Health

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Electroconvulsive therapy
ECT involves 6–12 administrations of electricity to the brain, under general anaesthesia, over several weeks, to produce tonic-clonic seizures. Since its invention in 1938, it has remained a controversial procedure. More than 80 years after ECT was introduced, there is no consensus about risks, benefits, mode of action or dosing protocols. One meta-analysis reported that ‘Views on ECT vary from researchers who consider that it is probably ineffective but certainly causes brain damage, through to those who think it is the most effective treatment available in psychiatry and is completely safe’. Presumably, this lack of consensus about efficacy and safety contributes to what one international review described as ‘large variation between continent, countries and regions in utilization, rates and clinical practice’. A recent audit found a 47-fold difference in rates of ECT usage between the highest and lowest using areas of England.

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ECT and informed consent
An audit of patient information leaflets at 36 ECT clinics in England found that ‘Patients are being misled about the risks they are taking and the limited nature of ECT’s benefits’. Specifically:

The most common inaccurate statements included: ECT corrects biological deficits; misleading claims of very low mortality risk; minimization of memory loss; claims that ECT saves lives; and claims of very high improvement rates. The current (2020) RCPsych leaflet contained seven inaccurate statements.

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