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Electro Convulsive Therapy (ECT) is still used widely used
in hospitals throughout the UK and is available as a treatment at
the Stonebow Unit in Hereford.
A recent survey by the Dept of Health found that between February
and April 1999 :
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There were about 16,500 administrations of ECT Electro-Convulsive
Therapy (ECT)
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2,800 patients received treatment
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There were 900 male patients receiving treatment, compared
with 1,900 female patients
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44% of female patients and 36% of male patients receiving
ECT treatment were aged 65 and over
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75% of ECT patients were not formally detained under the
Mental Health Act 1983
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Of the 700 patients formally detained while receiving ECT
treatment, 59% did not consent to treatment
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What is it ?
ECT involves placing electrodes on the temples, on one or both sides
of the patient's head, and the delivery of a small electrical current.
The aim is to produce a seizure lasting up to a minute, after which
brain activity should return to normal.
Patients may have more than one treatment a week, and perhaps more
than a dozen treatments in total.
The treatment is always given under a general anaesthetic. Muscle
relaxants given simultaneously mean that the induced seizure is
modified and externally there is little to observe beyond some twitching
of the face and feet.
What is it a treatment for ?
ECT is principally a treatment for depression but it also sometimes
used to treat people with schizophrenia and mania. There are two
psychiatric contingencies where ECT may be the treatment of choice.
· Persistent severe depression that does not respond to
anti-depressant medication or other treatments. Severe depression
at its most extreme can be a life threatening illness, which removes
a person's will to live. Occasionally people become so depressed
that they are unable to meet their most basic survival needs and
life is threatened. ECT can dramatically lift the mood of people
in this state and literally save their lives.
· Treatment resistant episodes of severe psychosis or mania
can also occasionally be brought under control by ECT. As with depression,
except under extraordinary circumstances (eg allergy to medication),
ECT should always be a second line treatment and only follow if
anti psychotic medication fails to do the trick.
Are there side effects ?
Side effects remain the most controversial aspect of ECT treatment
and accounts of their nature and severity vary widely.
The most common side effects are headache, stiffness, confusion
and temporary memory loss on awaking from the treatment - some of
these can be reduced by placing electrodes only on one side of the
head.
Sometimes people experience a temporay numbness in the fingers and
toes.
Very occasionally memory loss can be permanent and the spasms associated
with the seizure can cause fractured vertebrae and tooth damage.
A common argument against ECT is that it destroys brain cells, with
experiments conducted on animals in the 1940s often cited as evidence.
However, modern studies have yet to reproduce these findings in
the human brain.
Campaigners against ECT believe that evidence of long term damage
may yet emerge.
Does it work ?
One of the reasons that ECT has survived as a treatment despite
the controversy surrounding it is that it is possibly the most effective
treatment for depression available, at least in the short term.
An audit of ECT in Scotland between February 1996 and August 1999
said that in nearly three quarters of cases people with depressive
illness showed "a definite improvement" after ECT. However
it is less certain that it has any long term value. A common criticism
is that many people relapse after showing an initial improvement.
How does it work ?
The origins of ECT as a treatment lie in observations made of people
with epilepsy in the 1930s. Doctors looking after people with epilepsy
noticed that their patients often experienced a dramatic improvement
in mood and sense of wellbeing following a seizure.
They hit on the idea of utilising this naturally occurring mood
lift associated with seizures to treat people with chronic depression
and other psychiatric conditions. They used electricity applied
to the head as a means of artificially inducing a seizure.
However, now as then, there is still only a fairly sketchy understanding
of how it works.
American Academy of Family Physicians explains it thus : "It
is believed that ECT works by creating a seizure (a short period
of irregular brain activity). The seizure is caused by an electrical
shock. This seizure releases many chemicals in the brain. These
chemicals, called neurotransmitters, deliver messages from one brain
cell to another. The release of these chemicals makes the brain
cells work better. A patient's mood will improve when these brain
cells and chemical messengers work better."
Can it be given against your will ?
Yes, ECT is still sometimes given without the consent of the person
receiving it. The 1999 survey found that about 400 people (in a
three month period) were given ECT without consenting to the treatment.
Many of these were elderly and unable to express either consent
or dissent.
The Mental Health Act (MHA) requires that a consultant psychiatrist
must seek the opinion of a second doctor approved by the MHA Commission
(who must himself consult with a nurse and one other), before giving
ECT without consent.
Why is it controversial ?
The controversy surrounding ECT is rooted in the history of its
use and psychiatric abuse in the 1940s and 50s before the introduction
of anti-psychotic medication. There is little doubt that it was
used indiscriminately and at times punitively in attempts to control
ill and disturbed people and that some were damaged by it. The distaste
many people feel at the notion of passing electricity through someones
brain for any reason is difficult to dislodge, even though the reality
of ECT treatment today is very different to that popularised by
the film One Flew Over the Cuckoos Nest (set in the '50s).
The death rate from ECT used to be quoted as 1 for every 1,000 patients,
but with smaller amounts of electric current used in modern treatments,
accompanied by more safety techniques, this has reduced to as little
as 4.5 in 100,000 patients.
While it is possible that ECT inflicts as yet undetected damage,
it should be taken in the context both of the benefits it can offer
and the damage that some alternative treatments (medication) can
also occasionally inflict.
More about ECT
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