In recent years, electroconvulsive therapy (ECT) has remained a polarizing treatment within the psychiatric community, sparking intense debate about its safety, efficacy, and ethical application. A newly published survey in the Journal of Medical Ethics sheds critical light on the type of information patients and their families recall receiving prior to undergoing ECT, revealing a concerning tendency to overemphasize the therapy’s benefits while downplaying its risks. This study not only challenges prevailing assumptions about informed consent processes for ECT but also calls for urgent reforms in how clinicians communicate potential side effects and treatment outcomes.
Electroconvulsive therapy, introduced in the late 1930s, is a medical procedure that involves inducing brief, controlled seizures in the brain through electrical stimulation, typically administered over a course of 6 to 12 sessions. Despite its long history, questions remain unresolved in the psychiatric field regarding precisely how ECT exerts its therapeutic effects, the optimal dosing protocols, and which patient populations may genuinely benefit from the intervention. This ambiguity is compounded by the complex neurobiological mechanisms involved, such as alterations in neurotransmitter systems and neuroplasticity, which remain incompletely understood.
The recent survey targeted a convenience sample of 858 ECT recipients alongside 286 of their relatives and friends from 44 different countries. Conducted between January and September 2024, the data gathered presents a compelling snapshot of participant recall concerning pre-treatment counseling. Notably, most respondents were female, white, and had undergone ECT treatments within the last decade, although some reported experiences dating back as far as the mid-20th century. The primary indications for ECT included severe depression, psychosis and schizophrenia, bipolar disorders, and catatonia, reflecting the diverse clinical contexts in which the therapy is deployed.
A critical finding of the study was the disparity between reported communication of ECT’s benefits versus its risks. Patients were nearly four times more likely to recall being informed that memory problems following ECT were temporary rather than permanent, highlighting a significant minimization of long-term cognitive side effects. Memory impairment remains one of the most controversial and feared consequences of ECT, with evidence pointing to both transient and enduring deficits in autobiographical memory and other cognitive domains. This discrepancy in communicated risks raises profound ethical questions about the adequacy of informed consent and the patient’s capacity to make fully informed decisions.
Moreover, only a small fraction of participants, roughly 12%, remembered being warned about potential cardiac complications related to ECT. Cardiovascular risks, particularly arrhythmias and transient blood pressure changes, have long been recognized but often receive less emphasis during pre-treatment discussions. Similarly, less than a third of respondents were aware of the risks associated with repeated general anesthesia, which is routinely administered during ECT sessions. The neurocognitive effects of multiple anesthetic exposures, especially in vulnerable populations such as the elderly, remain a subject of ongoing research, but current clinical guidelines underscore the importance of disclosing these considerations to patients.
On the other hand, a substantial majority of respondents recalled being told that ECT is highly effective for severe depression and lifesaving in preventing suicide. These claims, while supported by some clinical trials demonstrating rapid symptom relief in treatment-resistant cases, continue to be contested within some psychiatric circles. The complexity of depression’s etiology and individual variability in treatment response complicate such broad generalizations. Additionally, 58% of patients and 53% of relatives reported having been informed that depression is caused by a chemical imbalance in the brain, a widely used but scientifically oversimplified explanation which has faced criticism for misrepresenting the nuanced pathophysiology underlying mood disorders.
Importantly, nearly 60% of respondents judged the information they received before ECT as inadequate, and an additional 17% were uncertain. This reflects a general dissatisfaction with the extent and quality of communication about both benefits and risks. The researchers emphasize that this dissatisfaction is consistent with previous smaller-scale studies, indicating systemic shortcomings in patient education and ethical practice surrounding this contentious intervention. They stress that the probability of informed consent being compromised has significant legal and professional ramifications, especially given the irreversible nature of some adverse effects linked to ECT.
The qualitative feedback from survey participants further underscores the problem of risk minimization. Many recalled messaging that effectively dismissed the possibility of long-term side effects or portrayed ECT as a completely safe and last-resort treatment option. Such framing can generate unrealistic expectations and potentially skew treatment decisions. Clinicians face a difficult balance between advocating for a treatment that may alleviate suffering and ensuring patients understand the full spectrum of consequences. The ethical imperative to provide balanced, evidence-based information is paramount to uphold patients’ autonomy.
The study also highlighted that family members and friends often share a similar recollection of the information given, underscoring the broader impact of communication strategies on support networks. Given that these individuals frequently play a role in treatment decisions and post-procedure care, enhancing transparency and clarity in pre-treatment consultations could improve overall outcomes and patient satisfaction.
Researchers and ethicists alike call for stronger enforcement of comprehensive informed consent protocols in ECT administration. They advocate for regulatory bodies and professional organizations to intervene if medical institutions fail to implement such standards. Transparent communication must include not only immediate side effects but also potential long-term cognitive impairments, legal rights, and the current limitations of scientific knowledge surrounding ECT’s mode of action and efficacy.
This survey’s limitations, primarily its reliance on voluntary self-reporting and retrospective recall, are acknowledged by the authors. Memory biases and dissatisfaction may have influenced responses, and the non-randomized sampling means findings may not be fully generalizable. However, the consistent trends across a sizable, international cohort lend credence to the notion that information asymmetry persists within ECT treatment paradigms.
In conclusion, this extensive survey highlights a pressing need to reevaluate how electroconvulsive therapy is presented to patients and their families. Ethical medical practice demands that providers deliver balanced and comprehensive information that neither exaggerates benefits nor minimizes risks. Only through transparent dialogue can patients provide truly informed consent and participate meaningfully in decisions about this complex and often last-resort psychiatric intervention. As ECT continues to evolve, robust patient-centered communication must remain at the forefront of clinical care and policy development.
Subject of Research: People
Article Title: A large exploratory survey of electroconvulsive therapy recipients, family members and friends: what information do they recall being given
News Publication Date: 14-Aug-2025
Web References: 10.1136/jme-2024-110629
Keywords: Psychiatry
