3.9 Effectiveness of E.C.T.

3.9.1 Clinical Audit and Research.

Within the Trust, clinical audit had been undertaken in regard to E.C.T., but this was only a single audit in 1992 about its administration rather than outcomes. The Project Team was told by consultants in the Trust that:

the recent reorganisation of the Elderly Service had left things somewhat disorganised, but it was felt that a suggestion should be put to Salford and Trafford Health Authority to seek an audit of E.C.T.

Although the Salford Case Register records information on research and audit, this appears irrelevant in the case of E.C.T., as so little research and audit has actually been undertaken.

3.9.2 Duration of Effect.

The Project Team was told by consultants in the Trust that:

Psychiatrists would look for a quick difference as a result of E.C.T. - an effect after two weeks. It would be difficult to check the effectiveness for patients having E.C.T. against those who do not.

The relapse rate of patients is fairly high, perhaps 60% within two years. E.C.T. should therefore always be followed up with maintenance treatment.

The Project Team was informed that "Psychiatrists in Salford do not prescribe E.C.T. expecting that this will reduce the rate of relapse. Psychiatrists in Salford do not prescribe E.C.T. to prevent long-term relapse. The Royal College of Psychiatrists' Committee on E.C.T. emphasise that it is essential that maintenance of the treatment with medication should be instituted after a course of E.C.T. to reduce the risk of relapse. This may be with antidepressants, lithium, carbamazepine or a combination." (Hyde, 1997: 5).

3.9.3 Survivors' Views.

No work had ever previously been done in Salford to assess patients', survivors' or relatives' views about E.C.T. and its use.

3.9.4 Who does E.C.T. work for?

On criteria to determine the effectiveness of E.C.T., the Project Team was told by consultants in the Trust that a major factor they used to decide how effective E.C.T. is likely to be for any patient is the presence of delusion and also biological symptoms. Both can, of course, be seen as matters of judgement rather than objective fact.

A depressive delusion involves a person believing that they are worthless, unlovable and not deserving of care or attention. In such a psychological state, there is no logical reason to continue to live, and the person will believe that everyone is better of without them. A delusion is a belief that cannot be questioned.

Biological symptoms are those which suggest a depressive illness that is not a response to grief, a lack of self-confidence or a lack of coping skills, but one that is related to biochemical and pathological changes in the brain and body.

3.9.5 E.C.T. and Alternatives.

The Project Team was informed by consultants that in the Trust the alternatives to E.C.T. used are mainly antidepressants. There was no mention of psychological services, "talking treatments" or other alternatives. This was despite the presence in the Mental Health Services of Salford of both a Psychotherapy Department and also a large, highly-trained Psychology Department that offers cognitive therapy and various other treatments that can be used to treat depression, either with or without physical treatments.

It was, however, reported that "In considering alternative treatments to E.C.T., it should be noted that patients treated with E.C.T. are normally too ill to be accessible to psychological treatments. These are available and will be considered where appropriate either when someone who has been severely depressed has improved or for an individual with a less severe depressive illness for whom E.C.T. would not be considered. Many individuals with depressive illnesses have a biologically determined illness and are not necessarily in need of psychological treatment." (Hyde, 1997: 8).

The C.H.C. was later informed that "When contemplating E.C.T. in Salford, we consider not only alternative pharmacological treatments but the availability of both eclectic psychological treatments, and specific psychological treatments of cognitive behavioural therapy and psychodynamic therapy. The majority of people receiving E.C.T. are not amenable at that time to psychological treatments." (Hyde, 1997: 5).