ECT is given in hospital. You will probably already be an inpatient in hospital, although some people do have ECT as day patients.

As a day patient, a named, responsible, adult will have to accompany you to and from the ECT clinic.

The treatment will usually be done in a set of rooms called the “ECT suite”, although some ECT services are based in an operating theatre. There should be a room where you can wait, a room where you have your treatment, and a room where you can recover properly before leaving. Qualified staff will look after you all the time you are there. They can help you with the process of waking up from the anaesthetic and during the time straight after the treatment.

If you have significant medical problems you may need to be treated in another hospital with more medical support.

Preparing for ECT

In the days before your course of ECT is started, your doctor will arrange for some tests to make sure it is safe for you to have a general anaesthetic. These may include:

a record of your heartbeat (ECG)

blood tests

a chest X-ray.

You must not eat or drink anything for 6 hours before the ECT, although you may be allowed to drink sips of water up to 2 hours beforehand. This is so you can have the anaesthetic safely.

What happens on the day of your ECT treatment?

If you are an in-patient, a member of staff will come with you to the ECT suite. They will know about your illness and can explain what is happening. Many ECT suites are happy for family members to stay in the waiting room while you have your treatment.

You will be met by a member of the ECT staff, who will do routine physical checks (if they have not already been done). They will check that you are still willing to have ECT and will ask if you have any further questions.

When ready, the ECT staff will take you into the treatment area.

The anaesthetic staff will connect monitoring equipment to check your heart rate, blood pressure and oxygen levels. Staff will also connect you to an electroencephalogram (EEG) machine. This will monitor your brain waves as the treatment happens, so staff can measure the length of the ECT fit.

You may be given oxygen to breathe through a mask. The anaesthetist will give your anaesthetic through an injection into the back of your hand. Once you are asleep, they will add a muscle relaxant. When you are asleep, a mouth guard is put in your month to protect your teeth.

While you are asleep, two electrical pads about the size of a 50 pence piece are placed on your head. One goes on each side in bilateral ECT and both go on the same side in unilateral ECT. These are connected by wires to the ECT machine.

The ECT machine delivers a series of brief electrical pulses, for three to eight seconds. This will make you have a controlled fit. Your body will stiffen and then there will be twitching, usually seen in your hands, feet, and face. The muscle relaxant reduces the amount of movement involved. This controlled fit usually lasts from less than 90 seconds

The muscle relaxant wears off within a couple of minutes. The mouth guard will then be removed. As soon as the anaesthetist is happy that you are waking up, staff will take you through to the recovery area. Here, an experienced nurse will look after you until you are fully awake.

When you wake up, you will be in the recovery room with a nurse. They will take your blood pressure and ask you simple questions to check how awake you are. There will be a small monitor on your finger to measure the oxygen in your blood. You may wake up with an oxygen mask. It can take a while to wake up fully and, at first, you may not know quite where you are. After half an hour or so, these effects should have worn off.

Most ECT units have a second area where you can sit and have a cup of tea or some other light refreshment. You will leave the ECT suite when your physical state is stable, and you feel ready to do so.

The whole process usually takes around an hour.

Before you leave the ECT suite, staff will advise you:

not to drink alcohol for 24 hours after each treatment

to have a responsible adult with you all the time for the 24 hours following each ECT treatment

to not sign any legal documents for at least 24 hours following each ECT treatment.

How often and how many times is ECT given?

Usually, twice per week, with a few days in between each treatment. It can take several sessions before you notice an improvement. It is not possible to predict, in advance, how many treatments you will need.

On average, the total number of treatments you might have in a course is between 9 and 10, although it is common to have 12 treatments and more may sometimes be needed.

If you have had no improvement at all after 6 treatments, your treatment plan should be reviewed with your doctor to discuss whether to continue or change the form of ECT.

Your medical team will regularly review how you are responding to the ECT. They will discuss your progress – and any side effects or concerns – usually every week.

ECT should be stopped soon after you have made a full recovery – or if you say you don't want to have it anymore and are well enough to understand this decision.

What happens after a course of ECT?

ECT is one part of getting better. It should also help you to use (or start again with) other treatments or types of support.

You will usually continue or start medication after ECT – this will help to maintain the improvements you have had from your ECT treatment.

Talking therapies – such as Psychotherapy, CBT and Counselling – can help you to work on any reasons for your depression and to develop ways of staying well. Changes in your day to day lifestyle can also be helpful: taking regular exercise, eating better, a regular sleep pattern and using techniques like mindfulness and meditation.

The clinic will usually contact you to ask about your memory 2 months after your last treatment.

How is the quality of ECT in my local hospital assessed?

The Royal College of Psychiatrists has set up the ECT Accreditation Service (ECTAS). This provides an independent assessment of the quality of ECT services. ECTAS sets standards for ECT and visits all the ECT units who are members. The visiting team involves a psychiatrist, anaesthetist, nurse, ECTAS patient representative, and a member of the ECTAS project team. Membership of ECTAS is not compulsory but almost all active ECT units are accredited. Your unit can tell you if they are accredited by ECTAS.