Intended for healthcare professionals

Rapid response to:

Head To Head Maudsley Debate

Should we stop using electroconvulsive therapy?

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5233 (Published 30 January 2019) Cite this as: BMJ 2019;364:k5233

Rapid Response:

Re: Should we stop using electroconvulsive therapy?

I would absolutely hate to have ECT, how barbaric! So is having your intestines cut open or a leg or breast amputated, but I recognise if I was very unwell with sepsis or ischaemia or cancer this may be my best option. ECT may also be my best option if I had psychotic depression to recover quickly and prevent weeks of agitation and distress due to nihilistic delusions of death, poverty, sin or paranoia. This is horrible for me, and also my loved ones to witness.
If I am elderly I have often been ill years before, and remember ECT works for me, and request this treatment. I may prefer ECT to the autonomic side effects, or tremor and reduced mobility high doses of medication that could get me better after several weeks, cause. My body is too frail for this option, I may need to start my recovery more quickly, and remain well after ECT on more tolerable doses of medication.
I have seen many older people whose lives have been completely saved by ECT; shut down mentally and physically, moribund, in danger of renal failure and pressure sores, not able to swallow medication, and likely experiencing a living hell.
I can only assume the authors of 'Yes, ECT should be stopped' have not witnessed the effects of severe depression on this population.
ECT may be a safer alternative for some severely ill people, and my experience of the older population is that this treatment may be more humane than the alternative treatments available to them. They recover and are grateful for a treatment that has stopped their distress when all other options have not helped.

Competing interests: No competing interests

02 February 2019
Catherine Gordon
consultant psychiatrist for older people
Nottinghamshire NHS FT