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Ect: kill or cure?

MagazineDecember 1996 (Vol. 7 Issue 9)Ect: kill or cure?

While ECT is traditionally viewed as a last resort in treatment, studies show that practitioners often opt for combined drug and ECT treatment as a first line for severely depressed patients

While ECT is traditionally viewed as a last resort in treatment, studies show that practitioners often opt for combined drug and ECT treatment as a first line for severely depressed patients. While the medical profession believes ECT is a "life saving option", there is no evidence for this. Although we know it can kill, there are few figures to show how often it does. Risk of death from ECT is under reported internationally. In the UK there is no audit of ECT use. In the US no national records are kept (except in the state of Texas) so it impossible to quote accurate figures.

The figure which is often quoted, 1 death per 10,000 patients, has an intriguing history. It is taken from the standard textbook Electroconvulsive Therapy by Robert Abrams (Oxford University Press). The author, however, is a director of one of the largest manufacturers of ECT equipment in the US. The figure, which appeared in the 1988 version, was dropped in the 1992 version, replaced by a figure of 1 in 50,000 treatments. As the average number of treatments per patient in the US is five, the figures are, in fact, the same.Because ECT requires a general anesthetic the risk of death should, at the very least, reflect the overall risk from this procedure 4.5 per 10,000. In addition the elderly, who receive most treatments, are much more likely to die from the procedure. Research from the State of Texas puts the figure at an alarmingly high 1 in 200. In 1993 a study at Browns University of patients 80 years and older, 27 per cent of patients were dead within a year, compared to 4 per cent of a similar group treated with antidepressives. Within two years 46 per cent of ECT patients were dead vs 10 per cent of those on drugs (USA Today, Dec 6, 1995). Similarly high death rates can be found in the UK (Br J Psych, 1980; 137: 9-16).

Other studies show high suicide rates following ECT (Arch Gen Psyh, 1976; 33: 1029-37; Br J Psych, 1992; 160: 149-53). In psychiatric hospitals the rate of suicide is 50 per 100,000 four times the national average.


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