Focused clinical reference

Electroconvulsive therapy (ECT)

A clinician overview of referral, consent, preparation, monitoring and continuation planning.

Reference information · Focused clinical reference
Last content update
2026-10-27
Clinical review
Not independently reviewed
Source jurisdiction
See individual sources
Coverage
Focused clinical reference
What changed in this edition

Clinical essentials #

ECT requires specialist assessment, anesthesia and a suitably equipped service. Referral is a discussion of indication, alternatives, urgency and individual risks.

For severe depression, NICE identifies situations including a need for rapid response or unsuccessful other treatment. Catatonia has a separate specialist evidence base.

Preparation and treatment review #

The ECT team assesses medical and anesthetic suitability and reviews medicines, baseline cognition and illness severity. Explain fasting, transport and post-anesthetic arrangements using the service’s instructions.

ECT is administered under general anesthesia with muscle relaxation. This reference does not specify stimulus dosing, electrode selection or anesthetic prescribing.

Response and cognitive effects #

Assess clinical benefit and adverse effects throughout the course, including memory and day-to-day function. Review continuation if adverse effects outweigh benefit or treatment goals have been reached.

Give patients and supporters a clear route to discuss memory concerns and recovery after treatment; avoid promising a uniform response.

After the course #

Plan ongoing medication/psychological treatment and relapse monitoring rather than ending care with the final session. Selected patients may discuss continuation or maintenance ECT with the specialist team.

Document the outcome, cognitive concerns and follow-up responsibilities in the handover.

References · 3
  1. NICE NG222, section 1.13: ECT for depression · United Kingdom; depression guideline · Supports: Clinical essentials, Information and consent, Response and cognitive effects
  2. Royal College of Psychiatrists: ECT · United Kingdom; treatment information · Supports: Preparation and treatment review, Response and cognitive effects, After the course
  3. BAP catatonia consensus recommendations · United Kingdom; catatonia guidance · Supports: Clinical essentials

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