In most Western countries women account for about two-thirds of people given electroconvulsive therapy (ECT). That, say psychiatrists, is simply because they are more likely to suffer from depression, the diagnosis for which ECT is most frequently used. Although it is true that women are more likely than men to be admitted to hospital with a diagnosis of depression, the difference between the sexes is not so great as that between them when it comes to ECT. And yet the reason for that greater difference in the ECT statistics is never explored. The psychiatrists’ explanation also begs another question: why, in most Western countries, has ECT become largely a treatment for depression, a diagnosis which is more likely to be given to women? In those countries where ECT is more commonly used as a treatment for schizophrenia the sexes are more evenly balanced in the ECT statistics, or men predominate.
On the other side of the electrodes, meanwhile, ECT is very much a male business. It was invented by men. That was at a time when there were few women in psychiatry, but even as the numbers of women psychiatrists have increased it is still men who remain almost all of the “big names” in ECT. A survey carried out in the United States found that, all else being equal, female psychiatrists used much less ECT than male psychiatrists and the results of a more recent study from Scotland suggested something similar.
So I was quite surprised when I came across a recent article about ECT written by three women, Danish psychiatrists Anne Marie Svendsen, Kamilla Miskowiak and Maj Vinberg. It may not be a first. Publications often only give authors’ initials and I may have missed other multi-authored articles about ECT where the authors are all women. It is certainly, however, very unusual. And it is perhaps significant that the subject of the article (which appeared in the October 2013 issue of the Journal of the Danish Medical Association), a case history concerning a young women who suffered “long-lasting negative cognitive consequences after electroconvulsive therapy”, is also a very unusual topic for the male-dominated ECT literature. There are many ECT case reports, but they are usually of the “Electroconvulsive therapy in a catatonic patient with clavicle fracture” variety – psychiatrists describing how they have given ECT to someone with some unusual feature to their case.
There are very few articles published in the scientific press which describe the long-term effects of ECT on memory. We only hear about them because people who have undergone ECT write about their experiences, or appear on TV or websites or in newspapers (“Botched electroshock therapy ruined life of celebrated architect, family says” ran a recent headline on the website of My Central Jersey, for example).
Do psychiatrists even acknowledge the existence of people who suffer long-term damage from ECT? Whilst the emphasis is on the safety of ECT and side effects are generally described as minor and short-lived, there is sometimes a word of warning if you look hard enough, but little more than that. For a typical example, the ECT patient information leaflet of St Patrick’s Hospital, Dublin, warns patients (in page 12 of the green “easy to read” section) that their memory may be poor for a few weeks after ECT and then says: “This usually passes about 2 weeks after the end of all the ECT”. There is nothing about what happens to those people who are not covered by “usually”. Further on (page 32 of the blue pages which give “more detailed information but require a little more effort”) the statement is repeated more or less word for word: “For most people, the memory side-effects of ECT pass about 2 weeks after ECT, according to the best research”. Again, there is no mention of what the minority who experience more extensive memory loss may expect.
Unfortunately I have been unable to find a copy of the Danish article, so I don’t know what the authors say beyond the abstract:
“This case study describes a patient who had a unipolar depression and experienced long-lasting cognitive problems after electroconvulsive therapy (ECT). Neuropsychological testing revealed lower scores on measures of learning, memory and sustained attention. These results stress the importance of informing patients who have ECT of the potential cognitive consequences of this treatment as it may influence the patients’ functional capabilities. Prospective studies are needed since we do not have sufficient knowledge regarding the 3-5% of these patients who experience sustained cognitive problems.”
It is interesting to see what three men made of a similar case – a patient who was left with long-term cognitive problems following ECT. The authors in this case were psychologist Ian Baker and psychiatrists Matthew Jackson and Christopher Bass, all from Oxford University Hospitals. Their article was published in the journal Cognitive and Behavioral Neurology in 2005. It described how a man who had been given ECT for the treatment of catatonia was left with permanent cognitive impairments. The authors pointed out that, according to a patient information leaflet published by the Royal College of Psychiatrists, ECT did not have serious long term cognitive effects and therefore this man’s problems must have been caused by something else. Hence the title of their article: “Catatonia causing permanent cognitive impairment: a case study.”