Electroconvulsive therapy (ECT) is available at psychiatric hospitals, academic medical centers, and some outpatient psychiatric clinics. Most people access it through a referral from a psychiatrist, though the specific path depends on your diagnosis, insurance, and where you live. Finding a provider can take some legwork, but the treatment is widely offered across the United States, particularly at larger hospital systems with dedicated psychiatry departments.
Types of Facilities That Offer ECT
ECT is performed in medical settings equipped with anesthesia and monitoring equipment. The most common places to find it are university-affiliated medical centers, large hospital psychiatric units, and specialized interventional psychiatry programs. For example, UTHealth Houston runs a Center for Interventional Psychiatry that delivers ECT across inpatient, outpatient, and partial hospitalization levels of care. Many major health systems operate similar programs.
Community hospitals with psychiatric departments sometimes offer ECT as well, though availability varies widely by region. Rural areas tend to have fewer options, and you may need to travel to a larger city. Freestanding psychiatric hospitals and some Veterans Affairs medical centers also provide the treatment. Private practice psychiatrists almost never perform ECT in their offices because the procedure requires general anesthesia, recovery space, and a clinical team that includes an anesthesiologist or nurse anesthetist.
How to Find a Provider
The most direct route is to ask your current psychiatrist for a referral. If your psychiatrist doesn’t perform ECT (most don’t), they can refer you to a colleague or facility that does. If you don’t have a psychiatrist, your primary care doctor can make the referral.
You can also search on your own. The American Psychiatric Association maintains a public psychiatrist locator at finder.psychiatry.org, though it only lists members who have opted in and won’t specifically filter for ECT providers. A more practical approach is to call the psychiatry department at the nearest academic medical center or large hospital system and ask whether they have an ECT program. Many list their interventional psychiatry services on their websites. Searching “[your city] ECT treatment” or “[your city] interventional psychiatry” often surfaces the right departments quickly.
Your insurance company’s provider directory is another starting point. Call the number on your insurance card and ask specifically for in-network facilities that provide electroconvulsive therapy.
Who Qualifies for ECT
ECT is most commonly used for major depression, particularly treatment-resistant depression, which is defined as depression that hasn’t improved after two adequate trials of antidepressant medication. Unipolar and bipolar depression are the most frequent reasons people receive ECT.
It’s also used for several other psychiatric conditions. The recognized indications include:
- Severe depression with psychotic features, high suicide risk, refusal to eat or drink, or a need for rapid improvement
- Mania that hasn’t responded to medication, especially with dangerous agitation or mixed features
- Schizophrenia and schizoaffective disorder during acute psychotic episodes requiring intensive management
- Catatonia regardless of the underlying diagnosis
In emergency situations like active suicidality, catatonia, or severe psychotic agitation, ECT is considered a first-line treatment, meaning it doesn’t require trying multiple medications first. For depression without emergency features, it’s typically considered after at least two medication trials have failed. That said, clinical guidelines note that ECT should not be withheld simply because a patient hasn’t exhausted every possible drug combination, especially when symptoms are severe.
What Happens Before You’re Approved
Before starting ECT, you’ll go through a medical clearance process. This involves a physical exam, blood work (including a metabolic panel, thyroid function, and blood count), and an EKG to check your heart rhythm. Your doctor will do a dental evaluation for loose teeth (because of the brief jaw clenching during the procedure), a cardiovascular exam, and a neurological assessment. If you have a history of heart disease, brain lesions, or implanted devices like pacemakers or deep brain stimulators, you’ll need additional specialist evaluations and possibly imaging like a CT scan, MRI, or echocardiogram.
There are few absolute reasons ECT can’t be done, but certain conditions require extra caution. These include recent heart attacks or strokes, brain aneurysms, conditions that raise pressure inside the skull, and metal implants in the brain or scalp. The clearance process is designed to identify these risks, not to create barriers.
You’ll also go through an informed consent process. The treating psychiatrist will explain the expected benefits, risks (primarily short-term memory effects), and alternatives before you agree to proceed.
Outpatient vs. Inpatient ECT
ECT can be done on either an inpatient or outpatient basis. If you’re already hospitalized for a psychiatric crisis, treatment typically begins in the hospital. If your condition is stable enough, you can receive ECT as an outpatient, coming to the clinic for each session and going home afterward. You’ll need someone to drive you, since the general anesthesia means you can’t operate a vehicle that day.
Outpatient ECT is the more common arrangement for people with treatment-resistant depression who are functioning but not getting better with medication alone.
Treatment Schedule and Duration
A typical course involves two to three sessions per week. In the United States, three times weekly is common, while twice weekly is the standard in the United Kingdom. The American Psychiatric Association recommends two to three sessions per week and notes that more frequent sessions can produce faster improvement but carry a greater risk of cognitive side effects like memory problems. Twice-weekly treatment generally offers the best balance between effectiveness and cognitive outcomes.
Most acute courses run 6 to 12 sessions total, spread over two to six weeks depending on frequency and how quickly you respond. Some people then continue with less frequent “maintenance” ECT sessions, perhaps once a week tapering to once a month, to prevent relapse.
How Well ECT Works
ECT has the highest response rate of any treatment for severe depression, though it doesn’t work for everyone. In a recent community clinic study of patients who had tried an average of 5.3 antidepressant medications before starting ECT, 54.3% showed a meaningful response and 31.4% achieved full remission. These numbers reflect a highly treatment-resistant population, meaning the patients who are hardest to treat. For less resistant cases, response rates tend to be higher. Patients with severe co-occurring anxiety were less likely to respond, which may be worth discussing with your doctor if anxiety is a significant part of your symptoms.
Insurance Coverage and Cost
Most major insurance plans, including Medicare, cover ECT when it’s deemed medically necessary. Medicare specifically does not cover multiple-seizure ECT (where multiple seizures are induced in a single session), but standard single-seizure ECT is a covered service. Private insurers generally require documentation of treatment resistance or a qualifying emergency indication before authorizing coverage.
Out-of-pocket costs vary significantly depending on your plan, whether the facility is in-network, and whether you’re receiving inpatient or outpatient treatment. Each session involves charges for the psychiatrist, anesthesiologist, and facility use. With insurance, copays or coinsurance apply. Without insurance, a full course can cost thousands of dollars. Calling both your insurance company and the ECT facility’s billing department before starting treatment will give you the clearest picture of what you’ll owe.