ECT is a non-invasive strategy, where an electric current penetrates deep brain structures(unilateral, bitemporal  is most commonly used) in order to induce a tonic clonic seizure. Prior toi the procedure the patient is put under brif general anaesthesia, and a muscle relaxant is administered in order to minimise muscle activity whihch may result in serious injury/bodily harm.  During the procedure, the patient remains unconscious, and after undergoing the one hour procedure, the patient awakes and is fully alert.
ECT enhances post-synaptic 5HT (1A) receptor activity. Although serotonergic and noradrenergic systems seem to induce the (antidepressant action) of ECT, studies have revealed that decreased levels of serotonin and catecholamine do not precipitate relapse of depressive symptoms.

 

When is Electroconvulsive therapy indicated? 

Electroconvulsive therapy (ECT) is reserved for the treatment of severe and complex depression. In the initial weeks of therapy since antidepressants do not exert an immediate response, ECT may be used if the situation can cause serious damage or harm.   

 

What does NICE say?

NICE discourages the use of ECT for patients with moderate depression, but it may be considered if their depression is unresponsie to multiple drug therapy.  Repeat trials can be considered only after reviewing the adequacy of the previous treatment.