News of the World on ECT

News of the World (although there's rarely much world news, so it's clearly an ironic title) recently published a feature on the Coronation Street actress Bev Callard's experience of a severe depressive episode during which she received ECT. It was titled: "Frankenstein op saved me from suicide".

It's relatively rare for someone in the public spotlight to talk about their experiences of mental illness; less frequent for them to touch on treatments such as ECT. So, this is to be commended. It's a shame that the paper didn't really take much of an opportunity to provide the information that the average reader might have found helpful. Such as:

1. ECT is not always a "last-resort". Indeed, in this case, it seems as though it was suggested relatively early in a course of treatment.
2. For many people, ECT is offerred for a variety of reasons which include: a) a quick response is needed. This is the case when someone is at high risk of suicide, or they are not eating/ drinking; b) ECT has worked in the past and the person wishes to have it again because they know it works. For some people, ECT can be more effective than drugs, and in most cases will work more quickly. The most common reasons for giving ECT in Scotland are 'Previous Good response' and 'Resistance [to antidepressants]' (Scottish ECT Accreditation Network (SEAN) Annual Report, 2009).
3. Effects on memory are not uncommon, with approximately two-thirds of people experiencing some effect on autobiographical memory for the period in which they're receiving ECT. The vast majority of studies have found that memory returns to normal 2-3 months after a course of ECT, but memories from the period of treatment may always be hazy. However, the majority of people in hospital for severe depression do not report unbroken and clear autobiographical memory anyway.
4. Twelve treatments is the typical maximum number of treatments in a course, although some people might choose to stop after fewer, and other people (those with delayed response and chronic depression) might have more. Like most things, it's a discussion about risk versus benefit. Someone who has had 10 treatments with no benefit and memory problems might choose to stop. Another with partial improvement and few memory problems might choose to continue. In Scotland, the mean number of treatments per course is 7.6 (Scottish ECT Accreditation Network Annual Report, 2009).

The article does reflect some realities about ECT:

1. Most people will experience some sense of improvement after 3-4 treatments.
2. ECT can be very effective. Indeed, it is probably one of the most effective treatments in modern psychiatry. The SEAN Report 2009 indicates that 50% of people experienced a 75-100% improvement in depressive symptoms from baseline to end of treatment. A further 26% experienced a 50-74% improvement. In psychiatry, a 50% improvement in symptoms is usually classified as 'response' (not remission), so in Scotland approximately 75% of people respond to ECT.