When I wrote about electroconvulsive therapy (ECT) in Worcester, United Kingdom, two years ago I was unable to find any publications on the treatment from psychiatrists, etc., working in Worcester. However, an article about ECT in Worcester has now been published. The article, Patients’ experiences of and attitudes to ECT, by Latha Guruvaiah, Karthikeyan Veerasamy, Muhammad Naveed, Swami Kudur, Farah Chaudary and Ann Paraiso appeared in the April – June edition of Progress in Neurology and Psychiatry. As the title suggests, people who had undergone ECT were asked to fill in a questionnaire about their experience. The people who were asked to fill in the questionnaire had all been treated by the Worcestershire Health and Care NHS Trust in 2013 and 2014. The lead author is a psychiatrist at the 2together NHS Foundation Trust in Gloucestershire, the others are psychiatrists at Worcestershire Health and Care NHS Trust.
The questionnaire was based on one used by Scottish psychiatrists for a similar study in the 1970s. The authors say: “Since its publication in 1980, we could not find any similar published literature in the UK highlighting the experience and attitudes of patients and carers towards ECT” which is surprising as several such studies have been published. People who had undergone ECT were asked questions about their experience and, based on their answers, the authors concluded that “It is clear from this study that the overall experience and attitude of patients and carers were positive”. For example:
- 15 out of 27 consenting patients said they had signed a consent form (the others could not remember);
- 4 out of 27 consenting patients felt forced or pressurised to have ECT (19 did not and four could not remember);
- 22 out of 30 patients said a member of staff accompanied them to the ECT clinic (2 said no and six could not remember);
- 28 out of 30 said the clinic was clean and comfortable (2 could not remember);
- 17 out of 30 rated the recovery period for a few hours after ECT as “pleasant”, 5 as “neutral”, 4 as “unpleasant” and 4 as “do not know”.
Of 29 patients, 24 said they experienced memory loss after treatment, and 13 said they experienced confusion. The authors suggested that the high incidence of memory loss might be explained by the fact that all the patients had been given bilateral treatment. (The survey did not ask participants if they had been given a choice of bilateral or unilateral treatment.)
The researchers found 30 people who were willing to take part in the survey, out of 60 people who had completed a course ECT during 2013 and 2014. The trust came up with a slightly different figure when I put in a Freedom of Information request – 69. Perhaps the difference is explained by people who did not complete a course of treatment. The interviews were conducted in early 2015, that is from immediately to just over two years after treatment (I am going to say on average one year). Six people could not be traced, five people could not take part due to significant cognitive impairment, 11 refused to take part and eight had died. The authors made no comment about those with cognitive impairment or whether it was caused by ECT, and they said that the deaths were “not related to ECT” but due to either “old age or physical ailments”.
But should eight people, out of 60, have died within, on average, a year of ECT? The average age of the people in the final sample of 30 was 62 years (ranging from 20 to 81). The trust told me that the average age of all people who received ECT in 2012 and 2013 was about 63 (64 in 2013 and 62 in 2014). A woman (and nearly all those who received ECT were women) in her early sixties in England can expect to live over twenty years more, so that appears to be a high death rate. It is something that at least deserves more explanation than a vague comment about old age.
Almost all – 28 out of 30 – the people taking part in this study were women. When I read the study I assumed that that must be because women were more willing to participate in the study. But the trust told me that, astonishingly, 63 of the 69 people who underwent ECT in 2013-2014 were women. Over 90 per cent of their ECT patients were women. Again, the authors are unconcerned, saying that depression is more common in women than men. Possibly – but certainly not in the ratio of 9 to 1.