Following recent concerns in the headlines about the ethics and efficacy of electroconvulsive shock therapy (ECT) as a treatment for depression, 40 mental health professionals together with patients and their families have now submitted a letter to the Care Quality Commission requesting that the use of ECT be suspended throughout the NHS pending further studies into its safety.
The letter, dated 2 July 2020 to coincide with the 59th anniversary of the death of author Ernest Hemingway (who committed suicide following a protracted course of ECT), draws on the findings of a recent in-depth review of ECT co-authored by Professor John Read of the University of East London, Dr Irving Kirsch of Harvard Medical School, and Dr Laura McGrath of the University of East London. The review emphasises the scarcity and poor quality of existing research in support of the short-term benefits of ECT for patients with depression and the corresponding complete lack of any evidential support for its long-term benefits. Likewise the high risk of permanent memory loss and a small increase in the risk of death is noted. The review concludes:
“Given the high risk of permanent memory loss and the small mortality risk, the long-standing failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomised, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.”
Despite growing concerns over its use, ECT is still administered to over a million people annually throughout the world, some 2500 of which are in the UK. These are mainly women over the age of 60 (women are indeed twice as likely as men to be prescribed ECT for their depression.). A dwindling number of psychiatrists continue to advocate for its use however and the current National Institute for Clinical Excellence (NICE) guidelines recommend ECT to achieve rapid and short-term improvement of severe depressive symptoms after other treatment options have been exhausted. The NICE guidelines date from 2009 however and, prompted by the concerns expressed by Professor Read and others, are presently under review.
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