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Electroconvulsive therapy is a life-saving medical procedure for depression
December 20, 2012
Last week the Toronto Star published ?Shock: An investigation into the startling comeback of electroconvulsive therapy.? Describing ECT as ?a brute force assault on the brain? and an ?electrical lobotomy,? the authors painted a very worrisome picture in which the use of ECT in Ontario had grown at an alarming rate and without proper oversight. In the last few days, numerous patients have requested that we provide a more balanced perspective on this treatment. This article is for them.
Roughly 10 per cent of the population will experience a depression in their lifetime. Depression takes an enormous personal toll on people?s work, their relationships, their self-esteem, their memories and sometimes their reason for living. Ten per cent of patients with depression die by suicide. That represents several hundred people in Toronto every year, far higher than our city?s homicide rate. In the next decade, depression is projected to be the costliest medical illnesses in western society.
Between 30 and 50 per cent of patients with depression will not respond to antidepressant medications, psychotherapy or other treatments. Every year, in Toronto, this leaves several Rogers Centres full of patients battling depressive symptoms with little relief. These patients are twice as likely to be hospitalized and are at significantly higher risk of dying by suicide.
ECT works when other treatments do not. Remission rates with ECT are between 60 and 80 per cent ? making it two to three times as effective as any other treatment for resistant depression. People respond within two to four weeks, whereas medications typically take four to six weeks to work. However, ECT is used in only about 1 per cent of patients with medication-resistant depression. This is primarily due to the media and social stigma that engender irrational fear and avoidance of this very effective treatment.
Today, ECT is a very different procedure than that portrayed in old movies. During ECT, the patient is asleep under general anesthetic and a current is passed between electrodes on the scalp to induce a controlled therapeutic seizure that is barely visible to the naked eye. This seizure usually lasts between 20 to 60 seconds. Afterward, the typical response of both the medical observer and patient alike is ?Is that it??
We feel compelled to address specific points in the authors? article. ECT rates have not increased dramatically over the last 10 years. As the authors point out, there have been flaws in the way ECT has been reported to administrative databases e.g. most of the provincial psychiatric hospitals did not report ECT to administrative databases prior to 2005. Therefore, the perceived dramatic increases in rates of ECT use are actually due to improved data reporting since 2005. ECT actually remains an underutilized treatment.
Clear guidelines on the use of ECT exist from national and international bodies, such as those published in 2009 by the Canadian Network for Mood and Anxiety Treatments (CANMAT). When practiced in accordance with these guidelines, ECT is very safe and effective with some degree of memory loss being the most common side-effect. Lack of adherence to guidelines can occur in all areas of medicine and is not specific to ECT. We would agree that improved measures to ensure adherence to safe ECT practise in which the most up-to-date methods are followed will undoubtedly improve patient outcomes across the province.
We also agree that there is a need for new treatments that are comparable to ECT in their rates of improvement but are associated with even fewer side effects. The good news is that such groundbreaking studies are currently underway in several academic centres across the country. For example, CAMH recently opened the Temerty Centre for Therapeutic Brain Stimulation to investigate several new treatments (including magnetic seizure therapy); early results show promising rates of efficacy that are comparable to ECT with minimal risk of memory impairment. There is much hope for the future.
ECT is a life-saving medical procedure that has a complex history. Despite this complex history, it has persisted because it is by far and away the most effective treatment for resistant and severe forms of depression. The safety of the procedure has evolved dramatically over its 70-year history. Sensationalized articles that promulgate misinformation only serve to frighten and put our most vulnerable and severely ill patients at significant risk.
Dr. Daniel M. Blumberger is head of the late-life mood disorders clinic at the Centre for Addiction and Mental Health (CAMH). Dr. Zafiris J. Daskalakis is director of the research training and clinician scientist program at CAMH.
December 20, 2012
Last week the Toronto Star published ?Shock: An investigation into the startling comeback of electroconvulsive therapy.? Describing ECT as ?a brute force assault on the brain? and an ?electrical lobotomy,? the authors painted a very worrisome picture in which the use of ECT in Ontario had grown at an alarming rate and without proper oversight. In the last few days, numerous patients have requested that we provide a more balanced perspective on this treatment. This article is for them.
Roughly 10 per cent of the population will experience a depression in their lifetime. Depression takes an enormous personal toll on people?s work, their relationships, their self-esteem, their memories and sometimes their reason for living. Ten per cent of patients with depression die by suicide. That represents several hundred people in Toronto every year, far higher than our city?s homicide rate. In the next decade, depression is projected to be the costliest medical illnesses in western society.
Between 30 and 50 per cent of patients with depression will not respond to antidepressant medications, psychotherapy or other treatments. Every year, in Toronto, this leaves several Rogers Centres full of patients battling depressive symptoms with little relief. These patients are twice as likely to be hospitalized and are at significantly higher risk of dying by suicide.
ECT works when other treatments do not. Remission rates with ECT are between 60 and 80 per cent ? making it two to three times as effective as any other treatment for resistant depression. People respond within two to four weeks, whereas medications typically take four to six weeks to work. However, ECT is used in only about 1 per cent of patients with medication-resistant depression. This is primarily due to the media and social stigma that engender irrational fear and avoidance of this very effective treatment.
Today, ECT is a very different procedure than that portrayed in old movies. During ECT, the patient is asleep under general anesthetic and a current is passed between electrodes on the scalp to induce a controlled therapeutic seizure that is barely visible to the naked eye. This seizure usually lasts between 20 to 60 seconds. Afterward, the typical response of both the medical observer and patient alike is ?Is that it??
We feel compelled to address specific points in the authors? article. ECT rates have not increased dramatically over the last 10 years. As the authors point out, there have been flaws in the way ECT has been reported to administrative databases e.g. most of the provincial psychiatric hospitals did not report ECT to administrative databases prior to 2005. Therefore, the perceived dramatic increases in rates of ECT use are actually due to improved data reporting since 2005. ECT actually remains an underutilized treatment.
Clear guidelines on the use of ECT exist from national and international bodies, such as those published in 2009 by the Canadian Network for Mood and Anxiety Treatments (CANMAT). When practiced in accordance with these guidelines, ECT is very safe and effective with some degree of memory loss being the most common side-effect. Lack of adherence to guidelines can occur in all areas of medicine and is not specific to ECT. We would agree that improved measures to ensure adherence to safe ECT practise in which the most up-to-date methods are followed will undoubtedly improve patient outcomes across the province.
We also agree that there is a need for new treatments that are comparable to ECT in their rates of improvement but are associated with even fewer side effects. The good news is that such groundbreaking studies are currently underway in several academic centres across the country. For example, CAMH recently opened the Temerty Centre for Therapeutic Brain Stimulation to investigate several new treatments (including magnetic seizure therapy); early results show promising rates of efficacy that are comparable to ECT with minimal risk of memory impairment. There is much hope for the future.
ECT is a life-saving medical procedure that has a complex history. Despite this complex history, it has persisted because it is by far and away the most effective treatment for resistant and severe forms of depression. The safety of the procedure has evolved dramatically over its 70-year history. Sensationalized articles that promulgate misinformation only serve to frighten and put our most vulnerable and severely ill patients at significant risk.
Dr. Daniel M. Blumberger is head of the late-life mood disorders clinic at the Centre for Addiction and Mental Health (CAMH). Dr. Zafiris J. Daskalakis is director of the research training and clinician scientist program at CAMH.
