Letters

Electroconvulsive therapy

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7415.621-b (Published 11 September 2003) Cite this as: BMJ 2003;327:621

Patients must be confident that evidence of efficacy is compelling

  1. H Louise Relton, co-chair (l.relton{at}lmh.nhs.uk)
  1. UK Advocacy Network, Sheffield S1 2DA

    EDITOR—I was a member of the review group that produced the guidelines on electroconvulsive therapy for the National Institute for Clinical Excellence (NICE).1 I have personal experience of the treatment and have spent a large amount of my own time researching (qualitatively) patients' experience of it. With the recent recognition and acknowledgement that patients' expertise in relation to their lived experience is valid, the climate for partnership and inclusive working has improved to the benefit of patients and practitioners (and you may of course be either at different times in life).

    The new guidelines were produced after a full and thorough assessment of all available data both clinical and experiential, and representation on the group included all key stakeholders. Everyone, including the Royal College of Psychiatrists, thought that the new guidelines were appropriate and workable and were a great step forward.

    • Much information for patients and carers (which is scant) denies the possiblity of long term cognitive impairment

    • There is no long term follow up of live patients in terms of cognitive abilities and therefore no reliable evidence of long term effect

    • It is openly acknowledged by the Royal College of Psychiatrists that practice within any previous guidelines has not been to standards that the college set for itself in terms of safety, consistency, environments,and expertise of professionals who carry out treatments

    • Patients (myself included) have sought help to live with the consequences of treatment as opposed to the consequences of illness.

    Although electroconvulsive therapy remains an accepted and useful treatment for some people, they should be able to have the greatest possible confidence that they are receiving it only when the evidence of likely efficacy is compelling from the best available data and experience. The NICE guidelines desire to achieve only this.

    Footnotes

    • Competing interests None declared.

    References

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