Focus On... Electroconvulsive Therapy

Electroconvulsive therapy is recommended for certain illnesses by the Royal College of Psychiatrists (RCPsych) the National Institute of Clinical Excellence (NICE), the British Association for Psychopharmacology , the American Psychiatric Association (APA), and the World Health Organisation. Some media controversy exists around its use.

Stephen Finch, the lead ECT nurse from GMMH’s Bolton Mental Health Directorate, and a member of the National Association of Lead ECT Nurses (NALNECT) explains more.

What is ECT?

Electroconvulsive Therapy (ECT) is used to treat the symptoms of severe depression, catatonia or a prolonged manic episode. The procedure involves the administration of a sedative and muscle relaxant before a carefully controlled electronic current is passed through the patient’s brain inducing a seizure which is necessary for the treatment to work.

ECT is only used when other treatments – such as psychotherapy and medication – have shown to be ineffective. ECT is administered twice a week, usually lasting no more than one minute, and the average duration of treatment is between six and eight sessions.

Where did it all start?

The first use of therapeutic seizure induction was documented in the London Medical Journal in 1785, and the first test on a person was recorded in 1937 in Italy. The procedure was introduced into the UK in the 1940’s and was used widely throughout the 1950’s and 60’s for a wide number of mental health conditions.

Since then, research has shown that ECT is most effective for treating symptoms of severe depression and so although the use has declined, the likelihood of recovery has increased.

Why is it so controversial?

ECT, as with many mental health problems and treatments, still has stigma attached to it. Commonly reported side effects include short term memory loss, headaches, stiffness and confusion. However, these side affects can be associated with any procedure requiring anesthetic, and the effects usually wear off within a couple of hours.

A UK review in 2003 looked into the effectiveness of ECT, with the number of people finding it useful ranging from 30 – 80%. The treatment can work better for some, which may be part of the reason why there are so many mixed reviews.

Does it work?

Research has been conducted into ECT, using ‘sham’ treatment to evaluate the effectiveness of the procedure. Sham treatment involves administering anesthetic and muscle relaxant, but not the electronic current. Sham treatment has shown an improvement in the wellness of some, although the Royal College of Psychiatrists note that this may be because of the additional attention and treatment received.

ECT is used once medication, talking therapy, and other psychological and social supports are exhausted, and so adds another dimension to the recovery process. Medication and talking therapy may still be used in addition to ECT to ensure the positive outcomes of the treatment are sustained.

What does GMMH do?

There are currently three ECT clinics based within GMMH: one at the Royal Bolton Hospital; one at Salford Royal Hospital and one at Trafford General Hospital. The Trust has an ECT committee with representatives from Doctors across the three areas.

In 2003, the Royal College of Psychiatrists established the ECT Accreditation Service (ECTAS) to promote better standards of practice in ECT services in England, Wales, Northern Ireland and the Republic of Ireland. GMMH plans to consider applying for this accreditation in the near future.

Further Information

The Royal College of Psychiatrists and the National Institute for Health and Clinical Excellence (NICE) both publish useful guides which provide further information on ECT.

More information on the ECT Accreditation Service can be found at http://www.ectas.org.uk