Many patients arrive at this crossroad after several medications and months of hard work. They’ve heard about electroconvulsive therapy (ECT) and ketamine therapy and want a clear, plain-language comparison. In clinical practice, it’s common to see both options help some people with treatment‑resistant depression. 

This guide explains what modern ECT actually involves, how it compares with ketamine treatment, what the stigma is around both treatments and how to combat it, how people decide, and where the two may fit together over time.

What ECT is today (modern anesthesia, physiology, overlap with ketamine’s downstream effects)

Modern ECT is a carefully planned medical procedure done under general anesthesia with continuous monitoring. A brief, controlled sequence of electrical impulses are passed through the scalp and into discrete areas of the brain. These pulses are delivered over a matter of several seconds to excite brain cells, resulting in hyperactivation that can last for a brief time longer. An anesthesiologist provides short‑acting anesthesia and a muscle relaxant to keep the treatment comfortable. A psychiatrist trained in neuromodulation chooses the stimulus settings and where in the brain the stimulus is provided based on your diagnosis, medical history, and past response.

ECT aims to exercise the brain (which is the hyperactivation alluded to, before - also known as a “modified seizure”). lated networks that have become rigid and under‑responsive through these currents. This activation triggers cascades of neurotransmitters and neurotrophic signals that can restore balance in networks involved with motivation, sleep, and affect regulation. Many clinicians describe the effect as increasing plasticity and resetting network rhythms, much like how ketamine therapy achieves the same effects through different mechanisms. 

Where ECT and ketamine therapy overlap is not in the momentary experience or treatment administration, but in some downstream biology effects. Ketamine works differently by engaging glutamate signaling at AMPA receptors which boosts a growth hormone called “BDNF,” changes how the brain manages endorphins (the “feel good” chemicals associated with a runner’s high), alters how brain cells register anxiety and futility, and ultimately causes the growth and maintenance of connections in the brains (a process called “synaptogenesis”.) ECT increases neurotrophic factors and connectivity as well. The paths are different, yet both can create conditions where learning and behavior change may take hold. The experience, logistics, equipment required, and side‑effect profiles are quite distinct.

The stigma around ECTs & what the modified seizure actually does 

Some people rightly are concerned when hearing the word “seizure” described as an intentional, safe, and integral part of the ECT experience. It’s a word and a treatment coated in decades of stigma through how the treatment is portrayed in the media, how the treatment is misunderstood by the public – and providers, alike! – and how little the treatment is spoken about commonly.. 

In fact, these seizures are induced by carefully controlled electrical impulses and rigorously monitored for safety and efficacy. Under careful supervision, these seizures can be instrumental in providing stimulation to parts of the brain that can result in a system that operates more effectively. 

Indications, pace of relief, safety conversations for ECT and ketamine therapy 

When clinicians consider ECT

• Severe major depression that has not responded to multiple medication trials or psychotherapy
• Depression with psychotic features
• Catatonia 
• When a rapid, reliable intervention is needed because the illness is dangerously impairing

When clinicians consider ketamine therapy

• Treatment‑resistant depression after several medication trials
• Patients seeking a different mechanism with the possibility of earlier symptom change
• Individuals open to monitored dosing that can include short‑term perceptual shifts
• Individuals who are concerned about ECT side effects
  
  

Pace of relief

• Many patients begin to improve during the acute ECT series (often 2–3 sessions per week for several weeks). Some notice changes within the first few treatments, others later in the course.
• With ketamine treatment, some people feel relief within hours to days of early doses. Spravato treatment typically occurs twice weekly for the first month, then tapers.
  
  

Safety conversations

• ECT: short anesthesia exposure, brief controlled seizure through electrical currents, and potential cognitive side effects. Some patients experience temporary confusion after sessions and varying degrees of memory effects, which are discussed in detail before starting. Medical screening and coordination with other clinicians are standard.
  
  
• Ketamine therapy: transient increases in blood pressure and pulse, nausea for some, and short‑term perceptual/psychedelic or dissociative symptoms during dosing. After Spravato treatment or ketaminel dosing, you cannot drive until the next day and will need a ride home. Monitoring occurs on‑site.

Neither option is completely risk‑free and both suffer from being some degree of stigma, despite exhibiting a clinically-proven safety and efficacy profile for their respective indications. Many patients decide between ECT and ketamine therapy by weighing medical history, urgency, and the kind of experience they feel open to having.

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FAQs

Is ECT still used and why?
Yes. Modern ECT is one of the most effective treatments for severe, treatment‑resistant depression, psychotic depression, bipolar disorder, treatment refractory schizophrenia/schizoaffective disorder, and catatonia. It is used today because for some patients it provides relief when other options have not. It is delivered with anesthesia and close monitoring to support safety.

How does recovery differ between ECT and Spravato?
After ECT, patients typically rest the day of treatment, avoid driving, and may feel tired or a bit foggy as anesthesia wears off. Some experience temporary memory effects that are reviewed before starting. After Spravato treatment, you’ll stay in the Spravato clinic for observation, arrange a ride home, and avoid driving until the next day. Transient perceptual changes are common during dosing and usually resolve the same day.

Can I combine ECT and ketamine therapy?
Some patients use both across a year – often sequentially. Your team coordinates timing based on response, safety, and logistics.

Is one safer than the other?
They have different risk profiles. ECT involves brief anesthesia and a controlled seizure with potential cognitive side effects, cardiovascular effects, and other side effects that are discussed in advance. Ketamine therapy involves monitored dosing with short‑term perceptual changes and cardiovascular monitoring. Your medical history helps guide fit.

Will psychotherapy help with either?
Many patients find psychotherapy or skills‑based support useful with both and may be especially helpful with ketamine and esketamine treatment – these treatments impact memory less and the treatments, themselves, may make gains in psychotherapy more easily achieved. 

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