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Electroconvulsive therapy effectiveness and harm

Published online by Cambridge University Press:  27 January 2020

Marco Chiesa*
Affiliation:
Consultant Psychiatrist and Visiting Professor, University College London, UK. Email: [email protected]
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Abstract

Type
Correspondence
Copyright
Copyright © The Royal College of Psychiatrists 2020

Dr Tracy states that there is no reliable and convincing evidence with regard to the effectiveness of electroconvulsive therapy (ECT) (forgetting why, remember how), and then continues by saying that ECT critics are ‘…folk [who] are curiously happy with anecdote when it comes to harms'.Reference Tracy1 Curiously, in the light of the acknowledged uncertainty of the evidence base regarding effectiveness and, I would add, seriousness of adverse effects, Dr Tracy omits to explain the basis upon which proponents of ECT continue to practice this intervention on a relatively large scale (perhaps on anecdote when it comes to ‘good' outcome?). But, we do have some evidence through systematic reviews that ECT is not effective beyond the treatment period.Reference Read and Bentall2, 3 There is little or nothing in the literature to suggest that ECT ‘saves lives’ or that it prevents suicide, as it is often repeated. In fact, a study by ECT advocates found an overall increased rate of suicide in patients treated with ECT.Reference Munk-Olsen, Laursen, Videbech, Mortensen and Rosenberg4 With regard to other harm done, a large study carried out by ECT-advocate Harold Sackeim revealed highly significant cognitive dysfunctions (memory loss and other impairment of cognitive functioning) in 347 patients tested 6 months after ECT, as well as persistent electro-encephalogram abnormalities, indicating the presence of persistent brain damage.Reference Sackeim, Prudic, Fuller, Keilp, Lavori and Olfson5

References

1Tracy, DK.Highlights of this issue. Br J Psychiatry 2019; 214: A13.CrossRefGoogle ScholarPubMed
2Read, J, Bentall, R.The effectiveness of electroconvulsive therapy: a literature review. Epidemiol Psichiatr Soc 2010; 19: 333–47.CrossRefGoogle ScholarPubMed
3UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799808.CrossRefGoogle Scholar
4Munk-Olsen, T, Laursen, TM, Videbech, P, Mortensen, PB, Rosenberg, R.All-cause mortality among recipients of electroconvulsive therapy: register-based cohort study. Br J Psychiatry 2007; 190: 435–9.CrossRefGoogle ScholarPubMed
5Sackeim, HA, Prudic, J, Fuller, R, Keilp, J, Lavori, PW, Olfson, M.The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology 2007; 32: 244–54.CrossRefGoogle ScholarPubMed
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