ECT for all ages: from 15 to 94

In this post I want to revisit two of last year’s posts. In September I wrote about an article in the Journal of ECT that described how three women in their 70s and 80s in Australia had been given large numbers of ECT without their consent. In December it emerged that a 44 year old man in Australia was protesting about having been given 31 treatments without his consent since August. His treatment appears to occupy the gray area between behaviour control and therapy for an illness, and serves as a reminder that ECT isn’t just a treatment for older people (although I wonder if it is signficant that the younger man’s treatment became a news story, while that of the older women was reported in a journal that is little read outside the world of psychiatrists who have a particular interest in ECT.)

In July I wrote about the discussion around brief pulse (BP) and ultra brief pulse (UBP) ECT and mentioned an article from the Netherlands that was a follow-up study. I have now found the original study, which looked at the short-term effects of BP versus UBP ECT and gives more information about the people receiving ECT. They ranged in age from 15 to 94, with a mean age of 60, again a reminder that ECT affects all age groups. The authors concluded that UBP and BP ECT had similar cognitive effects and that BP had an advantage in the relief of symptoms and so was the preferable treatment. However in the BP group of 58 patients, 6 did not complete the study because of confusion following ECT, compared to none in the UBP. Apparently this does not reach statistical significance, and therefore did not affect the authors’ conclusions.

Use of UBP seems restricted to ECT where unilateral electrode placement is used (I am not sure why) and so discussion of UBP v BP is academic in those places, for example the United Kingdom, where bilateral electrode placement is still the standard form of ECT.

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