In the UK electroconvulsive therapy (ECT) is used mainly in the treatment of depression, and women and older people are over-represented in the statistics. Its use has been declining for many years. The law allows for the treatment of patients without their consent, and about a quarter of ECT patients are treated in this way. But this is not necessarily the picture across the rest of the world.
ECT was originally developed as a treatment for schizophrenia. In Western countries nowadays only a small minority of ECT patients have a diagnosis of schizophrenia; over the years ECT has come to be seen as a treatment for depression. In 2002 for example, in England fewer than 5 per cent of ECT patients had a diagnosis of schizophrenia. Yet in many parts of the world ECT is still used widely in the treatment of schizophrenia. Here are a few examples, bearing in mind that information on ECT use in recent years is not available for most of the world
In Spain in the 1990s 17 per cent of ECT patients were being treated for schizophrenia; the figure was similar for France.
In Hungary in 2002 over half of ECT patients had a diagnosis of schizophrenia.
In Australia in the early 2000s nearly 10 per cent of ECT patients had a diagnosis of schizophrenia.
In Texas (one of the few states in the US for which information on ECT use is available) in the 1990s just under 10 per cent of ECT patients had a diagnosis of schizophrenia or schizoaffective disorder
In Kuwait in the early 1990s schizophrenia was the most common indication for ECT, accounting for nearly 40 per cent of patients.
In Asia in the early 2000s schizophrenia was the most common diagnosis for ECT patients, accounting for over 40 per cent.
A higher percentage of patients being treated for schizophrenia is associated with a younger age of patients and a more even distribution between the sexes. In the Asian survey nearly three-quarters of patients were aged under 45 (compared to just under a quarter in England at that time).
In Western countries the general trend appears to be for a decline in overall ECT use, however there are countries in which this is not the case. In Texas the numbers of people undergoing ECT annually have remained fairly constant since the 1990s. There are reports that ECT use in Australia is increasing. The Netherlands, where ECT virtually disappeared in the 1970s, has seen increasing use in recent years (showing that trends can always be reversed). The UK is unusual in that ECT is still used in all, or nearly all hospitals. In other countries hospitals are divided between those that use ECT and those that don’t. For example, in France about half of psychiatric hospitals use ECT.
In the United Kingdom ECT is always given with anaesthesia. This is also the case in the United States, Canada, Australia, and some other countries. However in many parts of the world there are still hospitals where the use of ECT without anaesthesia is routine. In a survey of ECT use in Asia 2001-2003 more than half of patients were receiving ECT without anaesthesia. The use of ECT without anaesthesia is not restricted to Third World countries; there are countries who enter the Eurovision Song Contest and have hospitals not using anaesthesia for ECT.
Bilateral ECT (where electrodes are put one on either side of the head) remains the most used form of ECT nearly the world over, although it is known to cause more damage than unilateral ECT (where both electrodes are put on one side of the head). In Scotland over 90 per cent of patients receive bilateral ECT. In Asia over three-quarters of hospitals used exclusively bilateral in the early 2000s. Australia is unusual in having a relatively high use of unilateral electrode placement.