ECT in Nordic and western European countries

The journal European Psychiatry has published an article about the use of electroconvulsive therapy (ECT) in Nordic and western European countries. There is a list of twenty authors at the beginning of the article but at the end it says that two of them, Richard Braithwaite and George Kirov, “devised the project, recruited national experts and aided calculation of outcomes” so I will credit them with authorship. Braithwaite and Kirov are two of the Science Media Centre’s experts on ECT, most recently called upon to criticise a survey of ECT experiences authored by people who had had ECT and psychologists. The other 18 authors of the European Psychiatry article were other psychiatrists (called experts in the article) who had been contacted to provide information about ECT use in their countries.

Given the views of Braithwaite and Kirov, it is unsurprising that the article begins “Electroconvulsive therapy (ECT) is a safe and well-tolerated medical treatment for several psychiatric and neurological disorders” and ends with a plea for the “international ECT community” to “come together to support improved patient access in areas with underdeveloped or no services”.

It comes as no surprise to read that there is wide variation in ECT use between different countries. As the tables are not available with the on-line version of the article, it is impossible to give more details, other than that the authors says use is highest in the Nordic countries. There is also wide variation in techniques. For example: “Unilateral placement varied from 16% of treatments in United Kingdom to 79% in Norway”.

While over half of ECT patients in England, Wales and Northern Ireland do not consent to treatment, in Italy it is, the authors say, only used on consenting patients. In the Netherlands, ECT use has increased four-fold over the past 25 years. (The authors do not say this, but in the 1970s ECT use in the Netherlands was almost zero.) In the United Kingdom meanwhile the authors say that ECT use has shown a “steady decline” over the past 25 years. They do not say that in fact the decline started about 50 years ago. They go on to suggest the decline is down to the 2003 NICE guidance (which they call “stringent”) and a “UK-based campaign to discredit ECT”. There may be some interesting statistics in the tables (if I could see them) but the discussion section is weak and more like what you would expect in the Science Media Centre than in an academic journal.

NHS England ECT statistics in the media

It was only a matter of time before the fake electroconvulsive therapy (ECT) statistics, provided by NHS England in answer to a parliamentary question (see my posts here and here), would make their way into the media. And, sure enough, on 21 May 2026, North East Londoner published an article with the title “ECT in NHS England: a controversial resurgence in treating depression“.

The article begins with the fake statistics:

“Electro-convulsive therapy (ECT) use for treating severe mental illness within NHS England has almost tripled in use in the last decade despite recent calls for its suspension. NHS England data has indicated a 176% increase in the number of patients receiving the controversial treatment in England from 2016/17 to 2024/25. During this period, a total of 5001 patients received ECT, with 955 in the last year – a massive rise from the 346 patients in 2016/17.”

There follows a colourful graph, showing this supposed increase, and another graph showing another supposed increased of ECT use for depression. And it is only at this stage that a warning about “data limitations” and “undercount” appears. In fact, the statistics are completely meaningless because, as of 2024/25, about half of NHS Trusts did not report their ECT use to NHS England, and those that did report their use did not necessarily do so accurately. The “increase” since 2016/17 is simply down to more ECT use being reported, and not a genuine increase.

The article goes on to interview Professor John Read, Anna Webb of Life After ECT, and Jan Giles who had ECT and described it as miraculous. A spokesperson for the East London NHS Trust (one of the Trusts that does not submit ECT statistics to NHS England) is quoted as saying:

“There is evidence that severe depression is caused by problems with certain brain chemicals. It is thought that ECT causes the release of these chemicals and, probably more importantly, makes the chemicals more likely to work and so help recovery.”

Psychiatrists now reject the biochemical imbalance theory of depression and further claim they never advocated such a theory. Well, they did – and still do – in East London. At least the article goes on to quote another NHS source saying “no-one is certain how ECT works“.

Another person who didn’t get the memo about the rejection of the biochemical imbalance theory of depression is psychiatrist David Nutt. In a recent interview he gave his views on how ECT works:

“And it turns out that ECT turns on, in a progressive way, different neurotransmitters. The first thing ECT does is turn on the dopamine system. And then after a few more seizures, it turns on the noradrenaline system. And in the end, it turns on the serotonin system. So three of the main monoamine neurotransmitters, which are necessary for appropriate levels of mood and different aspects of mental functioning, are enhanced by ECT.”

He also re-writes the history of ECT, saying it was used, in the early days, for “treatment-resistant” depression. No it wasn’t. It was used for depression (or indeed anything else that came the way of psychiatrists). Treatment-resistant depression is a modern concept.

In response to a Freedom of Information request (it wasn’t me!), NHS England has published statistics on the use of ECT by local authority, which, since they are based on the original statistics collected from about half of NHS Trusts, are meaningless. If a local authority shows zero use of ECT it doesn’t mean that no-one in the area received ECT; it just means that the local NHS Trust does not submit figures on their ECT use to NHS England. At least this time they include various warnings about the statistics, saying that, where no ECT is recorded, it is not an indication that none was used and that “the figures reported in the tables are likely an undercount of the true usage of ECT across time”.

Science Media Centre experts comment on ECT survey – again

Ratio of women to men having had electroconvulsive therapy (ECT) in the online survey = 3 to 1

Ratio of women to men authors of the survey = 2 to 1

Ratio of women to men experts at Science Media Centre commenting on the survey = nought to 6

I have written before (here) about the Science Media Centre comments on the online ECT survey. On 22 April 2026, the experts appeared on the Science Media Centre website again, this time commenting on the latest article by the authors of the online survey, which looks at the experience of friends and relatives of people who have undergone ECT.* Again, the Science Media Centre has found three male psychiatrists: George Kirov appears as before; Declan McLoughlin and Sameer Jauhar have been replaced by Richard Braithwaite and Robert Howard, both of whom have previously featured on this blog (here and here).

The three men are all prominent supporters of ECT and they say what you would expect them to say about the survey: “not representative”… “conclusions irrelevant”…. “poorly conducted research”…. “ECT is an effective and life-saving treatment”…. etc, etc.

On 25 April The Independent published an article featuring Lisa Morrison, one of the authors of the online survey, describing her own experience of ECT and memory loss. The article concluded with a quote from the Department of Health and Social Care:

A Department of Health and Social Care spokesperson said: “Our thoughts are with anyone who has experienced harm or distressing side effects following ECT. Patient safety is paramount to us and we take all accounts of this kind incredibly seriously.”

Taking something seriously is the standard phrase used by organisations that have been caught taking something rather less than seriously. Having thoughts with anyone harmed by ECT is something new.

*Due to a problem with Cloudflare, I haven’t been able to read the article.

ECT – past and present

Last week (7-15 March 2026) was National Lottery Open Week, when places which have received lottery funding offer free or reduced price entry to people who produce a lottery ticket. I took advantage of the opportunity to visit the Chelsea Physic Garden.

Meanwhile, in Bristol, Glenside Hospital Museum was offering lottery ticket holders a “learning experience like no other” as it said on their facebook page. Visitors were able to operate the controls on an old, “de-activated”, electroconvulsive therapy (ECT) machine, as well as trying on a straitjacket, etc.

On the subject of operating the controls on an ECT machine, it appears that this task, traditionally carried out by doctors, is now being assigned to nurses. The Devon Partnership NHS Trust is advertising for a registered mental health nurse to join their team at the ECT clinic in Exeter. The advertisement says:

“Duties include preparing patients for ECT, administering treatment initially under supervision, then on qualifying independently, monitoring recovery, and conducting three-month post-treatment follow-ups. “

I could not find any patient information on ECT on the Devon Partnership website, but, while searching, I did came across an article about the use of ECT in the mid-twentieth century on the Devon County Mental Hospital website. The article describes “how much hope relatives placed in the treatment” and how much trust they placed in psychiatrists, quoting from one letter:

“Thank you for your intimation that [our son] is starting a course of Electrical Convulsive Treatment – needless to say I do not know what all that means, but I do know you will apply same for his help and benefit.”

The article says: “The use of ECT declined with the advent of drug treatment, but interestingly, the late 1960s witnessed a resurgence of ECT…” This tallies with my understanding of ECT statistics, in which the treatment was probably at its height in Britain in about 1970 and has been declining ever since.

The Devon Partnership is one of the trusts whose ECT use does not appear in the statistics for England. NHS England has suggested the following reasons for why statistics are missing from about half of Trusts:

“The provider is not submitting to the MHSDS; The provider is submitting but is not submitting that care pathway; The provider is submitting but their EPR does not support SNOMED code recording; The provider is submitting but they are submitting incorrect SNOMED codes.”

Perhaps the new nurse at Exeter can be trained in finding their way around the abbreviations, or just counting how many people they treat.

In The Telegraph on 13 March 2026, Lydia Dickinson published a memoir of her mother, who had been diagnosed with manic-depression as a teenager and given ECT in a Harley Street clinic.

“Back in London, she had electroconvulsive therapy at a Harley Street clinic. It was 1957, and the procedure was brutal at that time. Consequently, she suffered significant memory loss, finding herself unable to piece together large parts of her childhood.”

I wonder if by “brutal” the author was referring to the possibility that her mother was given ECT without an anaesthetic. At that time, some psychiatrists were using modified ECT (with anaesthetic and a muscle-paralysing drug) and some were still using unmodified ECT (without anaesthetic). But significant memory loss can still be experienced with ECT today. The author does not say who her mother’s psychiatrist was. Was it possibly William Sargant, who had a Harley Street practice at around that time?

More about inaccurate ECT statistics in England

Since this post in December 2025, I have been trying to work out why statistics on electroconvulsive therapy (ECT) use in the NHS in England are so inaccurate.

As I suspected, the main problem is that about half of Trusts using ECT simply don’t submit any statistics to NHS England, which collects, collates and publishes data. They have opted out of, or perhaps not opted into, the system and nobody seems to be doing anything about it, not even warning people that the statistics only cover a sample of Trusts.

The published statistics cover the following Trusts: Sussex Partnership NHS Foundation Trust; Tees, Esk and Wear Valleys NHS Foundation Trust; Lancashire Care NHS Foundation Trust; Northumberland, Tyne and Wear NHS Foundation Trust; Birmingham and Solihull Mental Health NHS Foundation Trust; Greater Manchester West Mental Health NHS Foundation Trust; Nottingham Healthcare NHS Foundation Trust; South West Yorkshire Partnership NHS Foundation Trust; Cambridgeshire and Peterborough NHS Foundation Trust; Mersey Care NHS Foundation Trust; Leeds and York Partnership NHS Foundation Trust; Hertfordshire Partnership University NHS Foundation Trust; Black Country Partnership NHS Foundation Trust; Pennine Care NHS Foundation Trust; Worcestershire Health and Care NHS Foundation Trust; Avon and Wiltshire Mental Health NHS Foundation Trust; Navigo Health and Social Care CIC; Humber Teaching NHS Foundation Trust; South London and Maudsley NHS Foundation Trust; Northamptonshire Healthcare NHS Foundation Trust; Essex Partnership University NHS Foundation Trust; Somerset Partnership NHS Foundation Trust; Norfolk and Suffolk NHS Foundation Trust; Oxford Health NHS Foundation Trust; Oxleas NHS Foundation Trust; Berkshire Health NHS Foundation Trust.

And the ones who are missing include: Barnet, Enfield and Haringey Mental Health Trust; Camden and Islington NHS Foundation Trust; Central and North West London NHS Foundation Trust; East London Foundation NHS Trust; North East London Foundation NHS Trust; South West London and St George’s Mental Health NHS Trust; West London NHS Trust; Coventry and Warwickshire Partnership NHS Trust; Derbyshire Healthcare NHS Foundation Trust; Dudley and Walsall Mental Health Partnership NHS Trust; Leicestershire Partnership NHS Trust; Lincolnshire Partnership NHS Foundation Trust; Midlands Partnership NHS Foundation Trust; Cheshire and Wirral Partnership NHS Foundation Trust; Rotherham Doncaster and South Humber NHS Foundation Trust; Sheffield Health Partnership University NHS Foundation Trust; Kent and Medway NHS and Social Care Partnership Trust; Southern Health NHS Foundation Trust; Surrey and Borders Partnership NHS Foundation Trust; East Sussex Healthcare NHS Trust; Herefordshire and Worcestershire NHS Foundation Trust; Gloucester Health and Care NHS Foundation Trust; Cornwall Partnership NHS Foundation Trust; Devon Partnership NHS Trust; Dorset Healthcare University NHS Foundation Trust; Livewell Southwest.

The above list of non-reporters is taken from the list of ECTAS member clinics. Some Trusts which do no report their ECT use at least collect statistics internally. For example the West London NHS Trust replied to someone’s Freedom of Information request saying that in 2024 between 47 and 50 people underwent ECT.

The NHS England list of Trusts reporting ECT use gave a figure for the number of patients being treated, ranging from 140 for Sussex Partnership NHS Foundation Trust at the top down to five or fewer for Somerset Partnership NHS Foundation Trust, Norfolk and Suffolk NHS Foundation Trust, Oxford Health NHS Foundation Trust, Oxleas NHS Foundation Trust and Berkshire Health NHS Foundation Trust at the bottom.

I was suspicious of some of the low numbers. The Norfolk and Suffolk Trust, for example, covers a large area and has ECTAS member clinics in three hospitals. Can they really have treated only five patients in a year? I put in a Freedom of Information request only to be told that they do not collate information on ECT use. In which case where did the figure of 5 patients come from?

The Avon and Wiltshire Trust reported 25 patients to NHS England in 2024/25, a figure which seemed suspiciously low. In response to a Freedom of Information request they told me that they had given ECT to 121 patients in 2024/25. The difference between 25 and 121 is not a minor statistical error – it is out by a factor of nearly five.

So the problem is not just that some Trusts are not reporting ECT use to NHS England; even the figures given by the Trusts that do report their ECT use cannot be relied upon.

A thesis about psychosurgery in the UK

Dr Rebecca Watterson of Ulster University has published an interesting PhD thesis on Psychosurgery in the United Kingdom: 1940-1986.

In the introduction, Watterson identifies the absence of a comprehensive history of psychosurgery in Britain, with most books focussing on the United States, and only two books devoted to the use of psychosurgery in other countries, namely Germany and Denmark, while journal articles fill in some of the gaps.

“This thesis addresses the absence of a general British history of psychosurgery, other than a handful of short studies of institutions such as North Wales Hospital in Denbigh which may not be representative of the broader landscape of British psychosurgery.”

Watterson acknowledges that it is difficult to find the patient voice in psychosurgery. The only first-person account to feature in the thesis is that of Derek Hutchinson. In fact, there are more that could have been included, although, as she says, they are difficult to find. The end date of 1986, chosen because it was when the UK legislated for psychosurgery and the number of operations declined, excludes Cathy Wield, who wrote two books about her experience of psychiatric treatment, which included psychosurgery. Psychologist Asenath Petrie is introduced as one of only two women to be involved in early research into leucotomy, but the patient autobiographies that are included in her book are not mentioned, even though they would have been a useful addition to the patient voice.

People who have undergone psychosurgery sometimes appear later in life in different contexts. Even though not the patient voice, it does tell us more about the lives of patients than the brief descriptions found in the medical literature. For example, I have written about Gabrielle de Woolf and Annabel Adair on this blog (here and here). An important source that was missed by Watterson was the book by Maurice Partridge, Pre-frontal leucotomy: A survey of 300 Cases personally followed over 1½ – 3 Years. It is the patient experience seen through the eyes of a psychiatrist, but nevertheless provides some limited information about what happened to people after undergoing surgery.

Watterson has filled a gap in the historiography of psychiatry in Britain, and hopefully she will consider writing a book, or at least a journal article, on the same theme. The thesis concludes with the words:

“My thesis invites psychiatric practice to engage more sympathetically in debates regarding the continued use of psychosurgeries and other shock therapies, such as ECT, by examining the impact of such practices on patients. It asks psychiatrists to connect with patients beyond their medical diagnoses and reflect on wider social and cultural implications on behaviours (as well as why there may be demands for these to be changed through psychiatric treatments).”

The recent work of psychologist Professor Read and co-authors has been looking at the impact of ECT on patients, but I am yet to see sympathetic engagement by the psychiatric profession.

ECT: another euphemism for an electric shock

Electroconvulsive therapy (ECT) involves the administration of an electric shock (current 900 milliamps and voltage up to 450 volts for several seconds) to a patient’s head. But psychiatrists avoid the term “electric shock” and prefer to use euphemisms such as stimulus or electric pulse.

The latest one I have noticed is “electrical impulse”.

“A controlled electrical impulse will be passed through your brain… ” (St John of God Hospital, Dublin, patient information leaflet)

“Under close supervision by multiple medical professionals, an electrical impulse is emitted through the electrodes… ” Demystifying ECT: An Exploration of a Misunderstood Gold Standard Procedure Bridge House Health, Utah

What exactly are electrical impulses? The term refers to the way in which nerve cells communicate (with action potentials measured in millivolts). Doubtless, psychiatrists are trying to make ECT sound benign and somehow physiological when they use the term.

UK Government replies to parliamentary question on ECT with inaccurate statistics

On 24 November 2025, Conservative MP for Romford, Andrew Rosindell, asked the Secretary of State for Health and Social Care “how many patients received NHS electroshock therapy in every year since 2010 in (a) England and (b) Romford constituency”.

On 15 December 2025, he received an answer from Dr Zubir Ahmed, Under-Secretary of State:

Financial year	Number of patients receiving ECT in England
2016/2017	346
2017/2018	441
2018/2019	326
2019/2020	572
2020/2021	464
2021/2022	571
2022/2023	609
2023/2024	717
2024/2025	955

These statistics, which come from NHS England, are rubbish. They represent only a fraction – less than half – of the people undergoing ECT in England. There was not even a caveat about data quality. The Department for Health and Social Care has not collected even remotely accurate statistics about ECT since 1991. I wrote about it here.

How do we know they are inaccurate?

Looking at 2016/17: the Royal College of Psychiatrists reported 1,682 people receiving ECT. Their survey covered 74% of ECTAS-registered clinics in England, Ireland, Wales and Northern Ireland, so is not an exact figure for England. But it is totally incompatible with the NHS England figure of 346.

The CQC publishes annual figures on the use of ECT without consent, which now accounts for about half of all ECT. In 2023/24, for example, over 1,000 people were treated without their consent, which would mean that, over 2,000 people in total were given ECT. Again, this is incompatible with the NHS England figure of 717.

And the Royal College and CQC reports for other years reveal similar discrepancies with NHS England figures.

Also, an independent survey of ECT use in England in 2019 found that 1,964 people were given ECT in 37 NHS Trusts. Allowing for the additional 19 Trusts who did not respond to the request for information, the authors of the survey estimated that about 2,500 people received ECT.

Doesn’t anyone check statistics before they are published in answer to a parliamentary question?

ECT and oxygen-deprivation therapy

Five months ago I wrote (here) about the latest theory of how electroconvulsive therapy (ECT) works. It was the “postictal wave of spreading depolarization” theory. There has never been a shortage of theories; it is just that none of them has stuck. And now the latest theory comes along from China – the adenosine signalling theory.

Nature has published an article* by a group of researchers from the Beijing Institute for Brain Research and the Changchun Institute of Applied Chemistry, who did some experiments on mice and decided that the mechanism of action of ECT and ketamine involves adenosine signalling. The team is now experimenting on people by using oxygen-deprivation therapy to cause the brain to produce adenosine, as explained in this article in the South China Morning Post. When I first saw the article, it had the word “strangulation” in the title, which has now been changed to “Short bursts of oxygen deprivation could help treat depression, Chinese study concludes”. (Or perhaps it was another publication – unfortunately I did not take a screenshot.) But the first sentence of the article still includes the word “suffocation”:

Brief, controlled bouts of oxygen deprivation – essentially moments of safe suffocation – can alleviate severe depression as effectively as electroconvulsive therapy (ECT) and ketamine, two of the most powerful treatments known to psychiatry, Chinese scientists have concluded.

The researchers have developed a device to deliver these “bouts of oxygen deprivation”. I am reminded of something I once read somewhere about how, in the 1940s or 1950s, a psychiatrist said he would pinch a patient’s nostrils during ECT, in order to enhance its effects.

*Yue, C., Wang, N., Zhai, H. et al. Adenosine signalling drives antidepressant actions of ketamine and ECT. Nature (2025)

More articles from the online ECT survey

The online electroconvulsive therapy (ECT) survey by John Read, Lucy Johnstone, Sarah Price Hancock, Chris Harrop, Lisa Morrison and Sue Cunliffe, which I wrote about here, has generated another two articles, both published online on 19 November 2025.

Lisa Morrison, who herself underwent ECT, takes the lead authorship for “Electroconvulsive therapy and women: An international survey” published by Healthcare for Women International. The majority (73%) of respondents to the survey were women, as indeed are the majority of those given ECT in the countries from which respondents came, although the figure for respondents may be slightly higher. Most of the respondents to the survey (81%) were given ECT by a male psychiatrist. The authors say: “ECT seems to be something done, predominantly, by men to women.”

Professor of psychology John Read returns as lead author for “The adverse effects of electroconvulsive therapy beyond memory loss: an international survey of recipients and relatives” published by the International Journal of Mental Health. The survey had asked participants if they had experienced a list of possible adverse effects, such as, emotional blunting, fatigue, difficulty using money, etc. There were twenty-five in the list, with a further twenty added under “other”. The most common adverse effects, reported by over 80% of respondents who had had ECT, were “losing train of thought”, and “difficulty concentrating”.

While acknowledging that “The distinction between memory loss and some of the effects reported is not a clear one,” the authors conclude:

“The high incidences of a wide range of adverse effects reported here by patients and family members, confirm multiple smaller studies. These findings are concerning. Researchers and clinicians should pay attention to a much broader range of adverse effects beyond memory loss, besides being aware of the many and profound implications of memory loss itself.”

The survey found that more recent ECT was not associated with less memory loss. This is not surprising, as modern ECT machines deliver electric shocks which, if anything, are more powerful than those of early machines. This 1946 documentary about Roffey Park shows a woman being prepared for ECT, with a doctor adjusting the controls on the machine and saying: “The apparatus is set to pass a given strength of current for three tenths of a second.” That is about one-tenth of the duration typically used in modern ECT, with modern machines delivering a current for up to eight seconds. The scene occurs at 13:23, but it is worth watching the whole 30 minute film.

The research by Read and co-authors was picked up by The Guardian, which published an article with the title “Electroconvulsive therapy may have more adverse effects than thought”.