ECT is neither ‘completely safe’ nor ‘completely effective’.
It is estimated that the use of ECT (Electroconvulsive Therapy) in the USA alone provides around 1.8 billion dollars in annual income to psychiatry. It is big business and that business is being protected.
Unfortunately, this is being reflected in the materials and even studies on the subject, where you will find over and over again statements of how ECT is “safe and effective” and yet these give little actual data or statistics to back these statements up. It would appear marketing and science are in conflict.
So, setting all of the glib “safe and effective” aside, here are at least some things that anyone affected by the subject really does need to know.

Psychiatry does not know why it works, if it does.
Despite lots of theories being thrown up, psychiatry does not know why Electroconvulsive Therapy works, if it does. The use of “shock” and inducing seizures through drugs or other things to bring about change in individuals, goes right back to the Greeks and possibly even earlier but remarkably, no one in psychiatry has ever found the reason why. 1
Just like anything where little is actually known about it, it can have unpredictable results and consequences.
ECT does not cure anything
If the mental illness symptoms, among other side-effects, are even temporarily changed by the ECT then a psychiatrist may consider the treatment successful, but to say anything has been cured is nonsense.
When beginning a course of ECT there is no attempt to find the actual cause of the illness that people may have, e.g. to actually find out WHY a person who is severely depressed IS severely depressed.
There is no mental illness where the cause is “the patient has yet to receive an electric current slamming across his brain”.
If the mental illness symptoms, among other side-effects, are even temporarily changed by the ECT then a psychiatrist may consider the treatment successful, but to say anything has been cured is nonsense.
Does it even work at all?
It is now even in question if ECT works at all or if it is simply a placebo effect.
“There is still no evidence that ECT is more effective than placebo for depression reduction or suicide prevention. Given the well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.”
John Read, Chelsea Arnold. Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009. 2017. 2
Just what are side effects?
“What these shock doctors don’t know is about writers and such things as remorse and contrition and what they do to them… 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.”
Nobel Prize-winning author, Ernest Hemingway by way of his friend and biographer, A E Hotchner. After his second course of ECT Mr Hemingway killed himself. 3
Here are some of the side effects of ECT presented in the scientific literature:
Retrograde Amnesia and Memory Loss
“Retrograde amnesia occurs to some extent in almost all ECT recipients, […] In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss”
American Psychiatric Association Committee on Electroconvulsive Therapy. 2001.
“Retrograde amnesia occurs to some extent in almost all ECT recipients, […] In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss”
American Psychiatric Association Committee on Electroconvulsive Therapy. (2001). 4 5
“ECT may result in anterograde or retrograde amnesia. Such post-treatment amnesia typically dissipates over time; however, incomplete recovery is possible. In rare cases, patients may experience permanent memory loss or permanent brain damage.”
Regulatory Update to Thymatron System IV Instruction Manual. 2018. 6
“Regardless, this study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.”
Sackeim, H., Prudic, J., Fuller, R. et al. The Cognitive Effects of Electroconvulsive Therapy in Community Settings. 2007 7
Brain Damage
“A small minority of patients treated with ECT later report devastating cognitive consequences. Patients may indicate that they have dense amnesia extending far back into the past for events of personal significance or that broad cognitive function are so impaired that the patients are no longer able to engage in former occupations…“
American Psychiatric Association Committee on Electroconvulsive Therapy. 2001.
“Despite many scientific and governmental authorities having concluded that ECT does not cause brain damage, there is significant evidence that ECT has indeed caused brain damage in some patients, both historically and recently, and evidence that it always causes some form or degree of brain damage.”
Christopher Dubey. Electroconvulsive Therapy and Brain Damage: Survey of the Evidence From a Philosophical Promontory. 8
“The demonstration of differences in the long-term cognitive outcomes as a function of hospital setting and treatment technique supports the conclusion that some forms of ECT have persistent long-term effects on cognitive performance.”
Sackeim, H., Prudic, J., Fuller, R. et al. The Cognitive Effects of Electroconvulsive Therapy in Community Settings. 2007 9
“ECT studies indicate brain temperature increases with relevance to electroconvulsive therapy stimulation. Concerns over heat stress relevant to ECT associated memory loss/brain damage may be relevant to irreversible inactivation of the genes and brain heat shock gene Sirtuin 1”
Martins IJ. Electroconvulsive Therapy and Heat Shock Gene Inactivation in Neurodegenerative Diseases. 2018. 10
“A small minority of patients treated with ECT later report devastating cognitive consequences. Patients may indicate that they have dense amnesia extending far back into the past for events of personal significance or that broad cognitive function are so impaired that the patients are no longer able to engage in former occupations…in some patient self-reports of profound ECT-induced deficits may reflect objective loss of function…In rare cases, ECT may result in a dense and persistent retrograde amnesia extending to years…”
American Psychiatric Association Committee on Electroconvulsive Therapy. (2001) 11 Regulatory Update to Thymatron System IV Instruction Manual. 2018. 12
Violent Postictal delirium
“A common adverse effect of ECT immediately following the procedure is the emergence of postictal delirium. This state is characterized by a lack of awareness, disorientation, agitation, and sometimes erratic and even violent behaviour lasting between 5 and 45 minutes, occurring in as many as 52% of patients. Although postictal delirium generally lasts less than 1 hour, overall consciousness remains blunted for several hours.”
Irving M. Reti et al Predictors of Electroconvulsive Therapy Postictal Delirium. 13
The complete list
The following is a list of significant adverse events from ECT treatment taken from the FDA Executive Summary, January 27-28, 2011 meeting of the Neurological Devices Panel. 14
adverse reaction to anesthetic agents / neuromuscular blocking agents
cognition and memory
impairment
general motor dysfunction
neurological symptoms (e.g., paresthesia, dyskinesias – burning sensations on or involuntary movements of the body)
non-convulsive status epilepticus (a prolonged seizure that manifests primarily as altered mental status)
auditory complications
substance abuse
device malfunction (creating potential risks such as excessive dose administration)
adverse skin reactions (e.g., skin burns)
brain injury
physical trauma (i.e., if inadequate
supportive drug treatment is provided to mitigate unconscious violent movements during convulsions) including fractures, contusions, injury from falls, dental or oral injury
tardive seizures (potentially fatal seizures that occur after the ECT treatment is finished)
pulmonary complications (e.g.,
aspiration/inhalation of foreign material, pneumonia, hypoxia, respiratory obstruction such as laryngospasm, pulmonary embolism, prolonged apnea)
onset/exacerbation of psychiatric symptoms
homicidal tendencies
cardiac complications, including arrhythmia,
ischemia/infarction (i.e., heart attack), acute hypertension, hypotension, and stroke
dental/oral trauma
hypomanic or manic symptoms (e.g., treatment-emergent mania, postictal delirium or excitement)
prolonged seizures
visual disturbance
partial relief of depression enabling completed suicide
coma
falls
death
The full effect and range of side effects have never been investigated.
There seems to be a tremendous reticence in psychiatry in doing research into the full side-effects and consequences of the use of ECT. As Sackeim et al stated in their 2006 study The Cognitive Effects of Electroconvulsive Therapy in Community Settings, in the 68 years of prior use, no one had done a large-scale study of the effects of ECT.
“Despite ongoing controversy, there has never been a large-scale, prospective study of the cognitive effects of electroconvulsive therapy (ECT).”
Sackeim, H., Prudic, J., Fuller, R. et al. The Cognitive Effects of Electroconvulsive Therapy in Community Settings. 2007 15
The Sackeim study only examined side-effects 6 months after treatment – there has never been a study of the very long term effect of the treatment.
The FDA Executive Summary, January 27-28, 2011 meeting of the Neurological Devices Panel. Meeting to Discuss the Classification of Electroconvulsive Therapy Devices (ECT) also found significant adverse side effects had never been researched: 16
- the effect of ECT on the lifespan of the patient.
- sleep disturbances including nightmares.
- visual disturbance i.e. changes in vision, visual impairment or corneal trauma (abrasion).
- auditory complications decreased acuity, hyperacuity, and tinnitus.
- urinary complaints
- substance abuse – increased use
- coma
- homicidal tendencies
Even so, there are other aspects of ECT that have never been investigated. For example, in Sackeim et al 2006, The Cognitive Effects of Electroconvulsive Therapy in Community Settings there is an astonishing discrepancy between occurrences of retrograde amnesia in women compared to men.
“There was also a gender difference, … with a greater preponderance of women (81.6%) compared to men (18.4%) in the persistent deficit group.“
Sackeim, H., Prudic, J., Fuller, R. et al. The Cognitive Effects of Electroconvulsive Therapy in Community Settings. 2007 17
Other studies point out other discrepancies in the genders in relation to ECT and yet no study has found the reason for these gender differences.
The very important question of whether ECT causes brain damage, even from this very conservative view below of what is and isn’t brain damage from 2020, has never been settled.
“The review of literature suggests that ECT does cause at least structural and functional changes in the brain, and these are in all probability related to the effects of the ECT. However, these cannot be construed as brain damage as is usually understood. Due to the relative scarcity of data that directly examines the question of whether ECT causes brain damage, it is not possible to conclusively answer this question. However, in light of enduring ECT survivor accounts, there is a need to design studies that specifically answer this question.”
Amal Joseph Jolly and Shubh Mohan Singh. Does electroconvulsive therapy cause brain damage: An update. 18
The science is dreadfully incomplete.
Is it really effective?
Very high relapse rates
“Our study indicates that without active treatment, virtually all remitted patients relapse within 6 months of stopping ECT“
Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. 2001.
If you do not find the actual reason for the mental illness or reason why the tool you are using “works”, then symptoms often come back and that is exactly what is occurring with ECT.
A study from 2001:
“Our study indicates that without active treatment, virtually all remitted patients relapse within 6 months of stopping ECT.”
Sackeim et al Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. 19
Other studies from 2000:
Of 62 patients…
“Thirty-three (53%) of the 62 patients relapsed during the year; 31 (94%) of the relapses occurred during the first 6 months.”
Sackheim et al. A Prospective, Randomized, Double-blind Comparison of Bilateral and Right Unilateral Electroconvulsive Therapy at Different Stimulus Intensities. 2000.20
“Relapse of severe depression after successful treatment with electroconvulsive therapy (ECT) continues to be a major problem. We review the literature on relapse after ECT and factors that predict relapse. Early studies showed that the relapse rate was ∼50% without follow-up treatment and that the majority of these relapses occurred in the first 6 months.”
L Bourgon, C Kellner. Relapse of Depression After ECT: A Review. 2000. 21
Maintenance ECT
Psychiatry has come up with “maintenance” or “continuation” ECT as a solution to relapse.
This is a patient having to endure ECT every few months for years or even the rest of their lives. Of course, this is being done without preliminary studies of the effect of long-term and continued production of grand mal seizures in a patient from a mental or even physical viewpoint.
ECT is a risk for pregnant women.
A 2013 study of 169 case reports of pregnant women who had received ECT found that in 29% of the women adverse events were recorded, such as foetal heart rate reduction, uterine contractions, and premature labour. The overall child mortality was 7.1%.
Electroconvulsive therapy during pregnancy: a systematic review of case studies. 2015.
Despite many general statements that there is minimal risk to pregnant women and children during ECT treatment, actual studies give a different picture. What is presented is that if there is a risk to mother and child safety due to an extreme mental state of the mother then ECT is a viable treatment alternative. Even if this were true, the actual risks should still be known. So what do actual studies say?
A 2013 study of 169 case reports of pregnant women who had received ECT found that in 29% of the women adverse events were recorded, such as foetal heart rate reduction, uterine contractions, and premature labour. The overall child mortality was 7.1%. 22
Do not assume high or even any standards of application
In 1981 the editor of the UK-based medical journal The Lancet issued this warning:
“Every British Psychiatrist should read this report and feel ashamed and worried about the state of British Psychiatry. If ECT is ever legislated against or falls into disuse it will not be because it is an ineffective or dangerous treatment; it will be because psychiatrists have failed to supervise and monitor its use adequately. It is not ECT which has brought psychiatry into disrepute. Psychiatry has done just that for ECT.”
Eve Russel. Running an ECT department. 2018 23
This was in the United Kingdom where there were at least published standards and yet, further audits of the state of delivery of ECT in 1992 and again in 1998 still found serious deficits in using updated equipment and the training and supervision of staff involved.
Conclusion
There is another reoccurring theme in ECT materials and particularly in response to criticisms of ECT; “We know its bad, but if we don’t use it we will lose the patient.”
Well, ECT has been in use for 84 years, and maybe in 1940 this excuse would hold water. Now one is left to say; “Is this really the best you can do?”
Isn’t it long past time that therapies that ACTUALLY are safe and ACTUALLY are effective and ACTUALLY do cure people of their mental afflictions are found and put to use?
Further References:

Another ECT myth debunked, again

ECT psychs aren’t telling patients the truth
- John Read, PhD, Sarah Hancock, MS, CRC, Sue Cunliffe, MBchB, RCPCH. 2021. ECT: Dangerous on Either Side of the Pond. Psychiatric Times, Vol 38, Issue 4, Volume 04,
- John Read, Chelsea Arnold. Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009. 2017. Ethical Human Psychology and Psychiatry 19(1):5-23.
- Steven R. Smith, Robert Meyer. Law, Behavior, and Mental Health: Policy and Practice. 1988
- American Psychiatric Association Committee on Electroconvulsive Therapy. (2001). The practice of electroconvulsive therapy: Recommendations for treatment, training, and privileging: A task force report of the American Psychiatric Association (2nd ed.). American Psychiatric Association.
- Seniuk, P. I’m shocked: informed consent in ECT and the phenomenological-self. 2018. Life Sci Soc Policy 14, 5 .
- Regulatory Update to Thymatron System IV Instruction Manual. 2018
- Sackeim, H., Prudic, J., Fuller, R. et al. The Cognitive Effects of Electroconvulsive Therapy in Community Settings. 2007 Neuropsychopharmacol 32, 244–254.
- Christopher Dubey. Electroconvulsive Therapy and Brain Damage: Survey of the Evidence From a Philosophical Promontory. Ethical Human Psychology and Psychiatry, Volume 19, Number 1, 2017.
- Sackeim, H., Prudic, J., Fuller, R. et al. The Cognitive Effects of Electroconvulsive Therapy in Community Settings. 2007 Neuropsychopharmacol 32, 244–254.
- Martins IJ (2018) Electroconvulsive Therapy and Heat Shock Gene Inactivation in Neurodegenerative Diseases. Ann Neurodegener Dis 3(1): 1028
- American Psychiatric Association Committee on Electroconvulsive Therapy. 2001. The practice of electroconvulsive therapy: Recommendations for treatment, training, and privileging: A task force report of the American Psychiatric Association (2nd ed.). American Psychiatric Association.
- Regulatory Update to Thymatron System IV Instruction Manual. 2018
- Irving M. Reti, Aparna Krishnan, Adam Podlisky, April Sharp, Karin J. Neufeld, Matthew J. Hayat (2014) Predictors of Electroconvulsive Therapy Postictal Delirium. Psychosomatics. Volume 55, Issue 3, May–June 2014, Pages 272-279
- FDA Executive Summary. Meeting to Discuss the Classification of Electroconvulsive Therapy Devices (ECT) 2011.
- Sackeim, H., Prudic, J., Fuller, R. et al. The Cognitive Effects of Electroconvulsive Therapy in Community Settings. 2007 Neuropsychopharmacol 32, 244–254.
- FDA Executive Summary. Meeting to Discuss the Classification of Electroconvulsive Therapy Devices (ECT) 2011.
- Sackeim, H., Prudic, J., Fuller, R. et al. The Cognitive Effects of Electroconvulsive Therapy in Community Settings. 2007 Neuropsychopharmacol 32, 244–254.
- Amal Joseph Jolly and Shubh Mohan Singh. Does electroconvulsive therapy cause brain damage: An update. Indian J Psychiatry. 2020 Jul-Aug; 62(4): 339–353.
- Sackeim et al Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001 Mar 14;285(10):1299-307.
- Sackheim et al. A Prospective, Randomized, Double-blind Comparison of Bilateral and Right Unilateral Electroconvulsive Therapy at Different Stimulus Intensities. Arch Gen Psychiatry. 2000;57(5):425-434.
- L Bourgon, C Kellner. Relapse of Depression After ECT: A Review. The Journal of ECT: March 2000 – Volume 16 – Issue 1 – p 19-31
- Kari Ann Leiknes , Mary Jennifer Cooke, Lindy Jarosch-von Schweder, Ingrid Harboe, Bjørg Høie. Electroconvulsive therapy during pregnancy: a systematic review of case studies. 2015. Arch Women’s Mental Health
- Eve Russel. Running an ECT department 2018 Cambridge University Press