The Huffington Post yesterday (4th October 2017) ran an advertisement for electroconvulsive therapy (ECT) at the McLean Hospital, Belmont, Massachussetts, USA, psychiatric affiliate of Harvard Medical School and “ranked #1 by U.S. News and World Report”.
“The truth about electroconvulsive therapy” was written by McLean psychiatrist Stephen J. Steiner and took a well-worn path: stigmatized by misleading portrayals in Hollywood – anaesthesia – mild discomforts (little pinprick and mild headaches) – doesn’t damage the brain – neurogenesis – improves cognition and anterograde memory – trivial amount of retrograde amnesia (forgetting details of a play) – only rarely administered involuntarily and only when there is a court order and even then the majority of involuntary patients are “very grateful afterward”, etc. etc.
At the end of the there is a link to the McLean ECT service where there is more of the same: “mild electrical currents”, and “minor problems with memory”.
“The great majority of patients will have only minor problems with memory, though some will experience no difficulties at all. While these problems usually subside, there is no way to predict their extent. The psychiatrist will discuss this potential side effect in greater detail during consultation.”
You don’t have to look far though to find McLean Hospital talking about ECT-induced memory loss in a rather more brutal fashion: “ECT treatment can lead to several known side effects including confusion and memory loss”. This is a typical example of how psychiatrists forget about the minor and transient (usually) nature of memory loss when they are trying to sell an alternative to ECT. In this case it is intracranial electrical seizure therapy (ICEST) for which McClean filed for a patent in 2011. The technique is similar to ECT but involves planting electrodes into the brain rather than putting them on a person’s head. Memory loss would have to be pretty bad before invasive brain surgery becomes a better alternative.
You also don’t have to look very far to find Stephen Seiner and colleagues experimenting with ECT as a treatment to control agitated and aggressive behaviour in people with dementia. The results were published in the International Journal of Geriatric Psychiatry in 2015. The authors made it clear that they were treating behaviour rather than depression: “The treating psychiatrist, in consultation with the ECT service, made a clinical decision regarding the use of ECT treatment for agitation or aggression associated with dementia, irrespective of mood symptoms”. Twenty-three patients from McLean Hospital and Pine Rest Christian Mental Health Services were given ECT. One person died a month after ECT (due the authors said to dementia and not ECT) and several people experienced delirium and other adverse events; scores improved on Cohen-Mansfield Agitation Inventory (CMAI)-short form. The authors found the results “encouraging” and concluded that ECT was a safe and effective treatment. Fifteen of the patients were recommended for continuation ECT.