Wide divergence of opinion about the treatment

Press, 25 May 1977, Page 21

Wide divergence of opinion about the treatment

Electro-convulsive therapy

JENNIFER HAMILTON

writes the second of

three articles about the controversial subject of E.C.T.

Those in favour:

Many people who have recovered from melancholia after receiving E.C.T. feel very grateful. “You feel as though the cobwebs have been blown away,” said a former patient. “After three weeks in hospital, I was completely cured and lecturing by the end of the year,” she said. Another patient, Judith, said that doctors had tried just about everything; and E.C.T. was the only treatment that stopped her feeling suicidal. “I didn’t like the thought of having it and was pretty depressed, but after each treatment I felt

slightly better.” She said she was left with very slight forgetful-

ness that disappeared. “E.C.T. is highly sophisticated. I don’t think that it is at all barbaric.” Others share her sentiments.

“It was definitely beneficial. At no time did I find it a frightening experience.” said a patient who had had E.C.T. that morning. A nurse said that she

did not know what would have happened to her without the treatment. “I hope that I don’t have to have it again; but I wouldn’t hesitate,” said another. There seems to be a consensus among psychiatrists, in Christchurch anyway, that E.C.T. is a life-saving treatment. In the 19305, before E.C.T. was used at the Edinburgh Royal Infirmary, there was a 10 per cent mortality rate among depressed patients. These figures have been drastically reduced by treating the high-risk patients with E.C.T. —

from which there are three to nine deaths per 100,000 treatments.

A survey of 14 studies of depressive illness showed a higher suicide rate for the antidepressant drug compared with suicide rates when E.C.T.

was available. Supporters of E.C.T. also point to its quick effectiveness, especially among patients who are not responding to antidepressant drugs, where

there is a failure rate of between 10 and 30 per cent.

The report from the Sainsbury Committee of the Royal College of Psychiatrists concluded that E.C.T. is at least as effective as the best antidepressant medication and acts more rapidly.

“You can afford to take risks when you believe the patient will die without treatment,” said Dr John Dobson, a Christchurch psychiatrist.

Risks include amnesia, disorientation, fear, and memory loss. Doctor Dobson believes that these side effects are usually short-term; and he said that memory could be affected by the depressive illness itself. “Four or five treatments closely together disturb memory function, but six to nine months later one’s power to remember is fully recovered,” he said.

He added that there was significantly less memory loss if treatment was given unilaterally — that is, when the electrodes were placed on only one side of the head.

"Anti-depressant drugs cause urinary retention and adversely affect the heart by causing conduction problems,” said Dr Dobson. Statistics show that tricyclic anti-depressant drugs accounted for 9 per cent of all deaths from poisons, solids and liquids in Britain.

Professor Garth McQueen, in Dunedin, wrote that undue risks had sometimes been accepted in trying this form of therapy rather than referring a patient to a specialist psychiatrist for “what is still the most effective therapy — E.C.T.”

Mark L. Cunningham, writing in the Medical Journal of Australia, strongly supports E.C.T.

“Perhaps the most important of all indicators for E.C.T. is in the treatment of the acute episode of psychotic depression,” he said.

“The risk of self-injury or injury to others (possibly even homicidal acts) render early treatment of this condition imperative. Electro-therapy offers the most rapid and reliable treatment yet available.

“One cannot but accept

the evidence of one’s own experience (and that of many others) of the remarkably rapid improvement in psychotic disorders when patients have been previously outside the reach of any reasoned communication.”

E.C.T. draws wide support even if that support is defensive.

The British Minister of Health last year (Dr David Owen) traversed the topic in Parliament. He said that it was of proven value to many patients.

“Controlled clinical trials into the use of E.C.T. indicate that it is quick in producing a beneficial response and free from serious side affects. The Medical Research Council has advised that there is no evidence that E.C.T. given in the proper manner, and with proper safeguards, causes brain damage — a commonly made criticism of this treatment.”

Would psychiatrists have E.C.T.?

“An eminent British psychiatrist has received the treatment and I would willingly have E.C.T. if I needed it,” said Robyn Hewland, a psychiatrist at Sunnyside Hospital.