Electroconvulsive therapy: NICE guidance may deny many patients treatment that they might benefit from

doi:10.1136/bmj.327.7415.621-a

BMJ 2003;327:621 (13 September), doi:10.1136/bmj.327.7415.621-a

Letter

Electroconvulsive therapy

NICE guidance may deny many patients treatment that they might benefit from

The first 150 words of the full text of this article appear below.

EDITOR—Carney and Geddes predict that most parties willbe reasonably satisfied with the appraisal of electroconvulsivetherapy by the National Institute for Clinical Excellence (NICE).^{1
2} Our clinical experience is that many patients who may benefitfrom electroconvulsive therapy will be denied it under theseguidelines.

Apparently, the NICE appraisal panel did not include a singlepsychiatrist, which may partly explain why clinical experienceof the potential benefits of maintenance electroconvulsive therapy,as described in many reports,³ seems to have been discounted.

The recommendations from NICE have also not acknowledged thedifferent potential for memory disruption and cognitive sideeffects arising from bilateral as opposed to unilateral electroconvulsivetherapy.⁴ Given the concerns about memory disturbance as a sideeffect of bilateral electroconvulsive therapy, this is a surprisingomission.

NICE recommends that the use of electroconvulsive therapy indepressive illness should be restricted to patients with severedepressive illness or . . . [Full text of this article]

Catherine Cole, specialist registrar in psychiatry, Robert Tobiansky, consultant old age psychiatrist

robert.tobiansky@bhct-tr.nthames.nhs.uk Barnet, Enfield, and Haringey Mental Health NHS Trust, Colindale Hospital, London NW9 5HG