the risks of untreated symptoms may outweigh the risks of ECT. Potential complications of ECT during pregnancy can be minimized by modifications in technique. The use of ECT during pregnancy requires thorough evaluation of the patient's capacity for informed consent.<a href="#cite_note-Miller1994-79">[79]</a> <div class="mw-heading mw-heading3"><h3 id="Effects_on_the_heart">Effects on the heart</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=14" title="Edit section: Effects on the heart">edit</a>]</div> ECT can cause a lack of blood flow and oxygen to the heart, <a href="/wiki/Heart_arrhythmia" class="mw-redirect" title="Heart arrhythmia">heart arrhythmia</a>, and "persistent <a href="/wiki/Asystole" title="Asystole">asystole</a>". A 2019 <a href="/wiki/Systematic_review" title="Systematic review">systematic review</a> and <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> of 82 studies found that the rate of major adverse cardiac events with ECT was 1 in 39 patients or about 1 in 200 to 500 procedures.<a href="#cite_note-pmid30557212-80">[80]</a><a href="#cite_note-pmid35100527-81">[81]</a> The risk of death with ECT however is low.<a href="#cite_note-ReadKirschMcGrath2019-82">[82]</a><a href="#cite_note-pmid30557212-80">[80]</a> If death does occur, cardiovascular complications are considered as causal in about 30% of individuals.<a href="#cite_note-pmid30557212-80">[80]</a> <div class="mw-heading mw-heading2"><h2 id="Procedure">Procedure</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=15" title="Edit section: Procedure">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:ECT_machine_03.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/21/ECT_machine_03.JPG/220px-ECT_machine_03.JPG" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/21/ECT_machine_03.JPG/330px-ECT_machine_03.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/21/ECT_machine_03.JPG/440px-ECT_machine_03.JPG 2x" data-file-width="3456" data-file-height="2304" /></a><figcaption>Electroconvulsive therapy machine on display at <a href="/wiki/Glenside_Museum" title="Glenside Museum">Glenside Museum</a> in <a href="/wiki/Bristol" title="Bristol">Bristol</a>, England</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:NTM_Eg_Asyl_ECT_apparatus_IMG_0977.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/09/NTM_Eg_Asyl_ECT_apparatus_IMG_0977.JPG/220px-NTM_Eg_Asyl_ECT_apparatus_IMG_0977.JPG" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/09/NTM_Eg_Asyl_ECT_apparatus_IMG_0977.JPG/330px-NTM_Eg_Asyl_ECT_apparatus_IMG_0977.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/09/NTM_Eg_Asyl_ECT_apparatus_IMG_0977.JPG/440px-NTM_Eg_Asyl_ECT_apparatus_IMG_0977.JPG 2x" data-file-width="4608" data-file-height="3456" /></a><figcaption>ECT device produced by <a href="/wiki/Siemens" title="Siemens">Siemens</a> and used for example at the Asyl psychiatric hospital in <a href="/wiki/Kristiansand" title="Kristiansand">Kristiansand</a>, <a href="/wiki/Norway" title="Norway">Norway</a> from the 1960s to the 1980s</figcaption></figure> The placement of electrodes, as well as the dose and duration of the stimulation is determined on a per-patient basis.<a href="#cite_note-Rudorfer-1">[1]</a>: 1881  In unilateral ECT, both electrodes are placed on the same side of the patient's head. Unilateral ECT may be used first to minimize side effects such as memory loss. In bilateral ECT, the two electrodes are placed on opposite sides of the head. Usually bitemporal placement is used, whereby the electrodes are placed on the temples. Uncommonly bifrontal placement is used; this involves positioning the electrodes on the patient's forehead, roughly above each eye. Unilateral ECT is thought to cause fewer cognitive effects than bilateral treatment, but is less effective unless administered at higher doses.<a href="#cite_note-Rudorfer-1">[1]</a>: 1881  Most patients in the US<a href="#cite_note-Prudic_01-83">[83]</a> and almost all in the UK<a href="#cite_note-Dr.Jamal-84">[84]</a><a href="#cite_note-The_Royal_College-85">[85]</a><a href="#cite_note-Duffett-86">[86]</a> receive bilateral ECT. The electrodes deliver an electrical stimulus. The stimulus levels recommended for ECT are in excess of an individual's seizure threshold: about one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT.<a href="#cite_note-Rudorfer-1">[1]</a>: 1881  Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more severe cognitive impairment without additional therapeutic gains.<a href="#cite_note-Lock-87">[87]</a> Seizure threshold is determined by trial and error ("<a href="/wiki/Dose_titration" class="mw-redirect" title="Dose titration">dose titration</a>"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex.<a href="#cite_note-Prudic_01-83">[83]</a> Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold. Immediately prior to treatment, a patient is given a short-acting anesthetic such as <a href="/wiki/Methohexital" title="Methohexital">methohexital</a>, <a href="/wiki/Propofol" title="Propofol">propofol</a>, <a href="/wiki/Etomidate" title="Etomidate">etomidate</a>, or <a href="/wiki/Thiopental" class="mw-redirect" title="Thiopental">thiopental</a>,<a href="#cite_note-Rudorfer-1">[1]</a> a muscle relaxant such as <a href="/wiki/Suxamethonium" class="mw-redirect" title="Suxamethonium">suxamethonium</a> (succinylcholine), and occasionally <a href="/wiki/Atropine" title="Atropine">atropine</a> to inhibit salivation.<a href="#cite_note-Rudorfer-1">[1]</a>: 1882  Studies have shown that adding ketamine, an NMDA receptor antagonist, to the anesthesia regimen produced greater decreases in depression scores when compared to propofol, methohexital, and thiopental alone. <a href="#cite_note-88">[88]</a>In a minority of countries such as Japan,<a href="#cite_note-89">[89]</a> India,<a href="#cite_note-90">[90]</a> and Nigeria,<a href="#cite_note-91">[91]</a> ECT may be used without anesthesia. The Union Health Ministry of India recommended a ban on ECT without anesthesia in India's Mental Health Care Bill of 2010 and the Mental Health Care Bill of 2013.<a href="#cite_note-92">[92]</a><a href="#cite_note-93">[93]</a> The practice was abolished in Turkey's largest psychiatric hospital in 2008.<a href="#cite_note-94">[94]</a> The patient's <a href="/wiki/EEG" class="mw-redirect" title="EEG">EEG</a>, <a href="/wiki/ECG" class="mw-redirect" title="ECG">ECG</a>, and <a href="/wiki/Blood_oxygen_level" class="mw-redirect" title="Blood oxygen level">blood oxygen levels</a> are monitored during treatment.<a href="#cite_note-Rudorfer-1">[1]</a>: 1882  ECT is usually administered three times a week, on alternate days, over a course of two to four weeks.<a href="#cite_note-Rudorfer-1">[1]</a>: 1882–1883  <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Electroconvulsive_Therapy.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d3/Electroconvulsive_Therapy.png/220px-Electroconvulsive_Therapy.png" decoding="async" width="220" height="110" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d3/Electroconvulsive_Therapy.png/330px-Electroconvulsive_Therapy.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d3/Electroconvulsive_Therapy.png/440px-Electroconvulsive_Therapy.png 2x" data-file-width="1500" data-file-height="750" /></a><figcaption>An illustration depicting electroconvulsive therapy</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Neuroimaging_prior_to_ECT">Neuroimaging prior to ECT</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=16" title="Edit section: Neuroimaging prior to ECT">edit</a>]</div> Neuroimaging prior to ECT may be useful for detecting intracranial pressure or mass given that patients respond less when one of these conditions exist. Nonetheless, it is not indicated due to high cost and low prevalence of these conditions in patients needing ECT.<a href="#cite_note-LWW-95">[95]</a> <div class="mw-heading mw-heading3"><h3 id="Concurrent_pharmacotherapy">Concurrent pharmacotherapy</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=17" title="Edit section: Concurrent pharmacotherapy">edit</a>]</div> Whether psychiatric medications are terminated prior to treatment or maintained, varies.<a href="#cite_note-Rudorfer-1">[1]</a>: 1885 <a href="#cite_note-96">[96]</a> However, drugs that are known to cause toxicity in combination with ECT, such as <a href="/wiki/Lithium_(medication)" title="Lithium (medication)">lithium</a>, are discontinued, and <a href="/wiki/Benzodiazepines" class="mw-redirect" title="Benzodiazepines">benzodiazepines</a>, which increase the <a href="/wiki/Seizure_threshold" title="Seizure threshold">seizure threshold</a>,<a href="#cite_note-97">[97]</a> are either discontinued, a benzodiazepine antagonist is administered at each ECT session, or the ECT treatment is adjusted accordingly.<a href="#cite_note-Rudorfer-1">[1]</a>: 1875, 1879  A 2009 RCT provides some evidence indicating that concurrent use of some antidepressant improves ECT efficacy.<a href="#cite_note-Psychiatry_p.-38">[38]</a> <div class="mw-heading mw-heading3"><h3 id="Course">Course</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=18" title="Edit section: Course">edit</a>]</div> ECT is usually done from 6 to 12 times in 2 to 4 weeks but can sometimes exceed 12 rounds.<a href="#cite_note-Psychiatry_p.-38">[38]</a> It is also recommended to not do ECT more than 3 times per week.<a href="#cite_note-Psychiatry_p.-38">[38]</a> Evidence suggest that ECTs for depression may be stopped if there is no improvement during the first six sessions.<a href="#cite_note-h382-98">[98]</a> <div class="mw-heading mw-heading3"><h3 id="Treatment_team">Treatment team</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=19" title="Edit section: Treatment team">edit</a>]</div> In the US, the medical team performing the procedure typically consists of a psychiatrist, an anesthetist, an ECT treatment nurse or qualified assistant, and one or more recovery nurses.<a href="#cite_note-APA2001guideline-5">[5]</a>: 109  Medical trainees may assist, but only under the direct supervision of credentialed attending physicians and staff.<a href="#cite_note-APA2001guideline-5">[5]</a>: 110  <div class="mw-heading mw-heading3"><h3 id="Devices">Devices</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=20" title="Edit section: Devices">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Siemens_konvulsator_III_(ECT_machine).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Siemens_konvulsator_III_%28ECT_machine%29.jpg/220px-Siemens_konvulsator_III_%28ECT_machine%29.jpg" decoding="async" width="220" height="170" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Siemens_konvulsator_III_%28ECT_machine%29.jpg/330px-Siemens_konvulsator_III_%28ECT_machine%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Siemens_konvulsator_III_%28ECT_machine%29.jpg/440px-Siemens_konvulsator_III_%28ECT_machine%29.jpg 2x" data-file-width="3832" data-file-height="2963" /></a><figcaption>Vintage ECT machine from before 1960</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:ThymatronIV.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/94/ThymatronIV.jpg/220px-ThymatronIV.jpg" decoding="async" width="220" height="155" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/94/ThymatronIV.jpg/330px-ThymatronIV.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/94/ThymatronIV.jpg/440px-ThymatronIV.jpg 2x" data-file-width="1690" data-file-height="1190" /></a><figcaption>Modern ECT machine</figcaption></figure> Most modern ECT devices deliver a brief-pulse current, which is thought to cause fewer cognitive effects than the sine-wave currents which were originally used in ECT.<a href="#cite_note-Rudorfer-1">[1]</a> A small minority of psychiatrists in the US still use sine-wave stimuli.<a href="#cite_note-Prudic_01-83">[83]</a> Sine-wave is no longer used in the UK or Ireland.<a href="#cite_note-Duffett-86">[86]</a> Typically, the electrical stimulus used in ECT is about 800 <a href="/wiki/Amperes" class="mw-redirect" title="Amperes">milliamps</a> and has up to several hundred <a href="/wiki/Watt" title="Watt">watts</a>, and the current flows for between one and six seconds.<a href="#cite_note-Lock-87">[87]</a> In the US, ECT devices are manufactured by two companies, Somatics, which is owned by psychiatrists Richard Abrams and Conrad Swartz, and Mecta.<a href="#cite_note-99">[99]</a> In the UK, the market for ECT devices was long monopolized by Ectron Ltd, which was set up by psychiatrist Robert Russell.<a href="#cite_note-100">[100]</a> <div class="mw-heading mw-heading2"><h2 id="Mechanism_of_action">Mechanism of action</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=21" title="Edit section: Mechanism of action">edit</a>]</div> Despite decades of research, the exact mechanism of action of ECT remains elusive. A review from 2022 of <a href="/wiki/Neuroimaging" title="Neuroimaging">neuroimaging</a> studies based on a global data collaboration resulted in a model of temporary disruption of neural circuits followed by augmented neuroplasticity and rewiring.<a href="#cite_note-Ousdal_2022-32">[32]</a> Other brain changes observed after ECT include increased <a href="/wiki/Gray_matter" class="mw-redirect" title="Gray matter">gray matter</a> volume in the frontolimbic areas including the <a href="/wiki/Hippocampus" title="Hippocampus">hippocampus</a> and <a href="/wiki/Amygdala" title="Amygdala">amygdala</a>, increased <a href="/wiki/White_matter" title="White matter">white matter</a> tracts in the <a href="/wiki/Frontal_lobe" title="Frontal lobe">frontal</a> and <a href="/wiki/Temporal_lobe" title="Temporal lobe">temporal</a> lobes, increased <a href="/wiki/Monoamine" class="mw-redirect" title="Monoamine">monoamine</a> neurotransmitters and increased neurogenesis in the <a href="/wiki/Dentate_gyrus" title="Dentate gyrus">dentate gyrus</a>.<a href="#cite_note-Espinoza_2022-35">[35]</a> Changes in sleep architecture due to the induced seizures have also been hypothesized as a mechanism of action.<a href="#cite_note-101">[101]</a> <div class="mw-heading mw-heading2"><h2 id="Use">Use</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=22" title="Edit section: Use">edit</a>]</div> As of 2001, it was estimated that about one million people received ECT annually.<a href="#cite_note-LeiknesWWrev2012-26">[26]</a> There is wide variation in ECT use between different countries, different hospitals, and different psychiatrists.<a href="#cite_note-Rudorfer-1">[1]</a><a href="#cite_note-LeiknesWWrev2012-26">[26]</a> International practice varies considerably from widespread use of the therapy in many Western countries to a small minority of countries that do not use ECT at all, such as Slovenia.<a href="#cite_note-102">[102]</a> About 70 percent of ECT patients are women.<a href="#cite_note-Rudorfer-1">[1]</a> This may be because women are more likely to be diagnosed with depression.<a href="#cite_note-Rudorfer-1">[1]</a><a href="#cite_note-Reid-103">[103]</a> Older and more affluent patients are also more likely to receive ECT. The use of ECT is not as common in ethnic minorities.<a href="#cite_note-Reid-103">[103]</a><a href="#cite_note-104">[104]</a> In Sweden, which has a complete register of all ECT treatments in the country, in 2013 the rate of persons treated in that year per 100,000 inhabitants was 41. Almost the same rate had already been present in 1975 with 42 patients per 100,000 inhabitants.<a href="#cite_note-pmid25973769-105">[105]</a><a href="#cite_note-pmid27093104-106">[106]</a> <div class="mw-heading mw-heading3"><h3 id="United_States">United States</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=23" title="Edit section: United States">edit</a>]</div> ECT became popular in the US in the 1940s. At the time, psychiatric hospitals were overrun with patients whom doctors were desperate to treat and cure. Whereas <a href="/wiki/Lobotomies" class="mw-redirect" title="Lobotomies">lobotomies</a> would reduce a patient to a more manageable submissive state, ECT helped to improve mood in those with severe depression. A survey of psychiatric practice in the late 1980s found that an estimated 100,000 people received ECT annually, with wide variation between metropolitan statistical areas.<a href="#cite_note-Hermann_95-107">[107]</a> Accurate statistics about the frequency, context and circumstances of ECT in the US are difficult to obtain because only a few states have reporting laws that require the treating facility to supply state authorities with this information.<a href="#cite_note-108">[108]</a> In 13 of the 50 states, the practice of ECT is regulated by law.<a href="#cite_note-109">[109]</a> In the mid-1990s in Texas, ECT was used in about one third of psychiatric facilities and given to about 1,650 people annually.<a href="#cite_note-Reid-103">[103]</a> Usage of ECT has since declined slightly; in 2000–01 ECT was given to about 1,500 people aged from 16 to 97 (in Texas it is illegal to give ECT to anyone under sixteen).<a href="#cite_note-110">[110]</a> ECT is more commonly used in private psychiatric hospitals than in public hospitals, and minority patients are underrepresented in the ECT statistics.<a href="#cite_note-Rudorfer-1">[1]</a> In the United States, ECT is usually given three times a week; in the United Kingdom, it is usually given twice a week.<a href="#cite_note-Rudorfer-1">[1]</a> Occasionally it is given on a daily basis.<a href="#cite_note-Rudorfer-1">[1]</a> A course usually consists of 6–12 treatments, but may be more or fewer. Following a course of ECT some patients may be given continuation or maintenance ECT with further treatments at weekly, fortnightly or monthly intervals.<a href="#cite_note-Rudorfer-1">[1]</a> A few psychiatrists in the US use multiple-monitored ECT (MMECT), where patients receive more than one treatment per anesthetic.<a href="#cite_note-Rudorfer-1">[1]</a> Electroconvulsive therapy is not a required subject in US medical schools and not a required skill in psychiatric residency training. Privileging for ECT practice at institutions is a local option: no national certification standards are established, and no ECT-specific continuing training experiences are required of ECT practitioners.<a href="#cite_note-Fink2007-111">[111]</a> <div class="mw-heading mw-heading3"><h3 id="United_Kingdom">United Kingdom</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=24" title="Edit section: United Kingdom">edit</a>]</div> In the UK in 1980, an estimated 50,000 people received ECT annually, with use declining steadily since then<a href="#cite_note-112">[112]</a> to about 12,000 per annum in 2002.<a href="#cite_note-UKstats2002-113">[113]</a> It is still used in nearly all psychiatric hospitals, with a survey of ECT use from 2002 finding that 71 percent of patients were women and 46 percent were over 65 years of age. Eighty-one percent had a diagnosis of <a href="/wiki/Mood_disorder" title="Mood disorder">mood disorder</a>; schizophrenia was the next most common diagnosis. Sixteen percent were treated without their consent.<a href="#cite_note-UKstats2002-113">[113]</a> In 2003, the <a href="/wiki/National_Institute_for_Health_and_Care_Excellence" title="National Institute for Health and Care Excellence">National Institute for Health and Care Excellence</a>, a government body which was set up to standardize treatment throughout the <a href="/wiki/National_Health_Service" title="National Health Service">National Health Service</a> in England and Wales, issued guidance on the use of ECT. Its use was recommended "only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode".<a href="#cite_note-nice_intro-114">[114]</a> The guidance received a mixed reception. It was welcomed by an editorial in the <a href="/wiki/The_BMJ" title="The BMJ">British Medical Journal</a><a href="#cite_note-115">[115]</a> but the <a href="/wiki/Royal_College_of_Psychiatrists" title="Royal College of Psychiatrists">Royal College of Psychiatrists</a> launched an unsuccessful appeal.<a href="#cite_note-116">[116]</a> The NICE guidance, as the British Medical Journal editorial points out, is only a policy statement and psychiatrists may deviate from it if they see fit. Adherence to standards has not been universal in the past. A survey of ECT use in 1980 found that more than half of ECT clinics failed to meet minimum standards set by the Royal College of Psychiatrists, with a later survey in 1998 finding that minimum standards were largely adhered to, but that two-thirds of clinics still fell short of current guidelines, particularly in the training and supervision of junior doctors involved in the procedure.<a href="#cite_note-117">[117]</a> A voluntary accreditation scheme, ECTAS, was set up in 2004 by the Royal College, and as of 2017<a class="external text" href="https://en.wikipedia.org/w/index.php?title=Electroconvulsive_therapy&action=edit">[update]</a> the vast majority of ECT clinics in England, Wales, Northern Ireland and the Republic of Ireland have signed up.<a href="#cite_note-118">[118]</a> The <a href="/wiki/Mental_Health_Act_2007" title="Mental Health Act 2007">Mental Health Act 2007</a> allows people to be treated against their will. This law has extra protections regarding ECT. A patient capable of making the decision can decline the treatment, and in that case treatment cannot be given unless it will save that patient's life or is immediately necessary to prevent deterioration of the patient's condition. A patient may not be capable of making the decision (they "lack capacity"), and in that situation ECT can be given if it is appropriate and also if there are no advance directives that prevent the use of ECT.<a href="#cite_note-119">[119]</a> <div class="mw-heading mw-heading3"><h3 id="China">China</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=25" title="Edit section: China">edit</a>]</div> ECT was introduced in China in the early 1950s and while it was originally practiced without anesthesia, as of 2012 almost all procedures were conducted with it. As of 2012, there are approximately 400 ECT machines in China, and 150,000 ECT treatments are performed each year.<a href="#cite_note-Tang-120">[120]</a> Chinese national practice guidelines recommend ECT for the treatment of schizophrenia, depressive disorders, and bipolar disorder and in the Chinese literature, ECT is an effective treatment for schizophrenia and mood disorders.<a href="#cite_note-Tang-120">[120]</a> Although the Chinese government stopped classifying homosexuality as an illness in 2001, electroconvulsive therapy is still used by some establishments as a form of "<a href="/wiki/Conversion_therapy" title="Conversion therapy">conversion therapy</a>".<a href="#cite_note-121">[121]</a><a href="#cite_note-122">[122]</a> Alleged <a href="/wiki/Internet_addiction_disorder" title="Internet addiction disorder">Internet addiction</a> (or general unruliness) in <a href="/wiki/Adolescence" title="Adolescence">adolescents</a> is also known to have been treated with ECT, sometimes without anestheia, most notably by <a href="/wiki/Yang_Yongxin" title="Yang Yongxin">Yang Yongxin</a>. The practice was banned in 2009 after news on Yang broke out.<a href="#cite_note-sciencemag-123">[123]</a> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=26" title="Edit section: Society and culture">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Controversy">Controversy</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=27" title="Edit section: Controversy">edit</a>]</div> Surveys of public opinion, the testimony of former patients, legal restrictions on the use of ECT and disputes as to the efficacy, ethics and adverse effects of ECT within the psychiatric and wider medical community indicate that the use of ECT remains controversial.<a href="#cite_note-124">[124]</a><a href="#cite_note-125">[125]</a><a href="#cite_note-126">[126]</a><a href="#cite_note-127">[127]</a><a href="#cite_note-128">[128]</a><a href="#cite_note-129">[129]</a><a href="#cite_note-Teh-130">[130]</a> This is reflected in the January 2011 vote by the FDA's Neurological Devices Advisory Panel to recommend that FDA maintain ECT devices in the Class III device category for high risk devices, except for patients with catatonia, major depressive disorder, and bipolar disorder.<a href="#cite_note-:1-131">[131]</a> This may result in the manufacturers of such devices having to do controlled trials on their safety and efficacy for the first time.<a href="#cite_note-FDA2011rev-4">[4]</a><a href="#cite_note-PsychTimes-132">[132]</a><a href="#cite_note-NYTimesReg-133">[133]</a> In justifying their position, panelists referred to the memory loss associated with ECT and the lack of long-term data.<a href="#cite_note-134">[134]</a> <div class="mw-heading mw-heading3"><h3 id="Legal_status">Legal status</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=28" title="Edit section: Legal status">edit</a>]</div> <div class="mw-heading mw-heading4"><h4 id="Informed_consent">Informed consent</h4>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=29" title="Edit section: Informed consent">edit</a>]</div> The <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> (2005) advises that ECT should be used only with the informed consent of the patient (or their guardian if their incapacity to consent has been established).<a href="#cite_note-who.int-34">[34]</a> In the US, this doctrine places a legal obligation on a doctor to make a patient aware of the reason for treatment, the risks and benefits of a proposed treatment, the risks and benefits of alternative treatment, and the risks and benefits of receiving no treatment. The patient is then given the opportunity to accept or reject the treatment. The form states how many treatments are recommended and also makes the patient aware that consent may be revoked and treatment discontinued at any time during a course of ECT.<a href="#cite_note-SG-3">[3]</a> The US Surgeon General's Report on Mental Health states that patients should be warned that the benefits of ECT are short-lived without active continuation treatment in the form of drugs or further ECT, and that there may be some risk of permanent, severe memory loss after ECT.<a href="#cite_note-SG-3">[3]</a> The report advises psychiatrists to involve patients in discussion, possibly with the aid of leaflets or videos, both before and during a course of ECT. According to the US Surgeon General, involuntary treatment is uncommon in the US and is typically used only in cases of great extremity, and only when all other treatment options have been exhausted. The use of ECT is believed to be a potentially life-saving treatment.<a href="#cite_note-surgeon-73">[73]</a> In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent.<a href="#cite_note-SEAN-135">[135]</a> In the UK, in order for consent to be valid it requires an explanation in "broad terms" of the nature of the procedure and its likely effects.<a href="#cite_note-136">[136]</a> One review from 2005 found that only about half of patients felt they were given sufficient information about ECT and its adverse effects<a href="#cite_note-Information,_consent_and_perceived_coercion-137">[137]</a> and another survey found that about fifty percent of psychiatrists and nurses agreed with them.<a href="#cite_note-Lutchman-138">[138]</a> A 2005 study published in the <a href="/wiki/British_Journal_of_Psychiatry" title="British Journal of Psychiatry">British Journal of Psychiatry</a> described patients' perspectives on the adequacy of informed consent before ECT.<a href="#cite_note-Information,_consent_and_perceived_coercion-137">[137]</a> The study found that "About half (45–55%) of patients reported they were given an adequate explanation of ECT, implying a similar percentage felt they were not." The authors also stated: <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote">Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form. The proportion who feel they did not freely choose the treatment has actually increased over time. The same themes arise whether the patient had received treatment a year ago or 30 years ago. Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.<a href="#cite_note-Information,_consent_and_perceived_coercion-137">[137]</a></blockquote> <div class="mw-heading mw-heading4"><h4 id="Involuntary_ECT">Involuntary ECT</h4>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=30" title="Edit section: Involuntary ECT">edit</a>]</div> Procedures for involuntary ECT vary from country to country depending on local <a href="/wiki/Mental_health_law" title="Mental health law">mental health laws</a>. <div class="mw-heading mw-heading5"><h5 id="United_States_2">United States</h5>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=31" title="Edit section: United States">edit</a>]</div> In most states in the US, a judicial order following a formal hearing is needed before a patient can be forced to undergo involuntary ECT.<a href="#cite_note-SG-3">[3]</a> However, ECT can also be involuntarily administered in situations with less immediate danger. Suicidal intent is a common justification for its involuntary use, especially when other treatments are ineffective.<a href="#cite_note-SG-3">[3]</a> In 2007, a psychiatric patient in the <a href="/wiki/Creedmoor_Psychiatric_Center" title="Creedmoor Psychiatric Center">Creedmoor Psychiatric Center</a> in New York, given the pseudonym of <a href="/wiki/Simone_D." title="Simone D.">Simone D.</a>, won a court ruling which set aside a two-year-old court order to give her electroshock treatment against her will.<a href="#cite_note-139">[139]</a> <div class="mw-heading mw-heading5"><h5 id="United_Kingdom_2">United Kingdom</h5>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=32" title="Edit section: United Kingdom">edit</a>]</div> Until 2007 in England and Wales, the <a href="/wiki/Mental_Health_Act_1983" title="Mental Health Act 1983">Mental Health Act 1983</a> allowed the use of ECT on detained patients whether or not they had <a href="/wiki/Capacity_(law)" title="Capacity (law)">capacity</a> to consent to it. However, following <a href="/wiki/Mental_Health_Act_2007" title="Mental Health Act 2007">amendments</a> which took effect in 2007, ECT may not generally be given to a patient who has capacity and refuses it, irrespective of his or her detention under the Act.<a href="#cite_note-140">[140]</a> In fact, even if a patient is deemed to lack capacity, if they made a valid <a href="/wiki/Advance_health_care_directive" class="mw-redirect" title="Advance health care directive">advance decision</a> refusing ECT then they should not be given it; and even if they do not have an advance decision, the psychiatrist must obtain an independent second opinion (which is also the case if the patient is under age of consent).<a href="#cite_note-141">[141]</a> However, there is an exception regardless of consent and capacity; under Section 62 of the Act, if the treating psychiatrist says the need for treatment is urgent they may start a course of ECT without authorization.<a href="#cite_note-142">[142]</a> From 2003 to 2005, about 2,000 people a year in England and Wales were treated without their consent under the Mental Health Act.<a href="#cite_note-143">[143]</a> Concerns have been raised by the official regulator that psychiatrists are too readily assuming that patients have the capacity to consent to their treatments, and that there is a worrying lack of independent <a href="/wiki/Advocacy" title="Advocacy">advocacy</a>.<a href="#cite_note-144">[144]</a> In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 also gives patients with capacity the right to refuse ECT.<a href="#cite_note-145">[145]</a> <div class="mw-heading mw-heading4"><h4 id="Regulation">Regulation</h4>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=33" title="Edit section: Regulation">edit</a>]</div> In the US, ECT devices came into existence prior to medical devices being regulated by the <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a>. In 1976, the <a href="/wiki/Medical_Device_Regulation_Act" title="Medical Device Regulation Act">Medical Device Regulation Act</a> required the FDA to retrospectively review already existing devices, classify them, and determine whether clinical trials were needed to prove efficacy and safety. The FDA initially classified the devices used to administer ECT as <a href="/wiki/Medical_devices#Class_III:_General_controls,_Special_Controls_and_premarket_approval" class="mw-redirect" title="Medical devices">Class III medical devices</a>. In 2014, the <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> petitioned the FDA to reclassify ECT devices from Class III (high-risk) to Class II (medium-risk). A similar reclassification proposal in 2010 did not pass.<a href="#cite_note-146">[146]</a> In 2018, the FDA re-classified ECT devices as Class II devices when used to treat catatonia or a severe major depressive episode associated with major depressive disorder or bipolar disorder.<a href="#cite_note-:1-131">[131]</a> <div class="mw-heading mw-heading4"><h4 id="By_country">By country</h4>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=34" title="Edit section: By country">edit</a>]</div> <div class="mw-heading mw-heading5"><h5 id="Australia">Australia</h5>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=35" title="Edit section: Australia">edit</a>]</div> In <a href="/wiki/Western_Australia" title="Western Australia">Western Australia</a>, ECT has been heavily restricted since 2014, after a bill passed with bipartisan support introducing restrictions on ECT, which were welcomed by mental health experts. Children under 14 are prohibited from receiving ECT, while those aged 14 to 18 must have informed consent approval from the Mental Health Tribunal. The law imposes a $15,000 fine on anyone who performs ECT on a child under the age of 14.<a href="#cite_note-147">[147]</a> Similarly, ECT is also banned on children under the age of 12 in the <a href="/wiki/Australian_Capital_Territory" title="Australian Capital Territory">Australian Capital Territory</a> (ACT).<a href="#cite_note-148">[148]</a> <div class="mw-heading mw-heading5"><h5 id="United_States_3">United States</h5>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=36" title="Edit section: United States">edit</a>]</div> Many mental health facilities offer ECT for specific diagnoses, such as <a href="/wiki/Chronic_depression" class="mw-redirect" title="Chronic depression">chronic depression</a>, <a href="/wiki/Mania" title="Mania">mania</a>, <a href="/wiki/Catatonia" title="Catatonia">catatonia</a> and <a href="/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a>. However, ECT is often only used as a treatment of last resort.<a href="#cite_note-149">[149]</a> To be considered for ECT, often testing such as an EKG and lab tests are required, in addition to a physical and neurological exam. Certain medications and conditions, such as cardiac conditions or hypertension, may disqualify a patient from ECT. Patients should give proper informed consent before ECT is performed. In the United States, ECT is performed under general anesthesia. Both trained health professionals with experience in ECT administration as well as a specifically trained and certified anesthesiologist should administer the procedure and anesthesia respectively.<a href="#cite_note-150">[150]</a> <div class="mw-heading mw-heading3"><h3 id="Public_perception">Public perception</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=37" title="Edit section: Public perception">edit</a>]</div> A questionnaire survey of 379 members of the general public in <a href="/wiki/Australia" title="Australia">Australia</a> indicated that more than 60% of respondents had some knowledge about the main aspects of ECT. Participants were generally opposed to the use of ECT on depressed individuals with psychosocial issues, on children, and on involuntary patients. Public perceptions of ECT were found to be mainly negative.<a href="#cite_note-Teh-130">[130]</a> A sample of the general public, <a href="/wiki/MBBS" class="mw-redirect" title="MBBS">medical students</a>, and <a href="/wiki/MRCPsych" class="mw-redirect" title="MRCPsych">psychiatry</a> trainees in the <a href="/wiki/United_Kingdom" title="United Kingdom">United Kingdom</a> found that the psychiatry trainees were more knowledgeable and had more favorable opinions of ECT than did the other groups.<a href="#cite_note-McFarquhar_et_al_2008-151">[151]</a> More members of the general public believed that ECT was used for control or punishment purposes than medical students or psychiatry trainees.<a href="#cite_note-McFarquhar_et_al_2008-151">[151]</a> <div class="mw-heading mw-heading3"><h3 id="Famous_cases">Famous cases</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=38" title="Edit section: Famous cases">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/List_of_people_who_have_undergone_electroconvulsive_therapy" title="List of people who have undergone electroconvulsive therapy">List of people who have undergone electroconvulsive therapy</a></div> <ul><li><a href="/wiki/Ernest_Hemingway" title="Ernest Hemingway">Ernest Hemingway</a>, an American author, died by suicide in 1961 half a year after ECT treatment at the <a href="/wiki/Mayo_Clinic" title="Mayo Clinic">Mayo Clinic</a> in 1960.<a href="#cite_note-152">[152]</a> He is reported to have said to his biographer, "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient."<a href="#cite_note-153">[153]</a> However, the same biographer (<a href="/wiki/A._E._Hotchner" title="A. E. Hotchner">Hotchner</a>, 1966) and also a second biographer (<a href="/wiki/Kenneth_S._Lynn" title="Kenneth S. Lynn">Lynn</a>, 1987) emphasized - according to a review from 2008 - "that Hemingway’s serious mental illness and plans for suicide significantly predated his ECT treatments."<a href="#cite_note-pmid18196545-154">[154]</a></li> <li><a href="/wiki/Robert_Pirsig" class="mw-redirect" title="Robert Pirsig">Robert Pirsig</a> had a nervous breakdown and spent time in and out of psychiatric hospitals between 1961 and 1963.<a href="#cite_note-155">[155]</a> He was diagnosed with paranoid schizophrenia and clinical depression as a result of an evaluation conducted by psychoanalysts, and was treated with electroconvulsive therapy on numerous occasions,<a href="#cite_note-156">[156]</a> a treatment he discusses in his novel, <a href="/wiki/Zen_and_the_Art_of_Motorcycle_Maintenance" title="Zen and the Art of Motorcycle Maintenance">Zen and the Art of Motorcycle Maintenance</a>.<a href="#cite_note-157">[157]</a></li> <li><a href="/wiki/Thomas_Eagleton" title="Thomas Eagleton">Thomas Eagleton</a>, <a href="/wiki/United_States_Senator" class="mw-redirect" title="United States Senator">United States Senator</a> from <a href="/wiki/Missouri" title="Missouri">Missouri</a>, was dropped from the <a href="/wiki/Democratic_Party_(United_States)" title="Democratic Party (United States)">Democratic ticket</a> in the <a href="/wiki/1972_United_States_Presidential_Election" class="mw-redirect" title="1972 United States Presidential Election">1972 United States Presidential Election</a> as the party's vice presidential candidate after it was revealed that he had received electroshock treatment in the past for depression.<a href="#cite_note-158">[158]</a> Presidential nominee <a href="/wiki/George_McGovern" title="George McGovern">George McGovern</a> replaced him with <a href="/wiki/Sargent_Shriver" title="Sargent Shriver">Sargent Shriver</a>, and later went on to lose by a landslide to <a href="/wiki/Richard_Nixon" title="Richard Nixon">Richard Nixon</a>.</li> <li>American surgeon and award-winning author <a href="/wiki/Sherwin_B._Nuland" title="Sherwin B. Nuland">Sherwin B. Nuland</a> is another notable person who has undergone ECT.<a href="#cite_note-159">[159]</a> In his 40s, his depression became so severe that he had to be institutionalized. After exhausting all treatment options, a young resident assigned to his case suggested ECT, which was successful.<a href="#cite_note-160">[160]</a></li> <li>Author <a href="/wiki/David_Foster_Wallace" title="David Foster Wallace">David Foster Wallace</a> also received ECT for many years, beginning as a teenager, before his suicide at age 46.<a href="#cite_note-RS-161">[161]</a></li> <li>New Zealand author <a href="/wiki/Janet_Frame" title="Janet Frame">Janet Frame</a> experienced both insulin coma therapy and ECT (but without the use of anesthesia or muscle relaxants).<a href="#cite_note-Lim_et_al_2019-162">[162]</a> She wrote about this in her autobiography, <a href="/wiki/An_Angel_at_My_Table" title="An Angel at My Table">An Angel at My Table</a> (1984),<a href="#cite_note-Lim_et_al_2019-162">[162]</a> which was later adapted into a film (1990).<a href="#cite_note-NYT_1991_C15-163">[163]</a></li> <li>American actor <a href="/wiki/Carrie_Fisher" title="Carrie Fisher">Carrie Fisher</a> wrote about her experience with memory loss after ECT treatments in her memoir <a href="/wiki/Wishful_Drinking" title="Wishful Drinking">Wishful Drinking</a>.<a href="#cite_note-164">[164]</a></li> <li><a href="/wiki/Lou_Reed" title="Lou Reed">Lou Reed</a> had ECT as a teenager to "cure" his homosexuality.<a href="#cite_note-:3-165">[165]</a> He later claimed it had induced multiple personality disorder, and resulted in his hatred of psychiatrists.<a href="#cite_note-166">[166]</a> After Reed's death, his sister denied the ECT treatments were intended to suppress his "homosexual urges", asserting that their parents were not <a href="/wiki/Homophobia" title="Homophobia">homophobic</a> but had been told by his doctors that ECT was necessary to treat Reed's mental and behavioral issues.<a href="#cite_note-:3-165">[165]</a></li> <li>On October 31, 2024, a Chinese transgender woman was approved by Changli county people’s court in <a href="/wiki/Qinhuangdao" title="Qinhuangdao">Qinhuangdao</a> to receive 60,000 yuan (£6,552) in compensation from a hospital that gave her electroshock conversion treatment against her will. This was the first time any transgender person in China won a legal challenge against the use of electroshock conversion treatment.<a href="#cite_note-167">[167]</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="Fictional_examples">Fictional examples</h3>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=39" title="Edit section: Fictional examples">edit</a>]</div> Electroconvulsive therapy has been depicted in fiction, including fictional works partly based on true experiences. These include <a href="/wiki/Sylvia_Plath" title="Sylvia Plath">Sylvia Plath</a>'s semi-autobiographical novel, <a href="/wiki/The_Bell_Jar" title="The Bell Jar">The Bell Jar</a>, <a href="/wiki/Ken_Loach" title="Ken Loach">Ken Loach</a>'s film <a href="/wiki/Family_Life_(1971_British_film)" title="Family Life (1971 British film)">Family Life</a>, and <a href="/wiki/Ken_Kesey" title="Ken Kesey">Ken Kesey</a>'s novel <a href="/wiki/One_Flew_Over_the_Cuckoo%27s_Nest_(novel)" title="One Flew Over the Cuckoo's Nest (novel)">One Flew Over the Cuckoo's Nest</a>; Kesey's novel is a direct product of his time working the <a href="/wiki/Shift_plan#Graveyard_shift" title="Shift plan">graveyard shift</a> as an orderly at a mental health facility in Menlo Park, California.<a href="#cite_note-168">[168]</a><a href="#cite_note-169">[169]</a> Two analyses of large numbers of films using ECT scenes found that almost all presented fictional settings that were unrelated to real treatment routines and were apparently aimed at stigmatizing ECT as a tool of repression and of mind and behavior control - having effects of memory-erosion, pain and damage.<a href="#cite_note-pmid27522170-170">[170]</a><a href="#cite_note-pmid27008331-171">[171]</a> The song “The Mind Electric” by <a href="/wiki/Miracle_Musical" class="mw-redirect" title="Miracle Musical">Miracle Musical</a> is typically interpreted as depicting someone undergoing ECT.<a href="#cite_note-172">[172]</a> In the television series "<a href="/wiki/Mr_Bates_vs_The_Post_Office" title="Mr Bates vs The Post Office">Mr Bates vs The Post Office</a>", which is based on true events, the character of Saman Kaur receives ECT following a deep <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a> and attempted <a href="/wiki/Suicide" title="Suicide">suicide</a>.<a href="#cite_note-173">[173]</a> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=40" title="Edit section: See also">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239009302">.mw-parser-output .portalbox{padding:0;margin:0.5em 0;display:table;box-sizing:border-box;max-width:175px;list-style:none}.mw-parser-output .portalborder{border:1px solid var(--border-color-base,#a2a9b1);padding:0.1em;background:var(--background-color-neutral-subtle,#f8f9fa)}.mw-parser-output .portalbox-entry{display:table-row;font-size:85%;line-height:110%;height:1.9em;font-style:italic;font-weight:bold}.mw-parser-output .portalbox-image{display:table-cell;padding:0.2em;vertical-align:middle;text-align:center}.mw-parser-output .portalbox-link{display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle}@media(min-width:720px){.mw-parser-output .portalleft{clear:left;float:left;margin:0.5em 1em 0.5em 0}.mw-parser-output .portalright{clear:right;float:right;margin:0.5em 0 0.5em 1em}}</style><ul 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stimulation">Transcranial magnetic stimulation</a></li> <li><a href="/wiki/Magnetic_seizure_therapy" title="Magnetic seizure therapy">Magnetic seizure therapy</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Electroconvulsive_therapy&action=edit&section=41" title="Edit section: References">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-Rudorfer-1">^ <a href="#cite_ref-Rudorfer_1-0">a</a> <a href="#cite_ref-Rudorfer_1-1">b</a> <a href="#cite_ref-Rudorfer_1-2">c</a> <a href="#cite_ref-Rudorfer_1-3">d</a> <a href="#cite_ref-Rudorfer_1-4">e</a> <a href="#cite_ref-Rudorfer_1-5">f</a> <a href="#cite_ref-Rudorfer_1-6">g</a> <a href="#cite_ref-Rudorfer_1-7">h</a> <a href="#cite_ref-Rudorfer_1-8">i</a> <a href="#cite_ref-Rudorfer_1-9">j</a> <a href="#cite_ref-Rudorfer_1-10">k</a> <a href="#cite_ref-Rudorfer_1-11">l</a> <a href="#cite_ref-Rudorfer_1-12">m</a> <a href="#cite_ref-Rudorfer_1-13">n</a> <a href="#cite_ref-Rudorfer_1-14">o</a> <a href="#cite_ref-Rudorfer_1-15">p</a> <a href="#cite_ref-Rudorfer_1-16">q</a> <a href="#cite_ref-Rudorfer_1-17">r</a> <a href="#cite_ref-Rudorfer_1-18">s</a> <a href="#cite_ref-Rudorfer_1-19">t</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFRudorferHenrySackeim2003" class="citation book cs1">Rudorfer MV, Henry ME, Sackeim HA (2003). <a rel="nofollow" class="external text" href="http://media.wiley.com/assets/138/93/UK_Tasman_Chap92.pdf">"Electroconvulsive therapy"</a> (PDF). In Tasman A, Kay J, Lieberman JA (eds.). Psychiatry (Second ed.). Chichester: John Wiley & Sons Ltd. pp. 1865–1901. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20070810172506/http://media.wiley.com/assets/138/93/UK_Tasman_Chap92.pdf">Archived</a> (PDF) from the original on 2007-08-10.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Electroconvulsive+therapy&rft.btitle=Psychiatry&rft.place=Chichester&rft.pages=1865-1901&rft.edition=Second&rft.pub=John+Wiley+%26+Sons+Ltd&rft.date=2003&rft.aulast=Rudorfer&rft.aufirst=MV&rft.au=Henry%2C+ME&rft.au=Sackeim%2C+HA&rft_id=http%3A%2F%2Fmedia.wiley.com%2Fassets%2F138%2F93%2FUK_Tasman_Chap92.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"> </li> <li id="cite_note-2"><a href="#cite_ref-2">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSolano2009" class="citation web cs1">Solano J (2009-04-20). <a rel="nofollow" class="external text" href="https://personalpages.manchester.ac.uk/staff/fumie.costen/tmp/ect.pdf">"Electroconvulsive Therapy"</a> (PDF). p. 4. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20220218125601/https://personalpages.manchester.ac.uk/staff/fumie.costen/tmp/ect.pdf">Archived</a> (PDF) from the original on 2022-02-18. Retrieved 2022-05-17.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Electroconvulsive+Therapy&rft.pages=4&rft.date=2009-04-20&rft.aulast=Solano&rft.aufirst=J&rft_id=https%3A%2F%2Fpersonalpages.manchester.ac.uk%2Fstaff%2Ffumie.costen%2Ftmp%2Fect.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"> </li> <li id="cite_note-SG-3">^ <a href="#cite_ref-SG_3-0">a</a> <a href="#cite_ref-SG_3-1">b</a> <a href="#cite_ref-SG_3-2">c</a> <a href="#cite_ref-SG_3-3">d</a> <a href="#cite_ref-SG_3-4">e</a> <a href="#cite_ref-SG_3-5">f</a> Surgeon General (1999). <a rel="nofollow" class="external text" href="https://www.surgeongeneral.gov/library/mentalhealth/home.html">Mental Health: A Report of the Surgeon General</a>, chapter 4. </li> <li id="cite_note-FDA2011rev-4">^ <a href="#cite_ref-FDA2011rev_4-0">a</a> <a href="#cite_ref-FDA2011rev_4-1">b</a> <a href="#cite_ref-FDA2011rev_4-2">c</a> <a href="#cite_ref-FDA2011rev_4-3">d</a> <a href="#cite_ref-FDA2011rev_4-4">e</a> <a href="#cite_ref-FDA2011rev_4-5">f</a> <a href="#cite_ref-FDA2011rev_4-6">g</a> <a href="#cite_ref-FDA2011rev_4-7">h</a> FDA. <a rel="nofollow" class="external text" href="http://psychrights.org/research/digest/Electroshock/FinalECT515iFDAReport.pdf">FDA Executive Summary</a>. Prepared for the January 27–28, 2011 meeting of the Neurological Devices Panel Meeting to Discuss the Classification of Electroconvulsive Therapy Devices (ECT). Quote, p. 38: "Three major practice guidelines have been published on ECT. These guidelines include: APA Task Force on ECT (2001); Third report of the Royal College of Psychiatrists' Special Committee on ECT (2004); National Institute for Health and Clinical Excellence (NICE 2003; NICE 2009). 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Retrieved 2008-01-01.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Federal+Report+Praising+Electroshock+Stirs+Uproar&rft.date=1999-10-06&rft.aulast=Goode&rft.aufirst=E&rft_id=https%3A%2F%2Fquery.nytimes.com%2Fgst%2Ffullpage.html%3Fsec%3Dhealth%26res%3D9805E1DD1431F935A35753C1A96F958260&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"> </li> <li id="cite_note-Goleman_1990-25"><a href="#cite_ref-Goleman_1990_25-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGoleman1990" class="citation news cs1">Goleman D (1990-08-02). <a rel="nofollow" class="external text" href="https://query.nytimes.com/gst/fullpage.html?res=9C0CE0D81F3EF931A3575BC0A966958260">"The Quiet Comeback of Electroshock Therapy"</a>. The New York Times. p. B5. Retrieved 2008-01-01.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=The+Quiet+Comeback+of+Electroshock+Therapy&rft.pages=B5&rft.date=1990-08-02&rft.aulast=Goleman&rft.aufirst=D&rft_id=https%3A%2F%2Fquery.nytimes.com%2Fgst%2Ffullpage.html%3Fres%3D9C0CE0D81F3EF931A3575BC0A966958260&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"> </li> <li id="cite_note-LeiknesWWrev2012-26">^ <a href="#cite_ref-LeiknesWWrev2012_26-0">a</a> <a href="#cite_ref-LeiknesWWrev2012_26-1">b</a> <a href="#cite_ref-LeiknesWWrev2012_26-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLeiknesJarosh-von_SchwederHøie2012" class="citation journal cs1">Leiknes KA, Jarosh-von Schweder L, Høie B (May 2012). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3381633">"Contemporary use and practice of electroconvulsive therapy worldwide"</a>. Brain and Behavior. 2 (3): 283–344. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fbrb3.37">10.1002/brb3.37</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3381633">3381633</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/22741102">22741102</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Brain+and+Behavior&rft.atitle=Contemporary+use+and+practice+of+electroconvulsive+therapy+worldwide&rft.volume=2&rft.issue=3&rft.pages=283-344&rft.date=2012-05&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3381633%23id-name%3DPMC&rft_id=info%3Apmid%2F22741102&rft_id=info%3Adoi%2F10.1002%2Fbrb3.37&rft.aulast=Leiknes&rft.aufirst=KA&rft.au=Jarosh-von+Schweder%2C+L&rft.au=H%C3%B8ie%2C+B&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3381633&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"> </li> <li id="cite_note-27"><a href="#cite_ref-27">^</a> See: <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFriedberg1977" class="citation journal cs1">Friedberg J (September 1977). "Shock treatment, brain damage, and memory loss: a neurological perspective". The American Journal of Psychiatry. 134 (9). American Psychiatric Association Publishing: 1010–1014. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1176%2Fajp.134.9.1010">10.1176/ajp.134.9.1010</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/900284">900284</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Journal+of+Psychiatry&rft.atitle=Shock+treatment%2C+brain+damage%2C+and+memory+loss%3A+a+neurological+perspective&rft.volume=134&rft.issue=9&rft.pages=1010-1014&rft.date=1977-09&rft_id=info%3Adoi%2F10.1176%2Fajp.134.9.1010&rft_id=info%3Apmid%2F900284&rft.aulast=Friedberg&rft.aufirst=J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBreggin1979" class="citation book cs1">Breggin PR (1979). Electroshock: its brain-disabling effects. New York: Springer. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/082612710X" title="Special:BookSources/082612710X"><bdi>082612710X</bdi></a>. <a href="/wiki/OCLC_(identifier)" class="mw-redirect" title="OCLC (identifier)">OCLC</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/oclc/5029460">5029460</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Electroshock%3A+its+brain-disabling+effects&rft.place=New+York&rft.pub=Springer&rft.date=1979&rft_id=info%3Aoclcnum%2F5029460&rft.isbn=082612710X&rft.aulast=Breggin&rft.aufirst=PR&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"></li></ul> </li> <li id="cite_note-28"><a href="#cite_ref-28">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBlaineClark1986" class="citation journal cs1">Blaine JD, Clark SM (1986). 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USA Today. Archived from <a rel="nofollow" class="external text" href="http://www.harborside.com/~equinox/ect1.htm">the original</a> on 2008-01-15. 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Brain Stimulation. 9 (6): 882–891. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.brs.2016.07.005">10.1016/j.brs.2016.07.005</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/27522170">27522170</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:206356310">206356310</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Brain+Stimulation&rft.atitle=Based+on+a+True+Story%3F+The+Portrayal+of+ECT+in+International+Movies+and+Television+Programs&rft.volume=9&rft.issue=6&rft.pages=882-891&rft.date=2016&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A206356310%23id-name%3DS2CID&rft_id=info%3Apmid%2F27522170&rft_id=info%3Adoi%2F10.1016%2Fj.brs.2016.07.005&rft.aulast=Sienaert&rft.aufirst=P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"> </li> <li id="cite_note-pmid27008331-171"><a href="#cite_ref-pmid27008331_171-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMatthewsRosenquistMcCall2016" class="citation journal cs1">Matthews AM, Rosenquist PB, McCall WV (September 2016). 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The Journal of ECT. 32 (3): 187–191. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2FYCT.0000000000000312">10.1097/YCT.0000000000000312</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/27008331">27008331</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:206144447">206144447</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+ECT&rft.atitle=Representations+of+ECT+in+English-Language+Film+and+Television+in+the+New+Millennium&rft.volume=32&rft.issue=3&rft.pages=187-191&rft.date=2016-09&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A206144447%23id-name%3DS2CID&rft_id=info%3Apmid%2F27008331&rft_id=info%3Adoi%2F10.1097%2FYCT.0000000000000312&rft.aulast=Matthews&rft.aufirst=AM&rft.au=Rosenquist%2C+PB&rft.au=McCall%2C+WV&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"> </li> <li id="cite_note-172"><a href="#cite_ref-172">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://tvtropes.org/pmwiki/pmwiki.php/Main/ElectroconvulsiveTherapyIsTorture">"Electroconvulsive Therapy Is Torture"</a>. TV Tropes. 2024-03-16. Retrieved 2024-03-16.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=TV+Tropes&rft.atitle=Electroconvulsive+Therapy+Is+Torture&rft.date=2024-03-16&rft_id=https%3A%2F%2Ftvtropes.org%2Fpmwiki%2Fpmwiki.php%2FMain%2FElectroconvulsiveTherapyIsTorture&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectroconvulsive+therapy" class="Z3988"> </li> <li id="cite_note-173"><a href="#cite_ref-173">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.pbs.org/wgbh/masterpiece/specialfeatures/the-real-people-and-cast-of-mr-bates-vs-the-post-office/">"The Real People and Cast of Mr Bates vs The Post Office"</a>. Masterpiece. PBS. 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