ECT for OCD: Understanding the Procedure, Effectiveness, and Side Effects

Electroconvulsive therapy (ECT), also known as “shock therapy,” is a medical procedure that is performed under general anesthesia. It is typically used in severe cases of depression (in those over the age of 60), schizophrenia (with psychosis), and bipolar (with mania), although it is also sometimes used to treat anxiety conditions like OCD.

ECT involves “sparking” the brain with electricity to trigger a mini or temporary seizure. The goal of ECT is to elicit changes in the brain that can quickly ease various mental health symptoms. This medical procedure is usually recommended when the symptoms are severe and other treatments have been unsuccessful.

However, ECT may not be beneficial or successful for some people. ECT is controversial and even taboo in some circles, primarily because of its dubious history. In the late 1930s, this medical procedure was largely unresearched and poorly administered for depression and a variety of other mental health issues.

The results were so damaging and risky that they often led to life-threatening consequences or death. In the earlier stages of ECT, unregulated and highly lethal doses of electricity were administered to patients without anesthesia, leading to confusion, mood, and personality changes, paralysis, extreme pain, memory loss, broken bones, brain damage, etc.

Fortunately today, ECT is regulated, safer, and more effective in severe or “untreatable” cases of mental illness. While ECT still causes some pretty serious side effects and complications, it now involves using streams of electricity that are controlled to garner the most benefits with the lowest possible risks.

Most mental health conditions, like OCD, are treated with a combination of psychotherapies, like cognitive-behavioral therapy (CBT) or exposure-response and prevention (ERP) therapy, medications, like SSRI antidepressants, and natural remedies like mindfulness meditation, crystal therapy, hypnosis, and/or Impulse Therapy, an online OCD treatment recovery program.

Electroconvulsive therapy is an alternative treatment that has been proven to help some people with severe or treatment-resistant OCD. In this article, you will learn what electroconvulsive therapy is, how it works, if it is safe and effective for OCD, and its possible side effects to help you determine if it could be a viable treatment for you.

Is ECT Painful?

No, ECT is not painful because you are unconscious during the procedure.

Can ECT Be Used to Treat OCD?

Yes, ECT can be used to treat OCD. 

The belief is that administering electricity to the brain can disrupt the frequency and severity of a person’s intrusive, upsetting, and repetitive thoughts, urges, fears, visions, emotions (obsessions), and ritualistic behaviors (compulsions). Understand, however, that ECT should never be the first line of treatment, rather, it should only be considered or administered after all other treatments have failed to produce satisfactory results.

What is the ECT Procedure for OCD?

The actual ECT procedure typically takes between 5-15 minutes in total, however, the preparation and recovery can take much longer. The medical procedure can be conducted in a hospital or outpatient setting. 

Before The Procedure

Listed below are ways you can prepare for an ECT procedure:

• General Anesthesia

Unlike in the past, patients of ECT can expect to be placed under general anesthesia during the procedure. What does that mean? It means no food or drink after midnight before the procedure. However, you can take a sip of water to take your approved medications. Your psychiatrist or psychologist should provide you with specific pre-procedure instructions to follow.

• Physical Exam

You can also expect to receive a pre-procedure physical exam, which will likely include a blood pressure and temperature check, and an examination of your heart and lungs.

• Labs

Labs will also be required. More specifically, a complete blood count, a metabolic panel, and thyroid and kidney function tests are just some of the labs that will be conducted before ECT.

• Imaging Tests

Imaging tests on your skull, brain, and spine will also be performed before ECT. These tests may include X-rays and/or computerized tomography (CT) scans.

• Intravenous (IV) Line

Your nurse or anesthesiologist will insert an IV into your arm, shoulder, or hand, so medications and fluids can enter your body. You may also receive an anti-anxiety medication before the procedure to help you relax. 

• Electrodes

Small round electrodes (pads) will be placed on one or both sides of your head. The purpose of these pads is to regulate or equally distribute the electrical currents to your brain.

During the Procedure

At the beginning of the procedure, medications and fluids will be pushed through your IV. One of these medications will be an anesthetic that will render you unconscious. The purpose of this anesthetic is to make you oblivious to what is happening during the procedure. You will also be given a muscle relaxant so your muscles do not clench up during the procedure, and to prevent or reduce seizures or an injury like a broken jaw. You may also receive other medications if you have other conditions through your IV at this time and/or to prevent an allergic reaction.

A blood pressure monitor will be placed around your ankle to make sure your blood pressure does not get too high during the procedure. This monitor will also prevent the muscle relaxer from transcending into your food and affecting the muscles in that area. The purpose of keeping your feet on “alert” is to allow the anesthesiologist to detect if you are having a seizure. A rhythmic motion exhibited in your food is an indication that you are having a seizure.

You will be connected to monitors that will constantly check your heart, blood pressure, and oxygen levels. As a precaution or in case of a drop in your oxygen level, an oxygen mask may be used. Once asleep, a mouthguard will be placed in your mouth to prevent your tongue or teeth from being damaged during the procedure. Once everything is in place, your doctor will turn on the ECT machine, causing small amounts of electrical current to pass through the electrodes placed on one or both sides of your head. The currents will enter your brain, triggering mini or temporary seizures. Each seizure lasts about 1 minute, although it can be shorter or longer than this timeframe.

You will remain “asleep,” unaware, and relaxed during the procedure. However, your brain activity significantly increases during this time due to the constant electrical current traveling through your brain. During the procedure, an electroencephalogram (EEG) records the amount of electrical activity in your brain. A sudden boost in brain activity on an EEG can signal the start of a seizure, while a decline in brain activity can signal the ending of the seizure. 

Once the procedure is over the anesthetic and muscle relaxer will gradually wear off, and you will be transferred to the recovery area, where medical staff (i.e., nurses) will check your vitals and watch for any complications. You will likely stay in the recovery area for about an hour or so. Upon waking, you will feel groggy, and perhaps, a bit confused. You may also become nauseous and vomit. This is a normal reaction to the anesthesia, muscle relaxer, and procedure. These aftereffects can last a few minutes to a couple of hours or more. 

US-based ECT treatments for OCD are typically administered about 2-3 times a week for approximately 3 or 4 weeks. This equals out to about 6-12 ECT treatments. A new ECT is being used to treat OCD symptoms. It is called “right unilateral ultra-brief pulse electroconvulsive therapy.” This type of ECT is normally administered daily (Monday thru Friday). The number of ECT treatments needed to improve your OCD largely depends on the type, frequency, and severity of your symptoms, and your health status. 

However, most OCD sufferers can, in general, return to their normal activities, such as eating, bathing, dressing, walking, etc., within a few hours. However, it is generally advised not to return to school, work, or operating machinery, including your vehicle for at least 2 weeks following the last ECT treatment. It is also advised not to make important or life-altering decisions until this time. 

If only one or two maintenance ECT treatments are needed to stop your OCD cycle or keep your symptoms at bay, then most doctors recommend refraining from making these decisions until at least 24 hours have passed following each session. Understand, however, that returning to previous activities will depend on how quickly your memory loss, mental confusion, and/or agitation resolves. 

After the Procedure

Most OCD sufferers experience some improvement within 6 weeks of undergoing ECT. Full improvement, however, usually takes more time. Also, keep in mind that ECT may not be effective for everyone. While some OCD sufferers may only need one bout of ECT treatments, others may need periodic ECT treatments to keep their OCD symptoms at bay. 

So, even after your OCD symptoms ease up, there is a chance you may still need regular ECT sessions to avoid an OCD relapse. For most OCD sufferers, maintenance ECT sessions will likely be less frequent but still include psychotherapies like CBT and ERP therapy, medications like antidepressants or antipsychotics, natural remedies like CBD, acupuncture, OCD support groups or podcasts, healthy coping strategies, etc.

How Does ECT Work For OCD?

ECT appears to work for OCD by disrupting “unbalanced” or “abnormal” brain activity patterns, often linked to OCD. The truth is the exact way that ECT helps mental health conditions like depression, anxiety, and OCD is unknown at this time. However, most researchers agree that ECT changes specific brain processes, before and after the procedure, that could rescue or stop the rapid depletion of serotonin in the brain, helping it maintain a healthy level, and thereby, reducing obsessions and compulsions.

ECT may also alter or disrupt the activity of certain neurotransmitters (chemical messengers in the brain) that can cause you to get wrapped up in an OCD loop of stress and anxiety, intrusive thoughts, and compulsive behaviors. This disruption or change in brain activity is presumed to be responsible for the reduction in OCD symptoms, which is why some OCD sufferers need several courses of ECT treatments to experience real relief.

So, the consensus is that ECT works for OCD by calming brain activity and disrupting or balancing neurotransmitter signals in the brain. The result? Fewer intrusive, upsetting, and/or repetitive thoughts, urges, emotions, visions, fears (obsessions), or ritualistic behaviors (compulsions). It is important, however, that when used to treat severe OCD, ECT be combined with other therapies and treatments for lasting results. Because ECT may not be right for all OCD sufferers it is important to weigh the pros and cons of using this type of OCD treatment with your doctor and loved ones.

Is ECT Effective for OCD?

In the past, most researchers believed that while ECT could help with moodiness and depression, it was not particularly effective for OCD when these elements were not present. A previous study found that ECT did not reduce or improve OCD symptoms, and in some cases, worsened OCD symptoms in some people. However, upon further research, the general assumption is that ECT may be effective for OCD, but further research is still needed to determine if this theory is true. 

A recent study found that approximately 60% of OCD sufferers may experience some degree of improvement in their symptoms, however, the jury is still out and further research is warranted before determining that ECT is an ineffective treatment for OCD. Similarly, another study found that ECT significantly improved OCD symptoms and that this improvement continues to persist during follow-ups. Thus, the researchers surmised that ECT could be a viable treatment option for severe OCD. 

However, some studies suggest that there is not enough evidence to determine if ECT is effective for OCD or not. According to these researchers, more evidence is needed to determine if and how effective this treatment is for severe OCD.

What Are The Benefits of Using ECT for OCD?

There are several benefits of using ECT for OCD such as:

• ECT can be effective for some OCD sufferers (especially when mood conditions, like depression, are involved). 
• ECT can offer an alternative treatment option for people who struggle with severe OCD that is treatment-resistant. 
• ECT is generally thought to be safe for most people.
• Even pregnant women can safely use ECT to manage their severe OCD symptoms.
• ECT works quickly. More specifically, you do not have to wait weeks (like you do with antidepressants and other OCD medications) to experience relief or fewer obsessions and/or compulsions.
• ECT can be used when other OCD medications are unavailable. For instance, ECT can be used when an OCD sufferer is unable to take traditional OCD medications like SSRI antidepressants due to another condition.
• It can safely be combined with most other medications, such as antidepressants or antipsychotics, boosting its effectiveness and reducing OCD symptoms.

What Are The Side Effects?

Like most OCD treatments, ECT can cause side effects and complications.

The most common side effects of ECT include:

• Nausea and Vomiting
• Severe and Unrelenting Headaches
• Severe Fatigue
• Moodiness
• Anger
• Agitation
• Changes in Mood, Personality, and/or Behavior
• Confusion
• Temporary or Permanent Memory Loss
• Brain Damage
• Suicidal Ideation (Thoughts and Attempts)
• Fast or Irregular Heartbeats
• Death

Note: These side effects can last for minutes or hours and typically occur in the hours following the procedure. Understand, however, that the benefits must outweigh the risks when using it to treat mental health conditions like severe OCD.

What is It Like To Experience ECT for OCD?

One of the best ways to get a feel of what ECT is and how it may or may not help OCD is to hear from other OCD sufferers who have used ECT for OCD.

Listed below are real-life reviews from people with OCD who have used ECT to combat their symptoms:

• Ok, here’s my time to shine. I just recently had ECT done, and 9 back-to-back treatments. I go in monthly for additional treatments to keep everything in check. I did ECT for my extreme depression because nothing was working. I also have and have had major OCD most of my life.

  As for the depression, it improved an insane amount. At this point, I feel like I went from extreme major depression to mild or borderline depression (although I did have a huge loss in short-term memory at first, a couple of months, but after a couple of months my memory got better. As for the OCD, ECT did not do much.”

• “I took ECT for OCD and it did not work for me. Though the conscious part of the obsession is gone, I was still filled with vague panic. And, guess what? My compulsions got worse as a result. I did not understand what I was doing because I could not even process what I was feeling or even my thoughts.”

• “I suffered from horrible OCD intrusive thoughts and suicidal imagery. But after seven ECT treatments, I no longer have them. ECT did the trick for me! It was truly liberating.”

• “I have had 3 sets of 12 ECT treatments in the past, and they did not do much for my OCD. I also suffered from severe depression, and that got better with the ECT, but only for a couple of months, then the depression came back. I tried TMS, and it not only did well for my depression but also for my OCD. But unfortunately, it didn’t last, and my OCD and depression came back. ECT has also left me with some short-term memory loss. I am not a doctor so I can’t tell you what to do like a doctor can, but speaking for myself, the ECT did not have much effect on my OCD.”

Final Thoughts

In some cases, OCD can be extremely hard to treat and manage. Traditional OCD treatments, like SSRI antidepressants, CBT or ERP therapy, and natural remedies simply do not work. When this occurs, it is time to think of alternative solutions like electroconvulsive therapy or ECT. Understand, however, that ECT is no longer the scary, life-altering treatment it once was. Today ECT is a safe and controlled treatment that can help some people better manage their OCD symptoms, however, the jury is still out as to how effective it is and can be in the future.

Therefore more research is needed to determine its full effectiveness when treating OCD. Researchers have found that this medical procedure can be highly effective for people suffering from a mood condition like depression, so the hope is that ECT combined with other OCD treatments, can and will also one day be an effective treatment for moderate to severe OCD. With the right treatment, you can have a life free of intrusive, unwanted, and repetitive obsessions and/or compulsions.

References

• Lins-Martins, N., Yucel, M., Tovar-Moll, F., Rodrigues, E., & Fontenelle, L. (2014). Electroconvulsive therapy in obsessive-compulsive disorder: A chart review and evaluation of its potential therapeutic effects. The Journal of Neuropsychiatry and Clinical Neurosciences, 27. Retrieved from https://www.researchgate.net/publication/264628423_Electroconvulsive_Therapy_in_Obsessive-Compulsive_Disorder_A_Chart_Review_and_Evaluation_of_Its_Potential_Therapeutic_Effects
• Fontenelle, L. F., Coutinho, E. S., Lins-Martins, N. M., Fitzgerald, P. B., Fujiwara, H., & Yücel, M. (2015). Electroconvulsive therapy for obsessive-compulsive disorder: a systematic review. The Journal of Clinical Psychiatry, 76(7), 949–957. Retrieved from https://doi.org/10.4088/JCP.14r09129
• Liu, X., Cui, H., Wei, Q., Wang, Y., Wang, K., Wang, C., Zhu, C., & Xie, X. (2014). Electroconvulsive therapy on severe obsessive-compulsive disorder comorbid depressive symptoms. Psychiatry Investigation, 11(2), 210–213. Retrieved from https://doi.org/10.4306/pi.2014.11.2.210
• Li, K., Long, J., Deng, W., Cheng, B., & Wang, J. (2022). Electroconvulsive therapy for obsessive-compulsive disorder: A retrospective study. Frontiers in Psychiatry, 13, 1040443. Retrieved from https://doi.org/10.3389/fpsyt.2022.1040443
• Li, M., Yao, X., Sun, L., Zhao, L., Xu, W., Zhao, H., Zhao, F., Zou, X., Cheng, Z., Li, B., Yang, W., & Cui, R. (2020). Effects of electroconvulsive therapy on depression and its potential mechanism. Frontiers in Psychology, 11, 80. Retrieved from https://doi.org/10.3389/fpsyg.2020.00080
• Lins-Martins, N., Yucel, M., Tovar-Moll, F., Rodrigues, E., & Fontenelle, L. (2014). Electroconvulsive therapy in obsessive-compulsive disorder: A chart review and evaluation of its potential therapeutic effects. The Journal of Neuropsychiatry and Clinical Neurosciences, 27. Retrieved from https://www.researchgate.net/publication/264628423_Electroconvulsive_Therapy_in_Obsessive-Compulsive_Disorder_A_Chart_Review_and_Evaluation_of_Its_Potential_Therapeutic_Effects