Longer shocks

Last month the Daily Mail published an article  about electroconvulsive therapy with the misleading title: How short shocks could transform depression.

It is misleading for two reasons: firstly, we are talking not about transforming depression but about a slight adjustment to the waveform of the electrical current used in ECT machines (it is just about possible that one could lead to the other, but certainly not a foregone conclusion); secondly the shocks are actually longer, not shorter.

The article is about ultra-brief pulse ECT, but the ultra-brief refers to the width of the pulses of the electric current and not to the length of the shock. Pyschiatrists are saying that, in order for ultra-brief pulse ECT to work, the shocks should be lengthened to 8 seconds, compared to about 3 seconds for brief pulse waveform (the most commonly used waveform in ECT). What would be reduced is the width of the pulse – from about a  millisecond to about a third of a millisecond.

 “A new type of electroconvulsive therapy” the article says. But in fact ultra-brief pulse ECT goes back to the 1940s. And it has not suddenly been rediscovered either. There are articles about ultra-brief pulse ECT from the 1960s and 1990s. Even the piece of research on which this article is based is several years old.  It comes out of Columbia University, and one of the authors has financial ties with a company, Mecta, which manufactures ECT machines and claims on their website that their machine is the best at delivering ultra brief pulse ECT.

The article included a quote from Dr Andrew Easton, chair of the Royal College of Psychiatrists’ special committee on ECT, who pointed out that more studies are needed. He also pointed out that the advantages of the ultra-brief pulse waveform are only apparent with unilateral (electrodes on one side of the head) ECT and not bilateral (electrodes on either side of the head).

What he didn’t add, however, is that unilateral ECT (another modification of ECT that reduces the likelihood of damage) is hardly ever used in the UK anyway.

In this country doctors prefer to brazen it out with claims that ECT simply doesn’t cause significant memory loss, rather than adopting techniques to minimize the risks. Take this example from Dr Max Pemberton, writing in the Daily Telegraph:

“Longer-standing memory problems – where patients complain of gaps in memory for past events or biographical information – are associated with very high voltages of electricity, which are no longer used. There is no evidence that ECT, as practised in Britain today, causes permanent, severe memory disturbance, although the myth persists”. (More…)

Wrong on all three counts: recent research showed 45 per cent of patients reporting persistent memory loss following ECT*; there is no evidence that the degree of memory loss is dependent on the voltage; and voltages used in ECT are just as high today as they were seventy years ago.

*M. Philpot et al 2004 Eliciting users’ views of ECT in 2 mental health trusts with a user-designed questionnaire. Journal of Mental Health 13(4)

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