CLINICAL REFLECTIONS: POINT/COUNTERPOINT
The rhetoric surrounding the merits of electroconvulsive therapy (ECT) can sometimes become so heated that one is reminded of the wise prohibition against discussing politics or religion in a bar. This is disappointing because we can truthfully say that we have more experience with this procedure, which was introduced in 1938, than we do with any other psychopharmacological intervention. We have decades of data on its use and effects. How can there still be such disagreement?
It should come as no surprise that stigma is an important underlying theme in this discussion. ECT canstill sound frightening and conjure up images out of a horror movie. We know our patients contend with negative opinions and perceptions from the general public, acquaintances, and friends. However, the problem becomes all the more salient when the stigmatization involves professionals, whether they be pharmacists, physicians in other specialties, or indeed, even psychiatrists.
What we need is good data, clear analysis, and sound clinical judgement. Ultimately, no treatment in medicine is completely apropriate for all individuals. The trick is to find the right treatment for the right person at the right time. We often make the mistake of generalizing our experiences to all patients. It may be that some patients benefit more from ECT than others. Perhaps there are even genotypic differences that could help predict which patients are most likely to benefit from this treatment.
Despite the controversy and lingering stigma, ECT has undoubtedly been foundational in the field of interventional psychiatry. It is firmly ensconced in our armamentarium, along with its younger siblings transcranial magnetic stimulation, vagal nerve stimulation, deep brain stimulation, and intravenous ketamine. I have no doubt that as we continue to progress, the list of potential interventions will continue to grow. My hope is that we will become better at identifying the best treatments for each particular patient. We must remember to make our treatment recommendations based on the evidence and, to the greatest extent possible, to do so consistently.
We are certainly fortunate to work in a field so tightly connected to the human experience. Differences of opinions and perspectives present a great opportunity to learn. I have certainly benefited from the following Point-Counterpoint articles.
We encourage you to read these thoughtful pieces, consider the data, and share your viewpoints with us at PTEditor@mmhgroup.com.
Dr Capote is the medical director, Division of Neuropsychiatry, at Dent Neurologic Institute and the medical director, Addiction Services, at Brylin Hospital in Buffalo, New York. ❒