# Electroconvulsive Therapy

> ECT notes for NEET-PG Psychiatry covering indications like catatonia and psychotic depression, relative contraindications, technique, anaesthesia and memory effects.

- Canonical URL: https://prepelephant.com/topics/neet-pg/psychiatry/electroconvulsive-therapy
- Exam / course: NEET-PG · Subject: Psychiatry
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Electroconvulsive Therapy", PrepElephant, https://prepelephant.com/topics/neet-pg/psychiatry/electroconvulsive-therapy

## Direct answer

Electroconvulsive therapy (ECT) induces a controlled generalised seizure under short-acting general anaesthesia with a muscle relaxant to treat severe mental illness. Its strongest indications are catatonia, severe depression with psychosis, suicidality or refusal of food, mania unresponsive to drugs, treatment-resistant illness, and states where speed of response is life-saving. There is no absolute contraindication; conditions such as raised intracranial pressure are the most serious relative risks.

## What you must remember

- **Indications:** severe depression with psychotic features, high suicide risk or food and fluid refusal; catatonia (one of the most rapid responses); mania unresponsive to drugs; treatment-resistant depression and schizophrenia; depression in pregnancy when drugs are unsuitable.
- **Contraindications:** none absolute; relative risks include raised intracranial pressure, recent myocardial infarction or stroke, unstable vascular aneurysm, retinal detachment, phaeochromocytoma and severe osteoporosis.
- **Technique:** unilateral non-dominant electrode placement minimises memory disturbance, while bitemporal placement is stronger and faster; an adequate seizure generally needs to last at least about 25 to 30 seconds, and seizure threshold rises over the course.
- **Course:** typically six to twelve treatments given two to three times per week; maintenance pharmacotherapy must follow to prevent relapse.
- **Anaesthesia:** propofol or etomidate for induction, suxamethonium for muscle relaxation, with atropine premedication; the physiological surge transiently raises blood pressure and intracranial pressure.
- **Adverse effects:** headache, myalgia and transient confusion are common; memory impairment — anterograde resolves quickly, retrograde largely recovers over weeks to months; mortality is extremely low and comparable to brief anaesthesia.
- **Indian legal position:** under the Mental Healthcare Act 2017, ECT must be given under anaesthesia with muscle relaxants, with informed consent; use in minors is restricted to exceptional circumstances with guardian consent and approval of the concerned board.

## Common confusion

The recurring confusion is ECT's perceived danger versus its actual risk profile — it is among the safest treatments in psychiatry, and its memory effects are mostly transient, unlike the cognitive loss families fear. Distinguish electrode placements by outcome: unilateral non-dominant for fewer cognitive effects, bitemporal for urgency and severity. Also separate ECT from psychosurgery: ECT induces a therapeutic seizure and causes no structural brain damage, whereas psychosurgery such as anterior cingulotomy is a neurosurgical lesion reserved for the most refractory obsessive-compulsive and depressive illness.

## Exam-focused takeaway

NEET-PG tests ECT as an indications-and-facts topic: a depressed patient refusing food or with nihilistic delusions, or a mute, posturing catatonic patient, makes ECT the answer; the first step in catatonia management is often a lorazepam challenge with ECT for refractory cases. Learn the relative-contraindication list with raised intracranial pressure at the top, the seizure-duration requirement, the anaesthetic and relaxant agents, unilateral versus bitemporal differences, and the Mental Healthcare Act 2017 provisions — a genuinely Indian exam favourite. Memory effects are tested as transient and largely reversible.

## Frequently asked questions

### What is the commonest indication for ECT?

Severe depression — especially with psychotic features, suicidality or refusal of food — with catatonia the classic indication for the fastest response.

### Does ECT have an absolute contraindication?

No; raised intracranial pressure and recent cardiovascular events are the most serious relative contraindications.

### Which electrode placement causes fewer memory effects?

Unilateral placement over the non-dominant hemisphere; bitemporal placement is more effective in urgent, severe illness.

### Which drugs are used during ECT?

A short-acting induction agent such as propofol or etomidate, suxamethonium for muscle relaxation, and atropine premedication.

### Is memory loss after ECT permanent?

No — anterograde impairment settles quickly and retrograde gaps mostly recover over weeks to months.

### What does the Mental Healthcare Act 2017 say about ECT?

It requires ECT under anaesthesia with muscle relaxants and informed consent, and restricts its use in minors to exceptional, board-approved circumstances.