ECT risk reconsidered

The United States Food and Drug Administration (FDA) was due to hold an advisory committee meeting in January, to consider downgrading the risk category for electroconvulsive therapy (ECT). The procedure involves an anaesthetised patient receiving an electric current through their brain, which induces a seizure. Despite opposition from patient advocacy groups and some psychologists, the procedure remains popular among US psychiatrists, especially for patients with severe depression or schizophrenia who have shown no benefit from other treatments.

The American Psychiatric Association (APA) is lobbying for the risk level to be relaxed. 'The safety of ECT when properly administered is well documented in the scientific literature and its effectiveness in treating severe mental illnesses is recognized by the American Psychiatric Association, the American Medical Association, and others in the United States and many other countries,' the organisation claimed in an earlier statement. The New York Times reported in January that APA medical director and chief executive James Scully Jr. had also written personally to the FDA, claiming that ECT is effective 80 per cent of the time, and that there's no evidence that it causes brain damage.

This view runs entirely contrary to evidence published in timely fashion by two clinical psychologists late last year in the journal Epidemiologia e Psichiatria Sociale (tinyurl.com/5tktsgh), and submitted to the FDA hearing. BPS Fellow Richard Bentall of the University of Bangor and John Read of the University of Auckland reviewed the findings from all studies over the last 60 years that compared ECT for depression or schizophrenia against a placebo control procedure. From the eight meta-analyses they located, Bentall and Read concluded that the benefits of ECT, in the rare cases they arise, are minimal, short-lived and come with the significant risk of memory impairment and a slight risk of death.

Peter Kinderman, chair of the Society's Division of Clinical Psychology, welcomed the review. 'Psychologists have long expressed serious reservations about the use of ECT, and this paper supports that position. People have a fundamental right to be protected from inhumane or degrading treatment.'

--Christian Jarrett