Since my last post, about the use of electroconvulsive therapy (ECT) in Australia, the chief psychiatrist’s annual report for 2009-10 has appeared on the website of the Victorian Department of Health. The statistics for ECT are very similar to those in the 2008-9 report: there is a small increase in the number of treatments and a small decrease in the number of patients. The report says the increase in the average number of treatments per person is due to an increase in the use of maintenance treatment (although they don’t say how many people were receiving maintenance ECT). The number of treatments given to men in their forties have increased by about fifty per cent. Young people under the age of 18 received 83 treatments – up from 46 in 2008-9, although the number of under 18 year olds treated remained the same (seven in both years). Surely they cannot be using maintenance ECT on this age group? This statistic was reported incorrectly in The Age as: “A total of 1750 patients received electroconvulsive therapy (ECT), including 83 children, the youngest of whom was 13.” It was seven children and 83 treatments, not 83 children. The youngest was indeed 13. Perhaps surprisingly, since ECT is usually talked about as a treatment for depression – at least in Western countries, about one in five of the treatments were being given to people with a diagnosis of “schizophrenia, schizotypal or delusional disorders”.
ECT appears to be used at about twice the rate in Victoria as in neighbouring New South Wales (at least in public hospitals) but, according to this article in the The Sydney Morning Herald, New South Wales is using more ECT on the under 24s. In New Zealand, which shares a professional psychiatric body – The Royal Australian and New Zealand College of Psychiatrists (RANZCP) – with Australia, the use of ECT is lower still. The most recent figures date from five years ago, but show 307 people receiving an average of 7 treatments each. That means Victoria is using ECT at more than four times the rate of New Zealand. Which, if either, is right? Is it used too much in Victoria or too little in New Zealand? Such questions are never tackled. As the authors of a paper called “Epidemiological analysis of electroconvulsive therapy in Victoria, Australia” and published in the Australian and New Zealand Journal of Psychiatry in 2003 pointed out: “Despite decades of use, the appropriate rate of ECT utilization is still unclear”.
The recent articles about ECT in The Sydney Morning Herald inspired this letter from a reader:
“I was, through an involuntary court order, forced to undergo multiple courses of electroconvulsive therapy in 2008. I am concerned that recent articles (”Controversy hasn’t killed off electric shock therapy”, May 30; ”ECT patients under anaesthetic for two days”, June 18; ”Electric shock therapy on the rise for young”, June 26) overstate the efficacy of this form of treatment and understate its potential for serious side effects. Current research shows the effectiveness of ”modern” ECT is far below the 80 per cent quoted, and even when it is effective, relapse rates within six months are extremely high. ECT was initially ”effective” for me, but my improvement would not even last three days. So I was shocked again and again. I have suffered severe, persistent and disabling side effects, including a profound loss of memory affecting more than 10 years before the ECT. I am unable to return to my legal career, having forgotten my previous jobs and much of my legal education. I no longer recognise many close friends. The risk of serious side effects is well-known, but patients are seldom informed about them. We need more honesty from those providing ECT, and better research from journalists reporting it.” Mariana Oppermann, Lyons (ACT)
It is a reminder that, in spite of claims from psychiatrists that ECT has changed in recent years, the risk of memory loss remains. One of the “new” techniques being promoted by psychiatrists in Australia at the moment is ultra-brief pulse ECT, which involves a slight modification to the wave form of the current used in ECT and isn’t new at all, having been first used in the 1940s. This is what the Victoria chief psychiatrist’s report has to say about it.
“Ultra brief pulse ECT is increasingly being used in the private sector and its proponents believe it has potential to minimise possible side-effects of ECT, such as temporary memory loss. This model of providing ECT was discussed by the ECT sub-committee of the QAC in 2009-10. The majority view was that the model has not yet been adequately evaluated and needs a stronger evidence base before it can be accepted more widely”.