This week (14 November 2017) the Scottish ECT Accreditation Network (SEAN) published their annual report on the use of electroconvulsive therapy (ECT) in Scotland.
In 2016 in Scotland 344 people received 408 courses of ECT, compared to 367 and 448 the previous year (a decrease of about 8 per cent in the number of people and 9 per cent in the number of courses). The proportion of people who consented to treatment rose slightly, to 67 per cent. The third of patients who didn’t consent were considered to lack the capacity to make a decision.
As usual, the majority of patients (69 per cent) were women and “the trend for relative use of ECT to increase with age persists”, with more than 70 per cent of patients aged over 50. The report says that the proportion of women receiving ECT is “in keeping with the rates of depressive disorder in the general population”. But it is not that simple. In the general population in Scotland men and women report equal rates of the symptoms of depression. Women however accounted for 67 per cent of people prescribed antidepressants in 2012/13. When it comes to hospital treatment of depression, the ratio is nearer 60/40.
On the subject of women and men, it is predominantly male psychiatrists who are involved with the SEAN reports. On the steering group there are six male psychiatrists and no female psychiatrists. On the report writing group there are three male psychiatrists and one female psychiatrist.
ECT was given with bilateral electrode placement in 98 per cent of courses. A survey published in 2009 found that 18 per cent of the psychiatrists in Scotland who responded preferred unilateral electrode placement. What happened to them I wonder? Or perhaps it is a case of what they say and what they do are different things.
Just over one fifth of courses were not completed as planned. This, says the report, is evidence that ECT is “well-tolerated” (although it could equally be seen as evidence for the opposite).
Once again, chair of Healthcare Improvement Scotland Dame Denise Coia has cut-and-pasted her annual foreword to the report. “I am delighted to be asked, once again to provide the foreword for the Scottish ECT Accreditation Network’s (SEAN) ninth annual report” it begins. A few words have been changed or shuffled around and a comma added but apart from that it is identical to previous ones.