When standard treatments for major depression, medication and therapy, do not bring enough relief, electroconvulsive therapy (ECT) is sometimes considered. ECT uses a controlled electrical current to bring on a brief seizure in the brain. It has been used for decades to treat severe depression, despite ongoing misconceptions that have made it less accepted than the evidence might justify.
A 2023 study compared outcomes for 220 people with severe major depressive disorder, some of whom received ECT and some of whom continued with medication and therapy. Depression scores improved in both groups over the 12-week study. Improvement was more pronounced, though, in the group who received ECT. That group also showed greater improvement in quality of life and cognitive function than the comparison group, and showed smaller changes in two biological markers linked to brain plasticity and inflammation. Side effects were mild and similar in both groups.
ECT is a medical procedure delivered by psychiatrists in a hospital setting, not something provided as part of psychological treatment. But understanding that it has a genuine evidence base matters for anyone facing a decision about severe, treatment-resistant depression. If you or someone you love is struggling with depression that has not responded to treatment, talk to your GP or psychiatrist about the full range of options, and consider psychological support alongside any medical treatment.
What the study did
This 2023 prospective cohort study set out to compare the efficacy and safety of electroconvulsive therapy (ECT) against medication and/or therapy in people with severe major depressive disorder (MDD). It enrolled 220 individuals with severe MDD, dividing them into an ECT group and a non-ECT group. Those in the ECT group underwent bilateral ECT three times a week until they either achieved remission or reached a maximum of 12 sessions. The non-ECT group received medication and/or therapy in line with standard clinical guidelines for MDD. Over 12 weeks, the researchers tracked depression severity using the Hamilton Depression Rating Scale, along with quality of life, cognitive function and two biological markers: brain-derived neurotrophic factor (BDNF) and the inflammatory marker interleukin-6 (IL-6).
What it found
Both groups improved over the 12-week period. The improvement in depression scores, though, was more pronounced among those who received ECT. The ECT group also showed a more substantial improvement in quality of life and in cognitive function compared with the non-ECT group, which speaks directly to a common concern: that ECT harms thinking and memory. On the biological measures, the ECT group showed evidently lower variation in BDNF and IL-6 levels than the comparison group, markers the authors link to neuroplasticity and inflammation respectively. Side effects were mild in both groups. The authors concluded that ECT was safer and more effective than medication and/or therapy at reducing depressive symptoms, improving wellbeing and supporting cognitive function in this group with severe MDD, describing it as a potentially advantageous approach for people who have not responded to other treatments.
Why it matters
ECT carries a level of public stigma that does not always match what the evidence shows. This study adds to that evidence base by directly comparing ECT against standard treatment in people with severe depression, finding not only stronger improvement in mood but also better outcomes for quality of life and cognitive function, an area many people worry about most. It is important to be clear about scope: ECT is a medical procedure, administered by psychiatrists, typically within a hospital setting, and it sits outside what a psychologist provides. Psychological therapy remains a central part of treatment and recovery, whether or not ECT is part of someone's care, and the two are not mutually exclusive.
Its limits
This was a cohort study rather than a randomised controlled trial, meaning participants were not randomly assigned to ECT or standard treatment, which leaves room for other differences between the groups to have influenced the results. The study followed participants for 12 weeks, so it does not speak to longer-term outcomes or durability of improvement beyond that window. It also does not detail the specific magnitude of the differences between groups in numerical terms, describing them only in relative terms such as more pronounced and more substantial.
Decisions about ECT are made with a psychiatrist, based on an individual's full clinical picture. Whatever role medical treatment plays, psychological support can help you and your family manage the experience of severe depression and work toward recovery.