ECT and young people

Is the use of electroconvulsive therapy (ECT) in young people disappearing in the United Kingdom? In Scotland, according to the Scottish ECT Accreditation Network in 2009, no-one under the age of 20 had undergone ECT since 2005.

In England no recent figures on the numbers of children and teenagers being treated with ECT are available. The Department of Health survey of ECT use over a three-month period in 2002 found four 16-18 year olds and 43 19-24 year olds (there were no patients under 16 years of age).

Since October 2008, when new regulations came into force, psychiatrists in England and Wales wishing to give ECT to anyone under the age of 18, even if they consent to treatment, will have to seek authorisation from a psychiatrist from the Care Quality Commission’s panel. This means (unless I have misunderstood, or psychiatrists have found a way round it) that the Quality Care Commission should be keeping track of all ECT used on under 18 year olds.

A generation ago, in 1980, when a comprehensive survey of ECT use in Great Britain was carried out, over 400 patients a year were under the age of twenty. There are probably over ten thousand people in Britain who had ECT when they were teenagers or, more rarely, children. What happened to them? We don’t know, because nobody bothered to ask. There are no follow-up studies of young ECT patients in the United Kingdom. Psychiatrists however have always defended the use of ECT on young people, or at least those that are responsible for the guidelines and write the textbooks and articles in journals, have done. For example a good practice statement on ECT published in 1997 by the Scottish Office devoted several pages to the use of ECT in those under 18 years old. They endorsed its use as a treatment for depression, schizophrenia and mania, envisaged that there might be situations where it could be used as a first-line treatment, and said that there was “no evidence that ECT is less effective or associated with more adverse effects in those under the age of 18.” They argued against a ban for ECT in those under 18, saying: “It does not make sense to deprive one segment of the population of the most effective treatment available for certain psychiatric illnesses.” And yet, although there has been no ban, it appears that Scottish psychiatrists are no longer using ECT on teenagers.

What about the rest of the world? A 2001 survey of ECT use in 45 countries in Asia found that over 5 per cent of patients were under the age of 18. In fact, ECT patients under the age of 18 outnumbered patients over the age of 65. Reports of ECT use on children and teenagers have recently come from the USA and the Netherlands. In Australia ECT is given to very young children: statistics show 55 treatments given to children under 5 according to a newspaper report. It is two Australian psychiatrists, Garry Walter and Joseph Rey, from the University of Sydney medical school who are largely responsible for promoting the use of ECT on young people in the medical literature. Their most recent article advocates Lauretta Bender, an American psychiatrist who experimented with ECT and LSD on children in the 1940s and 1950s, as a role model for modern researchers.

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