Electroconvulsive therapy controversy

Morbidity and Mortality

A study by Freeman and Kendell (1980) found two deaths out of 183 ECT patients at Royal Edinburgh Hospital, Scotland, in 1976. That gives a death rate of a little over one per cent.

A register-based cohort study of all inpatients admitted to a psychiatric hospital from 1976 to 2000 showed that ECT patients had an increased suicide rate in the first week after the last treatment.

One difficulty in assessing the mortality rate of ECT patients is the tendency for doctors to assume that some other, pre-existing condition was the cause of the patient's death. An example: a case study in Clinical Geriatrics magazine reported that an 80 year old man developed catatonia and died of aspiration pneumonia after an ineffective course of ECT. The author ascribed the death to undiagnosed catatonia, rather than ECT.

A retrospective CAT scan and case review of 41 patients at least six months after ECT treatment showed a significant relationship between frontal lobe atrophy and ECT.

In 2007 Dr. Harold A. Sackeim of Columbia University published a study of 250 electroshock patients in New York City hospitals. The results indicated that certain types of electroshock treatment (bi-lateral, temple to temple) do cause long-term amnesia and mental impairment, especially among women and elderly patients.

History of Dissent

American psychiatrist Max Fink, editor in chief of 'Convulsive Therapy' magazine, who has been researching and writing about ECT for over 50 years, traces the origins of the controversy surrounding ECT back to the post World War II conflict between psychoanalysts (who in the 1960s headed most academic departments of psychiatry in the USA) and those who favoured somatic therapies. The introduction of neuroleptic and anti-depressant drugs in the late 1950s temporarily distracted from the conflict, but by the 1970s psychiatrists were becoming aware of the shortcomings of the new drugs and began to turn again to somatic therapies. Fink sees this as unfortunate timing as the 1970s also saw increasing concerns for the rights of people with mental illness.

In 1971 the Massachusetts Psychiatric Society formed a task force on ECT, concluding that it was a proven treatment for depression, but unproven in the treatment of schizophrenia or in the treatment of young children. In 1973 California introduced a law preventing the use of ECT on children under 12. Other states imposed lower age limits: Tennessee 14 (1976); Colorado 16 (1977); Texas 16 (1993). Texas also introduced reporting requirements and collects statistics on the use of ECT.

In 1975 the American Psychiatric Association followed the example of the Massachusetts Psychiatric Society and set up a task force, concluding that ECT was a useful treatment for depression, especially depression that had not responded to drugs, and mania. Researchers in Britain reached similar conclusions, but found low standards of care in many British hospitals. Fink quotes from the ensuing editorial in the medical journal The Lancet: “If ECT is ever legislated against or falls into disuse it will not be because it is an ineffective or dangerous treatment; it will be because psychiatrists have failed to supervise and monitor its use adequately.”

Max Fink says that the controversy surrounding ECT has led to “sparse and uneven” availability of the treatment, and that few psychiatric residency programmes offer training in ECT. As a consequence psychiatrists start to treat patients with ECT when they have little skill or knowledge.

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