Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-19T04:17:05.579Z Has data issue: false hasContentIssue false

The effectiveness of electroconvulsive therapy: A literature review

Published online by Cambridge University Press:  11 April 2011

John Read*
Department of Psychology, University of Auckland (New Zeland)
Richard Bentall
Department of Psychology, Bangor University, Wales (United Kingdom)
Address for correspondence: Professor J. Read, Department of Psychology, University of Auckland, Room: 721.305, Tamaki Campus, Auckland 1142, (New Zealand). E-mail:


Aim – To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. MethodsPsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. Results – These placebo controlled studies show minimal support for effectiveness with either depression or ‘schizophrenia’ during the course of treatment (i.e. only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Conclusions – Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.

Declaration of Interest: Neither author has any financial conflicts of interest in relation to this paper.

Original Articles
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



Abraham, K. & Kulhara, P. (1987). The efficacy of ECT in the treatment of schizophrenia. British Journal of Psychiatry 15, 152155.CrossRefGoogle Scholar
Allen, I. (1959). Cerebral lesions from ECT. New Zealand Medical Journal 58, 369377.Google Scholar
Alpers, B. (1946). The brain changes associated with electrical shock treatment: A critical review. Lancet 66, 363369.Google Scholar
American Psychiatric Association (2001). The Practice of ECT, A Task Force Report, 2nd ed.APA: Washington, DC.Google Scholar
Andre, L. (2008). Doctors of Deception: What They Don't Want You to Know About Shock Treatment. Rutgers University Press: New Brunswick, NJ.Google Scholar
Asioli, F. & Fioritti, A. (2000). Electroshock (ESK) and electroconvul-sive therapy (ECT). Epidemiologia e Psichiatria Sociale 9, 99102.CrossRefGoogle ScholarPubMed
Avery, D. & Winokur, G. (1976). Mortality in depressed patients treated with ECT and antidepressants. Archives of General Psychiatry 33, 10291037.CrossRefGoogle ScholarPubMed
Avery, D. & Winokur, G. (1978). Suicide, attempted suicide, and relapse rates in depression. Archives of General Psychiatry 35, 749753.CrossRefGoogle ScholarPubMed
Benbow, S. (2004). Adverse effects of ECT. In The ECT Handbook. The Third Report of the Royal College of Psychiatrists' Special Committee on ECT (2nd ed.) (ed. Scott, D.), pp. 170174. RCP: London.Google Scholar
Bentall, R. (2009). Doctoring the Mind: Why Psychiatric Treatments Fail. Penguin: London.Google Scholar
Black, D., Winokur, G., Mohandoss, E., Woolson, R. & Nasrallah, A. (1989). Does treatment influence mortality in depressives? Annals of Clinical Psychiatry 1, 165173.CrossRefGoogle Scholar
Bond, E. (1954). Results of treatment in psychoses with a control series. II. Involutional psychotic reaction. American Journal of Psychiatry 110, 881885.CrossRefGoogle ScholarPubMed
Bond, E. & Morris, H. (1954). Results of treatment in psychoses with a control series. III. Manic-depressive reactions. American Journal of Psychiatry 110, 885887.CrossRefGoogle ScholarPubMed
Bradvik, L. & Berglund, M. (2000). Treatment and suicide in severe depression: A case-contol study of antidepressant therapy at last contact before suicide. Journal of ECT 16, 399408.CrossRefGoogle Scholar
Bradvik, L. & Berglund, M. (2006). Long-term treatment and suicidal behavior in severe depression: ECT and antidepressant pharma-cotherapy may have different effects on the occurrence and seriousness of suicide attempts. Depression and Anxiety 23, 3441.CrossRefGoogle Scholar
Brandon, S., Cowley, P., McDonald, C., Neville, P., Palmer, R. & Wellstood-Eason, S. (1984). ECT results in depressive illness from the Leicestershire trial. British Medical Journal 288, 2225.CrossRefGoogle Scholar
Brandon, S., Cowley, P., McDonald, C., Neville, P., Palmer, R. & Wellstood-Eason, S. (1985). Leicester ECT trial: Results in schizophrenia. British Journal of Psychiatry 146, 177183.CrossRefGoogle ScholarPubMed
Breggin, P. (1984). Electroshock therapy and brain damage: The acute organic brain syndrome as treatment. Brain and Behavioral Science 7, 2425.CrossRefGoogle Scholar
Breggin, P. (2008). Brain-disabling Treatments in Psychiatry. Springer: New York.Google Scholar
Brill, N., Crumpton, E., Eiduson, S., Grayson, H., Hellman, L. & Richards, R. (1959). Relative effectiveness of various components of ECT. Archives of Neurology and Psychiatry 81, 627635.CrossRefGoogle Scholar
Brodarty, H., Hickie, I., Mason, C. & Prenter, L. (2000). A prospective follow-up study of ECT outcome in older depressed patients. Journal of Affective Disorders 60, 101111.CrossRefGoogle Scholar
Calloway, S., Dolan, R., Jacoby, R. & Levy, R. (1981). ECT and cerebral atrophy. Acta Psychiatrica Scandinavica 64, 442445.CrossRefGoogle ScholarPubMed
Cipriani, A., Girlanda, F. & Barbui, C. (2009). Superiority, equivalence or non-inferiority. Epidemiologia e Psichiatria Sociale 18, 311313.Google Scholar
Cochrane, A. (1972). Effectiveness and Efficiency: Random Reflections on Health Services. Nuffield Provincial Hospital Trust: London.Google Scholar
Coffey, C., Weiner, R., Djang, W., Figiel, G., Soady, S. & Patterson, L. (1991). Brain anatomic effects of ECT. Archives of General Psychiatry 48, 10131021.CrossRefGoogle Scholar
Crow, T. (2004). Book review. Acta Psychiatrica Scandinavica 110, 317.CrossRefGoogle Scholar
Devereaux, P. & Yusuf, S. (2003). The evolution of the randomized controlled trail and its role in evidence-based decision making. Journal of Internal Medicine 254, 105113.CrossRefGoogle Scholar
Doroshow, D. (2006). Performing a cure for schizophrenia: Insulin coma therapy on the wards. Journal of the History of Medicine and Allied Sciences 62, 213243.CrossRefGoogle ScholarPubMed
Eastwood, M. & Peacocke, J. (1976). Seasonal patterns of suicide, depression and ECT. British Journal of Psychiatry 129, 472475.Google Scholar
Fahy, P., Imlah, N. & Harrington, J. (1963). A controlled comparison of ECT, imipramine and thiopentone sleep in depression. Journal of Neuropsychiatry 4, 310314.Google Scholar
Feliu, M., Edwards, C., Sudhakar, S., McDougald, C., Raynor, R. & Johnson, S. (2008). Neuropsychological effects and attitudes in patients following ECT. Neuropsychiatric Disease and Treatment 4, 613617.Google Scholar
Frank, L. (1978). The History of Shock Treatment. Frank: San Francisco.Google Scholar
Freeman, C. & Kendell, R. (1980). ECT Patients' experiences and attitudes. British Journal of Psychiatry 137, 816.CrossRefGoogle Scholar
Freeman, C., Basson, J. & Crighton, A. (1978). Double-blind controlled trial of ECT and simulated ECT in depressive illness. Lancet ii, 738740.CrossRefGoogle ScholarPubMed
Freeman, C., Basson, J., & Crighton, A. (1980). ECT patients who complain. British Journal of Psychiatry 137, 1725.Google Scholar
Freeman, W. (1941). Brain-damaging therapeutics. Diseases of the Nervous System 2, 83.Google Scholar
Friedberg, J. (1976). Shock Treatment is Not Good for Your Brain. Glide: San Francisco.Google Scholar
Friedberg, J. (1977). Shock treatment, brain damage, and memory loss: A neurological perspective. American Journal of Psychiatry 134, 10101014.Google Scholar
Gabor, G. & Laszio, T. (2005). The efficacy of ECT treatment in depression: A metanalysis. Psychiatria Hungarica 20, 195200.Google Scholar
Gazdag, G., Bitter, I., Ungvari, G. & Baran, B. (2009). Convulsive therapy turns 75. British Journal of Psychiatry 194, 387388.Google Scholar
Gillon, R. (1985). Philosophical Medical Ethics. Wiley: London.Google Scholar
Goldman, H, Gomer, F. & Templer, D. (1972). Long-term effects of ECT upon memory and perceptual motor performance. Journal of Clinical Psychology 28, 3234.Google Scholar
Greenhalgh, J., Knight, C., Hind, D., Beverley, C. & Walters, S. (2005). Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: Systematic reviews and economic modelling studies. Health Technology Assessment 9, 1170.Google Scholar
Gregory, S., Shawcross, C. & Gill, D. (1985). The Nottingham ECT study. British Journal of Psychiatry 146, 520524.Google Scholar
Halliday, A., Davison, K., Browne, M. & Kreeger, L. (1968). A comparison of the effects on depression of bilateral and unilateral ECT to the dominant and non-dominant hemispheres. British Journal of Psychiatry 114, 9971012.Google Scholar
Harris, J. & Robin, A. (1960). A controlled trial of phenelzine in depressive reactions. Journal of Mental Science 106, 14321437CrossRefGoogle ScholarPubMed
Huston, P.E. & Locher, L.W. (1948). Manic-depressive psychosis. Course when treated and untreated with electric shock. Archives of Neurology and Psychiatry 60: 3748.CrossRefGoogle ScholarPubMed
Impastato, D. (1957). Prevention of fatalities in ECT. Diseases of the Nervous System 18, 3475.Google Scholar
Janicak, P., Davis, J., Gibbons, R., Eriksen, S., Chang, S. & Gallagher, P. (1985). Efficacy of ECT: A meta-analysis. American Journal of Psychiatry 142, 297302.Google ScholarPubMed
Janis, I. (1950). Psychological effects of ECT. Journal of Nervous and Mental Disease 111, 359397.CrossRefGoogle Scholar
Johnstone, E., Deakin, J., Lawler, P., Frith, C., Stevens, M., McPherson, K., Crow, T. (1980). The Northwick Park ECT trial. Lancet ii, 13171320.CrossRefGoogle Scholar
Johnstone, L. (1999). Adverse psychological effects of ECT. Journal of Mental Health 8, 6985CrossRefGoogle Scholar
Kalinowsky, L. (1944). Experience with electric convulsive therapy in various types of psychiatric patients. Bulletin of the New York Academy of Medicine 20, 485494.Google Scholar
Karagulla, S. (1950). Evaluation of ECT as compared with conservative methods of treatment in depressive states. Journal of Mental Science 96, 10601091.Google Scholar
Kellner, C., Fink, M., Knapp, R., Petrides, G., Husain, M. & Rummans, T. (2005). Relief of expressed suicidal intent by ECT. American Journal of Psychiatry 162, 977982.Google Scholar
Kellner, C., Knapp, R., Petrides, G., Rummans, T., Hussain, M., & Rasmussen, K. (2006). Continuation ECT versus pharmacotherapy for relapse prevention in major depression: A multi-site study from CORE. Archives of General Psychiatry 63, 13371344.CrossRefGoogle Scholar
Kendell, R. (1981). The present state of ECT. British Journal of Psychiatry 139, 265293.Google Scholar
Kho, K., van Vreewijk, M., Simpson, S. & Zwinderman, A. (2003). A meta-analysis of electroconvulsive therapy in depression. Journal of ECT 19, 139147.Google Scholar
Kirsch, I., Deacon, B., Huedo-Medina, T., Scoboria, A., Moore, T. & Johnson, B. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. Public Library of Science: Medicine 5, e45 Feb.Google Scholar
Lagasse, R. (2002). Anesthesia safety, model or myth? A review of the published data and analysis of current original data. Anesthesiology 97, 16091617.Google Scholar
Lambourn, J. & Gill, D. (1978). A controlled comparison of simulated and real ECT. British Journal of Psychiatry 133, 514519.Google Scholar
McElhiney, M., Moody, B., Steif, B., Prudic, J., Devanand, D. & Nobler, P. (1995). Autobiographical memory and mood: Effects of ECT. Neuropsychology 9, 101117.Google Scholar
Medical Research Council (1965). Clinical trial of the treatment of depressive illness. British Medical Journal 1(5439), 881886.CrossRefGoogle Scholar
Miller, D., Clancy, J. & Cumming, E. (1953). A comparison between unidirectional current non convulsive electrical stimulation, standard alternating current electroshock and pentothal in chronic schizophrenia. American Journal of Psychiatry 109, 617621.Google Scholar
Milstein, V., Small, J., Small, I. & Green, G. (1986). Does ECT prevent suicide? Convulsive Therapy 2, 36.Google ScholarPubMed
Ministry of Health (2004). Use of ECT in New Zealand: A Review of Efficacy, Safety and Regulatory Controls. Ministry of Health: Wellington, New Zealand.Google Scholar
Munk-Olsen, T., Laursen, T., Videbich, P., Mortensen, P. & Rosenberg, R. (2007). All-cause mortality among recipients of ECT. British Journal of Psychiatry 190, 435439.CrossRefGoogle Scholar
Myerson, A. (1941). Experience with electric-shock therapy in mental disease. New England Journal of Medicine 224, 20822085.Google Scholar
Myerson, A, (1942). Fatalities following ECT. Transactions of the American Neurological Association 68, 39.Google Scholar
Neylan, T., Canick, J., Hall, S., Reus, V., Sapolsky, R. & Wolkowitz, O.(2001). Cortisol levels predict cognitive impairment induced by ECT. Biological Psychiatry 50, 331336.CrossRefGoogle Scholar
Northwick Park ECT Trial. (1984). Predictors of response to real and simulated ECT. British Journal of Psychiatry 144, 227237.CrossRefGoogle Scholar
Nuttall, G., Bowersox, M., Douglas, S., McDonald, J., Rasmussen, L., Decker, P., Oliver, W. & Rasmussen, K. (2004). Morbidity and mortality in the use of electroconvulsive therapy. Journal of ECT 20, 237241.Google Scholar
O'Leary, D., Gill, D., Gregory, S. & Shawcross, C. (1994). The effectiveness of real versus simulated electroconvulsive therapy in depressed elderly patients. International Journal of Geriatric Psychiatry 9, 567571.Google Scholar
Pagnin, D., de Queiroz, V., Pini, S. & Cassano, G. (2004). Efficacy of ECT in depression: A meta-analytic review. Journal of ECT 20, 1320.Google Scholar
Painuly, L. & Chakrabati, S. (2006). Combined use of electroconvulsive therapy and antipsychotics in schizophrenia: The Indian evidence. Journal of ECT 22, 5966CrossRefGoogle ScholarPubMed
Parker, G. (2009). Antidepressants on trial: How valid is the evidence? British Journal of Psychiatry 184, 13.Google Scholar
Philibert, R., Richards, L., Lynch, C. & Winokur, G. (1995). Effect of ECT on mortality and clinical outcome in geriatric unipolar depression. Journal of Clinical Psychiatry 56, 390394.Google ScholarPubMed
Pippard, J. & Ellam, L. (1981). ECT in Great Britain. Gaskell: London.Google Scholar
Porter, R., Heenan, H. & Reeves, J. (2008). Early effects of ECT on cognitive function. Journal of ECT 24, 3539.Google Scholar
Pribram, K. (1974). Lobotomy to physics to Freud. American Psychological Association Monitor 5, 910.Google Scholar
Prudic, J. & Sackeim, H. (1999). ECT and suicide risk. Journal of Clinical Psychiatry 60, Suppl. 2, 104–110.Google ScholarPubMed
Rami-Gonzalez, L., Bernardo, M., Boget, T., Salamero, M., Gil-Verona, J. & Junque, C. (2001). Subtypes of memory dysfunction associated with ECT: Characteristics and neurobiological bases. Journal of ECT 17, 129135.Google Scholar
Rasmussen, K. (2009). Sham electroconvulsive therapy studies in depressive illness: A Review of the literature and consideration of the placebo phenomenon in electroconvulsive therapy practice. Journal of ECT 25, 5459.Google Scholar
Read, J. (2004). Electroconvulsive therapy. In Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia (ed. Read, J., Mosher, L. and Bentall, R.), pp. 8599. Routledge: London.CrossRefGoogle Scholar
Robertson, H. & Pryror, R. (2006). Memory and cognitive effects of ECT: Informing and assessing patients. Advances in Psychiatric Treatment 12, 228238.CrossRefGoogle Scholar
Rose, D., Wykes, T., Leese, M., Bindman, J. & Fleischmann, P. (2003). Patients' perspectives on ECT: Systematic review. British Medical Journal 326, 13631366.Google Scholar
Ross, C. (2006). The sham ECT literature: Implications for consent to ECT. Ethical Human Psychology and Psychiatry 8, 1728.Google Scholar
Royal College of Psychiatrists (1977). Memorandum on the Use of ECT. British Journal of Psychiatry 131, 261272.Google Scholar
Sackeim, H., Haskett, R., Mulsant, B., Thase, M., Mann, J., Pettinati, H., Greenberg, R., Crowe, R., Cooper, T. & Prudic, J. (2001). Continuation pharmacotherapy in the prevention of relapse following ECT: A randomized controlled trial. Journal of the American Medical Association 285, 12991307.Google Scholar
Sackeim, H., Prudic, J., Fuller, R., Keilp, J., Lavori, P. & Olfson, M. (2007). The cognitive effects of ECT in community settings. Neuropyschophamacology 32, 244254.Google Scholar
Sackett, D., Rosenberg, W., Gray, J., Haynes, R. & Richardson, S. (1996). Evidence based medicine: What it is and what it isn't. British Medical Journal 312, 7172.Google Scholar
Sarita, E, Janakiramiaiah, N., Gangadhar, B., Subbakrishna, D. & Rao, K. (1998). Efficacy of combined ECT after two weeks of neuroleptics in schizophrenia. NIMHANS Journal 16, 243251.Google Scholar
Scherer, I. (1951). Prognoses and psychological scores in ECT, psy-chosurgery and spontaneous remission. American Journal of Psychiatry 107, 926931.Google Scholar
Sharma, V. (1999). Retrospective controlled study of inpatient ECT: Does it prevent suicide? Journal of Affective Disorders 56, 183187.Google Scholar
Shiwach, R., Reid, W. & Carmody, T. (2001). An analysis of reported deaths following ECT in Texas, 1993–1998. Psychiatric Services 52, 10951097.Google Scholar
Shorter, E. & Healey, D. (2007). Shock Therapy: A History of ECT in Mental Illness. Rutgers University Press: New Jersey.Google Scholar
Shukla, G. (1981). ECT in a rural teaching general hospital in India. British Journal of Psychiatry 139, 569571.Google Scholar
Smith, L., Hughes, J., Hastings, D. & Alpers, B. (1942). Electroshock treatment in the psychoses. American Journal of Psychiatry 98, 558561.Google Scholar
Squire, L. & Slater, P. (1983). ECT and complaints of memory dysfunction. British Journal of Psychiatry 142, 18.Google Scholar
Squire, L., Slater, P. & Miller, P. (1981). Retrograde amnesia and bilateral electroconvulsive therapy: Long-term follow-up. Archives of General Psychiatry 38, 8995.Google Scholar
Sterling, P. (2000). ECT damage is easy to find if you look for it. Nature 403, 242.Google Scholar
Strensrud, P. (1958). Cerebral complications following 24,562 convulsion treatments in 893 patients. Acta Psychiatrica Neurologica Scandinavica 33, 115126.Google Scholar
Taylor, P. & Fleminger, J. (1980). ECT for schizophrenia. Lancet i, 380382.Google Scholar
Tecoult, E. & Nathan, N. (2001). Morbidity in ECT. European Journal of Anaesthesisology 18, 511518.Google Scholar
Tharyan, P. & Adams, C. (2005). Electroconvulsive therapy for schizophrenia. Cochrane Database of Systematic Reviews Issue2, CD000076.CrossRefGoogle Scholar
Tillotson, K. & Sulzbach, W. (1945). A comparative study and evaluation of electric shock therapy in depressive states. American Journal of Psychiatry 101, 455459.Google Scholar
UK ECT Review Group (Carney, S., et al.) (2003). Efficacy and safety of ECT in depressive disorders. Lancet 361, 799808.Google Scholar
Ukpong, D., Makanjuola, R. & Morakinyo, O. (2002). A controlled trial of modified electroconvulsive therapy in schizophrenia in aNigerian teaching hospital. West African Journal of Medicine 21, 237240.Google Scholar
Ulett, G., Smith, K. & Gleser, G. (1956). Evaluation of convulsive and subconvulsive shock therapies utilizing a control group. American Journal of Psychiatry 112, 795802.CrossRefGoogle ScholarPubMed
van der Wurff, F., Stek, M., Hooogendijk, W. & Beekman, A. (2003). Electroconvulsive therapy for the depressed elderly. Cochrane Database of Systematic Reviews Issue 2, CD003593.Google Scholar
West, E. (1981). ECT in depression. British Medical Journal 282, 355357.Google Scholar
Ziskind, E., Somerfeld-Ziskind, E. & Ziskind, L. (1945). Metrazol and ECT of the affective psychoses. AMA Archives of Neurology and Psychiatry 53, 212217.CrossRefGoogle Scholar