AFTER receiving a muscle relaxant and general anaesthetic, you are wheeled into the operating theatre for a procedure that will last less than a minute. A couple of hours of recovery and it’s home time. Eight to 10 such sessions should see you free from the depression you’ve found so debilitating. What a relief!
Serious depression creates misery for many people, including friends and family. Drug and talking therapies are hit and miss, so a surgical procedure that promises relief sounds great. At least until you hear it is electroconvulsive therapy or ECT, in which an electric current is passed through the brain to induce a seizure.
ECT fell from favour at the end of the last century, in part because it is so extreme, but it never went away. The description above is how its advocates would like modern ECT to be seen – a routine outpatient procedure. The costs of lifting depression are temporary, they say: muscle pain, a headache, confusion and memory loss. In the US they hope to dispel the stigma attached to ECT and offer it to more people and for disorders other than serious depression in adults.
Ranged against them is a variety of groups – some credible, some not – claiming that ECT can cause permanent memory loss and brain damage. Some even argue that ECT does not work.
The evidence does not support that last contention. Analyses of many trials show that ECT is an effective short-term treatment for depression, and probably better than drugs. However, medical science has fallen short when it comes to the downsides of ECT.
The UK’s National Institute for Health and Care Excellence points out that study of the scale and longevity of cognitive impairments caused by ECT has been neglected in randomised controlled trials. Is the damage done by follow-up courses of ECT cumulative? We cannot say.
Work needs to be done here. To recast a popular phrase, rehabilitating such an extraordinary treatment will require extraordinary evidence. We need to be certain not only of ECT’s benefits, but also its costs.
This article appeared in print under the headline “A real headache”
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