Leading Journal Debates If Electroconvulsive Therapy Should Continue

A display of an electroconvulsice therapy machine with mannequins at Glenside Museum. Rodw via Wikimedia Commons. CC-by-4.0

Few medical procedures have faced as bad publicity as Electroconvulsive Therapy (ECT). Indeed so negative is its image that many people assume it has been confined to history like the use of mercury to treat syphilis. In the British Medical Journal, the University of East London's Professor John Read argues this is exactly what should happen. However, ECT remains in widespread use and in the same issue, Dr Sameer Jauhar of Kings College London makes the case for why this should continue.

The debate is important for people who have conditions treated with ECT, primarily depression that resists other treatments, or loved ones in that position. It's also an example of a real scientific debate, one conducted in a journal dedicated to getting at the truth, rather than one fought out on social media or by TV shock jocks who think they know everything about a topic they've barely studied.

ECT was first applied in 1938. It involves applying an electrical stimulus to one or both brain hemispheres strong enough to induce a seizure. In an era when treatment options for depression were few, it became widely used.

It's easy to see why ECT has such a terrible reputation. The idea of putting a large electric shock through the brain doesn't exactly sit well. Early versions caused patients to thrash in obvious pain. Some great writers who were subjected to it, or watched others experience it, have been damning. “A great jolt drubbed me till I thought my bones would break,” wrote Sylvia Plath. 

To make things worse, we have only hazy ideas as to why it works. Now that transcranial magnetic stimulation (TMS) offers many of the same benefits without the drawbacks, it's something of a surprise to learn that more than a million people undergo ECT each year.

Read points out the first study of ECT “showed that people who had had ECT fared worse than those who hadn't.” Half the studies conducted since have shown no benefits of the treatment. In the other half, Read claims, the benefits were temporary. “In the famous Northwick Park study5 this minimal improvement was perceived only by psychiatrists, not by nurses or patients,” he writes.

Read's case is co-written with Sue Cunliffe, who attributes her memory loss and inability to perform basic functions she once found easy to having undergone ECT. However, Cunliffe has been denied compensation because psychiatrists were unconvinced the treatment caused her symptoms.

Jauhar responds that large scale studies find ECT more effective than both placebos and antidepressant drugs. He claims the studies Read refers to are flawed or used inadequate samples, and that the side effects, while real, “resolve within weeks”, and are reducing as techniques improve.

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