[13] Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures first with camphor and then metrazol (cardiazol).

[15] The ECT procedure was first conducted in 1938 by Italian neuro-psychiatrist Ugo Cerletti[18] and rapidly replaced less safe and effective forms of biological treatments in use at the time.

At the time the ECT device was patented and commercialized abroad, the two Italian inventors had competitive tensions that damaged their relationship.

[22] In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse.

The Surgeon General stated there were problems with electroshock therapy in the initial years before anesthesia was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media.

[27] Specifically, critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT.

In 1978, the American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended.

The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented.

[31] In a review from 2022 of neuroimaging studies based on a global data collaboration ECT was suggested to work via a temporary disruption of neural circuits followed by augmented neuroplasticity and rewiring.

[4][40][41] ECT has also been used in selected cases of depression occurring in the setting of multiple sclerosis, Parkinson's disease, Huntington's chorea, developmental delay, brain arteriovenous malformations, and hydrocephalus.

[35] There is no defined schedule for maintenance ECT, however it is usually started weekly with intervals extended permissibly with the goal of maintaining remission.

[58] While there are no absolute contraindications for ECT, there is an increased risk for patients who have unstable or severe cardiovascular conditions or aneurysms; who have recently had a stroke; who have increased intracranial pressure (for instance, due to a solid brain tumor); who have severe pulmonary conditions; or who are generally at high risk for adverse effects from anesthesia.

[64][65][66][67] The American Psychiatric Association (APA) report in 2001 acknowledged: "In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss".

[70] Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral and with outdated sine-wave rather than brief-pulse currents.

[5][41] A 1999 report by the US Surgeon General states: "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals.

[76][77] If steps are taken to decrease potential risks, ECT is generally considered relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments.

[6][78] Suggested preparation for ECT during pregnancy includes a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid.

During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended.

A 2019 systematic review and meta-analysis of 82 studies found that the rate of major adverse cardiac events with ECT was 1 in 39 patients or about 1 in 200 to 500 procedures.

Immediately prior to treatment, a patient is given a short-acting anesthetic such as methohexital, propofol, etomidate, or thiopental,[1] a muscle relaxant such as suxamethonium (succinylcholine), and occasionally atropine to inhibit salivation.

[1]: 1882  Studies have shown that adding ketamine, an NMDA receptor antagonist, to the anesthesia regimen produced greater decreases in depression scores when compared to propofol, methohexital, and thiopental alone.

A review from 2022 of neuroimaging studies based on a global data collaboration resulted in a model of temporary disruption of neural circuits followed by augmented neuroplasticity and rewiring.

A survey of psychiatric practice in the late 1980s found that an estimated 100,000 people received ECT annually, with wide variation between metropolitan statistical areas.

A survey of ECT use in 1980 found that more than half of ECT clinics failed to meet minimum standards set by the Royal College of Psychiatrists, with a later survey in 1998 finding that minimum standards were largely adhered to, but that two-thirds of clinics still fell short of current guidelines, particularly in the training and supervision of junior doctors involved in the procedure.

[137] The study found that "About half (45–55%) of patients reported they were given an adequate explanation of ECT, implying a similar percentage felt they were not."

[141] However, there is an exception regardless of consent and capacity; under Section 62 of the Act, if the treating psychiatrist says the need for treatment is urgent they may start a course of ECT without authorization.

[143] Concerns have been raised by the official regulator that psychiatrists are too readily assuming that patients have the capacity to consent to their treatments, and that there is a worrying lack of independent advocacy.

[151] More members of the general public believed that ECT was used for control or punishment purposes than medical students or psychiatry trainees.

These include Sylvia Plath's semi-autobiographical novel, The Bell Jar, Ken Loach's film Family Life, and Ken Kesey's novel One Flew Over the Cuckoo's Nest; Kesey's novel is a direct product of his time working the graveyard shift as an orderly at a mental health facility in Menlo Park, California.

[172] In the television series "Mr Bates vs The Post Office", which is based on true events, the character of Saman Kaur receives ECT following a deep depression and attempted suicide.