electroconvulsive therapy

Last edited 07/2021 and last reviewed 12/2021

ECT uses induced epileptic seizures as a means to treat severe depression and psychosis.

ECT was first introduced in the 1930's as a treatment for psychosis but was noticed to benefit those patients with marked depressive symptoms.

ECT is considered to be the treatment of last resort, however it provides effective and rapid relief from severe depression and some psychotic disorders.

Note that the Mental Health Act 2007 made specific safeguards to the use of ECT:

• except in emergencies, detained patients may in future only be given ECT if they have capacity and agree or, if they do not have capacity, the ECT is authorised by a Second Opinion Appointed Doctor (SOAD
  • this means that a detained patient can refuse to have ECT, and, except in emergencies, this can be overturned only if a SOAD agrees that the patient does not have capacity to make the decision and that giving the ECT treatment would be appropriate. In this case, the SOAD also needs to be sure that there is no valid advance decision refusing the use of ECT. If such an advance decision has been made, then ECT cannot be given, except in an emergency
  • in the case of young people (aged under 18), even if the patient agrees, unless it is an emergency, they may only be given ECT with the additional agreement of a SOAD. These rules apply to young people whether or not they are detained
  • in all these cases, it is only an emergency if the ECT is immediately necessary to save the patient’s life or prevent serious deterioration in their condition

Safety aspects:

• based on the number of treatments given, it was estimated the mortality rate associated with ECT as less than 1 death per 73,440 treatments (1). The most common reported adverse events related to ECT were injury to the mouth (including dental and tongue injury)
• in a retrospective cohort study (n=10,016, Ontario), there was no clinically significant increase in risk for serious medical events with ECT (0.25 vs. 0.33/person/year in exposed vs. unexposed group; HR 0.78; 95% CI 0.61-1.00) and risk of suicide was significantly reduced (p<0.03) (2)

Reference:

• Watts BV et al. An examination of mortality and other adverse events related to electroconvulsive therapy using a national adverse event report system. J ECT. 2011 Jun;27(2):105-8.
• Kaster TS et al. Risk of serious medical events in patients with depression treated with electroconvulsive therapy: a propensity score-matched, retrospective cohort study. Lancet Psychiatry (July 12th 2021).