MHM Magazine

Major depressive disorder, bipolar disorder, and catatonia are familiar conditions in psychiatry. Every so often, there’s the catatonic patient: motionless, barely eating or drinking. Or the individual in the grip of a relentless depressive episode, weeks into an illness that has drained every ounce of energy, leaving their family desperate for answers. Sometimes it’s a new mother with a fragile newborn at home, where keeping her in hospital for weeks to stabilise a bipolar relapse feels far from ideal. In such moments, the treating psychiatrist may suggest electroconvulsive therapy (ECT). The words hang in the air. The room falls silent. Family members exchange uneasy glances. One relative leans closer and whispers: “Isn’t that the shock treatment from old movies?” For decades, ECT has carried the baggage of its cinematic portrayals: patients strapped down, electricity surging through their bodies, punishment disguised as medicine. It’s no surprise that the term alone can trigger discomfort, even among health professionals. Yet behind the stigma lies a very different reality: in carefully selected cases, ECT can be life-saving, often working faster than medication when time is critical. And here’s the important part for health care providers: you are often the first professional families turn to when depression, mania, or catatonia takes a dangerous turn. The way you talk about ECT, whether with reassurance or hesitation can shape a patient’s journey. So what do health professionals really need to know about ECT? A Treatment Stuck in the Past To understand why ECT remains controversial, we need to revisit its history. Developed in the 1930s, the early years of ECT were rough by today’s standards. Patients were not always given anaesthesia or muscle relaxants, and the images that survived from that era: convulsions, restraints, fear became the public’s lasting memory. Hollywood cemented the stigma. Films like One Flew Over the Cuckoo’s Nest painted ECT as a barbaric punishment, not a medical treatment. These cultural depictions have outlived the reality of modern practice, which looks nothing like the movies. Today, ECT is delivered under full anaesthesia with muscle relaxants. The electrical stimulus is carefully measured and administered in a controlled hospital setting with monitoring and safety protocols. Patients don’t feel the “shock”; they wake up minutes later, typically describing the experience as far less intimidating than they expected. Yet, the ghost of history lingers. Patients hesitate, families resist, and even doctors sometimes fail to raise ECT as a viable option. What the Evidence Says The clinical case for ECT is compelling. Decades of research consistently show it as one of the most effective treatments for severe depression, particularly when rapid improvement is critical or when medications have failed. According to the Canadian Network for Mood and Anxiety Treatments (CANMAT, 2016), ECT can achieve response rates of 70–80% in major depressive disorder, with remission rates of 40–50% or higher, depending on patient characteristics and technical factors such as By Dr. Lerato Masenya Psychiatrist Northwest Province Email: dr.lerato@brainhaven.co.za ELECTROCONVULSIVE THERAPY: KNOWLEDGE, ATTITUDES AND THE FUTURE OF AN OLD TREATMENT MHM | 2025 | Volume 12 | Issue 4 | Electroconvulsive Therapy: Knowledge, Attitudes and the Future of an Old Treatment MHM 28 | MENTAL HEALTH MATTERS | 2025 | Issue 4 H