A Spirited Defense of ECT: From Our Readers

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A Psychiatric Times point/counterpoint feature on electroconvulsive therapy elicited strong responses.

Editorial note: the April issue of Psychiatric TimesTM included a Point/Counterpoint feature on electroconvulsive therapy (ECT). The feature elicited strong reactions from our readers. You can read the introductory essay, “Electroconvulsive Therapy: Obsolete and Dangerous or Still Just Misunderstood?” by Horacio A. Capote, MD, here. The authors of the original Point/Counterpoint have also continued their debate online. You can read a brief against ECT here, and a defense of the procedure here.

We thank the editors of Psychiatric TimesTM for the opportunity to comment on the recent Point/Counterpoint articles in the April, 2021 issue on (ECT). The choice was presented as “Dangerous on Either Side of the Pond” versus “An Effective and Safe Treatment.” It is no choice at all: ECT is demonstrably safe and effective, but yes, still badly misunderstood.

ECT has evolved into a modern medical treatment for a limited number of psychiatric illnesses, primarily severe depression, but also psychosis and catatonia. ECT is what it is today, not what it was before modern general anesthesia, and needs to be objectively assessed, by true experts with recent experience in its use, and an understanding of the severity of the disorders it treats. We strongly support Michael E. Henry, MD’s position on ECT. He offers an accurate expert opinion based on evidence and experience. That is the information that should guide patients and physicians about ECT.

ECT has saved and improved countless lives, but as with any medical treatment or procedure, particularly one involving general anesthesia, there are risks and adverse effects; the decision to prescribe ECT always involves balancing those risks against potential benefits to the patient. That is the true, evidence-based process that expert ECT physicians follow when making a recommendation to consider ECT for a particular patient. Such a recommendation is never made cavalierly; it takes into account the severity and urgency of the psychiatric illness, the medical condition, and the treatment wishes of the patient. The informed consent process for ECT in the United States is comprehensive and follows modern ethical guidelines.

Unfortunately, misinformation perpetuates the stigma surrounding ECT. Attempts to discredit it are often based on ignorance of the realities of contemporary ECT, or worse, are ideologically driven and with questionable motives. ECT is not an ideology, a belief, or a religion. It is simply a medical procedure, with benefits and side effects. In truth there is no real point-counterpoint when one side is misinformation and distortions and the other side is medical fact.

Severe depression is disabling and sometimes life-threatening; until a worthy replacement for ECT is developed, patients and psychiatrists can be reassured that ECT is available when other treatments are ineffective. In knowledgeable medical circles, there is no controversy about that.

Dr Coffey is the president of the International Society for ECT and Neurostimulation (ISEN). Dr Kellner is the chair of the Board of Directors of the ISEN.