Electroconvulsive therapy, a procedure involving the induction of controlled seizures through electrical stimulation of the brain, has been employed for decades as a treatment for severe psychiatric disorders such as depression and bipolar disorder. Despite its recognized efficacy in certain cases, this form of neuromodulation remains highly contentious due to the array of potential adverse effects that many patients and their families experience but rarely find acknowledged in clinical settings.

The cross-national study, which represents the largest survey of its kind, enlisted 286 relatives and friends from 22 different countries. It sought to capture the lived realities and nuanced perspectives of those who witness firsthand the aftermath of ECT treatment. The findings reveal a complex landscape: while 45% of respondents observed some improvement in the targeted psychiatric condition, a nearly equivalent 42% perceived a deterioration in their loved one’s mental health following the intervention.

More alarmingly, the study surfaces a pervasive decline in overall quality of life post-treatment. A staggering 61% of relatives noted this diminution, juxtaposed with 34% who believed that ECT had directly caused brain damage. The cognitive impairments reported include significant memory loss, with more than half of the respondents noting these deficits persisted for at least three years. Such enduring impairments strongly suggest permanent neurological impact, challenging the frequently claimed temporary nature of ECT-induced cognitive disruption.

The scope of side effects expressed by families extends beyond memory deficits, encompassing difficulties in concentration, emotional blunting—a state characterized by an attenuation of both positive and negative affect—and a consequential loss of independence. These effects combine to fracture interpersonal relationships deeply, with 70% of participants reporting substantial strain on familial bonds and social connections. These qualitative and quantitative insights demand a reevaluation of how these outcomes are framed within the medical discourse on ECT.

The emotional toll on caregivers and relatives emerges as a poignant theme. Many recounted experiences of profound grief due to the transformation of their loved ones, lamenting a perceived loss of identity and vibrant personality. Additionally, the added responsibility of caregiving for individuals impaired cognitively and physically places significant burdens on families, who frequently feel powerless or guilty for not preventing the treatment despite their reservations.

Tragically, the survey also recorded reports of mortality linked to ECT. Eight respondents explicitly identified ECT as the direct cause of death in a loved one, while nineteen others considered the therapy a contributing factor to fatal outcomes. This underscores a critical need for rigorous risk assessment and comprehensive informed consent protocols that encompass these severe, albeit less commonly recognized, dangers.

Academic voices involved in the study emphasize the urgency of reforming current informational and ethical frameworks surrounding ECT. Professor John Read, a leading clinical psychologist and co-author of the research, underscores that relatives bear witness to the profound and often devastating effects of ECT, which are insufficiently communicated in clinical environments. He stresses that true informed consent must encompass an honest dialogue regarding both the potential benefits and risks to patients and their families.

Dr. Chris Harrop, the study’s lead author, condemns the historical neglect of family experiences in shaping our understanding of ECT’s impacts. He describes the findings as deeply troubling and commends the bravery of the respondents who shared their stories, pointing to a profound gap in mental health services’ engagement with caregivers’ perspectives.

Voices from those directly affected by ECT further illuminate the controversy. Lisa Morrison, an ECT recipient and co-author of the study, critiques the systemic minimization of patient-reported harms, framing this as a violation of human rights. Her personal narrative highlights the paradox of treatments intended to alleviate suffering that instead exacerbate distress and familial discord. Her husband, Gary Morrison, poignantly describes the emotional and functional regression observed after ECT, lamenting the false hope often engendered by the promise of relief through electric shock.

Sarah Price Hancock, another study co-author and ECT recipient, expresses a fractured sense of relief and sorrow, recognizing the life-saving outcomes reported by some families while grieving the widespread breakdown of familial relationships documented. Her father recounts the immediate and lasting cognitive and neurological impairments experienced by his daughter, linking these to the repetitive nature of the electrical trauma inflicted during ECT sessions—a perspective that challenges commonly held clinical assurances about the safety profile of the procedure.

The study, published in the British Psychological Society’s journal Psychology and Psychotherapy: Theory, Research and Practice, calls for a paradigm shift in how ECT is presented, understood, and administered globally. It advocates for multidimensional evaluations that integrate patient narratives, family observations, and objective clinical data. Furthermore, it spotlights the necessity for mental health professionals to develop and implement protocols that facilitate truly informed consent and safeguard the rights and well-being of all parties involved.

Compiling evidence from this and related publications reveals a consistent pattern: memory loss, cognitive deficits, emotional impairment, and social dysfunction are not anomalies but frequent outcomes of ECT. These insights demand serious ethical scrutiny and mandating transparent communication within clinical practice. The ramifications extend beyond individual patients, affecting entire family systems and social networks, confounding the narrative of ECT as a straightforward therapeutic intervention.

As mental health services worldwide grapple with the challenge of treating refractory affective disorders, this emerging body of research underscores an urgent need for alternative therapeutics and support mechanisms that respect patient autonomy and familial integrity. Moving forward, clinicians must balance the potential benefits of ECT against the documented sustained harms and give equal weight to the voices of those living with its consequences.

By bringing neglected perspectives into the spotlight, this pivotal study fuels an ongoing debate—pushing for reforms that prioritize holistic understanding, transparency, and ethical responsibility in psychiatric treatment. The urgent call is clear: a comprehensive, multidisciplinary approach to mental health care, inclusive of the lived experiences of patients and their families, is essential to ethically navigating the future of ECT and other neuromodulatory practices.

Subject of Research: Electroconvulsive therapy (ECT) and its long-term effects as reported by relatives and friends of patients.

Article Title: An international survey of the relatives and friends of electroconvulsive therapy recipients.

News Publication Date: 22nd April 2024.

Web References: DOI: 10.1111/papt.20062

References: Harrop, C., Cunliffe, S., Hancock, S.P., Johnstone, L., Morrison, L., Read, J. (2024). An international survey of the relatives and friends of electroconvulsive therapy recipients. Psychology and Psychotherapy: Theory, Research and Practice.

Keywords: Electroconvulsive therapy, ECT, Psychiatric treatment, Neuromodulation, Mental health, Memory loss, Cognitive impairment, Clinical psychology, Psychiatric ethics, Depression, Bipolar disorder, Caregiver burden.

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