Modern electroconvulsive therapy may help relieve depression when other treatments fail
June 4, 2026
For people living with severe depression or other serious mental health conditions, finding relief can feel impossible. While many mental health disorders can be managed with therapy, medication, or mental training programs, some patients with more serious conditions may not respond to these treatments.
When these standard therapies fall short, doctors may consider treatments that directly stimulate the brain. One such option is electroconvulsive therapy (ECT), which has proved to be both highly effective and safe for certain patients.
What is ECT?
To understand how ECT works and when it may be recommended, it helps to start with the basics. ECT involves a series of treatments in which a doctor applies an electrical current to the brain while a patient is under general anesthesia. This induces a brief, medically controlled seizure, causing changes in brain activity that can lead to noticeable improvements in mood and functioning. Patients may experience some mild cognitive issues afterward, but most report that these resolve over time.
Research shows ECT can provide substantial relief when other treatments fall short. Up to 70%-80% of patients respond positively to ECT in clinical studies. Response rates may be lower in people with highly treatment-resistant depression, but this is still substantially better than additional medication trials. In many cases, the more resistant that patients’ symptoms are to other treatments, the more likely they are to benefit from ECT.
Modern ECT is a proven treatment with minimal risk
Though ECT’s history stretches back more than 85 years – longer than the use of all psychotropic medications – many misconceptions about the therapy still linger. Most of these developed in the early days of treatment, when patient well-being was less of a concern, and were further spurred on by dramatic portrayals in movies and television. Modern ECT is a safe, highly controlled medical procedure that looks almost nothing like the outdated practices of the past.
Today, ECT carries a minimal risk of complications, similar to having minor surgery under general anesthesia. As a psychiatric tool, ECT devices have been approved by the Food and Drug Administration and endorsed by the National Institute of Mental Health, the American Psychiatric Association, the American Medical Association, and the U.S. Surgeon General for treating depression and other psychiatric disorders. Physician-led organizations, such as the International Society for ECT and Neurostimulation (ISEN), promote the safe and ethical use of ECT with a core focus on improving patients’ lives.
Unlike how ECT has been depicted in movies, patients aren’t restrained in any way. During treatment, patients are given general anesthesia and muscle relaxants to minimize movement and reduce the non-neurological effects of the controlled seizure.
Some movement is necessary for doctors to observe when the seizure starts and stops, but that’s limited to short, rhythmic tremors in the hands, feet, eyebrows, or lips. When our medical students first observe ECT sessions, they almost always say it was surprisingly quick or much more routine than they anticipated.
What can ECT treat?
The FDA has approved ECT to treat patients ages 13 and older who have not responded to other treatments or who need rapid intervention for a severe condition. The age limit may vary based on legal approvals and state laws, however. In Texas, for example, the minimum age is set at 16.
Some of the most common conditions treated with ECT include:
- Major depression, when a person feels extremely sad or hopeless, cannot function, has thoughts of suicide, or hears or sees things that are not there.
- Catatonia, where the body slows down significantly, with the patient moving very little, if at all. This is often a manifestation of severe depression but can appear without the presence of another condition.
- Bipolar disorder, in which a patient experiences episodes of mania or depression that do not improve with medication.
- Schizoaffective disorder, a chronic illness involving symptoms of psychosis (such as hallucinations or delusions) and mood disorders, similar to bipolar episodes.
In addition, ECT has been shown to be effective on a case-by-case basis for specialized conditions, such as Parkinson’s disease symptoms, agitation related to Alzheimer’s disease, or Down syndrome regression disorder (DSRD), a rare condition I’ve treated in the past.
‘Massive improvement’ with ECT
Katie Harlan, 42, has a history of major depression dating back to adolescence. She has tried numerous treatment approaches, including medication, residential treatment, therapy, and transcranial magnetic stimulation (TMS).
Several years ago, she learned about ECT and gave it a trial run during a depressive episode. To her relief, ECT proved effective, and she was able to “return to my life” after a series of treatments. When her depression returned, Katie resumed ECT as a long-term maintenance program.
After she and her family moved to Gilmer, which is about two hours east of Dallas, she was referred to the hospital facilities at UT Southwestern for ECT treatment. When her depression returned in July 2025, she underwent additional treatments, which she said brought “a massive improvement in mood.”
As of May, Katie continues maintenance ECT treatments every three weeks, with periods where she requires closer support and a more frequent treatment schedule. Although she experiences mild cognitive impairment for a few days after each session, she said the benefits far outweigh the side effects.
“I would recommend that anyone on the fence or unsure of trying ECT for depression consider this method,” she said. “I am thankful for the staff at UT Southwestern and the treatment they have provided me to recover.”
Is ECT the right treatment for you?
All patients recommended for ECT must first undergo a comprehensive evaluation by UTSW’s Interventional Psychiatry team to determine whether ECT is right for them. Doctors conduct in-depth interviews with patients, review their medical histories, confirm their diagnosis, and identify any conditions that may counteract the effects of treatment.
Depending on their overall condition, they could be directed to a different type of treatment such as transcranial magnetic stimulation (TMS), ketamine or esketamine therapy, vagus nerve stimulation (VNS), or deep brain stimulation (DBS) – though DBS is currently only offered in research studies. ECT is typically prescribed only after multiple other treatments have been attempted without success.
We can't cure depression, but we can treat it. ECT can produce full remission in around 60% of patients with otherwise difficult-to-treat depression, and most others experience meaningful improvement.
Joshua Hubregsen, M.D., Assistant Professor of Psychiatry
ECT’s treatment cycle
ECT requires a series of treatments, typically conducted three times a week over several weeks. The seizure itself lasts just one or two minutes, but the entire visit can take about three hours. Most of that time is spent recovering from anesthesia and being monitored before doctors release the patient.
Modern ECT techniques are designed to reduce cognitive side effects, often through adjustments in waveform and electrode placement. Because these approaches can be less intensive, some patients may need more treatments to achieve the same level of improvement.
In our clinic, most patients require 12 to 15 treatments over six to eight weeks. Our team also spaces out the time between treatments near the end, which prolongs the process but greatly lowers the risk of relapse. For example, three sessions per week could become two per week and then one before stopping altogether.
Even after successful ECT, patients are encouraged to continue treating their condition to reduce the risk of relapse. This typically includes ongoing medications and possibly a brief follow-up series of treatments.
During ECT treatments
For safety reasons, patients must make several temporary lifestyle adjustments during treatment:
- No driving: Since ECT can affect cognitive functions, including processing speed and reaction times, patients are not allowed to operate a vehicle while undergoing treatments.
- Medication changes: To help the treatments work effectively, patients may need to change their medications, which could cause short-term side effects.
- Frequent office visits: Most ECT patients should be prepared for treatments three times a week, which requires taking off work and canceling any other plans or responsibilities for an extended period.
- Recovery time: The cognitive side effects of ECT will fade over time. That can prolong the time it takes patients to get back to work or regular activities.
Effects of ECT on memory and cognition
While undergoing ECT, patients sometimes experience cognitive issues, though these are often mild and temporary. Immediately after a treatment, for example, patients may feel confused, but this usually resolves within an hour. Other cognitive effects can build over time, but they typically resolve completely within two weeks to two months after treatment ends.
Most patients report no memory problems during ECT, though temporary changes can occur. Some may have trouble recalling words during conversation or the plot of a TV show they just watched. Others may need more frequent reminders of information until they recover fully. That cognitive fuzziness will fade once they finish treatment, but some people may notice memory gaps from around the time of treatment.
Long-term memory issues are exceedingly rare these days, as physicians can adjust treatments if they notice greater cognitive problems. I often compare the process to rebooting a frozen computer: The active files may be lost, but the hard drive will remain functional.
Side effects from ECT have decreased over time, with advances in technology and techniques. Innovations such as constant-current devices, standardized pulse waveforms, shorter pulse widths, and various lead placement approaches have given physicians much more flexibility to balance the treatment's effectiveness with its side effects.
Seeing a difference with ECT
Fortunately, patients usually don’t have to wait until the end of the treatment cycle to see results. Most people start noticing the effects between their fourth and sixth treatments – some even start feeling better after the first session. Patients who are responding to ECT often report their depression doesn’t feel as overwhelming or heavy, that their thoughts are more positive, and that they start to feel life is more pleasurable.
Not all patients will benefit from ECT. Over more than a decade of treating patients with ECT, I’ve seen a wide range of reactions, from some who have one treatment and never want another to others whose lives have turned around and are incredibly grateful for the treatment.
In general, patients are often the last to notice an improvement. It’s usually their loved ones who report that they’re suddenly more active – like doing household chores for the first time all year. Once that happens, it’s just a matter of time before the patient recognizes the change too.
Related: Read "Breakthroughs in depression research lead to more effective treatments"
ECT at UT Southwestern
At UT Southwestern, we’re equipped to deliver a full range of ECT treatment options tailored to each patient’s needs. From our dedicated clinic space at the William P. Clements Jr. University Hospital, we can adjust factors such as lead placements, pulse widths, and charge delivery methods based on a patient’s condition and treatment goals.
Our clinicians and researchers are much more involved in the broader ECT community than anyone else in the Dallas area, conducting ongoing research and partnering with other institutions to lead major studies.
However, our main focus is always our patients. Our goal is always to help patients make informed decisions and feel supported every step of the way.
To talk to an expert about ECT options, call 214-645-8500 or request an appointment online.
