Is it time to BAN electric shock therapy?
Like a ‘zombie’ is how Gillian describes her state following electroconvulsive therapy for severe depression.
She was given the treatment after the birth of her third child triggered terrible flashbacks of childhood abuse and, in turn, major mental illness.
The 25 sessions of electroconvulsive therapy, or ECT, she underwent were ‘a worse invasion of my body than the original abuse’, says Gillian, who is now studying for a postgraduate qualification in social work.
The 58-year-old from Coventry (who wishes to remain anonymous) believes the treatment she had over two decades, ending in 2011, ’caused huge damage to my short and long-term memory — sometimes I just can’t make two and two equal four’.
ECT was first popularised in the 1930s as a treatment for depression. During a session, electrodes are attached to the head under general anaesthetic and a shock of 70 to 450 volts is administered to deliver a seizure-like fit.
The idea is that this somehow resets the brain’s malfunctioning circuitry that causes depressive and psychotic thoughts and behaviour, though the biological process for this has never been demonstrated.
The treatment is recommended by NICE for patients with severe depression, or psychotic depression that is resistant to other treatment such as medication, and more than 2,000 patients receive ECT in the UK each year — there are reports it has even been used on children as young as 11.
ECT is a deeply controversial treatment, and while it has been shown to help some patients with serious depression, some studies have suggested the benefits may be temporary or no better than dummy treatment, and critics say it can cause lingering problems.
The Royal College of Psychiatrists’ view is that most people who receive the treatment experience an improvement in their condition — acknowledging that, ‘there can be side-effects of differing severity including memory loss,’ as the chair of its ECT committee told Good Health.
But now a new analysis of the evidence base for ECT suggests it not only does not work, but it also causes lasting brain damage. The analysis, published in the journal Ethical Human Psychology and Psychiatry in May, concluded ‘there is no evidence ECT is effective’. ‘Given the high risk of permanent memory loss and the small mortality risk… its use should be immediately suspended,’ wrote the researchers, Professor John Read, a psychologist at the University of East London, and Dr Irving Kirsch, an expert in placebo or dummy treatments from Harvard Medical School in Boston.
Following this report, a letter signed by more than 40 psychiatrists, psychologists (including Professor Read) and former ECT patients and their families has just been sent to senior politicians and health policy makers, including health secretary Matt Hancock and mental health minister Nadine Dorries, and to the leaders of every hospital trust in Britain — calling for the treatment to be suspended.
Professor Read, 68, says his opposition to the treatment dates back to the 1970s when, as a trainee psychologist, he witnessed it being delivered to a queue of women at a hospital in New York. Setting out what his review found, he says: ‘The studies show a range of 12 to 55 per cent of patients suffer persistent memory loss as a result of ECT.
‘The psychiatrists who do it call it temporary cognitive dysfunction. They don’t like calling it brain damage and if the patients suffer permanent memory problems, they blame it on the depression.’ Richard Bentall, a professor of clinical psychology at Sheffield University, a co-signatory of the letter, is also critical.
‘There has never been proper research to show ECT works,’ he says. ‘The doctors doing it are not adhering to the rules of evidence based medicine.’ Among the psychiatrists who have signed the letter is Dr Joanna Moncrieff, of University College Hospital London, who last week wrote on Twitter: ‘When ECT does have effects, they are short-lived and the benefits can be achieved in safer ways — therefore it should be phased out.’
Last year she also voiced concerns that ECT was being used on teenagers. Dr Sue Cunliffe, 51, another signatory to the letter, is a former NHS paediatrician who in her mid-30s underwent 21 sessions of ECT for depression between 2004 and 2005.
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She says it caused such brain damage that it meant she forgot her medical training and was unable to return to work. ‘It completely destroyed my career as a doctor and my life,’ says Sue, a mother of three from Worcester. ‘I consented after being told ECT was safe, yet I suffered catastrophic brain injury,’ she wrote in a recent commentary for The BMJ.
‘It affected my memory… My independence and capacity to work have gone for ever.’ Just how long the effects might last is also controversial. Nigel Morton, 62, who now lives in sheltered housing in Northumberland, claims he is still suffering aftereffects such as memory problems and poor coordination due to damage from ECT almost 50 years after he received the treatment.
At the age of 15, Nigel, who was brought up in Beverley, East Yorkshire, found himself consigned to a mental hospital after he displayed symptoms of depression and serious obsessive behaviour while revising for exams.
When symptoms in one area indicate a problem elsewhere.
This week: Pain in the left arm could be a heart attack.
Sharp pain felt in the arm during a heart attack is a result of toxins or inflammatory chemicals, such as lactic acid, being released.
‘These stimulate the nerves which supply the heart,’ says Dr Glyn Thomas, a consultant cardiologist at theBristol Heart Institute.
‘As the nerves are inserted into the spinal cord at a similar level to the nerves supplying other areas, such as the arm, the brain cannot decipher the difference, which is why you get pain in the arm.’
‘I just couldn’t cope with the work,’ he says. ‘If I made a mistake in a practice essay, I would have to start again.’ In hospital, Nigel was prescribed powerful anti-anxiety drugs, which dulled his developing brain and sent him spiralling into worsening mental illness. When his obsessive behaviour and depression failed to improve, his psychiatrist resorted to ECT.
‘They gave me eight sessions in 20 days,’ he says. ‘Afterwards I was no longer me. Five decades on and I’m still suffering with poor coordination, no sense of direction and frequent memory blackouts.’
Echoing Gillian’s experience, he says: ‘I was left a zombie.’ He spent two years in the mental institution, emerging at the age of 16. He embarked on a degree in art and design, but was unable to resume an academic career.
Supporters of ECT point out that modern treatments use lower voltages and are better targeted to areas of the brain. Critics are concerned that there is no requirement for hospitals to record when mental health patients receive ECT, their age or what happens to them afterwards.
The Royal College of Psychiatrists says there are now 101 psychiatrists using it in Britain. While it encourages these doctors to join its ECT accreditation service, to monitor safety and standards in use of the treatment, not all of these 101 doctors are members — and among those who are, a quarter don’t submit any data.
‘It is impossible to find out what the real numbers are, but the use of this treatment is very worrying,’ says Professor Read.
Latest figures from the Electroconvulsive Therapy Accreditation Service, which is run by the Royal College, indicate a handful of children as young as 11 have received ECT in recent years — but others could have been treated with no record to show for it.
‘Common sense says you don’t put a high voltage of electricity through children’s brains,’ says Professor Read. ‘Very small numbers of them are being treated but we want to stop it altogether.’
Research he published recently in the journal Psychology And Psychotherapy, suggested that two out of five children and adults being given ECT in mental hospitals had not given informed consent to the treatment.
Charles Kellner, a psychiatrist based in New York, who advocates for ECT, maintains that depression damages memory anyway. ‘There is a significant percentage of patients who develop severe psychiatric illness younger than age 18,’ he told Good Health. ‘The vast majority of our patients are adults but one or two per cent are children who don’t respond to other treatment. ECT works very well.’