A patient and a professor have jumped to the defence of electroconvulsive therapy (ECT), the controversial treatment which involves inducing an epileptic fit in the brains of mental health patients. They have also spoken up on behalf of Bristol psychiatric staff, describing them as caring while achieving excellent results.
Bristol Live recently revealed that the Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) was England’s most prolific user of ECT and published the account of a former doctor who said the treatment “destroyed” him and cost him his career.
Previously thought a sort of miracle cure, and safer than the chemical-based treatments for psychosis which preceded it, ECT has come under fire in recent years for a range of potentially serious side effects and a lack of all but anecdotal evidence for its effectiveness.
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But now supporters of the practice, which has its roots in the early twentieth century, have come forward to contest the claim that ECT should be consigned to the past. Bristol Live has heard from two people – one patient and one professor – who dispute that the treatment is anything but effective.
The patient
By 2014, Ruth had been severely ill with agitated psychotic depression for almost three years. After years of unsuccessful counselling and medication, ECT was suggested.
“My mind was in utter torment,” explained Ruth. “I was virtually mute, far too ill to engage with any psychological therapies and my illness proved resistant to all medications I was given.”
Unlike “Peter”, the alias under which the retired doctor gave his damning account of ECT, Ruth says she was fully informed about and consented to the treatment. “The nature of the treatment and possible risks were fully explained to me and my family, in their role as my carers,” she said.
Ruth received ECT twice a week for 11 weeks as a day patient at Callington Road Hospital. Although she admits there were side effects, they were relatively mild and appear to have been only temporary.
“I had some short-term memory disorientation during the period of treatment and for a few months afterwards,” she said. “However, thankfully, I have remained extremely well since then.
Ruth told of her “deep gratitude” for the “very caring” Bristol ECT team, “compassionate” consultant psychiatrists, and her supportive family and friends. She now takes antidepressants daily, as a precaution against a relapse into depression – following ECT, these now appear to be working.
“My cognitive function has not been impaired,” Ruth insisted. “With my renewed vigour for life, I completed a Masters degree in 2020 with which I work full time as an educator.” Her belief in ECT as a valid and effective treatment is firm.
“Should I ever have a relapse to the same state in future, I have lodged with my medical team and family an advanced intention that I wish that ECT should be considered promptly as a treatment for me again,” she said. “I thank all ECT clinic staff who care for people in great mental distress. For many, me included, ECT has honestly been a lifesaver.”
The professor
Prof George Kirov is ECT lead at the Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine. He wrote to Bristol Live after reading the previous articles on electroshock therapy, to defend both ECT and AWP.
In his letter, Prof Kirov criticised claims by UK ECT Improving Standards Campaign Group spokeswoman Dr Lucy Johnstone that ECT is “essentially a head injury” and poorly regulated as “misinformation” by “a small but very active anti-ECT lobby”.
Contrary to claims by Dr Johnstone and former doctor “Peter”, which reflect factsheets on ECT published by the National Institute for Health and Care Excellence (NICE), textbook author Prof Kirov says the mechanisms for its action are increasingly well understood.
“We do know quite a lot about how ECT works,” he said, although “there are multiple changes resulting in the brain and the best theory has not been agreed upon.” He added: “I think it works in more than one way. But even if we have no clue what it does, it works very well and we should not give up on it.”
The consultant – who also wrote a book called Shocked , all about what he calls “easily the most controversial treatment in psychiatry” – has analysed the results of ECT clinics around the UK and Ireland, deeming AWP’s provision to be “one of the best in the country”.
“The improvements of patients on objective mood rating scales are about 64% – quite a stunning rate for patients who typically have not responded to other treatments,” he said. “They have assessed practically every patient with objective rating scales for depression and for cognitive problems, again doing better than the average clinic.”
Prof Kirov adds that the revelation that Bristol psychiatrists employ ECT up to 47 more than elsewhere is a meaningless “statistical fallacy”. “There will always be a clinic with the highest number of cases and one with the lowest number,” he explained.
“In fact, there are clinics that have treated zero patients in a given year – we could say that other clinics are using ECT at an infinitely higher rate. I estimate that for the year in question, Mersey must have treated only one or two cases, to reach the quoted 47-fold difference.”
The consultant suggested that the relatively high incidence of ECT use by AWP could reflect staff and patient confidence in the service. “The likely reason for treating so many patients is that psychiatrists in Bristol see their patients get well, have trust in the clinic, and refer more patients with confidence that they will improve,” he said.
“The alternative explanation is that there are a bunch of nasty psychiatrists practicing in Bristol who take pleasure in torturing old ladies – more or less what has been claimed by the anti-ECT lobby.”
“Peter” told Bristol Live that he was forced to have ECT after two psychiatrists claimed that he lacked insight into his illness or the mental capacity to make judgements about its treatment. Prof Kirov, a former ECT administrator, insists that the procedures for involuntary treatment are sound.
“It is actually three doctors who have to agree that a patient lacks capacity, and they normally consult with people like carers,” he said. “I have stopped ect once a patient has regained capacity in the course of treatment. In most such cases they proceed to consent.”
He added: “It would involve quite a big plot to administer ECT wrongly. It is possible, but why would psychiatrists want to do it? ECT is not prescribed easily – I’ve seen enough cases where a patient or the family have pestered the psychiatrist to prescribe it.”
Mental health charity Mind called for a review into the use of ECT in Britain during 2020, citing research published in Ethical Human Psychology and Psychiatry which found that “there is no evidence that ECT is effective for… severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients or children and adolescents”.
Stephen Buckley, head of information at Mind, called ECT “a potentially risky physical treatment that is still used to treat mental health problems in rare cases”. He acknowledged that it did help some people with severe depression, but reiterated that more research into its mechanisms was needed.
“Some people who have had ECT may have found they experience adverse side effects that are worse than the symptoms of the problem they’re trying to treat,” he added, so “it’s vital that a range of treatment options are offered and any side effects are explained properly. The decision to use ECT should never be taken lightly by the person receiving it, or the doctors presenting it as a treatment option.”
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