Electroconvulsive therapy may cause a wider range of side effects in treating depression than previously thought, according to a paper that calls for the practice to be paused pending more robust research.
While ECT is widely known to cause short-term and long-term memory loss, the study found 25 other side effects, including cardiovascular problems, fatigue and emotional dulling.
ECT involves passing electricity through the brain under general anesthesia to induce seizures, usually over a course of six to 12 treatments. It is prescribed to around 2,500 people in the UK each year, mainly for treatment-resistant depression, but also schizophrenia, bipolar disorder and catatonia.
Study published in the International Journal of Mental Healthis based on a survey of 747 ECT patients and 201 relatives and friends, which means it is not conclusive but may provide an indication of possible other side effects given the complexity of ECT research.
Professor John Reid, study author and professor in the Department of Psychology at the University of East London, said: “Given we still do not know whether ECT is more effective than placebo, these striking new findings make it even more urgent to suspend its use until a thorough study of its safety and effectiveness can be carried out.
“The study is so flawed and inconclusive that ECT would have absolutely no chance of gaining MHRA approval in the UK or FDA approval in the US if it were submitted today.”
The study found that nearly a quarter of participants (22.9%) reported heart problems such as arrhythmia after ECT, and more than half (53.9%) said they experienced occasional headaches. More than three quarters (76.4%) experienced emotional numbing. Some side effects have been linked to memory loss, such as relationship problems, difficulties with navigation and loss of vocabulary.
Sue Cunliffe, who was prescribed ECT for severe depression in 2004, said the side effects had “completely ruined my life since I was 38”. She said she was left with slurred speech, shaky hands and poor balance, and was unable to recognize faces, count money, follow directions or read and write correctly.
“The week before ECT I was jogging, playing badminton and able to write poetry, and six weeks later I'm falling down the stairs with bruises,” she said, adding that she still experiences brain fog and fatigue that has left her unable to work as a doctor and having to “really limit my day.”
ECT is a treatment method that divides mental health professionals. Although some people report improvement in their symptoms, it is not known exactly how ECT affects the brain.
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Professor Tanya Gergel, director of research at the charity Bipolar UK and emeritus professor of psychiatry at University College London, said there was “no evidence to support claims that modern ECT carries any serious risks to physical health or that it causes long-term brain damage and permanent cognitive decline.”
She said it should not be considered a “complete cure” and that there were “some modern cases of misuse”, but that it can reduce some of the most dangerous symptoms while allowing people to use other measures to support their recovery.
She said ECT was “the most important tool in helping me cope with the acute symptoms and risks” associated with her treatment-resistant bipolar disorder.
“But there is evidence that some people, including myself, experience autobiographical memory loss and disruptions to life around the time of treatment,” she added, calling for more research to understand and minimize these side effects.
Professor Georgiy Kirov, from Cardiff University, said ECT is “highly effective” and has been found to be “life-changing” for people with severe depression, with 60% reporting an improvement in their symptoms. He said the stigma had led to “under-use” in the UK, but it was more commonly used in some other northern European countries.
“There is very broad and compelling evidence that it is effective beyond the early placebo-controlled studies. For example, large meta-analyses show that it is superior to antidepressants, TMS, TMS and any other treatment,” he said, adding that calls for more placebo-controlled studies “have not been supported by the scientific community.”
Lucy Johnston, a clinical psychologist and member of the UK campaign group Improve ECT Standards, which advocates for stricter regulation, said very few people knew that ECT was still used as a treatment and that it was mainly prescribed to older women, with one third receiving it against their will.
She said a “significant proportion” of ECT patients were victims of domestic violence, which she believed was not always well studied by mental health professionals. “The pills aren't going to help, so it quickly becomes a question of, what do we do next? That's when the question of ECT comes up,” Johnston said.
Company representative National Institute for Health and Care Excellence (Nice) stated that its guidelines stipulate: “Clinicians should consider ECT only for the acute treatment of life-threatening severe depression and when a rapid response is required, when it is the individual's preference based on past experience with ECT, or when other treatments have been ineffective.”
Patients must be informed of the risks and benefits, and clinics must be accredited by the Electroconvulsive Therapy Accreditation Service (ECTAS) and record delivery and outcome data, the spokesman said.
