Electroconvulsive Therapy Background Paper

Written by RESEARCH-ABLE, INC.

Prepared for the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Mental Health Services

March 1998
Prepared pursuant to CMHS Contract No. 0353-95-0004

RESEARCH-ABLE, INC., 501 Niblick Drive, S.E., Vienna Virginia 22180

TABLE OF CONTENTS

PURPOSE

INTRODUCTION

I. HISTORY

II. ECT AS A METHOD OF TREATMENT

Administration of ECT
Risks
Theories Regarding Mechanism of Action
Conditions for Which ECT Is Used
Importance of Patient Consent to Treatment

III. CONSUMER AND PUBLIC ATTITUDES REGARDING ECT

Introduction
Basis of the Opposition to ECT
Questions Regarding Persons Giving Voluntary Informed Consent
Opponents of ECT
Proponents of ECT and Informed Consent

IV. LEGAL PERSPECTIVES AND STATE REGULATION

V. RESEARCH PRIORITIES IDENTIFIED BY 1985 NIMH CONSENSUS DEVELOPMENT CONFERENCE ON ECT

SUMMARY

APPENDIX A - Interviews with Representatives of Organizations

PURPOSE

The Center for Mental Health Services (CMHS) periodically issues reports on topics of concern to the mental health field and to the American public. Part of the CMHS's responsibility is to develop and disseminate information on the delivery of services to persons with mental illness and their families.

This report on electroconvulsive therapy (ECT) summarizes the following information:

1. the current state of knowledge regarding this treatment;
2. consumer and public views;
3. relevant laws and regulations; and
4. priority research tasks.

INTRODUCTION

ECT, a treatment for serious mental illness, involves the production of a generalized seizure through application of a brief electrical stimulus to the brain. Since ECT was first used in Italy more than 50 years ago, the procedures associated with ECT have been improved. Better methods have been developed in regard to anesthesia, the delivery of electrical current, and patient preparation and consent.

Broad agreement exists within the medical-psychiatric community about the effectiveness and safety of ECT for the treatment of people with certain mental illnesses. However, some of those to whom ECT has been administered, are greatly concerned about its possible misuse and abuse. They are also concerned about what they perceive to be a failure to protect the rights of patients. Their concern may be heightened both because treatment side effects (e.g., post-treatment confusion and memory loss) are not uncommon, and because scientists have yet to clarify precisely how ECT works to relieve symptoms. ECT is used primarily for people with severe depression. (1) The treatment is usually provided in the psychiatric units of general hospitals and in private psychiatric hospitals. According to a 1995 report, (2) per capita utilization rates of ECT vary widely across the United States, and an estimated 100,000 patients received ECT during 1988-1989.