Paris Jackson reveals nine rounds of electroconvulsive therapy and the uncertain balance of ECT in depression treatment

Executive summary

Paris Jackson recently disclosed that she underwent nine rounds of electroconvulsive therapy (ECT) to treat severe depression, noting that while the treatment appeared to be working, the prospect of ongoing monthly shock sessions was not feasible for her. The Conversation explains how ECT is delivered, its typical treatment course, and the conditions for which it is prescribed, alongside ongoing debates about its effectiveness and safety. The piece also discusses long-standing controversies, the limited placebo-controlled evidence, and potential memory-related side effects, while highlighting the availability of alternative therapies such as cognitive behavioral therapy and trauma-focused approaches. The author emphasizes informed consent and the need for addressing underlying factors such as childhood adversity before resorting to ECT. This post references the original interview and related clinical guidelines, and provides a broader context from a medical and policy perspective.

• Paris Jackson’s disclosure sheds light on real-world use and limits of ECT for depression.
• ECT’s effectiveness evidence is limited, with few robust placebo-controlled trials and mixed results.
• Memory loss and other side effects are a central safety consideration in ECT debates.
• The Conversation highlights the importance of trauma-informed care and alternatives to reduce reliance on ECT.

Author: The Conversation

Overview: ECT in the treatment of depression

The article centers on Paris Jackson’s revelation that she underwent nine rounds of electroconvulsive therapy (ECT) to treat severe depression. It clarifies how ECT is performed: a controlled electric current is applied to the brain under general anaesthesia to induce a seizure. Each course typically includes six to 12 treatments over two to four weeks. While ECT is most commonly used for depression, it is also employed for schizophrenia, catatonia, and bipolar disorder. The piece notes that clinical guidelines, such as those from the UK’s NICE, reserve ECT for extreme circumstances such as suicidality and when other treatments have failed.

Does ECT work? The evidence landscape

The author argues that the gold standard for evaluating a treatment’s effectiveness comes from randomized controlled trials, including placebo-controlled “sham ECT” studies. Only 11 placebo-controlled trials of ECT for depression have been identified, and they are small and methodologically flawed by today’s standards. Among these, four studies found ECT superior to sham ECT, five found no difference, and two reported differences only from psychiatrists’ assessments rather than patients’ experiences. Crucially, there is little evidence of long-term benefit beyond the last treatment, suggesting limited durability of ECT’s effects in many cases. A 1985 study was the most recent among these, highlighting a concerning lack of updated placebo-controlled evidence for decades.

Subsequent reviews have questioned whether ECT’s apparent advantages are confounded by concurrent antidepressants in many studies, and most studies lack follow-up data. A 2023 NEJM study suggested ECT may be less effective than ketamine in the short term, though it did not provide follow-up data. The overall conclusion drawn is that, roughly nine decades after ECT’s introduction, definitive evidence of sustained efficacy remains elusive, especially in the absence of placebo controls.

Safety and memory risks

The article discusses safety concerns associated with ECT, including memory problems that can last for months or longer. A 2003 review of 703 patients reported persistent memory loss in 29% to 55% of cases, while a 2020 review of 16 studies found memory complaints in most papers, including instances of memory gaps spanning years or even decades. The World Health Organization and United Nations 2023 report emphasizes that patients should be informed of both short- and long-term risks, including memory loss and potential brain injury.

In the author’s own international survey of more than 1,000 ECT recipients and family members, most respondents reported mood improvements were either absent or outweighed by adverse effects such as memory loss (61–84%), emotional numbing, relationship difficulties, and loss of independence. The data also indicated that women are more likely to receive ECT and experience greater adverse effects, underscoring potential gender disparities in care. The piece argues that addressing underlying psychosocial issues, trauma, and childhood adversity through trauma therapy or cognitive behavioral therapy may reduce reliance on ECT for some patients.

Alternatives and informed decision making

Beyond ECT, the article points to a spectrum of effective alternatives for depression and suicidality, including cognitive behavioral therapy, trauma therapy, interpersonal psychotherapy, mindfulness, and family therapy. It argues that a patient–clinician relationship built on genuine care and a careful assessment of depressing life circumstances are critical first steps. The author contends that, for some, ECT is a life-saving option; for others, it may not be necessary or the best long-term strategy given potential memory-related harms and limited evidence of enduring benefit.

Conclusion: a balanced, patient-centered approach

Ultimately, the article advocates for a cautious, evidence-based approach to ECT, prioritizing deep assessment of contributing factors such as trauma and stress, and offering a range of therapeutic options. It calls for ongoing, transparent discussions about the risks and benefits of ECT, enhanced information provision to patients, and increased attention to gender and other potential disparities in who receives ECT. The piece acknowledges that while some individuals report benefit from ECT, many do not experience meaningful mood improvements, reinforcing the need for ethical, patient-centered care that avoids over-reliance on any single treatment modality.