Here's Why Tracking Of Electroconvulsive Therapy Should Be Mandatory Across the Nation

Is ECT making mental healthcare better or worse?

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For those wishing to improve their mental health, a chief priority is usually to find one or more therapies that effectively improve well-being and quality of life. One that might come up in this search is electroconvulsive therapy (ECT) — which many don't realize is still being used today. However, the actual number of men, women and, yes, even children receiving ECT is not known due to a distinct lack of mandatory tracking and reporting. Not having this information both by state and nationally makes it difficult to really know the truth. Is ECT making things better — or worse? The data that is available clearly states that ECT has serious risks; as someone working to improve mental healthcare, I must urge how vital establishing such reporting is to providing adequate patient protection and efficacy of care.

What Is ECT?

Electroconvulsive therapy sends electricity through the brain. The voltage can be as high as 460, and the current causes a surge of electrical activity, resulting in a seizure.

ECT got its start in 1934 when psychiatrist Ladislas Meduna, having recognized that epilepsy patients seemed to improve after seizures, began using the stimulant Metrazol to induce seizures in psychotic patients. The violent seizures and terror induced by the drug were excruciating. In search of an alternative method, neurologist Ugo Cerletti and his colleague, Lucio Bini, developed the first ECT device in 1938 after observing how electric shock was used in slaughterhouses before killing pigs.

Those recommended as candidates for ECT include not only individuals with severe depression who haven't responded to other treatments but also individuals with disorders such as schizophrenia. However, the recent revelation that the chemical imbalance theory could be false and that low serotonin levels are not necessarily the cause of depression brings the entire concept of treatment-resistant depression into question.

Defenders assert that advances in ECT techniques, such as individualized dosing and the use of muscle relaxants, make ECT safer and more capable of better results than in the past.

However, mental health human rights advocates point to the lack of any clinical trials involving people, which is normally required by the FDA when determining the safety of a device; this fact, combined with the potential for harm, makes it a controversial mental health treatment option.

Potential Dangers and Risks of ECT

Like many other physical or mental health treatments, ECT has known adverse effects. These issues persist despite changes to ECT protocols. Patients who undergo treatment might experience headaches, nausea, myalgia (muscle pain) or confusion. More severe complications include cardiovascular, pulmonary or cerebrovascular events, as well as short- or long-term memory loss and even brain damage.

With these side effects in mind, one of the biggest reasons that patients undergo ECT is because of suicidal thoughts. The hope is that the treatment will reduce these types of dangerous urges and, subsequently, deaths. Some work does show that patients experience less severe symptoms after ECT. Even so, a study led by Dr. Bradley Watts of Dartmouth College found that, when those who received ECT and those in a control group were compared, the relative risk of death by suicide was 0.96 in 30 days and 1.38 in a year — the ECT group saw 137.34 deaths per 10,000 in 30 days and 804.39 in a year, while the control group saw 138.65 per 10,000 in 30 days and 564.52 in a year.

Watts and his colleagues thus concluded that ECT isn't any better than other mental health treatments at decreasing suicide risk. Another study by Munk-Olsen reported that ECT was associated with an increased risk of suicide.

A Psychiatric Times article reported on a review stating that "patients in the ECT group were 16 times more likely to attempt suicide over 12 months than the non-ECT patients." This same article noted that "The review's conclusion that there is no evidence ECT prevents suicide, as often claimed, has been unequivocally confirmed by a study of 14,810 patients who received ECT and 58,369 controls."

Penning in the Roaming Lion

American states are required to provide some information about the patients who receive ECT. However, there is "little comprehensive data on how many patients receive ECT in the United States, nor about the demographics of ECT recipients." Without this data, it is impossible to make an accurate statement about the risks or results of ECT, and so it becomes increasingly important to look at the anecdotal evidence surrounding its use.

A precious few guardrails, such as regulation from the FDA, are meant to maintain some control over ECT for patients. But those guardrails can and do fail: It's not always clear the degree to which big pharma funding and other influences sway studies or regulations. Authorities can also apply laws improperly or fail to convey the realities of ECT to patients prior to exposure. One instance of this occurred in Florida, where the Citizens Commission on Human Rights (CCHR) documented a lawsuit alleging that a patient was forcibly administered ECT without proper written consent.

Until Further Notice, Question Everything

Good treatments for mental health or physical well-being rely on rigorous scientific modeling — that is, they present a hypothesis and then test that hypothesis in a controlled way. But that journey is often a long, even multi-generational one, and sometimes new data becomes available that forces experts to reexamine and/or replace what they thought they once knew. As mentioned earlier, this recently proved the case for the chemical imbalance theory of depression, with a new meta-analysis of studies failing to prove the theory.

In this context, and since there have been no clinical studies to factually determine the safety and efficacy of ECT, continued questioning of the treatment, as well as of other mental health options, must be par for the course. While this fact alone should be enough to suspend the administration of ECT until such studies are completed, backers have repeatedly pushed the need for studies aside. So the first step becomes taking personal responsibility for one's own mental health, as well as for the support of others, by advocating for formal ECT tracking and researching the facts, both now and in the future.

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