Electroconvulsive therapy – Does it have a place in modern medicine?
18th August 2019
Electroconvulsive therapy (ECT) is a treatment for certain types of mental illness including severe depression, schizophrenia, catatonia or mania. With this treatment a current of electricity is passed through the brain (under anaesthesia) causing a fit or seizure. Although this treatment has been approved by the National Institute for Health and Care Excellence (NICE) for severe depression, we don’t actually know how it works.
In an article in the British Medical Journal (BMJ 2019;364; KS5233) this year, Professor John Read questions the data supporting the use of ECT stating that “The many reviews and meta-analyses claining that ECT works do so purely on the basis of temporary gains, in a minority of patients found in just half of the studies.” He continues his argument that “Despite this lack of evidence psychiatry remains so adamant that ECT works that no studies to establish efficacy have been conducted since 1985. Instead, many studies investigate which kind of ECT causes least damage.”
This debate, with a counter argument being proposed by Sameer Jauhar, formed part of the Maudsley debate (referenced above).
ECT was first used in 1938 and the first study in 1951 ( ie 13 years after it’s introduction) suggested that people who receive ECT fared worse than those that hadn’t. So let’s wind the clock forward by 81 years and look at what’s happening with the treatment of PANDAS and PANS where we are trying to get support for the use of antibiotics and anti-inflammatories for children with tics and obsessive compulsive behaviours and where the benefit:risk ratio is very much leaning towards benefit. Does this make sense?
I would love your thoughts…