Sunday Herald - 11 May 2003


I'll defy ECT guidelines, vows top psychiatrist
Scottish medic pledges to flout government ban on long-term use of electroconvulsive therapy

By Sarah-Kate Templeton, Health Editor

A leading Scottish psychiatrist has pledged to flout government guidelines and continue to give depressed patients regular electric shock treatment for periods of several years.

Dr Donny Lyons, consultant in electroconvulsive therapy (ECT) at Leverndale Hospital in Glasgow, has warned that he will ignore new guidelines, that the procedure should only be given in short courses, whenever he thinks it would be against a patient's interest.

He said: 'If I have a choice between following these guidelines and doing what I think is best for my patients, then I will do the latter. I am not going to tell my patients they cannot have this treatment because Nice [the National Institute of Clinical Excellence] advises against it. My duty to patients will take precedence. I have no difficulty deciding not to follow the guidelines because I do not think they are correct. I would be very unhappy if my ability to help people is impeded by guidelines that don't make any sense.'

Lyons, the Scottish spokesman for the Royal College of Psychiatrists, has received the backing of the prestigious professional body.

ECT is normally given as a series of between six and 12 sessions, but a small number of patients receive the treatment indefinitely -- sometimes for a number of years. This is known as continuation or maintenance ECT.

Nice, a government body set up to give advice on the use of medicines and medical procedures, has issued new guidance on ECT stating that it should not be used on a continual basis.

The Nice guidelines state: 'It is recommended that ECT is used only to achieve a short-term improvement of severe symptoms. As the long-term benefits and risks of ECT have not been clearly established, it is not recommended as a maintenance therapy in depressive illness.'

The Royal College of Psychiatrists has prepared a statement which, it says, 'contradicts the Nice guidelines on ECT in several important respects'.

On the issue of continuation ECT, it says: 'We feel there is sufficient evidence from clinical experience and from case studies to support the view that a small proportion of patients can only stay well when continuation ECT is used, and that although it is possible to gain a short-term improvement with ECT, this cannot be sustained by other available treatments such as lithium antidepressants or psychotherapy, and that only continuation ECT allows such patients to stay well.'

The Royal College of Psychiatrists also disagrees with the decision by Nice to restrict ECT to patients with severe depression. But Richard Norris, director of policy for the Scottish Association for Mental Health (SAMH), is surprised the guidelines are to be ignored. 'It is troubling that psychiatrists are saying they don't intend to abide by the guidelines. It is a serious issue if psychiatrists are saying they are not going to follow guidelines that have been issued after an expert committee has looked at this.

'Nice has made very clear its reasoning on this. We cannot support maintenance ECT because of the lack of evidence on the long-term effects. There is not good evidence that we can rely on to show whether this is safe or not in the long term. That is why Nice has recommended this is not used.

'The problem is, we do not know what the effect of someone having ECT over several years will be. What is the effect on their memory and the way their brain functions? Nice is saying it doesn't know.'

ECT is a means of inducing an epileptic fit by applying a pulse of electric current to the brain. It is thought to be a valuable method of psychiatric treatment, but has aroused widespread controversy and dislike, based on evidence, rejected by many psychiatrists, that it can cause permanent brain damage. Memory loss is the best-known side effect.

Joseph Doherty, from Glasgow, killed himself after being given ECT. In 1991, he was diagnosed schizophrenic and his illness did not respond to the usual medicines. According to his brother, Alex, it took three days of arm-twisting to persuade him to sign the consent forms for ECT. During the course of treatment, he absconded from hospital and threw himself off a bridge. Alex is now an independent mental health campaigner fighting against ECT being given to patients against their will.

A method of averting chronic depression ... or a treatment with serious side-effects?

Joy Smith has been receiving ECT every two weeks for the past two years.

The mother of two from Busby, near Glasgow, was given her first course of ECT three years ago after suffering from severe depression. Drug treatments had not worked and Smith, 51, spent months in hospital. She says the treatment allows her to lead a normal life. 'I receive maintenance ECT. I have been receiving maintenance ECT for a couple of years and couldn't do without it. It prevents me from becoming seriously ill.

'I received my first course of ECT three years ago when I was suffering from severe, chronic depression. I was in and out of hospital several times a year, sometimes for one or two months.

'I had tried a variety of antidepressant drugs but they didn't work. At first I had a course of ECT, but that wasn't sufficient to keep me well.

'Two years ago I moved on to maintenance ECT which means I get it all year round, twice a month.

'It helped so much when I started the maintenance programme. It allows me to lead a normal life. I can go out and about. I can do everyday things around the house. I think I live a pretty normal life now. That was not the case before. I only suffered slight memory loss. It was long-term memory loss, but it was only slight. I cannot remember some things that happened around 10 years back.

'This is so much better than what I had to suffer before.'

On the other hand, Ruth Lang, information officer for the Edinburgh-based Depression Alliance, has mixed views about ECT. She has had five separate courses since 1994. While her experiences of the first four were positive, Lang suffered significant memory loss after the last treatments, which ended earlier this year.

Lang suffers from severe depression. She said: 'With the first four courses I would say that it was good and that it did help me, particularly the fourth course. I was a lot better. The last treatment was more traumatic. I suffered severe memory problems afterwards.

'There had always been some memory loss. For example, my son insists we went to a Livingston football match and I cannot remember it. The last time was different. The memory loss was more severe. I had to be shown around my own office by my line manager and I had to relearn certain procedures.

'With the office practices, it is difficult to say whether I relearned them or whether they came back to me or a bit of both. I do not know whether I would have ECT again. If I have severe depression that is treatment-resistant, I may need to. I'd hope that I would have a say.'