Depression

Opinions of the treatment are so polarised that the answer depends on who you ask

“ I ’ ve been running an ECT department for the last 20 years , and the vast majority of patients I treat have severe depression that didn ’ t respond to other treatments , like medications and psychological therapy ”

With mental distress often lacking clear-cut solutions , these conflicting perspectives can perplex patients and their loved ones , leading them to either reject a potentially helpful treatment or make a choice they ’ ll come to regret .

Global Health Asia-Pacific talked to two experts with opposite views on the therapy . The result is a more detailed picture of its pros and cons .

The origins In the 1930s , psychiatrists observed that patients experiencing hallucinations , delusions , and depressive moods had some temporary relief from their distress after having seizures , which were sometimes caused by the potent drugs they were taking . One of these was Metrazol , which had the unpleasant effect of putting patients in an intense state of fear and panic .

In an attempt to offer a better way to induce convulsions , the Italian psychiatrist Ugo Cerletti developed a machine that delivered electricity by hooking it to the patients ’ temples . In a blink , patients experienced a seizure and its soothing after-effects without the need of medications . The invention got significant traction and was quickly adopted in many psychiatric hospitals around the world .

From the 1960s , however , a broader movement started to call into question the very scientific basis of psychiatry . Fuelled by that challenge , opposition to the use of electroconvulsive therapy , or ECT , also begun to mount . Critics pointed to the fact that the procedure was often used to control hospitalised patients instead of helping them — an accusation that was popularised in shocking terms by the movie One Flew Over the Cuckoo ’ s Nest , where the character played by Jack Nicholson undergoes forced ECT as a form of punishment .

While the film offered a sensational depiction of ECT , it was an accurate description of psychiatric care in the 1950s , the period when the fictional account was set , according to Jonathan Sadowsky , a professor of medical history at Case Western Reserve University .

“ There is no question that ECT was benefiting patients then , but there is also a lot of evidence from that period showing that ECT , and the threat of it , were used in mental hospitals to control difficult patients and to maintain order on wards ,” he wrote in The Conversation .

Though many psychiatric hospitals from that era have been shut down and psychiatrists who perform ECT today are no longer accused of using it as a form of social control , the controversy over the therapy lingers on but with a new focus on its risk-to-benefit ratio .

The benefits of ECT for people with depression Though ECT can be prescribed for several mental issues , it ’ s often used as a treatment for depression , in particular for some people suffering from severe distress .

“ I ’ ve been running an ECT department for the last 20 years , and the vast majority of patients I treat have severe depression that didn ’ t respond to other treatments , like medications and psychological therapy ,” Dr Timothy Oakley , a consultant psychiatrist in the UK , told Global Health Asia-Pacific .

In the worst cases , people with severe depression may not be speaking , eating , or drinking , and you may not get any response at all when you talk to them . “ And over the course of six to eight ECT [ sessions ] people are starting to interact , smile , enjoy activities like going to the restaurant . The most rewarding thing is to make a major change in the life of people who are really unwell ,” he said .

However , critics argue that the improvements are short-lived .

“ There ’ s no doubt that some people get some temporary , short-term lift in mood [ after receiving ECT ]. The best estimate from research is that about a third of people improve more than placebo ,” said Dr John Read , a professor of clinical psychology at the University of East London who has published several reviews of the studies comparing ECT with sham treatment or placebo .

While some patients may get temporary relief , the two best-designed studies that followed up patients three months after treatment actually found either no difference between ECT and placebo or better results for patients in the placebo group .

Given that there are only 11 poorly designed and very old studies comparing ECT with placebo , Dr Read believes the jury is still out on the efficacy of the therapy . “ I ’ m not saying it doesn ’ t work , I ’ m just saying we have no good evidence that it works better than placebo .”

But Dr Oakley believes it ’ s a mistake to focus

54 NOVEMBER 2020 GlobalHealthAsiaPacific . com