ECT ‘benefits majority’ despite Hollywood portrayals

Despite the "Hollywood version" of electroconvulsive therapy, the often controversial treatment has been found to benefit the vast majority of patients, the head of Ireland's Mental Health Commission has said.

The 10th annual report detailing the use of the technique has found that over the past 10 years, while the number of people who have received the treatment has decreased, its overall use has gone up.

Electroconvulsive therapy, or ECT, passes an electric current through the brain via electrodes applied to the scalp to induce generalised seizure activity. The patient is under general anaesthetic.

It is a treatment for specific types of major mental illnesses such as depression, mania and schizophrenia and is conducted in mental health treatment centres.

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A report by the commission published on Friday shows that between 2017 and 2018, the number of recipients increased by 10 per cent to 283, but had decreased from 396 in 2008. However, there were 2,936 individual treatments in 2018, up from 2,725 in 2008.

"Studies have shown that the Hollywood version of ECT, as shown in many films since the late 1940s, has left the impression that the treatment is negative, cruel and brutal, with no therapeutic benefit," said commission chief executive John Farrelly, who argues such portrayals are in no way similar to modern practice.

“The evidence in this report shows that ECT does work for the vast majority of people to whom it is administered, and it has helped many Irish people recover from mental illness.”

Mr Farrelly said in the vast majority of cases ECT is a last resort for those suffering mental illness who have been unresponsive to medication.

Average age

In 2018, the average age of patients was 59, but some were as young as 20 and as old as 91. The majority are diagnosed with depression.

About two-thirds of patients reported suffering from depressive disorders (63 per cent) and cited resistance to medication (67 per cent).

“Significant improvement” and “complete recovery” have consistently been the two most common outcomes since 2008, according to the commission. In 2018, 81 per cent of people receiving the treatment indicated improvement as a reason for ending the therapy.

The report also notes that in 2018, 516 individual treatments (18 per cent of the total) were administered without consent, involving 53 patients. Under the Mental Health (Amendment) Act 2015, ECT can only be administered with the written consent of the patient or, if unable, the approval of two consultant psychiatrists.

Twice as many women as men received the therapy. The higher number of women being administered ECT may be related to the relatively higher rate of diagnosed depressive disorders in women than men in Ireland, the report notes.