Telling the Truth About Electroconvulsive Therapy (ECT)

Introduction: Why Transparency Matters

Electroconvulsive Therapy (ECT) remains one of the most contested mental health treatments in psychiatry. Despite being in use for decades, debates around its effectiveness, safety, and ethics continue to divide clinicians, researchers, and patient advocacy groups. Recent work—including a blog post in the Journal of Medical Ethics (BMJ, 2025) and an expert reaction published by the Science Media Centre (2025)—has reignited discussion about whether patients and families are truly given full, accurate information before consenting to ECT. This raises important ethical and clinical questions: are we fully honest about what is known, what is uncertain, and what risks ECT carries? And if not, why not?

Patients’ Voices and Lived Experience

The BMJ blog highlights how many patients and families report not being told the whole truth about ECT. Some say they were led to believe it was safe, effective, and without long-term consequences, only to later experience memory loss, cognitive issues, or regret. The authors argue that withholding or downplaying these realities undermines informed consent and violates the principles of medical ethics—autonomy, beneficence, and non-maleficence (Beauchamp & Childress, 2019).

In parallel, the Science Media Centre (SMC) survey of ECT recipients (2025) sheds light on what patients actually recall being told. Strikingly, many participants reported limited or inconsistent information: while some were warned of memory loss, others were told little or nothing about cognitive risks. Some said they were reassured that side effects were minimal or temporary, despite evidence suggesting that memory problems can persist for years in a proportion of patients (Read et al., 2019).

Together, these perspectives highlight a troubling gap between professional discourse and lived experience. For patients, not knowing—or later discovering—that they were not fully informed compounds the trauma of undergoing such an invasive psychiatric treatment.

The Ethical Duty of Truth-Telling

At the heart of this issue is the ethical responsibility of truth-telling in healthcare. The BMJ blog draws attention to how ECT has long been defended by professional bodies on the grounds of clinical benefit, yet often without fully acknowledging the harms. Transparency, however, is not optional. Informed consent requires that patients are given clear, balanced, and accessible information—not only about potential benefits but also about risks, uncertainties, and alternatives (General Medical Council, 2020).

When clinicians minimise the risks of long-term memory impairment or exaggerate the likelihood of success, patients cannot make genuinely informed choices. This undermines trust in psychiatry as a discipline and risks perpetuating historical patterns where patients’ voices have been sidelined.

Evidence and Uncertainty

The SMC’s expert panel emphasised that while ECT can be effective for some individuals with severe depression—particularly where other treatments have failed—the research evidence is more mixed than often portrayed. For instance, while some trials report short-term symptom improvement, long-term outcomes are less clear, and cognitive side effects remain a significant concern (UK ECT Review Group, 2003; Read et al., 2019).

This uncertainty reinforces the need for openness. Presenting ECT as universally effective or risk-free is misleading; equally, dismissing it outright ignores the reports of those who do find relief. A pluralistic perspective recognises this complexity, valuing both empirical evidence and subjective experience, and advocating for nuanced dialogue rather than oversimplification.

Systemic Barriers to Full Disclosure

Why, then, do patients and families often feel misled? Several systemic factors may contribute:

• Institutional defensiveness: Psychiatry has historically faced criticism over coercion and harmful practices. There may be reluctance to admit uncertainties about ECT for fear of undermining credibility.

• Time pressures: In overstretched services, clinicians may not have the time to engage in detailed discussions, leading to oversimplified consent processes.

• Power dynamics: Patients in crisis are vulnerable, and the imbalance of power can mean they feel unable to question or challenge what they are told.

• Professional culture: ECT may be defended as a “last resort” intervention, with clinicians focusing on potential benefits rather than harms in the hope of persuading patients to accept treatment.

These dynamics underscore the need for cultural change within psychiatry and mental health services. Truth-telling is not just an individual clinician’s responsibility but a systemic obligation.

Towards a More Ethical Practice

What would more ethical communication about ECT look like? Based on the insights from both the BMJ blog and the SMC survey, several principles stand out:

• Full disclosure of risks and benefits: Patients should be clearly informed about both the potential for improvement and the risks of memory loss or cognitive impairment, including the possibility that these may be long-lasting.

• Acknowledgement of uncertainty: Clinicians should be transparent about the limitations of current evidence, particularly regarding long-term outcomes.

• Respect for patient autonomy: Consent should be ongoing, not a one-off event, with space for patients to ask questions, change their minds, and be supported in doing so.

• Inclusion of lived experience: Patient testimonies and peer support should be integrated into pre-treatment discussions, so that individuals hear from others who have undergone ECT.

• Systemic accountability: Professional bodies and healthcare systems must ensure that information materials, policies, and training reflect ethical standards of transparency and respect.

Conclusion: Building Trust Through Honesty

The current debates around ECT reveal more than just disagreements about a treatment. They expose deep questions about how psychiatry relates to patients, truth, and trust. If individuals continue to feel misled about what ECT involves, psychiatry risks further eroding its legitimacy.

For patients and families, the call is simple: tell us the truth—the whole truth. For clinicians, the challenge is to embrace complexity, acknowledge uncertainty, and resist the urge to oversimplify. And for professional bodies, the responsibility is to support a culture of openness that prioritises patients’ rights and voices.

In the end, honesty is not just an ethical requirement; it is a foundation for compassionate, trustworthy care. Only by facing uncomfortable truths about ECT can psychiatry begin to rebuild trust with those it seeks to serve.

Why Smart TMS Offers a Different Way Forward

At Smart TMS, we believe that patients deserve access to safe, effective, and transparent mental health treatment options. TMS treatment (Transcranial Magnetic Stimulation) is a non-invasive, drug-free alternative to ECT that uses a magnetic coil placed on the head to stimulate targeted areas of the brain. Unlike ECT, TMS does not require hospitalisation, anaesthesia, or electrical currents, and it carries minimal side effects. Research shows it can be highly effective for a range of mental health conditions including depression, anxiety, PTSD, bipolar disorder, ADHD, and more.

If you’re exploring alternatives to ECT or looking for an innovative mental health treatment that is safe, evidence-based, and patient-centred, TMS may be the right option for you.

To find out more, get in touch with Smart TMS today—our dedicated patient advisers are here to answer your questions and support you every step of the way.

References 

1. Beauchamp, T.L. & Childress, J.F. (2019). Principles of Biomedical Ethics (8th ed.). Oxford University Press. 
2. General Medical Council (2020). Decision making and consent. GMC. Available at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consent 
3. Read, J., Kirsch, I., & McGrath, L. (2019). Electroconvulsive therapy for depression: A review of the quality of ECT versus sham ECT trials and meta-analyses. Ethical Human Psychology and Psychiatry, 21(2), 64–103. 
4. UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. Lancet, 361(9360), 799–808. 
5. BMJ (2025). Why are patients and families not told the truth about electroconvulsive therapy? Journal of Medical Ethics Blog, 15 August. Available at: https://blogs.bmj.com/medical-ethics/2025/08/15/why-are-patients-and-families-not-told-the-truth-about-electroconvulsive-therapy/ 
6. Science Media Centre (2025). Expert reaction to survey of electroconvulsive therapy (ECT) recipients and what information they recall being given. Science Media Centre, 15 August. Available at: https://www.sciencemediacentre.org/expert-reaction-to-survey-of-electroconvulsive-therapy-ect-recipients-and-what-information-they-recall-being-given/