Electroconvulsive therapy may have more adverse effects than thought | Science

Electroconvulsive therapy may cause a wider range of side effects than previously thought when used to treat depression, according to a paper that calls for the practice to be suspended pending further research.

Although it is widely known that short- and long-term memory loss results from ECT, research has identified 25 other side effects of concern, including cardiovascular problems, fatigue, and emotional blunting.

ECT involves passing electricity through the brain under general anesthesia to induce seizures, usually over the course of six to 12 treatments. It is given to around 2,500 people in the UK each year, mainly to treat treatment-resistant depression, as well as schizophrenia, bipolar disorder and catatonia.

The research, published in the International Journal of Mental Health, is based on a survey of 747 ECT patients and 201 relatives and friends, meaning it is not conclusive but could give an indication of other possible side effects given the difficulty of researching ECT.

Professor John Read, study author and professor in the Department of Psychology at the University of East London, said: “Given that we still do not know whether ECT is more effective than placebo, these surprising new findings make it even more urgent to suspend it pending further investigation into safety and effectiveness.

“The research is so flawed and inconclusive that ECT would have absolutely no chance of gaining MHRA approval in the UK, or FDA approval in the US, if it were introduced today.”

The research found that almost a quarter of participants (22.9%) reported heart problems such as arrhythmia after ECT, while more than half (53.9%) reported having recurring headaches. More than three-quarters (76.4%) felt emotional weakening. Some side effects were related to memory loss, such as relationship problems, navigation difficulties and loss of vocabulary.

Sue Cunliffe, who received ECT in 2004 for severe depression, said the side effects had “completely destroyed my life since I was 38”. She said she had slurred speech, handshakes and balance problems, and was unable to recognize faces, count money, follow directions, or read and write correctly.

“A week before ECT I was on a running machine, playing badminton and able to write poetry, and six weeks later I’m falling down the stairs, bruised,” she said, adding that she still suffers from brain fog and fatigue, which prevents her from working as a doctor and has to “really limit my day.”

ECT is a treatment that divides mental health professionals. Although some people report improvement in their symptoms, it is not clear how ECT affects the brain.

Professor Tania Gergel, director of research at the charity Bipolar UK and honorary professor of psychiatry at University College London, said there was “no evidence to support claims that modern ECT carries a major risk to physical health or that it causes long-term brain damage and permanent deterioration in cognitive functioning”.

She said it should not be considered a “complete cure” and there have been “some modern cases of misuse”, but it could reduce some of the more dangerous symptoms, allowing people to use other interventions to support their recovery.

She said ECT was “the most important tool to help me manage the acute symptoms and risks” associated with her treatment-resistant bipolar disorder.

“But there is evidence that some people, including myself, experience autobiographical memory loss and lapses starting in the period of their lives close to treatment,” she added, calling for more research to understand and minimize these side effects.

Professor George Kirov from Cardiff University said ECT was “highly effective” and had observed it to be “life-changing” for people with severe depression, with 60% seeing an improvement in their symptoms. He said stigma had led to “underuse” in the UK, but it was more commonly used in some other northern European countries.

“There is very extensive and strong evidence for its effectiveness, beyond the first sham controlled trials. For example, large meta-analyses show that it outperforms antidepressants, TMS, tDCS and any other treatment,” he said, adding that calls for more placebo-controlled trials were “not supported by the scientific community.”

Lucy Johnstone, a clinical psychologist and member of the UK ECT Improving Standards Campaign Group, which is campaigning for tougher regulation, said very few people were aware that ECT was still being carried out as a treatment and that it was mainly given to older women, with a third of them receiving it against their will.

She said “a significant proportion” of ECT patients were victims of domestic violence, which she said was not always explored well by mental health professionals. “Pills won’t help, so it quickly comes to the question: What are we going to try next? That’s when ECT is brought up,” Johnstone said.

A spokesperson for the National Institute for Health and Care Excellence (Nice) said its guidelines stated: “Clinicians should only consider ECT for the acute treatment of severe, life-threatening depression and where a rapid response is required, when it is the person’s preference based on their past experience of ECT, or where other treatments have failed. »

Patients must be informed of the risks and benefits, and clinics must be accredited by the Electroconvulsive Therapies Accreditation Service (ECTAS) and record data on administration and outcomes, the spokesperson said.