Why Electric Shock Treatment Still Exists - Electric Shocks for Depression

Written by Sunday Times of London

As one formerly depressed person put it, 'If you're bad enough to need that sort of treatment, how can you possibly be in a state to make a sound judgment on it?' When it is deemed that any delay in treatment would be life-threatening, patients are treated without their consent. For this to happen, they must first be sectioned, a decision taken by two independent doctors and an independent, specially trained social worker, who must agree that there is no alternative. For ECT to be administered, the opinion of a third doctor must be sought. Still, treatment without consent is interpreted by some as the arrogance of the medical profession versus the powerlessness of the patient. The mental health charity Mind holds that nobody should have ECT against their wishes, whatever their mental capacity.

However, a recent study by Dundee and Aberdeen universities had some surprising results: 150 patients who had received ECT two weeks earlier were asked: 'Did ECT help you?' Of these, 110 said yes. Of the 11 among them who had not consented, nine also said yes. It is possible that some try to give the 'right' answers to health-care professionals, and that two weeks after treatment they may be too confused to give a true answer. But it is hard to dismiss these findings. Think of the alternatives, and the desperate need of those to whom ECT is given. Cognitive behavioural therapy has proved as effective as antidepressant medication for moderate depression, but there is a long waiting list. Antidepressant drugs, on the other hand, are unsuitable for pregnant women, as they can affect the foetus, and they have side effects that the elderly are far less able to tolerate. For them, ECT is often prescribed instead.

A governmental committee set up in 1999 to investigate ECT as part of an overall review of the 1983 Mental Health Act recommended that it continue to be used, within strict guidelines, both with and without patient consent. The committee's findings and recommendations were published in a white paper at the end of last year, and legislation is being drafted for a bill that will be debated in parliament.

Research is under way into a proposed alternative to ECT: repetitive transcranial magnetic stimulation (rTMS), which stimulates the brain using a magnetic field and is not thought to impair memory. But at present it is of limited use. ECT is here to stay, at least for the near future, and research into how it works continues.

'If we understood how ECT worked in detail, then we'd have the opportunity to replace it with something better,' says Professor Reid. Meanwhile, he has instructed his colleagues that if he ever has a severe depression, is not eating or drinking and is trying to kill himself, 'Please make sure I get the right treatment.' He says that if he, or anyone he cared about, had a depressive illness to the point of being suicidal, he would want them to have ECT: 'A psychotic depression is like your worst nightmare.' It's the one statement on which everybody agrees.

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