ELECTROCONVULSIVETHERAPY FEATUREqualities on the EEG – the greater the
improvement. Researchers have found
several possible pathways that could be
involved (see box, overleaf).
Karen’s rapid response was not unusual,
however. In 2004, results from one of the
largest ever ECT studies were published
in the Journal Of Clinical Psychiatry. The
study looked at 253 patients with major
depressive disorder, and found that three-
quarters of them reached remission after
receiving ECT. In this context, remission
can mean that mute patients start speaking,
or catatonic patients start moving. Suicidal
thoughts might recede, and patients may
begin to engage with long-term therapy.
McShane says that, for people with severe
depression, those rates of improvement are“EARLY ECT DIDN’T USE
MUSCLE RELAXANTS, SO IT
ILLUSTRATION: EMMANUEL POLANCO
considerably better than
for a nt idepr essa nt s.
But ECT research isn’t
without controversy.
Clinical psychologist
D r Joh n Read at t he
Un iver sit y of Ea st
London points out that no placebo-controlled study of ECT
has been published since 1985, and those published before
then were of “questionable methodological quality”. Without
trustworthy placebo-controlled studies, he says, any positive
ECT results could simply be due to a placebo effect. In contrast,
McShane says that the pre-1985 studies have already proved
ECT’s ef fectiveness, a nd cautions against repeating t hose
studies: “It would be unethical to take a group of people with
depression and treat half of the sample with an ineffective,
sham treatment.”
Read also has concerns that the effect of ECT doesn’t last,
and claims there has never been a long-term follow-up study
in which ECT outperfor ms a placebo. A nd indeed, K i rov
notes that in his clinic, and in others in the UK, about half of
patients become unwell again within a year. This is even with
the help of antidepressants, psychotherapy and what’s called
‘maintenance ECT’, where the patient continues with ECT, but
with decreasing frequency. Kirov says that relapse is ECT’s
biggest problem. “They get back into depression. Not necessarily
to the same level, but they go back.” And if relapse is the main
problem with ECT, then side effects are certainly the second.
In 2011, the late actor Carrie Fisher wrote about her experience
with ECT in her memoir Shockaholic. But her mostly positive
account came with a caveat: “the truly negative thing about
ECT is that it’s incredibly hungry and the only thing it has a
taste for is memory”.
ECT interferes with memory, both anterograde (the laying
dow n of new memories), a nd ret rograde (recalling t hings
from the past). Anterograde memory problems usually resolve
themselves a few months after finishing treatment, but for some
individuals – 13 to 55 per cent of people, depending on which
study you read – retrograde memory loss can be permanent.
Kirov says that for these people, continuing becomes a personal
choice: “Some of them are disturbed by their memory problems
and decide to stop.” Karen experienced retrograde memory loss,
though it has improved since finishing treatment. “I couldn’t
remember things, like what we did on holiday, and that was
quite frustrating. But I didn’t like being unwell, so there was
a trade-off.”REPUTATION PROBLEMS
Historical scars also mar ECT’s reputation: early applications
didn’t use muscle relaxants, so it produced violent seizures
where patients occasionally broke bones. Ken Kesey’s 1962 2