The words “safe and effective” have become super-glued to electroconvulsive therapy (ECT). But safety and effectiveness are relative concepts. Is ECT safe because you are extremely unlikely to die with the electrodes on your head? Or is it unsafe because it causes memory loss? Is it effective because it can temporarily reduce someone’s score on a checklist of symptoms? Or ineffective because many patients will soon find themselves depressed again?
The chair of the Scottish ECT Audit Network (SEAN), Julie Langan Martin, presented a paper on ECT at the European Congress of Psychiatry. At least, I suppose she did – I have only been able to find the press release.
The headline of the press release says: “Electroconvulsive therapy (ECT) shown to reduce severity of certain mental illnesses”. Reading the body of the press release, it transpires that Langan Martin has gone through a number of SEAN annual reports and found that 2,920 courses of ECT resulted in a mean reduction of their CGI-S score. The CGI-S score simply indicates whether the treating clinicians rate their patients as “much improved”, “very much improved”, etc.
She acknowledges that “confusion was reported in 19% and cognitive side effects in 26.2%” and goes on to conclude: “Our findings from this large naturalistic study across Scotland from over an 11-year period reinforce the widely held, but nonetheless underexplored view, that ECT is both a safe and effective treatment when delivered to appropriate groups of people with severe mental illness.” The issue of cognitive side effects is side-stepped with a nod to “monitoring”.
The “notes to editors” section at the end of the press release does not mention the fact that over 40 per cent of patients given ECT in Scotland over the period in question did not consent to the treatment.