Brain Stimulation Therapy

 A serious treatment for serious illness

Modified Electroconvulsive Therapy (ECT) is one of the most effective treatments in modern psychiatry — but it is also one of the most misunderstood. The image many people carry of ECT comes from films of the 1960s and 70s, when the procedure was given without anaesthesia. Modern modified ECT, as practised at our hospital-based unit in Porvorim, is a fundamentally different procedure — safe, controlled, and supported by decades of clinical evidence.

We offer modified ECT only when it is clearly the right treatment. It is never a first-line option. It is reserved for situations where the suffering is severe, time is critical, and other treatments have not worked.

When ECT is the right treatment

Modified ECT has strong evidence-based benefit for:

• Severe, treatment-resistant depression — particularly with suicidal thoughts, severe agitation, or refusal to eat or drink
• Treatment-resistant schizophrenia — when adequate trials of medication have not given relief
• Severe bipolar illness — including life-threatening mania and severe depressive episodes
• Catatonia — across diagnoses, where ECT often works rapidly when nothing else has
• Severe postpartum depression or psychosis — where rapid recovery is essential for mother and baby

ECT is not a first-line treatment for any of these conditions. It is considered when medication and psychotherapy have not produced enough benefit, when the illness is putting the person’s life at immediate risk, or when previous ECT has worked well and a similar response is needed.

What modified ECT actually involves

The word modified matters. Three things make modern ECT fundamentally different from the procedure as it was practised decades ago:

• General anaesthesia. You are fully asleep throughout the procedure, with no awareness or memory of it.
• A muscle relaxant. Visible muscle movement is almost completely prevented. The seizure that produces the therapeutic effect happens internally; outwardly, you simply rest.
• Continuous monitoring. Heart rhythm, blood pressure, breathing, and brain activity are monitored throughout.

Each session lasts only a few minutes once you are asleep. You wake up within 10–15 minutes after the procedure and are observed in a recovery area until you are fully alert.

The team in the room

Modified ECT at our centre is never performed by a single clinician working alone. Every procedure is supervised by:

• A consultant psychiatrist — to oversee the treatment, indications, dose, and clinical response
• A qualified anaesthetist — to manage the general anaesthesia and physiological monitoring
• Trained nursing staff — to support the patient before, during, and after each session

Our equipment is FDA-cleared and maintained to current standards.

What a course of ECT looks like

A typical course is 6–12 sessions, given two to three times a week over two to four weeks. The exact number depends on the response to treatment — we don’t continue beyond what is clinically needed.

Each session day looks like this:

• You are admitted to the hospital unit in the morning, fasting from the previous night.
• The psychiatrist and anaesthetist meet you, confirm consent, and answer questions.
• You enter the procedure room. Anaesthesia is given.
• The session itself lasts a few minutes.
• You recover in a monitored area for 30–60 minutes until fully alert.
• You go home the same day (or to your hospital room if admitted as an inpatient).

Side effects, recovery, and honesty about memory

We will not promise you that ECT has no side effects — that would not be honest. The most common are:

• Mild confusion in the hour or two after the procedure (clears quickly)
• Headache or muscle soreness for some patients (manageable with paracetamol)
• Short-term memory effects — particularly for events around the time of treatment. Most patients recover this fully within weeks to a few months. Persistent memory difficulties affecting day-to-day life are uncommon and are weighed carefully against the severity of the illness being treated.

Modern ECT does not cause brain damage, personality change, or loss of identity. These claims, common in older portrayals, are not supported by current evidence.

Informed consent and family involvement

Modified ECT is offered only after a careful informed-consent process. We will:

• Discuss the indication, expected benefits, and realistic timeline of response
• Explain the alternative treatments and why they may or may not be more appropriate
• Detail the risks and likely side effects in plain language
• Include family members in the conversation if you wish — and we strongly encourage this
• Provide written information for you to take home and re-read

You retain the right to withdraw consent at any point during the course.

Your rights under the law

ECT in India is governed by the Mental Healthcare Act, 2017. Under that Act, ECT may only be given in its modified form — under anaesthesia and with a muscle relaxant. Unmodified ECT is prohibited by law, and we do not offer it. Treatment is given with your informed consent, which you may withdraw at any point during the course. Where a person is too unwell to give consent — as can happen in severe catatonia or life-threatening mania — the Act sets out how decisions are made together with a nominated representative, and we will explain that process to you and your family before anything proceeds. For anyone under 18, the Act requires both the consent of a guardian and the prior permission of the Mental Health Review Board. We treat young people only occasionally and only where the illness is severe, and we will not begin without those safeguards in place.

Talking to us first

If you, or a family member, are considering ECT — or have been told by another doctor that it may be needed — please come in for a careful initial consultation first. We will go through your history, review previous treatments, and discuss together whether ECT is the right next step, or whether other options should be tried first. The decision is always collaborative, and is never made in a single visit.