Does electro-convulsive therapy have a place here?

How would you feel about having electric shock treatment? The field is mired in controversy, writes Justin Thomas

Few forms of medical treatment evoke more horror than the idea of electro-convulsive therapy. Ami Vitale / Getty Images
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Electrodes are attached to your head. You've been lightly anaesthetised to minimise suffering. The flick of a switch on the Thymatron System IV sends an electrical current coursing through your brain, inducing a seizure. This is not a judicial execution, this is a well-intentioned medical intervention.

Few forms of medical treatment evoke more horror than the idea of electro-convulsive therapy. Historically used as a general intervention for severe mental health problems, it eventually became more focused on the treatment of depression in people who had not responded well to medication.

When I discuss electro-convulsive therapy in my classes at least one student will always ask whether it is still “a thing”. The question is typically voiced with a hint of incredulity. The answer is, yes, it is a treatment option in this country as well.

The Guardian recently took advantage of the UK's Freedom of Information Act to request electro-convulsive therapy records from all mental health hospitals in England. Their findings suggest that between 2012 and 2016 the rate of procedures rose by 11 per cent.

Advocates of electro-convulsive therapy claim that it works. The exact details of how it works, however, are unclear. There is no shortage of pet theories as to why repeatedly electrifying the brain might liberate an individual from a depressive episode.

One idea is that electro-convulsive therapy might cause changes in brain chemistry that somehow reduce depressive symptoms.

Another idea is that electro-convulsive therapy is just a very powerful placebo, but the only way to definitively rule out that theory is to run trials.

To date, there are no studies showing that electro-convulsive therapy is any better than placebo beyond the end of treatment.

Furthermore, the few placebo-controlled studies that have attempted to make this comparison have suffered from small samples and poor design.

Over the long term, there is no evidence that electro-convulsive therapy is any superior to placebo.

Richard Bentall, professor of clinical psychology at the University of Liverpool in the UK, describes the use of ECT in the absence of rigorous scientific support as “a classic failure of evidence-based medicine”.

On the other hand, there is no shortage of evidence about electro-convulsive therapy's potential to cause harm. Among other side effects, there is substantial evidence that the procedure can lead to lasting memory dysfunction.

For every patient who claims electro-convulsive therapy has greatly helped them, there are others who claim ECT has ruined their lives. Similarly, for the many clinicians opposed to this type of therapy, there are other clinicians who are particularly enthusiastic about it.

This situation leads to what is termed “postcode prescribing” in the UK: if you live in area x, and therefore visit hospital y, then you are far more likely to receive ECT. Treatment is based on availability and the enthusiasm of a particular clinician or team, rather than the scientific evidence of its effectiveness.

Electro-convulsive therapy is practised in the UAE. How widely? I don't know. Some hospitals have previously boasted about having ECT clinics. The controversy surrounding electro-convulsive therapy warrants a closer look at the practice. In the UAE, for example, is it increasing or declining? Am I more likely to receive ECT if I seek treatment in emirate X rather than emirate Y?

World-class health care has to be based on best available scientific evidence. At present electro-convulsive therapy lacks such support. Does it have a place in the UAE?

Dr Justin Thomas is an associate professor at Zayed University

On Twitter: @DrJustinThomas