How safe is the week after ECT?

In their 13th biennial report the Mental Health Act Commission (MHAC) revealed that 39 detained patients had died within in a week of electroconvulsive therapy over a four-year period (2005-2008).

All the deaths were ascribed to natural causes, although the report did admit that in two cases “an event (aspiration) occurred during the ECT treatment itself that directly contributed towards the cause of death“.

39 out of how many? The MHAC report did not say. In 2002 approximately 2,464 detained patients underwent ECT, but ECT use has declined since then. A survey in 2006 estimated that ECT was given to  approximately 1,500 – 2,000 detained patients a year, but may have been an under-estimate. Let’s say a total of 8,000 (allowing for an under-estimate in 2006 balanced by a further decline since then) which means that one in about 200 patients did not survive the week after ECT.

There has never been a systematic effort in UK to collect information on the total number of people who die within a certain time of ECT. Officially, the death rate from ECT is virtually nil. One MP who asked a parliamentary question was told that one death in England and Wales was assigned to ECT between 1974 and 1983 (during that time there were more than a quarter of a million courses of ECT). This surprisingly low figure can be explained by the answer to an earlier parliamentary question on the same subject: “Whether death is associated with such treatment is a matter for the medical practitioners who certified the death, and, where appropriate, the coroner“.

It reminds me of  the Texan anesthesiologist who, when interviewed for an article in USA Today (6 December1995), said:

“Psychiatrists cannot bring themselves to admit any harm from ECT unless the patient gets electrocuted to death on the table while being videotaped and observed by a United Nations task force”.

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