Intended for healthcare professionals

Rapid response to:

Practice A Patient’s Journey

Electroconvulsive therapy

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2998 (Published 30 December 2008) Cite this as: BMJ 2008;337:a2998

Rapid Response:

Patient's experience of ECT

Webber's paper about his wife's experience of Electoconvulsive therapy is remarkable in at least one respect. It contains the only account of convulsion dependence in the medical literature since I described it in the 1950s.

I denoted an initial dynamic phase of ECT, followed by a convulsion-dependent phase with brief, protracted, and chronic forms, along with different management of these two phases. As this has never been recognised and taught in psychiatric training, ECT is commonly a waste of time producing temporary or no benefits. In ignorance of convulsion dependence, ECT is given in a fixed schedule, twice or thrice weekly, according to the hospital's habit, for 2-4 weeks. I have never understood why convulsion therapy is given in this way in an age of tailor made therapy, individual monitoring, and precise doseage adjustments. Were antibiotics always given in one rather limited doseage, for the same length of time, for every patient and all infections, they too would be found to have some advantage at first which was soon lost. For that matter, the same would apply to psychotropic drugs. Why don't psychiatrists give them in one set dose, for one month only, to every patient regardless? After all, they take it for granted that this curious method is the way to give ECT, as if there were no very different schedules advocated over the years here and there in the literature.

1) Bourne H - Lancet 1954. (ii) 1193

2) Bourne H - NZ Med. J. 1955 : 54.697

Competing interests:
None declared

Competing interests: No competing interests

27 January 2009
Harold Bourne
Emeritus Consultant Psychiatrist
Via P.de Cristofaro 40 Rome Italy