Just as I thought we were sailing into quieter waters and the ritual Christmas frenzy appeared to be abating I was dragged into action by a New Year ECT provocation. My January 2019 issue of The British Journal of Psychiatry front-paged itself as a “Themed Issue: Treatment-Resistant Mood Disorders. Hardly earth shattering I hear you say. But there is more. Nowhere in the scientific article’s content list is there mention of ECT.
However, page1 of the quite few advertising pages of the Journal has an ad for an Advanced ECT machine by the named vendor. Now some readers will know I am a strong supporter of ECT for carefully selected patients. It therefore seems odd indeed that ECT treatment appears not to be included in that January 2019 Mood Disorders Themed issue.
Alas, that is not the end of this intellectual discomfort. There is more. Enter the BMJ. Its 06/02/2019 issue has a Head to Head Maudsley Debate…..Should we stop using electroconvulsive therapy? ‘Yes’ is answered by John Read, a professor of clinical psychology, and, Sue Cunliffe, electroshock survivor.
NO, is supported by Sameer Jauhar, senior research fellow, Department of Psychological Medicine, Kings College. London and Declan M Mcloughlin, Department of Psychiatry, Trinity College, Dublin.
It amazes that the BMJ has supported this debate so generously in journal space.
Taken with the content cover of ECT in the top two paragraphs on this page raises a strong sense of curiosity about the density of so much focus on ECT. As one who strongly supports the therapeutic use in carefully selected patients it is probably not surprising that I perceive the BMJ NO response in the debate to be the therapeutically superior and appropriate response.
It was a pleasant surprise when a son who, unlike me, reads the Guardian newspaper drew my attention to its issue (24.4.2017) containing a piece by one of its columnists, Andrew Mayers . Its headline was “Drugs didn’t work for my brother. Electroconvulsive Therapy did”. He went on, in a lengthy article, “how doctors tried everything in an effort to treat the depression that engulfed my brother. In the end the only thing that did any good was ECT”….my brother ended up getting four amazing unexpected years of vitality: not a bad result from a seizure lasting less than a minute”. That piece overall is as moving as it is enlightened. It deserves to be read by a wide readership in which I include medical colleagues. Andrew’s brother Stephen sadly died later from a heart attack.
I would also aver that ECT is indeed one of the finest treatments across the whole of medicine. Would we belittle an antibiotic which cured a severe pneumonia because that patient might or might not have a recurrence of that illness? I have known patients profoundly depressed who received ECT thirty plus years earlier and still no recurrence. If a patient gets 4 or 8 yrs complete relief following a course of ECT for an acute mental illness and it recurs perhaps 8 years later and ECT is again successful that is truly remarkable; especially when likely as not antidepressant medication would have been prescribed without any or adequate effect. In the context of severe mental illness the severity of the suffering, so often prolonged before effective ECT treatment commences is indeed lamentable.
When patients are severely depressed, withdrawn and/or agitated because of their tortured mentally distracted state the kind of questioning and memorising they may undergo in simple memory testing can lead to a false conclusion of impaired memory functioning since they seem quite unable to answer appropriately. This of course can lead, understandably, to diagnostic thoughts of dementia. In the context of ECT which of course is administered under a general anaesthetic (which can lead to some, usually, short-lived, confusion). I recall decades ago, a young trainee psychiatric nurse declared his opinion to me that he didn’t really think much of ECT as a treatment. My response was to assure him he was entitled to express that opinion but that is was not an informed one and to muddy the waters further stated impishly, “actually, I have improved patients memory with ECT”. What heresy was this? Quite simply, the impaired Registration in memory caused by the illness distraction and which could lead to faux memory impairment, had been removed by the course of ECT. Respected follow-up studies have found that any mild cognitive impairment had disappeared in a few weeks.
Recently, quite out of the blue the thought struck me that I could not recall any patient of mine ever complaining of post ECT memory problems. Neither in talking informal shop over the decades with colleagues where not infrequently specially noted patient management difficulties might be discussed did post ECT memory problems crop up.
A thought. I can think of no other specialty across the whole spectrum of medical/surgical activity in which an ill informed public and a very few doctors have been allowed to publicly inhibit the use by doctors of the most effective treatment and relief of profound suffering associated with such as psychotic depression. It may annoy some folk when I mention that in the 1970 edition of Curran and Partridge, Psychological Medicine, where in the section dealing with indications for ECT( they preferred the term ‘Electrical Treatment’) it states,“The treatment is of established value only in (1) states of depression, (2) states of excitement, (3) confusional states. Yes ,I have read the journals since but I can also recall the benefits of these almost unmentionables today.
What Mr Andrew Mayers, a journalist, has written should help to improve public perception of ECT and its benefits. Is there another journalist of the national “Dailies” who can claim to have made such a positive difference in our medical psychiatric world? I salute him.
Dr Dermot J Ward
First published in the Irish Medical Times 25th March 2019