ECT in an Indian teaching hospital

A recent issue of the Online Journal of Health and Allied Sciences, Mangalore, India, contains an article entitled “Is Electroconvulsive Therapy Fading into Oblivion? – A Study of Ten Year Trends” by G. Aruna and M.B. Yadiyal. The authors looked at the use of electroconvulsive therapy (ECT) at the Father Muller Medical College Hospital, Mangalore, over the ten-year period from 2002 to 2011. Use of ECT at the hospital is low, with, on average, only just over one per cent of inpatients receiving ECT. There was an increase in use to a peak of  2.14% in 2006, and after that a decline.

Compared to ECT patients in Western countries, patients were younger (with a mean age in their 30s) and the distribution between the sexes was more even.  About half the patients were being treated for schizophrenia, a much higher proportion than in Western countries. These differences are fairly typical of surveys of ECT use in Asian countries, as the authors point out.

But there appears to be a major difference in the use of ECT at this Indian teaching hospital and its use in Western countries, that is, the number of treatments the patients received. In Western countries ECT is generally given in courses of, on average, 6 to 12 treatments. Some patients receive longer courses, or maintenance treatment, and some patients receive fewer treatments, but that is an average number of treatments. In Scotland, for example, the mean number of treatments per course in about 9. In this study however, the 189 patients received just 638 treatments, which is a mean of between 3 and 4 treatments per patient. The authors do not comment on this difference with Western practice. All they have to say on the number of treatments is:  “ECT is stopped once remission is achieved or when symptoms reach a plateau after 2 consecutive sessions. ECT is discontinued in case of non response or advent of untoward complications like delirium.”

It would be interesting to know why patients were receiving such small numbers of treatments, and whether it was due to speedy resolution of symptoms or to the intervention of complications.



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