Shock Treatment for OCD: Does It Work?

Obsessive-Compulsive Disorder (OCD) is a challenging mental health condition, with individuals experiencing intrusive thoughts (obsessions) and engaging in repetitive behaviors (compulsions) to reduce anxiety. In many cases, OCD can be managed effectively with Cognitive-Behavioral Therapy (CBT), particularly a subtype called Exposure and Response Prevention (ERP), and medications such as selective serotonin reuptake inhibitors (SSRIs). However, in some cases, OCD is resistant to these first-line treatments. For those individuals, Electroconvulsive Therapy (ECT) may be considered as a treatment option.

What is ECT?

Electroconvulsive Therapy (ECT) involves the application of small electrical currents to the brain, inducing a brief seizure. While ECT has been most commonly used to treat severe depression, it has also been studied and employed in cases of treatment-resistant OCD, particularly when other interventions have failed.

When is ECT Indicated for OCD?

ECT is typically considered for patients with OCD who have not responded to standard treatments, such as therapy and medications. This resistance is often referred to as “treatment-resistant OCD.” It is important to emphasize that ECT is generally considered a last resort, after all other options have been exhausted. When an individual’s OCD significantly impairs their daily functioning and other interventions have not yielded results, ECT may be considered.

Key Indications for ECT in OCD

Treatment-resistant OCD: When individuals do not improve through therapy, multiple trials of SSRIs, clomipramine (a tricyclic antidepressant), or other medications, ECT may be considered.
Severe impairment: For individuals whose OCD symptoms are so severe that they result in significant impairment in daily life—such as inability to work, care for themselves, or engage in social relationships—ECT might be used as a more rapid intervention.
Co-occurring severe psychiatric conditions: In cases where severe depression, psychosis, or other mood disorders are present alongside OCD, ECT might be used to address multiple mental health challenges at once.
Urgent need for symptom relief: In cases where symptoms are extremely debilitating and the patient’s quality of life is severely compromised, ECT can offer more immediate symptom relief than medications or therapy alone.

History of ECT

Electroconvulsive Therapy (ECT) has a complex and often controversial history, particularly concerning its use in treating Obsessive-Compulsive Disorder (OCD). Introduced in 1938, ECT became widely used in the mid-20th century, especially for conditions like depression and schizophrenia. However, its application was sometimes problematic. In the 1950s and 1960s, ECT was used not only as a treatment but also as a means of social control in psychiatric institutions, sometimes administered without patient consent or as a punishment for non-compliance Such historical misapplications have contributed to the stigma surrounding ECT, leading to misconceptions about its safety and efficacy.​

Despite these challenges, ECT has evolved into a more refined and controlled treatment modality. Modern ECT is administered under general anesthesia with muscle relaxants to minimize discomfort and prevent injury during induced seizures. It is now considered a safe and effective option for individuals with severe, treatment-resistant psychiatric conditions, including OCD. Studies have shown that ECT can lead to significant improvements in OCD symptoms, particularly when other treatments have failed 

Patient experiences with ECT vary widely. Some individuals report substantial relief from debilitating symptoms. For instance, a study found that 80% of patients who received ECT for various psychiatric disorders found it to be a useful procedure, with many stating they would readily undergo it again. However, others have had negative experiences. Jane Rice, who received approximately 80 ECT treatments between the ages of 17 and 24, described the aftermath as feeling like "someone took my brain apart and put it back together wrong," leading to significant memory loss and cognitive difficulties.​

These contrasting accounts highlight the importance of individualized treatment planning and informed consent in the administration of ECT. While some patients experience significant benefits, others may encounter adverse effects. Therefore, ECT should be considered carefully, weighing the potential benefits against the risks, and always with the patient's informed consent and understanding of the procedure.

The Literature on ECT for OCD

Research on the use of Electroconvulsive Therapy (ECT) for Obsessive-Compulsive Disorder (OCD) continues to evolve, particularly for individuals who have not responded to traditional first-line treatments like Cognitive-Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). Although still considered a last-resort intervention, recent studies suggest that ECT may offer symptom relief in cases of treatment-resistant OCD.

Efficacy

A growing body of literature supports the potential of ECT to alleviate OCD symptoms when other approaches have failed. A 2022 retrospective study examined 21 individuals with OCD who underwent ECT and found that 57.1% of patients responded positively to treatment. The average number of sessions was seven, and outcomes were notably less favorable in individuals with co-occurring depression or schizophrenia spectrum disorders, indicating the impact of comorbidities on ECT response (Zhang et al., 2022).

Similarly, a 2023 quasi-experimental study investigated the use of ECT in 12 patients with severe, treatment-resistant OCD without significant comorbid psychiatric disorders. Results showed a substantial reduction in symptom severity, with the average Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score dropping from 28.08 to 17.17 post-treatment. Importantly, these improvements were largely maintained at a two-month follow-up (Sharma & Kumar, 2023).

These findings suggest that ECT may be an effective short-term intervention for patients with refractory OCD, particularly when the disorder exists without additional complicating diagnoses.

Comparison with Other Treatments

While ECT shows promise, CBT with Exposure and Response Prevention (ERP) remains the first-line treatment for OCD. SSRIs, and in some cases clomipramine, are also standard pharmacological options. ECT is considered only after these interventions have failed to produce satisfactory outcomes. Moreover, there is a recognized need for larger, randomized controlled trials to establish ECT’s effectiveness more conclusively and to determine best practices for its implementation in OCD treatment protocols (Menon et al., 2019).

Weighing the Risks and Benefits of ECT for OCD

Like any medical intervention, ECT comes with both potential benefits and risks, which must be carefully considered by patients, families, and healthcare providers.

Potential Benefits

Rapid Symptom Relief

One of ECT’s most compelling advantages is the speed of symptom improvement. While SSRIs may take weeks to show effects, ECT can provide more immediate relief, which is critical when someone’s daily functioning is severely compromised.

Effectiveness in Treatment-Resistant Cases

For individuals who have spent years trying various medications and therapies without success, ECT can offer significant improvement in symptoms, especially in severe cases that have been unresponsive to all other treatments.

Simultaneous Treatment of Comorbid Conditions

Many patients with OCD also suffer from major depression or bipolar disorder. ECT has a well-established record for treating these conditions, so it may alleviate both OCD and mood symptoms concurrently, improving overall quality of life.

Modern Safety Improvements

Today’s ECT protocols are far safer and more refined than those of past decades. Performed in controlled settings with anesthesia and muscle relaxants, serious complications are rare, and most side effects are manageable and temporary. 

Potential Risks and Drawbacks

Cognitive Side Effects

The most commonly reported side effect is short-term memory loss, often affecting recent memories formed just before or after treatment. In rare cases, memory issues may persist, but modern ECT techniques (like unilateral electrode placement) reduce this risk.

Physical Side Effects

After treatment, some patients may experience headaches, muscle soreness, nausea, or general fatigue. These effects are typically short-lived but can be distressing in the moment.

Temporary Confusion or Disorientation

It's common to feel confused or mentally "foggy" after a session. This usually resolves within hours, but some individuals may find it disruptive, especially after multiple treatments. 

Relapse Risk

ECT is not a cure for OCD. Symptoms may return weeks or months after treatment. Many patients require ongoing maintenance therapy, either through medications, additional ECT sessions, or continued psychotherapy to prevent relapse. 

Stigma and Emotional Impact

Despite advances in safety and effectiveness, ECT still carries a public stigma. Some patients may feel ashamed or reluctant to pursue it due to outdated portrayals in media or fear of judgment, which can contribute to emotional stress during treatment. 

Invasiveness of the Procedure

ECT requires general anesthesia and seizure induction, which some may find invasive. While safe, the procedure may feel intimidating, and some individuals may be uncomfortable with the nature of the treatment itself.

What to Expect When Proceeding with ECT

If you or someone you know is considering ECT for treatment-resistant OCD, it’s important to understand the process and what to expect:

Initial Consultation

Before proceeding with ECT, you will meet with a psychiatrist or a healthcare provider who will evaluate your medical history, discuss potential risks, and determine whether you are a suitable candidate for the procedure.  

Preparation

ECT is typically performed under general anesthesia. A few hours before the procedure, you may be asked to fast. An intravenous (IV) line will be inserted to administer anesthesia, and an electrode will be placed on your scalp to deliver the electrical current. 

The Procedure

During the procedure, electrical impulses are delivered to the brain, inducing a controlled seizure. The treatment lasts only a few minutes, and the person undergoing ECT is unconscious during the process.

Post-procedure care

After the procedure, you will be monitored in a recovery room until the anesthesia wears off. You may experience confusion or memory difficulties temporarily, but these effects typically subside within hours.

Follow-up care

Most people will require multiple ECT sessions (usually 6-12 treatments, spaced a few days apart). Follow-up sessions may involve medication management and therapy to prevent relapse.

Conclusion

ECT is a valuable treatment option for individuals with treatment-resistant OCD, providing a means of symptom relief when other treatments have failed. While it carries risks, such as memory loss and temporary confusion, its benefits—particularly for those with severe, debilitating OCD—can be significant. If you or someone you know is considering ECT, it’s crucial to have a comprehensive discussion with a healthcare provider to determine whether it is the right treatment option. With proper management and a holistic approach to care, ECT can offer hope for those struggling with treatment-resistant OCD.

References

1. Sharma, S., & Kumar, D. (2023). Effectiveness of electroconvulsive therapy in the treatment of severe obsessive-compulsive disorder: A quasi-experimental study. Journal of Neurosciences in Rural Practice, 14(3), 505–510. https://doi.org/10.1055/s-0043-1772654
2. Zhang, H., Song, Y., Wang, T., Lin, Z., Wu, J., Wu, L., & Wang, C. (2022). Effectiveness of electroconvulsive therapy in patients with obsessive-compulsive disorder: A retrospective study. Journal of ECT, 38(4), 263–268. https://doi.org/10.1097/YCT.0000000000000836
3. Menon, M. S., Kandasamy, A., Reddy, Y. C. J., & Chand, P. K. (2019). Electroconvulsive therapy in obsessive-compulsive disorder: A systematic review and future directions. Indian Journal of Psychological Medicine, 41(4), 316–323. https://doi.org/10.4103/IJPSYM.IJPSYM_70_19
4. Hafner, M. (2019, May 14). Electroconvulsive therapy is one of the most effective treatments for severe depression. Why is it so stigmatized? Vox. https://www.vox.com/the-highlight/2019/5/14/18274191/electroconvulsive-therapy-depression-treatment-controversial-history
5. Psychiatric Times. (2022, February 25). Electroconvulsive therapy: History, controversy, and the potential for healing. PsyPost. https://www.psypost.org/electroconvulsive-therapy-history-controversy-also-help/
6. Neuroscience News. (2017, May 2). New study dispels common misconceptions about electroconvulsive therapy. https://neurosciencenews.com/ect-misconceptions-psychology-6828/
7. Vaidyanathan, S., & Kalmady, S. V. (2018). Electroconvulsive therapy in obsessive-compulsive disorder: A systematic review. Indian Journal of Psychological Medicine, 40(6), 491–497. https://doi.org/10.4103/IJPSYM.IJPSYM_75_18