Consultant psychiatry · United Kingdom
Electroconvulsive therapy in the UK, honestly explained.
Modern ECT — brief-pulse, delivered under general anaesthetic in an ECTAS-accredited suite by a consultant psychiatrist and consultant anaesthetist. Considered only where NICE says it should be, and only where consent and safeguards are in place.
Why patients choose us
- 01
ECTAS-accredited services only
We refer only into ECT clinics accredited by the Royal College of Psychiatrists’ ECTAS scheme — the mandatory UK quality standard for ECT.
- 02
Consultant psychiatrist and anaesthetist
A named consultant psychiatrist prescribes and reviews. A consultant anaesthetist runs the anaesthetic. No trainees running your treatment.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial. ECT is a serious decision — we make sure alternatives are exhausted first.
Indicative pricing
What private ECT costs in the UK.
Indicative ranges across ECTAS-accredited independent services. ECT is also delivered on the NHS at no cost — we help you weigh both routes honestly.
In short
A private acute course of ECT in the UK: £4,500–£12,000 across 6–12 sessions.
| Item | Indicative range | Typical duration | Follow-up |
|---|---|---|---|
| Psychiatric assessment for ECT suitability | £350–£600 | 60–90 min | Same visit |
| ECT — single session (private) | £650–£1,200 | 30 min + recovery | Same visit |
| Full acute course (6–12 sessions) | £4,500–£12,000 | 3–6 weeks | Weekly review |
| Maintenance ECT (per session) | £650–£1,200 | 30 min + recovery | Same visit |
| Cognitive monitoring (MoCA / MMSE, per visit) | £150–£300 | 30 min | Same visit |
| Second opinion (independent psychiatrist) | £400–£800 | 60 min | 1–2 weeks |
Prices vary by hospital, by whether inpatient care is involved, and by the anaesthetist’s fee. Insurance cover for ECT exists but is often subject to case-by-case authorisation — we confirm this in writing before anything begins.
The problem
A treatment shrouded in stigma — and, when needed, unmatched in effect.
ECT has one of the strongest evidence bases in psychiatry for severe depression and catatonia, and one of the longest histories of misuse and mistrust. Both facts deserve respect. Our job is to make sure the treatment is only ever considered where NICE says it should be, and that consent and safeguards are absolute.
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Not sure it should be on the table?
ECT is a specific, late-stage decision — not a routine option. We check that NICE TA59 criteria are met before referring.
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Worried about consent and rights?
Capacitous consent under Section 58A or SOAD authorisation is non-negotiable. Section 62 emergencies are narrow. We explain your rights, in writing.
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Want honest numbers?
Response rates, relapse risk, memory effects and mortality — the real figures, not sanitised ones. That is the only responsible way to consent.
The journey
From assessment to maintenance — what happens, in order.
One named consultant psychiatrist from first assessment through the acute course to a maintenance plan.
Phase 1 · Before treatment
Assessment, capacity, consent
Phase 2 · Each session
An hour in the ECT suite
Phase 3 · After
Course review and maintenance
- 01
Before
You tell us what has been tried
A confidential conversation about diagnosis, medications tried, and current risk. NICE reserves ECT for specific, severe presentations — we check the criteria are met.
- 02
Before
Consultant psychiatrist assessment
A full psychiatric assessment, capacity assessment, and physical work-up. If capacity is impaired, the Second Opinion Appointed Doctor (SOAD) route is arranged under the Mental Health Act.
- 03
Before
Consent, or SOAD authorisation
Capacitous patients give written consent under Section 58A. Where capacity is lacking, a SOAD from the CQC must authorise treatment. Nothing proceeds without this.
- 04
Each session
Arrival at the ECT suite
You are fasted from midnight. Anaesthetist review, ECG, and IV access. A named nurse stays with you through induction.
- 05
Each session
The treatment itself
General anaesthesia (usually methohexital or propofol) plus a muscle relaxant (suxamethonium). A brief-pulse stimulus induces a monitored seizure of 20–90 seconds. The visible convulsion is minimal.
- 06
Each session
Recovery in the suite
You wake within 5–15 minutes. Short-term confusion is usual. You stay in recovery for 1–2 hours, then home with an escort. No driving that day.
- 07
After
Course, response, and maintenance
Typically 6–12 sessions, twice weekly. Response is reviewed every two treatments using standardised scales. A maintenance plan — medication, m-ECT, or both — is essential to prevent relapse.
Typical acute course: 3–6 weeks at twice weekly. Maintenance planning starts before the acute course ends.
When it helps
The NICE-recognised indications for ECT.
NICE TA59 defines a narrow set of situations. Outside those, ECT should not be on the table — and we will say so.
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Severe treatment-resistant depression
Depression that has not responded to adequate trials of two or more antidepressants and psychological therapy — NICE TA59’s primary indication.
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Severe depression with high suicide risk
Where the clinical need is urgent and other treatments would work too slowly to be safe.
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Catatonia
Catatonia unresponsive to a lorazepam challenge — ECT is highly effective and often life-saving.
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Prolonged or severe mania
Mania that has not responded to mood stabilisers and antipsychotics, or where the physical toll is dangerous.
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Severe depression in pregnancy
Where medication carries teratogenic risk or has failed. ECT has a long, well-documented safety record in pregnancy.
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Life-threatening food or fluid refusal
When depressive stupor threatens life and other treatments are not viable in the time available.
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Post-partum psychosis (severe)
Selected cases where rapid response matters and other treatments have failed.
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Not a first-line treatment
ECT is not offered for mild-to-moderate depression, and not as maintenance in schizophrenia. NICE is explicit on this.
Treatment options
How modern ECT is delivered.
Placement, waveform, and course design each trade efficacy against cognitive burden. There is no single right answer — the choice is calibrated to the clinical urgency.
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Right unilateral (RUL) — first line
Electrodes on the right side only. Fewer cognitive effects than bilateral, and now the recommended starting position under ECTAS.
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Ultrabrief pulse RUL
A shorter (0.3 ms) pulse width with RUL placement. The lowest cognitive burden — first choice where cognition must be protected.
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Bitemporal (bilateral)
Electrodes on both temples. Faster and often more effective in the most severe or urgent cases — accepts a higher cognitive cost.
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Bifrontal
A middle-ground placement — efficacy closer to bitemporal, cognitive effects closer to RUL. Used in selected cases.
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Brief-pulse waveform
Modern ECT uses a brief-pulse square waveform — the old sine-wave devices, which caused far more cognitive harm, have not been used in UK practice since the 1980s.
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Acute course
Typically 6–12 sessions given twice weekly. Response is reviewed formally every two treatments; the course ends when remission is reached or a plateau is clear.
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Maintenance ECT (m-ECT)
Weekly, fortnightly, or monthly sessions after remission — for patients whose depression reliably relapses without it.
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Anaesthesia and monitoring
General anaesthetic (methohexital or propofol) with suxamethonium muscle relaxant. Continuous ECG, EEG, and pulse oximetry throughout.
Our vetted UK network
ECTAS-accredited services only, no exceptions.
A short list of consultant psychiatrists working in ECTAS-accredited services across the UK. Introductions are made privately, once we understand the clinical situation and legal framework.
Selection criteria
How we choose every ECT service in our network.
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ECTAS accreditation by the Royal College of Psychiatrists (mandatory)
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Consultant psychiatrist prescribing, consultant anaesthetist delivering
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Written protocols for capacity, consent, and SOAD referrals
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Structured cognitive monitoring before, during, and after the course
Safety, response, and side effects
The honest numbers.
ECT is one of the most effective treatments in psychiatry and, at the same time, one of the most personal in its side effects. Both facts belong in the same conversation, at consent.
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Mortality is low and quantified
Roughly 1 death per 80,000–100,000 sessions — comparable to any minor procedure under general anaesthetic. This is the honest number, not a marketing one.
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Retrograde amnesia is the main concern
Memory for events around and before the course is the most consistent side effect. Most people recover fully within weeks to months; a small subset report persistent gaps. This is discussed at consent, not downplayed.
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Short-term confusion is normal
A period of confusion after each session is expected and settles within an hour. Anterograde memory usually recovers within days of the course ending.
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Headache and muscle ache
Common, mild, and treated with simple analgesia. The muscle ache reflects the suxamethonium, not the seizure itself.
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GA risks apply
The anaesthetic carries the usual small risks of any short GA. Cardiac and dental checks happen beforehand.
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Response rates are high
In severe depression, response rates of 60–80% are typical — higher than any single antidepressant. That is why NICE keeps ECT on the table despite its history.
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Relapse without maintenance is common
About half of responders relapse within 6 months without maintenance. A maintenance plan (medication, m-ECT, or both) is not optional — it is part of the treatment.
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CQC oversight and MHA rights
Every UK ECT service is inspected by the Care Quality Commission. Patients detained under the Mental Health Act retain the right to a tribunal and a Second Opinion Appointed Doctor.
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Red flags to raise immediately
Persistent confusion beyond a day, significant new memory gaps between sessions, or worsening low mood should be raised with the team before the next treatment.
Reading your ECT record
Your ECT record in four parts. Read the last one first.
Whichever placement was used, the record kept for each session keeps to the same shape — and you are entitled to a copy.
A quiet reminder
Psychiatric language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the record before your next review, just ask.
- 01 Header
Indication, consent basis, and placement
Why ECT was recommended (e.g. severe treatment-resistant depression), whether consent was given under Section 58A or authorised by a SOAD, and the electrode placement (RUL, bitemporal, bifrontal).
- 02 Technique
Anaesthetic, stimulus, seizure quality
The anaesthetic agents and doses, the stimulus parameters (charge, pulse width), and the EEG-confirmed seizure duration — usually 20–90 seconds.
- 03 Findings
Response scales and cognitive monitoring
HAM-D or MADRS scores, MoCA or MMSE trend, and any subjective memory complaints. Read this to see whether the course is working and at what cognitive cost.
- 04 Impression
Plan for next session and maintenance
Read this first: whether to continue, adjust placement or dose, taper, or move to a maintenance schedule. The plan for preventing relapse should be explicit.
Recognised by major UK insurers
Insurance cover for ECT varies significantly by policy and requires case-by-case authorisation. We confirm what is covered — inpatient stay, anaesthetist fees, cognitive assessments — in writing before any treatment begins.
Frequently asked
Everything patients and families ask about ECT.
Straight answers on consent, memory, effectiveness, and how to tell whether a service meets the UK standard.
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Is ECT still used in the UK, and is it safe?
Yes. Around 2,000 people a year receive ECT in the NHS and independent sector in England, and every service is inspected by the Care Quality Commission and, in almost all cases, accredited by the Royal College of Psychiatrists’ ECTAS scheme. Modern ECT uses brief-pulse waveforms, muscle relaxants, general anaesthesia, and EEG monitoring — it bears little resemblance to the procedure of the 1950s.
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What does NICE actually say about ECT?
NICE Technology Appraisal 59 recommends ECT for severe depressive illness, catatonia, and prolonged or severe manic episodes — where these are life-threatening, where a rapid response is required, or when other treatments have failed. It is not recommended for mild-to-moderate depression or as long-term treatment in schizophrenia.
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How is consent handled — can I be given ECT against my will?
If you have capacity, you must give written consent under Section 58A of the Mental Health Act 1983, and you can withdraw it at any time. If you lack capacity, a Second Opinion Appointed Doctor (SOAD) from the Care Quality Commission must independently authorise treatment. Section 62 permits urgent treatment in a narrow set of life-threatening emergencies. Community Treatment Orders do not authorise ECT — capacity and consent still apply.
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What actually happens during a session?
You are given a general anaesthetic (usually methohexital or propofol) and a muscle relaxant (suxamethonium). Electrodes are placed on your scalp and a brief-pulse electrical stimulus induces a monitored seizure lasting 20–90 seconds on EEG. Because of the muscle relaxant, the visible convulsion is minimal. The whole appointment takes about an hour, most of it recovery.
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How many sessions will I need?
A typical acute course is 6–12 sessions given twice weekly. Response is reviewed every two treatments. The course stops when you reach remission or a clear plateau — it is not a fixed number.
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How well does it actually work?
For severe depression, response rates of 60–80% are typical — higher than any single antidepressant. Catatonia responds particularly well. The challenge is not the acute response but preventing relapse: about half of responders will relapse within six months without maintenance treatment, so an m-ECT or medication plan is arranged from the start.
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What about memory loss — is that real?
Yes, and it is the side effect that matters most. Retrograde amnesia — patchy loss of memory for events around and before the treatment period — is common. For most people it recovers substantially over weeks to months. A minority report persistent gaps, particularly with bilateral placement. Right unilateral and ultrabrief pulse placements carry less cognitive burden and are the current first-line choices.
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How do I know if the clinic is any good?
Look for accreditation by ECTAS (the Royal College of Psychiatrists’ ECT Accreditation Service). ECTAS accreditation is the UK quality standard — it covers consent processes, equipment, cognitive monitoring, anaesthesia, and outcomes. We only refer into ECTAS-accredited services.
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