It is one of the most dramatic techniques employed in modern psychiatry. An electric shock is administered to the brains of individuals who are suffering from depression.
But electroconvulsive therapy (ECT) is controversial among some psychologists and is now the focus of a huge row – which erupted last week – over claims that it can trigger brain damage, that guidelines covering its use are weak and that it is used disproportionately on women and the elderly.
Other psychologists and psychiatrists disagree, however. They say that while ECT induces mild fits and can also trigger significant memory disruptions, it is a valuable tool for treating seriously depressed individuals with suicidal urges and for whom all other treatments and drugs have failed. Alleviation can be induced by ECT which, they point out, is approved by the National Institute for Health Care and Excellence in the UK and by the Food and Drug Administration in the US.
“A lot of people who need ECT have psychoses,” said Sameer Jauhar of the Institute of Psychiatry, King’s College London. “They hear voices telling them they are bad and horrible people who should die. They are in danger from themselves. Other treatments can fail and you cannot make the assumption the episode will pass. That is where ECT comes in.”
ECT was developed more than 80 years ago and its use peaked in the UK in the 1970s and 1980s, when more than 50,000 treatments a year were administered, said Prof John Read of East London University. “Today, the figure is about 2,500,” added Reed, who is a leading critic of the use of ECT.
“We know it causes brain damage,” he told the Observer. “However, we don’t know how much damage is caused, or in how many patients, and until that is the case, there is no ethical or scientific justification for its use.”
However, supporters reject the idea that it causes brain damage. It can lead to memory impairment that can last for months but they insist its impact is not permanent.
Both sides also disagree about the efficacy of ECT. Opponents argue that their studies reveal little evidence to indicate the technique works as well as is claimed. “However, when you look at those studies you find they contain major methodological shortcomings and are inherently biased,” said Robert Howard, professor of old age psychiatry at University College London. “There is plenty of evidence to show that ECT is effective.”
Then there is the issue of the preponderance of women among patients given ECT. One recent study indicates they are twice as likely to be given the treatment as men. This suggests a significant bias on the part of psychiatrists, say ECT’s opponents.
But supporters point out that women are more likely to be treated for depression because they are more often diagnosed with the condition, are more likely than men to seek psychological help and they tend to live to greater ages, when the risks of depression will increase. More women are given ECT because more are vulnerable to depression, in other words.
“I also resent the implication that we are a patriarchy that is doing horrible things to women because we don’t like them,” said Howard. “We care about all people who are suffering from a serious psychotic condition. And it’s good we are able to give them treatment like ECT that can help them.”
But this explanation is rejected by Read. “Yes, women tend to be slightly more depressed than men but not twice as many. Women tend to be more depressed because they suffer more violence and abuse, while older people are more depressed because of loss and loneliness. The question is: how on earth can electricity address those issues?”
This point is backed by other ECT opponents. It is not clear how electric shocks, albeit mild ones, affect the brain, they argue, so we should not administer them.
Howard disagrees. “There are many medical procedures whose exact course of action isnot fully understood but we still use them because they work. Many of my patients – who are often highly distressed – have had antidepressants, anti-psychotic drugs and psychological therapies, and none have worked. ECT can make all the difference.”