Yes, electroconvulsive therapy (ECT), commonly called “shock therapy,” is still used and remains one of the most effective treatments available for severe depression. It looks nothing like the dramatic portrayals from old movies or the unregulated procedures of the mid-20th century. Modern ECT is performed under general anesthesia, uses precisely controlled electrical currents, and is backed by decades of clinical evidence showing strong results, particularly when medications have failed.
Why It’s Still Used
ECT persists in modern psychiatry for a simple reason: it works when other treatments don’t. A decade-long study of national data from Scotland found that 73% of patients with moderate to severe depression responded to ECT, and 51% achieved full remission. Those numbers are remarkably high for a population where, in most cases, multiple antidepressants have already failed. About 62% of patients referred for ECT had already been classified as medication-resistant.
The treatment is most commonly prescribed for major depressive episodes, but it’s also used for severe mania, catatonia, and certain psychotic conditions. It’s often considered when a person is in immediate danger, such as active suicidal crisis or refusal to eat and drink, because ECT can produce improvement faster than medications, which typically take weeks to build up in the body.
How Modern ECT Differs From the Past
The version of “shock therapy” that shaped public perception, patients strapped to tables, biting down on objects, bodies convulsing violently, hasn’t existed for decades. Today’s procedure takes place in a controlled medical setting with an anesthesiologist present. You receive general anesthesia so you’re completely unconscious, along with a muscle relaxant that prevents the physical convulsions that made the old procedure so distressing and sometimes caused broken bones.
Once you’re asleep, a carefully calibrated electrical current is delivered through electrodes placed on the scalp. The goal is to trigger a brief, controlled seizure in the brain lasting roughly 30 to 60 seconds. You don’t feel it, and your body barely moves. The entire session, from going under anesthesia to waking up, takes only minutes. Most people are alert and talking within an hour afterward.
What a Typical Course Looks Like
In the U.S., ECT is typically given two to three times per week over three to four weeks, for a total of 6 to 12 sessions. For a major depressive episode, the median number of treatments is around 10. Each visit is an outpatient procedure in most cases, meaning you go home the same day, though you’ll need someone to drive you.
Improvement sometimes begins after just a few sessions, though the full benefit usually builds over the course of treatment. After the initial round, many patients transition to maintenance ECT, where sessions are spaced further apart (weekly, then biweekly, then monthly) to prevent relapse. Research shows that maintenance ECT combined with medication reduces the relapse rate to about 23% over the following six months to a year, compared with 34% for medication alone.
How It Works in the Brain
The honest answer is that scientists don’t fully understand the mechanism, but the leading model involves three stages: disruption, neuroplasticity, and rewiring. The induced seizure appears to interrupt dysfunctional patterns of brain activity, then stimulate the brain’s natural ability to form new connections and reorganize neural circuits. Brain imaging studies consistently show measurable structural and functional changes after ECT, particularly in regions involved in mood regulation. This is fundamentally different from how antidepressants work, which is part of why ECT can succeed where medications have not.
Side Effects and Memory Concerns
Memory loss is the side effect that concerns most people, and it’s a legitimate trade-off to understand. There are two types that can occur. The first is difficulty forming new memories around the time of treatment, which is common and typically resolves within weeks after the course ends. The second, more troubling type involves gaps in autobiographical memory, where you lose some memories of events from weeks or months before treatment. For most people, these gaps are partial and improve over time, but some patients report persistent memory difficulties that don’t fully resolve.
Other short-term side effects include confusion immediately after waking from anesthesia (usually clearing within an hour), headache, nausea, and muscle soreness. These are generally mild and manageable. Serious medical complications are rare, on par with the general risks of brief anesthesia.
The placement of electrodes matters. Placing both electrodes on one side of the head (unilateral placement) causes fewer cognitive side effects than placing one on each side (bilateral), though bilateral placement may be more effective for some patients. Your treatment team balances these factors based on how you respond.
Why the Stigma Persists
ECT carries more stigma than almost any other medical procedure, largely because of its history. Before anesthesia became standard in the 1950s and 1960s, the treatment was genuinely brutal and sometimes used coercively in institutional settings. Films like “One Flew Over the Cuckoo’s Nest” cemented that image in public consciousness. The term “shock therapy” itself contributes to fear, which is why clinicians prefer “electroconvulsive therapy” or simply “ECT.”
That stigma has real consequences. Many patients who could benefit from ECT delay or refuse it, and some clinicians underutilize it. The American Psychiatric Association has published extensive clinical guidelines supporting its use, including detailed informed consent requirements that ensure patients understand what the procedure involves, what to expect, and what the risks are before agreeing to treatment. Nothing about modern ECT is done without the patient’s knowledge and permission.
The Relapse Challenge
ECT’s biggest limitation isn’t the procedure itself but what happens afterward. Depression has a high recurrence rate regardless of treatment, and ECT is no exception. Without ongoing treatment, a significant percentage of patients relapse within months. Maintenance ECT helps during the first year, cutting relapse risk by roughly a third compared to medication alone. But after that first year, the protective advantage fades. In one long-term study, about 55% of patients on maintenance ECT plus medication relapsed during extended follow-up, compared to 43% on medication alone, with no statistically significant difference between the groups.
This means ECT is best understood as a powerful tool for breaking out of a severe depressive episode, not a permanent cure. Most patients continue with medication, therapy, or periodic maintenance sessions to sustain their improvement.