Unwanted effects

• Memory impairment: transient memory impairment, both retrograde and anterograde, is frequent after each application, but usually settles within a few hours. ECT as used now does not seem to cause persisting memory problems. A small number of chronic ex-asylum patients may have had large numbers of treatments many years ago, and here a link to memory problems is more plausible. The whole question is of course confounded by the memory problems that accompany severe depressive illness, with or without ECT.

• Confusion: mild transient confusion after treatment is frequent. If a severe confusional state develops, ECT should be discontinued, and evidence for organic brain disease sought.

• Anaesthetic complications.

• Fractures: this is not a hazard if the fit is adequately modified by a muscle relaxant.

• Mania may be precipitated when ECT is given to patients with bipolar affective disorder in the depressed phase.

Mortality is 1 per 50 000 treatments, almost always from anaesthetic complications.

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