Risks of ECT outweigh benefits, review finds


Tue, Dec 07, 2010

A COMPREHENSIVE review of electroconvulsive therapy (ECT) has concluded that the risk of damage caused by the procedure cannot justify its continued use in medicine.

The review of more than 100 previous studies and reports into ECT was carried out by two psychologists, Dr John Read of the University of Auckland and Prof Richard Bentall of the University of Bangor in Wales. Both are noted critics of electro shock treatment and the medical model used in psychiatry.

The findings, published in the December issue of the international scientific journal, Epidemiologia e Psichiatria Sociale, state there is minimal support for the effectiveness of ECT in the treatment of depression or schizophrenia. In addition, it states there is no evidence of any benefits beyond the treatment period.

It concludes: “Given the strong evidence of persistent and, for some, permanent brain dysfunction . . . and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.”

In a statement, Dr Read said the findings suggest that ongoing campaigns by ECT recipients to have the treatment banned were supported by the lack of scientific evidence that it was either safe or effective.

“If we took an evidence-based approach to the heated controversy about ECT it would be banished to the historical rubbish bin of previous treatments thought to be effective in the past, such as rotating chairs, surprise baths and lobotomies,” he said.

Prof Bentall added that the short-term benefits gained by a small minority could not justify the risks to which patients were exposed.

“The continued use of ECT therefore represents a failure to introduce the ideals of evidence-based medicine into psychiatry. This failure has occurred not only in the design and execution of research, but also in the translation of research findings into clinical practice. It seems there is resistance to the research data in the ECT community, and perhaps in psychiatry in general,” he said.

The continued use of forced ECT is a source of ongoing controversy in Ireland. Latest figures show that about 400 psychiatric patients received ECT treatment during 2008. Of this number, at least 43 were involuntarily detained patients, either unable or unwilling to consent.

Under current mental health laws, ECT can be used where a patient is “unable or unwilling” to give consent once it has been approved by two consultant psychiatrists.

Mental health campaigners such as John McCarthy, founder of Mad Pride Ireland, say this section of the law should be deleted to protect patients.

The College of Psychiatry of Ireland, however, recommends the retention of the word “unable” on the basis that ECT is a “well-established, scientific evidence-based treatment” for vulnerable and sometimes incapacitated patients.

The college says ECT remains an important and potentially life-saving treatment, which has helped many patients recover from mental ill health – particularly where all other treatments have failed.

It also cites recent Scottish evidence which indicated that 86 per cent of people who received ECT in circumstances where consent was not given recorded an improvement in their condition.

Minister of State with responsibility for mental health John Moloney says he is considering submissions from both sides of the argument and is expected to make a decision on the matter shortly.

© 2010 The Irish Times