This is an email (Feb 2000) from Dr. Carl Littlejohns, an ECT MD. It appeared on the email list for ECT doctors, and expresses concern over the lack of standards in the practice of ECT.

The frontal placement sounds interesting - but more interesting is my growing feeling that there is no standardisation in the way that ECT is being given.

We used to think that it was a UK problem, but that has largely been improved by college initiatives - ok mostly we only do bilateral, but at least twice a week is a standard. Energy settings and electrode types are pretty standard now, and of course basic training is standardised too.

At an ECT training meeting (which presumably 'selected' clinicians that were at least interested in doing a good job) I met people restimulating on the basis of single channel EEG waveforms, people who didnt know what the 'seizure detection' line on the Thymatron meant, people that could not EVER get a seizure with anything less than 100% energy settings on the same machine. And that is before we started to talk about indications for ECT and evaluating outcome or side effects.

This list gives me a similar feeling sometimes. Im not about to say anyone is wrong (or even that I'm right) but the sheer spread of practice across the world is most unsettling.

Carl Littlejohns
Psychiatrist N.Wales.
http://www.priory.com/psych/ectol.htm

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