14 March, 2001
BBC

No warnings before shock treatment

Patients are not being given enough information or being offered the chance to opt out of a controversial treatment for depression, says a charity.

Mind said electro-convulsive therapy (ECT) could leave patients suffering a number of side-effects - and that patients were frequently not told about these prior to treatment.

But a separate study on ECT by American scientists said the therapy had a bad reputation in the past, but was now an effective means of combating depression.

ECT involves passing a current through an anaesthetised person's brain to produce a seizure with the aim of relieving severe depression.

Mind officials claim patients are left with permanent memory loss, anxiety, lack of concentration and forget skills such as counting or music learned before the treatment.

Out of over 400 people surveyed by Mind, 84% said they had suffered adverse side effects.

Four out of ten suffered permanent loss of some of their memories and 36% had permanent difficulty in concentrating.

But three quarters surveyed said they had not been given any information about possible side effects and only 8% were able to consult an independent expert before agreeing to treatment.

Forgotten past

One woman told Mind she could remember nothing about bringing up her children.

She said: "I can't remember hardly anything about my past life, only very little bits.

"As for bringing up my three daughters, I can't remember a thing."

A former taxi driver said she had lost all her directional skills following the treatment.

She said: "I was a taxi-driver for 20 years. Now I can only find my way if I have my carer present to give directions. I do not know my left from my right."

Worst fears

Under the Mental Health Act 1983, ECT can be given to detained patients without their consent.

Between January-March 1999, 2,800 patients received about 16,500 administrations of ECT.

Out of the quarter who were detained, well over half had not consented to the treatment.

Two thirds of the 418 people surveyed by Mind said they would not agree to have ECT again.

Margaret Pedler, head of policy development at Mind, said the results "confirmed their worst fears."

She said: "It is clear that people are still not being given enough information about temporary and permanent side-effects and this means that those who are giving their consent to ECT are not doing so out of informed choice."

Dr Susan Benbow, from the Royal College of Psychiatrists ECT committee, stressed the treatment is only given to seriously ill patients and was not a decision taken lightly.

"We are not talking about run-of-the-mill people who are feeling low, we are talking about seriously ill people."

She said depression causes memory loss, as do the drugs taken to combat it, so not all the problems can be blamed on ECT.

Beating depression

But a separate study by scientists from the New York State Psychiatric Institute, and the College of Physicians and Surgeons at Columbia University, New York, found that a combination of lithium and the anti-depressant drug nortriptyline following shock therapy substantially lowered the relapse rate of patients with major depression.

The patients involved in the trial were resistant to the usual drug-based depression treatments.

Richard Glass, deputy editor of the Journal of the American Medical Association, said in an editorial the therapy got a bad name in the middle part of the last century.

He said that the usefulness of shock treatments for combating depression "are among the most positive treatment effects in all of medicine ... yet this effective treatment too often remains in the shadows of stigma and fear.

"The study ... is a good example of the growing scientific database that can usefully inform clinical decisions about this treatment."