Is it time to BAN electric shock therapy?
It’s long been used to treat depression, but as a study suggests it can cause patients permanent brain damage...
‘It totally destroyed my career as a doctor and my life’
‘Five decades on I’m still suffering. I was left a zombie’
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 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 (not her real name), who is now studying for a postgraduate qualification in social work.
The 58-year-old from Coventry 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 the National Institute for Health and Care Excellence (NICE) for patients with severe depression or psychotic depression that is resistant to other treatments, such as medication.
More than 250 patients have ECT in Ireland each year.
It is a deeply controversial treatment, and while it has been shown to help some patients with serious depression, 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 — but it acknowledges that, ‘there can be side-effects of differing severity, including memory loss,’ as the chair of its ECT committee told Good Health.
The College of Psychiatry in Ireland’s position on ECT is that it is rarely used, clinically applied and regulated.
Now a new analysis of the evidence base for ECT suggests it not only does not work, but 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, Massachusetts.
Following this report, a letter calling for the treatment to be suspended and signed by more than 40 psychiatrists, psychologists and former ECT patients and their families has been sent to senior politicians and health policy makers in Britain.
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 per cent 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 the University of Sheffield and a co-signatory of the letter, adds: ‘There has never been proper research to show ECT works. The doctors doing it are not adhering to the rules of evidencebased medicine.’
Among the psychiatrists who 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 paediatrician who, in her mid-30s, underwent 21 sessions of ECT for depression between 2004 and 2005. She says it caused such brain damage that 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.
‘I consented after being told ECT was safe, yet I suffered catastrophic brain injury,’ she wrote in a 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, claims he is still suffering after-effects, such as memory problems and poor coordination, due to damage from ECT almost 50 years after he received the treatment.
Shortly after his 15th birthday, Nigel found himself consigned to a mental hospital after he displayed symptoms of depression and serious obsessive behaviour while revising for exams.
‘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 co-ordination, 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 hospital, 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 the correct areas of the brain.
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 in Britain — but others could have been treated with no record of 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 are not given informed consent to the treatment.
In Ireland, a recent study by the Mental Health Commission indicated that more than 50 people were given ECT without their consent in 2018.
In its report on the Administration of Electro-Convulsive Therapy in Approved Centres, the Mental Health Commission has also claimed that those treated with ECT did not understand why they were having it.
Since the commencement of the Mental Health (Amendment) Act 2015, ECT can only be administered with the written consent of the patient.
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 1 per cent or 2 per cent are children who don’t respond to other treatments. ECT works very well.’