FEATURE ELECTROCONVULSIVE THERAPY2 abusive: electroconvulsive therapy,
or ECT. In 2016-17, around 1,700 people
r eceived ECT i n E ng la nd, I r ela nd,
Wales and Northern Ireland. During the
treatment, an electric current is passed
t h roug h a pat ient’s bra in to induce a
seizure. Proponents of ECT claim that it
is the fastest acting and most effective
t reat ment for severe depression, a nd
argue that the stigma prevents patients
from receiving a potentially life-changing
therapy. One of those psychiatrists was
looking after Karen in December 2010,
seven mont h s a f ter her f i r st su icide
attempt, and saw the possibility of an
effective treatment when nothing else
she had tried had helped.
A modern ECT session, says Prof George
Kirov, a psychiatrist at Cardiff University’s
School of Medicine, goes like this: an
anaesthetist inserts a thin tube in the
back of the patient’s hand and administers
bot h muscle rela xa nt s a nd a genera l
anaesthetic, which puts the patient to
sleep. An ECT nurse squeezes conductive
gel onto a pair of electrodes and holds one
to each of the patient’s temples. Another
member of the team then sets the level
of the electrical current, and pushes a
button. Current pulses briefly through the
electrodes, eliciting a seizure that lasts
between 15 and 40 seconds. Prof Rupert
McShane, a consultant psychiat rist at
Oxford Health NHS Foundation Trust,
explains that the muscle relaxants keep
the patient mostly still. “Usually you can
see some muscle twitching, but we use
an electroencephalogram [which monitors
brain activity] to see that the patient is
having a fit.”
The procedure is surprisingly quick.
The patient wakes up a couple of minutes
after their seizure finishes, and they are
ta ken to a super vised recover y room.
When they feel up to moving, they are
offered a drink and some food. They’ll do
this twice a week, for around six weeks.
After Karen’s first session, in
December 2010, she woke up to “t he
worst headache of my life”, she says.
Other patients report becoming confused
and needing time to remember where they are. During the
weeks of treatment, patients often experience memory loss;
for t he major it y, t h is r esolves it sel f i n t he mont h s a f ter
treatment finishes.
After her fourth session, Karen went back to her ward and
asked for a drink. This was a big deal for two reasons. Karen
had lost any interest in eating or drinking over the preceding
weeks – now she was doing it voluntarily. She had also chosen
to speak to someone – another rarity. With each session she felt
progressively better, and eventually started eating on her own.
“It felt like there wasn’t something heavy on me any more,” she
says. Karen stopped after nine sessions, and her psychiatrist
discharged her a few weeks later, in February 2011.THE SCIENCE
What was going on in Karen’s brain that made her feel better
so quickly? No one knows, exactly. What we do know is that
the seizure is key: the better the seizure – gauged by certain68
The number of ECT
clinics that have closed
in England, Wales,
Ireland and Northern
Ireland since 2009.