ECT, traditionally viewed as a potentially life-saving intervention for severe depression and other psychiatric disorders, has been controversial due to concerns regarding its cognitive side effects and ethical implications. While some recipients report mood improvements and reduced suicidality, the study strikingly documents that more than half of participants (51%) experienced solely negative effects, highlighting a troubling disparity between clinical narratives and patient realities. This large-scale participant-reported data offers a rare glimpse into the long-term adverse impacts, often overlooked or minimized in clinical trials and regulatory assessments.

One of the most alarming revelations is the prevalence of persistent memory loss, which 82% of respondents identified as a consequence of ECT. This figure significantly exceeds prior clinical estimates, which typically underreport the extent and severity of memory impairments. Participants described disruptions in both retrograde and anterograde memory, underscoring a profound cognitive decline that hampers daily function, identity coherence, and quality of life. Such memory disturbances suggest that ECT may impart lasting neurobiological damage, calling into question the longstanding assumption that cognitive side effects are transient.

Beyond the cognitive domain, many recipients articulated experiences that transcended traditional symptom checklists. Approximately 29% reported “cognitive decline” in broader terms, implicating deficits in executive functioning, attention, and information processing speed. Moreover, 8% expressed feelings of having been “violated” by the procedure, evocative of psychological trauma. This qualitative dimension—accessed through open-ended survey questions—captures the emotional and existential toll of ECT, a facet rarely addressed in quantitative outcome studies but critical to comprehensive patient care.

The psychosocial ramifications surfaced as another critical concern. A striking 33% of participants reported job loss attributable to the aftermath of ECT, while a substantial 68% indicated relationship difficulties post-treatment. These statistics implicate not just neurological impairment but also social isolation, reduced employability, and diminished interpersonal trust. Such consequences underscore the necessity for an integrated approach to patient assessment, one that extends beyond symptom alleviation to encompass functional, social, and occupational domains.

The study’s methodological innovation lies in prioritizing patient voices through open questions rather than relying on predefined symptom lists. By doing so, the research uncovers nuanced adverse effects, including some that have historically been marginalized or omitted from medical discourse. This approach reveals a landscape where the clinical benefits claimed — such as a positive impact on depression (reported by 23%) and reduction in suicidality (13%) — must be weighed against a broad spectrum of potentially debilitating side effects.

Critically, the research team includes members with lived experience of ECT, alongside clinical psychologists, ensuring a multidimensional perspective that bridges scientific rigor with patient advocacy. Their findings challenge the psychiatric community to reconcile clinical guidelines with patient realities, advocating for transparent risk communication and the development of robust monitoring protocols. The team explicitly calls for further research that rigorously evaluates the benefit-risk ratio of ECT, emphasizing the importance of incorporating long-term adverse effect data into safety assessments and regulatory frameworks.

Lead researcher Professor John Read, a distinguished clinical psychologist, underscores the discrepancy between reported patient experiences and psychiatrists’ prevailing reassurances about ECT’s safety. Highlighting memory loss as one of the most consistently documented adverse effects, he points out that existing estimates vastly underestimate patient-reported severity and persistence. Read also stresses the psychological trauma inflicted by the treatment process and its cascading effects on social and occupational functioning—topics often neglected in mainstream psychiatric literature.

Adding a personal dimension, co-author and ECT survivor Lisa Morrison voices frustration at enduring neglect and systemic silencing of patients harmed by ECT. Morrison raises ethical and human rights concerns, emphasizing the absence of mechanisms for ongoing monitoring, rehabilitation, and support for those affected by the therapy’s debilitating consequences. Her commentary highlights the power imbalances inherent in psychiatric practice and regulatory oversight, echoing calls for reform grounded in respect and empathy for patient experiences.

Another co-author, Sue Cunliffe, a former medical doctor incapacitated by ECT-induced cognitive impairment, provides a clinical yet personal testament to the reality of brain injury following the procedure. Diagnosed by a neuropsychologist with specific brain damage attributable to ECT, her narrative confronts the frequently asserted notion that ECT cannot cause permanent neurological harm. This case exemplifies the urgent need for unbiased neuropsychological evaluations in post-ECT care and a reevaluation of clinical assumptions.

The study has garnered attention from mental health advocacy organizations, including Mind, whose Information Content Manager, Rosie Weatherley, echoes the researchers’ concerns. Mind calls for a comprehensive re-examination of ECT’s role in psychiatric treatment, emphasizing the necessity for evidence-based therapies that do not pose comparable risks. They advocate for increased funding and research to identify safer and more effective alternatives that prioritize patient wellbeing and informed consent.

Published in the Journal of Affective Disorders Reports, this landmark survey punctuates ongoing debates about ECT’s place in mental health treatment paradigms. It compels clinicians, policymakers, and researchers to rigorously scrutinize the true extent of adverse effects and to integrate patient-reported outcomes into the evaluation of psychiatric interventions. By centering patient narratives and employing innovative methodologies, this study illuminates the hidden complexities of ECT’s impact, urging a shift towards more compassionate, transparent, and ethically sound psychiatric care.

Ultimately, this research challenges the prevailing optimism surrounding ECT, revealing a more nuanced and troubling picture. It calls for an urgent reassessment of clinical practices, regulatory standards, and patient communication to ensure that decisions surrounding ECT are grounded in a balanced understanding of its benefits and harms. The findings implore the psychiatric community to move beyond reductionist efficacy models, embracing a holistic framework that honors patient experiences and prioritizes long-term health and dignity.

Subject of Research: The long-term self-reported positive and negative effects of Electroconvulsive Therapy (ECT) based on an international patient survey.

Article Title: ‘The self-reported positive and negative effects of electroconvulsive therapy: an international survey’

News Publication Date: February 3, 2026

Web References:

• Journal of Affective Disorders Reports: https://www.sciencedirect.com/science/article/pii/S2666915325001386
• DOI: 10.1016/j.jadr.2025.101008

References:

• Read, J., Cunliffe, S., Hancock, S.P., Harrop, C., Johnstone, L., Morrison, L. (2025). ‘The self-reported positive and negative effects of electroconvulsive therapy: an international survey’, Journal of Affective Disorders Reports.
• Additional related publications on ECT authored by the same research group in journals such as International Journal of Mental Health Nursing, Health Care for Women International, Journal of Medical Ethics, and Ethical Human Psychology and Psychiatry.

Keywords: Psychological science, Clinical psychology, Mental health, Electroconvulsive Therapy, Cognitive impairment, Memory loss, Patient-reported outcomes, Psychiatric treatment risks, Neuropsychological injury, Mental health ethics

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