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Last updated: 7/23/2022

General Electroconvulsive Therapy (ECT) Side Effects

There are many risks and side effects of ECT.

side effects patients are commonly told about

From psychiatry.org:

 The most common side effects of ECT on the day of treatment include nausea, headache, fatigue, confusion, and slight memory loss, which may last minutes to hours.

Side Effects listed by ECT Device Makers

From regulatory update to Thymatron® System IV instruction, Somatics LLC:

It is essential that doctors planning to use the Thymatron® System IV read and follow the warnings and recommendations of the Task Force Report of the American Psychiatric Association as set forth in “The Practice of Electroconvulsive Therapy” (APA, 2001), which states, in part, that “A small minority of patients treated with ECT later report devastating cognitive consequences. Patients may indicate that they have dense amnesia extending far back into the past for events of personal significance or that broad as of cognitive function are so impaired that the patients are no longer able to engage in former occupations…in some patient self-reports of profound ECT-induced deficits may reflect objective loss of function…In rare cases, ECT may result in a dense and persistent retrograde amnesia extending to years…”

page 1, REGULATORY UPDATE TO THYMATRON® SYSTEM IV INSTRUCTION MANUAL

Regulatory update, page 3, Other serious adverse events have occurred, including:

• Adverse reaction to anesthetic agents neuromuscular blocking agents
• Adverse skin reactions (e.g., skin burns)
• Cardiac complications, including
  • Arrhythmia
  • Ischemia/infarction (i.e., heart attack)
  • Acute hypertension
  • Hypotension
  • Stroke
• Cognition and memory impairment
• Brain damage
• Dental/oral trauma
• General motor dysfunction
• Physical trauma
  • (i.e., if inadequate supportive drug treatment is provided to mitigate unconscious violent movements during convulsions)
• Hypomanic or manic symptoms
  • (e.g., treatment-emergent mania, postictal delirium or excitement)
• Neurological symptoms
  • (e.g., paresthesia, dyskinesias)
• Seizures
  • Tardive seizures
  • Prolonged seizures
  • non-convulsive status epilepticus
• Pulmonary Complications
  • (e.g., aspiration/inhalation of foreign material, pneumonia, hypoxia, respiratory
  • Obstruction such as laryngospasm
  • Pulmonary embolism
  • Prolonged apnea)
• Visual disturbance
• Auditory complications
• Onset/exacerbation of psychiatric symptoms
  • Partial relief of depressive anergia enabling suicidal behavior
  • Homicidality
  • Substance abuse
  • Coma
  • Falls
• Device malfunction (creating potential risks such as excessive dose administration)

Other serious adverse events, continued:

“Certain patients are more likely to experience severe adverse events, including those with pre-existing cardiac illness, compromised pulmonary status, a history of brain injury, or medical complications after earlier courses of anesthesia or ECT. Concurrent administration of antipsychotic (neuroleptic) medication may increase the risks of adverse cardiac, pulmonary, and neurological events, and falls. Concurrent administration of stimulants may increase the risks of cardiac and neurological complications, such as prolonged seizure. All of this information should be assessed in developing the treatment plan for a particular patient.”

Page 3, REGULATORY UPDATE TO THYMATRON® SYSTEM IV INSTRUCTION MANUAL

Lesser known side Effects

There are lesser known side effects of ECT that need recognition, research and treatment development for those harmed.

The following symptom list is derived from formal & informal patient reports, medical literature research, and multiple electrical injury studies (see citations below).

Attention Problems

• Difficulties completing basic tasks or following up on longer tasks
• Difficulty multitasking
• Inability to pay attention
• More easily distracted after ECT than before
• Multitasking causing seizures
• Shorter attention span

Autonomic Nervous System

• Complex Regional Pain Syndrome (CRPS)
• Hyperadregeneric dysautonomia
• Orthostatic Hypotension
• Postural tachycardia
• Reflex Sympathetic Dystrophy
• Trigeminal Neuralgia

Cardiac Problems

• Arrhythmias (Long QT, etc)
• Heart attack
• Heart palpitations
• Irregular heart beat
• Other heart changes
• Pulmonary embolism
• Pulmonary insufficiency
• Valve regurgitation

Dental Problems

• Cracked teeth
• Dislocated jaw
• Jaw clenching
• Teeth grinding
• TMJ or other craniofacial pain

Difficulty with Daily Tasks

• Attending school
• Caring for family or pets
• Cleaning
• Cooking
• Driving
• Having conversations
• Housework
• Make and keep a budget
• Making and keeping plans
• Managing self-care
• Planning meals/grocery shopping
• Remembering where you live and how to get places
• Working

Emotional Problems

• Emotional numbness, trouble feeling emotions, feeling meaning
• Emotional outbursts (Especially when overwhelmed with sensory input (noise, lights, etc.)
• Laughing/giggling or crying when exhausted or startled though not feeling particularly happy or sad
• Trouble regulating emotions

Hearing Problems

• Central Auditory Processing Disorder
• Central vestibular disorder
• Hyperacusis (sound sensitivity)
• Problems retaining information you hear
• Problems understanding what you hear (auditory processing)
• Ringing/tinnitus
• Sirens or other loud noises trigger nausea or seizures
• Startling Noise causing arrhythmia
• Unable to enjoy music as you did before ECT
• Unable to ignore noise or filter out unnecessary noise

Memory Problems

• Long-term memories
• Memories don’t return after 6 months (or other time frame your doctor told you)
• Remembering directions
• Remembering education
• Remembering work experience
• Short-term memory
• Visual-memory (mind’s eye)
• Working memory (the ability to recall and hold information in mind so you can work with it. examples: mental math, rehearsing a phone number till you can dial it or write it down, etc)

Nervous System Problems

• Acquired channelopathies or other electrical injury-related conditions
• Balance problems, falling
• Bladder problems
  • Urinary retention
  • Incontinence
  • Frequent UTI infections
• Body temperature regulation difficulties
• Breathing problems
• Coordination problems
  • Walking
  • Talking
  • Breathing swallowing
• Coordination problems
  • Bumping into things
  • Misjudging distance
  • Not reacting fast enough when injured
• Easily overwhelmed by sights, sounds, changes in plans
• Episodes of dystonia (cervical, oromandibular, etc.)
• Episodes of Paralysis
• Kidney problems
• Motor Neuron Disease (i.e. ALS)
• Multiple Sclerosis
• Muscle stiffness
• Muscle twitching
• Myoneural Disorder
• Non-diabetic neuropathy
• Seizures
• Swallowing problems
• Trouble walking, talking, controlling limbs

Neurological Problems

• “General motor dysfunction”
  • Ataxia
  • Dystonia
  • Myoclonus
  • Spasms
  • Twitching/fasticulations
• Demyelinating Diseases
• Episodic paroxysmal neuromuscular disorders
• Muscular Sclerosis
• Neuropathy
• Parkinsonism
• Progressive ataxia, Motor Neuron Disease/Amyotrophic Lateral Sclerosis
• Progressive Supranuclear Palsy
• Seizures

Sleep Problems

• Central apnea
• Insomnia
• Other sleep disorder
• Sundowning

Speech Problems

• Diagnosed acquired speech disorder (verbal apraxia, dysarthria, anarthria)
• Difficulty holding on to words long enough to speak them
• Organizing speech
• Recalling words
• Slurred speech when tired
• Stuttering when overwhelmed

Unexpected Unusual Reactions to Previously Safe Medications

• Albuterol
• Lidocaine
• Novocaine
• Proparacaine
• OTC drugs that act on sodium/calcium/magnesium blockers (antacids, acid reducers, stool softeners, certain allergy meds like Allegra)
  • Drugs mentioned may cause
    • Transient hemiplegia
    • Stuttering or loss of speech (tetany seizures)
    • Heart palpitations
    • Irregular heart beat
    • Tachycardia or cardiac arrest  

Urological Dysfunction

• Erectile dysfunction
• Frequent UTIs
• Overactive bladder
• Renal failure
• Underactive bladder

Vision Problems

• Changes in vision, blurred, distorted
• Difficulty recognizing people who should be familiar
• Distorted vision
• Eyes not working together
• Headaches from using vision
• Motion sensitivity (if it causes you headaches, nausea, triggers seizures, etc)
• Photosensitivity to flashing or moving lights (if they cause you distress, trigger seizures, etc)
• Problems with depth perception
• Problems with hand/eye coordination
• Pupil dysfunction
• Reading causes seizures
• Sensitivity to lights, screens
• Visual neglect (not seeing or recognizing part of the area within your field of vision)

Citations

1. Morse MS, Berg JS, Ten Wolde RL. Diffuse Electrical Injury – A Study of 136 Subjects. Annu Int Conf IEEE Eng Med Biol – Proc. 2003;2(March):1694-1697. doi:10.1109/iembs.2003.1279716 

2. Morse MS, Berg JS, Ten Wolde RL. Diffuse electrical injury: A study of 89 subjects reporting long-term symptomatology that is remote to the theoretical current pathway. IEEE Trans Biomed Eng. 2004;51(8):1449-1459. doi:10.1109/TBME.2004.827343

Further Reading

• ECT Side Effects & Risks Archives