Health: Patients join the fight to curtail shock treatment

Miracle cure or dangerous practice? ECT is still used but there is growing opposition, writes Roger Dobson
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Indy Lifestyle Online
Jean Taylor has nightmares about that upstairs room. In flashbacks she sees herself on a hospital bed pushed against a white tiled wall and four people are looking down at her. As one of them moves aside to load a hypodermic needle, she sees for the first time the electric shock equipment. This is the ECT room, or as it is more anonymously signposted in many hospitals, the Treatment Area, and it is an image 64-year-old Jean Taylor has never forgotten.

Next month she will spearhead a campaign by the mental health charity Mind to highlight research which has identified a large number of women, particularly the middle-aged and elderly, who are being given the treatment.

In response to the controversy surrounding ECT, the Royal College of Psychiatrists has recently produced revised guidelines for its use. The college says it would be unacceptable for such an effective treatment, primarily used to treat severe depression and schizophrenia that have not responded to drugs, to be banned. They blame public misconceptions and the film One Flew Over the Cuckoo's Nest for the bad image ECT has gained.

ECT is an area of medicine that has been largely untouched by the passage of time. Although there have been modifications and refinements in the apparatus and the technique, the basic principle of putting an electric shock through the patient's brain to induce a fit is the same as it was when two Italian doctors, Binit and Cerletti, introduced the concept in 1938.

These days, patients may be anaesthetised and the leather restraining straps replaced with a muscle-relaxing drug, but the system of passing 100 volts of electricity - a voltage sufficient to power an electric razor or boil a kettle - through the temples is unchanged.

Its opponents, led by Mind, say it is used too frequently, patients are often denied the choice of alternative treatment or not made aware of their rights, there are serious side effects, and no one knows what putting an electric shock through the brain really does.

The college acknowledges that it can cause short-term memory loss but says the long-term memory loss is no greater than that caused by some drugs.

The modern convulsive therapy given to 20,000 NHS patients each year has its roots in 1934 when a Hungarian specialist induced fits in patients using drugs and found it had some beneficial effect on their mental illness. The problem with his drug-based method was that the convulsions were uncontrollable. When the Italians tested their electric shock idea on a schizophrenic patient in Rome in 1938, they provided a better control of the fit-inducing process. A single electric charge through both temples was enough to produce one fit, and a course of six such treatments per patient remains the norm today. Although the 100 volts is enough to power many domestic appliances, the resistance of the brain tissue means that the current is relatively low.

Experiments on rats' brains have shown a redistribution of chemicals after ECT. The theory is that the seizure affects the entire brain, including the centres which control thinking, mood, appetite and sleep. Repeated treatments alter chemical messages in the brain and restore abnormal responses to normal.

Dr Brian Harris, a consultant psychiatrist and senior lecturer at University of Wales College of Medicine, says: "No one knows how it works, but it does and is quicker than medication.

"The principle is the same as in 1938, but there have been many refinements. The patient is asleep and you minimise side effects from convulsions, such as broken bones, by using a drug which is like the stuff that South American Indians shoot in their blow darts. Patients are given pure oxygen and then they have the shock and convulsion."

Would he have ECT? "I would certainly have it if I needed it. I have seen some pretty miraculous results," he says.

The emeritus professor SydneyBrandon of Leicester University says: "There have been quite a number of well controlled studies and we do know it works. Like any treatment it needs to be carefully prescribed. There are indications that it has some effect on the chemical transmitters in the brain.

"I would not hesitate to have ECT if I needed it. A study was done in Edinburgh where patients were asked if they would rather have a further course of ECT or go to the dentist and the majority preferred ECT."

High success rates are claimed by psychiatrists. Dr Fiona Caldicott, president of the Royal College of Psychiatry, said at the guidelines' launch: "ECT can save lives when patients may be suicidal. In these kinds of life threatening illnesses, ECT has an 80 per cent success rate. It would therefore be totally unacceptable for such an effective treatment to be banned."

There is concern that growing public opposition to ECT is affecting treatment decisions. One senior consultant says: "I am aware of public opinion and it is possible that ECT may not be given as early as it should be."

Opponents are particularly worried about its use in young people. The college says that nine patients a year are aged under 18 but rejects the idea of a ban for juveniles or for those compulsorily detained under the Mental Health Act, who are thought to account for one in five treatments.

Phil Fennell, of University of Wales Law School, has carried out research into the use of compulsory treatments on detained patients. Second opinions should be sought for them but Fennell found that 22 per cent of the cases were classed as emergencies, allowing for immediate treatment.

Alison Cobb, Mind's policy officer, says: "Most people don't realise that ECT is still being used today. We want to see the number of treatments considerably reduced. ECT is often prescribed for people who don't always understand the effect of the treatment or their right to refuse it. Many find it frightening and traumatic."

Jean Taylor, from Blackpool, who was diagnosed with severe depression, endorses this view. She last had four sessions of ECT two years ago. She says she was not offered alternative treatment and not told of side effects.

"I had depression but I was not ill. I wish I had never been given it. It is dreadful to think of electric shocks being put through your head.

"A couple of nurses took me to the treatment area. I was put on to a sort of bed, my dentures were taken out, shoes taken off and a curtain drawn around. I was left alone. After a time I was wheeled into the next cubicle along. There are about six cubicles and each time you get nearer the treatment room. I remember four people talking and looking at notes. Then they put the needle in your hand and that's it."

Jean Taylor says there have been improvements in her condition, but that she has also been on medication. She finds the idea of ECT very distressing indeed.