British Medical Journal
BMJ 1999;319:1092 ( 23 October )
Although still in preliminary draft form and yet to be released officially to the
public, the long awaited US surgeon general's report on mental health has
already created an uproar, after a consumer health group released excerpts
highlighting the efficacy and safety of electroconvulsive therapy (ECT) in the
treatment of depression.
According to the draft report, which cites several clinical studies published between 1993 and 1997, electroconvulsive
therapy "is regarded as a safe and effective treatment for depression and is recommended for select groups of patients with
severe depression, particularly those with associated active suicidal ideation, psychosis or catatonia."
Moreover, the draft report says that the therapy "has the advantage over pharmacotherapy of more rapid resolution of
Calling the draft a "blanket endorsement" of electroconvulsive therapy, the National Mental Health Consumers' Self Help
Clearinghouse, based in Philadelphia, argues that the surgeon general's office overlooked numerous studies that found
electroconvulsive therapy to be more dangerous and less effective than pharmaceuticals for the treatment of severe
In a letter to the surgeon general, David Satcher, the clearinghouse cites numerous studies indicating higher suicide rates for
people receiving electroconvulsive therapy compared with those receiving drug treatment, as well as cardiovascular
problems, memory loss, and epileptic seizures.
In addition, the letter says that the draft report's underestimation of the risks of electroconvulsive therapy means that there is
"no opportunity for truly informed consent" as required by law.
The clearinghouse's executive director, Joseph Rogers, said that his organisation released the report because the draft
approves of electroconvulsive therapy in such an unqualified way.
Calling the report premature and unbalanced, Mr Rogers suspected that both politics and bias were factors in the draft
report's uncritical assessment of the therapy. "There was a lot of pressure on the National Institute of Mental Health from the
vice president's office," he speculated, "to get this report out after the White House conference [on mental health, held in
In addition, Mr Rogers said, the national institute's deputy director, Richard Nakamura, is "very pro-electroconvulsive
therapy, and I think he is looking for the surgeon general's report to give better legitimacy to electroconvulsive therapy and a
clearer and more definitive statement on electroconvulsive therapy."
The surgeon general's office refused to comment on the released draft except to say that it was not final and that it was still
undergoing a "rigorous review and revision process."