Electroconvulsive therapy could be causing a wider range of adverse effects when used to treat depression than previously understood, according to a paper that calls for the practice to be suspended pending more robust research.
Although short- and long-term memory loss is widely known to result from ECT, the research identified 25 further concerning side effects, which included cardiovascular problems, fatigue and emotional blunting.
ECT involves passing electricity through the brain while under general anaesthesia to cause seizures, usually over a course of six to 12 treatments. It is administered to about 2,500 people in the UK annually, primarily for treatment-resistant depression, as well as schizophrenia, bipolar disorder and catatonia.
The research, published in the International Journal of Mental Health, draws on a survey of 747 ECT patients and 201 relatives and friends, which means it is not conclusive but could give an indication of possible other side effects given the difficulty of researching ECT.
Prof John Read, the study’s author and a professor in the University of East London’s department of psychology, said: “Given that we still don’t know if ECT is more effective than placebo, these startling new findings make it even more urgent that it be suspended pending a thorough investigation into both safety and efficacy.
“The research is so flawed and inconclusive that ECT would have absolutely no chance of obtaining MHRA approval in the UK, or FDA approval in the USA, if it were introduced today.”
The research found that nearly a quarter of participants (22.9%) reported heart problems such as arrhythmia after ECT, while more than half (53.9%) said they had recurring headaches. More than three-quarters (76.4%) experienced emotional blunting. Some side effects were connected to memory loss, for example relationship problems, difficulty navigating and loss of vocabulary.
In ECT, electricity is passed through a patient’s brain to cause seizures while they are under anaesthesia. Photograph: powerofforever/Getty Images/iStockphoto
Sue Cunliffe, who was given ECT in 2004 for severe depression, said the side effects had “completely wrecked my life from age 38”. She said she was left with slurred speech, shaking hands and impaired balance, and was unable to recognise faces, count money, follow directions or read and write properly.
“A week before ECT I was on a running machine, playing badminton and able to write poetry, and six weeks later I’m falling down stairs, bruised,” she said, adding that she still experiences brain fog and fatigue, which has left her unable to work as a doctor and having to “really limit my day”.
ECT is a treatment that divides mental health professionals. Although some people report improvements in their symptoms, it is not known exactly how ECT affects the brain.
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Prof Tania Gergel, director of research at the charity Bipolar UK and an honorary psychiatry professor at University College London, said there was “no evidence to substantiate claims that modern ECT carries any major risk to physical health or that it causes long-term brain damage and permanent deterioration of cognitive functioning”.
She said it should not be seen as a “complete cure” and that there had been “some modern instances of misuse”, but that it could reduce some of the most dangerous symptoms, enabling people to engage with other interventions to support their recovery.
She said ECT was “the most important tool in helping me manage 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 gaps from the period of life close to treatment,” she added, urging more research to understand and minimise these side effects.
Prof George Kirov from Cardiff University said ECT was “highly effective” and he had observed it as “life-changing” for people with severe depression, with 60% seeing improvements in their symptoms. He said stigma had resulted in “under-utilisation” in the UK, but that it was more commonly used in some other northern European countries.
“There is a very wide and robust evidence that it is effective, beyond the early sham-controlled trials. For example large meta analyses show that it out-performs antidepressants, TMS, tDCS and any other treatments,” he said, adding that calls for more placebo-controlled trials were “not supported by the scientific community”.
Lucy Johnstone, a clinical psychologist and member of the UK ECT Improving Standards Campaign Group, which is pushing for stronger regulation, said very few people were aware that ECT was still performed as a treatment, and that it was mainly given to older women, with one-third receiving it against their will.
She said “a significant proportion” of ECT patients were victims of domestic abuse, which she believed was not always well explored by mental health professionals. “Pills won’t help, so it quickly gets to the point of: what do we try next? That’s when ECT gets raised,” Johnstone said.
A spokesperson from the National Institute for Health and Care Excellence (Nice) said its guidelines stipulated: ‘“Clinicians should only consider ECT for acute treatment of severe depression that is life-threatening and when a rapid response is required, when it is the person’s preference based on past experience of ECT, or when other treatments have failed.”
Patients should be informed of the risks and benefits, and clinics must be Electroconvulsive Therapy Accreditation Service (ECTAS) accredited and record data on delivery and outcomes, the spokesperson said.
