Intended for healthcare professionals

Rapid response to:

Head To Head Maudsley Debate

Should we stop using electroconvulsive therapy?

BMJ 2019; 364 doi: (Published 30 January 2019) Cite this as: BMJ 2019;364:k5233

Rapid Response:

Electroconvulsive therapy and the standard of rationality

Entirely apart from the discussion if electroconvulsive therapy should be stopped, debates in high rank scientific journals should follow scientific rules. One such rule should be to cite correctly. Regrettably, this doesn’t seem to be the case throughout the text by John Read and Sue Cunliffe (1).

Under the subheading ‘Memory loss and brain damage’ the authors claim that electric voltage ‘inevitably causes damage’ and refer to their own theoretical review article without any direct evidence for their assumption (2). In the same context, a 1941 article by Walter Freeman is cited to substantiate the brain damaging effects of ECT (3). However, this editorial comment does not cover electrical stimulation at all. Instead it refers to insulin coma, metrazol shock therapy and lobotomy, all of whom are long abandoned and undoubtedly differ vastly from today’s ECT practice.

I’m well aware that ECT remains an emotional topic for some people. Nevertheless, scientific debates should adhere to facts, not loose associations, and academic professions should not undercut this ‘standard of rationality’ (4).

1. Read J, Cunliffe S, Jauhar S, McLoughlin DM. Should we stop using electroconvulsive therapy? BMJ. 2019 Jan 9;364:k5233.
2. Fosse R, Read J. Electroconvulsive treatment: hypotheses about mechanisms of action. Front Psychiatry 2013;4:94-103.
3. Freeman W. Brain-damaging therapeutics. Dis Nerv Syst 1941;2:83.
4. Wiesing U, Fallgatter AJ. [Rationality and freedom in medicine: the case of electroconvulsive therapy]. Nervenarzt. 2018 Nov;89(11):1248-1253

Competing interests: No competing interests

13 August 2019
David Zilles
Psychiatrist, Senior consultant, Head of the ECT section
University Medical Center Göttingen, Department of Psychiatry and Psychotherapy
Von-Siebold-Str. 5, 37075 Göttingen, Germany