Safety concerns associated with electroconvulsive therapy (ECT) are not justified, according to a new study conducted in Frontiers in Psychology. Partly due to historical misuse and cinematic representations such as in Flight over a cuckoo’s nest, physicians and patients have been reluctant to use this approach. But there is ample evidence to show that ECT may be one of the most valuable and effective options for serious, treatment-resistant mental disorders such as schizophrenia and depression. This latest study of over 3,100 ECT sessions in a German psychiatric hospital appears to confirm that ECT is also very safe. There were no cases of permanent alteration of treatment and only three sessions (
Our research provides evidence that the negative attitude towards ECT – one of the most effective treatments for psychiatric illnesses – urgently needs to be corrected. “
Prof Göran Hajak, corresponding author, Social Foundation in Bamberg, Germany
Unjustified public fear
“Difficult to Treat Depression is a mental disorder that has been highlighted by the World Health Organization as one of the leading causes of human disability around the world, but the public’s irrational fear of suffering permanent damage to the ECT health has largely restricted its use in psychiatry. “Hajak said.” Only about 2% of eligible patients with severe, treatment-resistant depression are currently treated with ECT worldwide. “
Unlike its portrayal in non-scientific media or films, ECT is performed under short-term anesthesia and the medical team induces a single brief epileptic seizure during the treatment session. The technology uses a carefully controlled electric current that causes a nerve impulse discharge in the brain without affecting the rest of the body. It is believed to work as a “reset” of the brain functions underlying several mental disorders.
The present study is a retrospective analysis that examined the safety protocols and medical records of 157 patients who, combined, received more than 3,100 ECT sessions in the three years between 2018 and 2020. In this dataset , only three patients suffered life-threatening complications, but all three recovered without lasting effects. Less than 20% of patients reported milder adverse events, such as cognitive or brain disturbances. These minor effects were largely associated with higher doses of the electrical stimulus and an increased number of treatment sessions.
ECT is safe but should be performed under maximally controlled settings
One of the most important caveats from this work is the potential variation between ECT procedures in different hospitals and countries. The authors stress that ECT should only be performed in a setting controlled by an experienced medical team including a physician, nurse, and anesthesiologist, and that there should be access to intensive care methods in the event of a disease. ’emergency. To account for procedural variations, the authors recommend that each institution compile its own security data and its own risk profile.
“We hope our data will bring the discussion of ECT to a more factual level, as the low risk profile of ECT suggests that wider use could benefit many more patients,” he said. concluded Hajak.
Hajak, VL, et al. (2021) Risk assessment of electroconvulsive therapy in clinical routine: three-year analysis of life-threatening events during more than 3,000 treatment sessions. Frontiers in Psychology. doi.org/10.3389/fpsig.2021.767915.