Jun 13, 2020
This week on MIA Radio we
turn our attention to electroconvulsive therapy (known as
electroshock in the US). It’s fair to say that ECT remains a
controversial subject with proponents and detractors regularly
disagreeing on its safety and efficacy. The number of psychiatrists
willing to administer ECT, particularly in the UK, is in decline
but we are still using it to administer electric shocks to the
brains of an estimated 2,000 people each year.
In this interview, we discuss a recent paper from the journal
Ethical Human Psychology and Psychiatry. The title is
‘Electroconvulsive Therapy for Depression: A Review of the
Quality of ECT versus Sham ECT Trials and Meta-Analyses’ and
it is written by John Read, Irving Kirsch and Laura McGrath. On MIA
previously written about the study and its findings.
We hear from two of the authors, Professor of Psychology John
Read from the University of East London and Professor of Psychology
Irving Kirsch from Harvard Medical School.
- That the work aimed to review the quality of meta-analyses and
any relevant clinical studies of ECT.
- How there have only ever been 11 studies that have compared ECT
with sham ECT (SECT).
- Sham ECT is when the anaesthetic is administered but not
followed by shocks to the brain.
- That in addition to reviewing the quality of the studies, the
paper went on to consider the effect of placebo in the
administration of ECT.
- That when reviewing the quality of studies, a 24-point scale
was used and that the scorers were blinded to each other’s
- The 24-point scale included 5 basic Cochrane Collaboration
criteria and an additional 19 quality indicators, some of which
were specific to ECT procedures.
- The average quality score across all the studies was 12.3 out
of a 24 maximum.
- One of the most important findings was that none of the studies
reviewed were double-blind.
- The reason for this is that the patients can’t be blinded to
the procedure because the adverse after-effects are very
- In reviewing the studies it was sometimes the case that only
the treating psychiatrist was rating the effectiveness of the
procedure, not the patient.
- The 5 meta-analyses themselves only contained between 1 and 7
of the eleven available studies.
- The recommendation from the paper is that the use of ECT should
be suspended pending a properly controlled, rigorous clinical
- That the UK’s National Institute for Health and Clinical
Excellence (NICE) has decided to review their ECT recommendations
in their depression guidelines, considering the review.
- That the Royal College of Psychiatrists has indicated that they
will update their ECT position statement in light of the
- It has come to light recently that NHS Trusts in the UK are
sometimes using out of date or incorrect information in their ECT
guidance leaflets, an example of this is referring to ECT
correcting a ‘chemical imbalance in the brain’.
- How the expectations of the treating doctor can influence the
condition of the person undergoing the treatment.
- That the placebo effect can be large and long-lasting and that
the more invasive the procedure, the larger the effect.
- That one of the characteristics of depression is the feeling of
hopelessness and that when you are given a new treatment, it can
instil a sense of hope which counters the hopelessness.
- That the call to prohibit ECT is because the negative effects
of ECT are so strong, the fact that the evidence supporting it is
so weak (especially in the long-term and beyond the improvement due
to placebo) and that there are other means of addressing the
difficulties that the person is dealing with.
- That placebos are, in essence, a type of psychological
Links and further reading:
Electroconvulsive Therapy for
Depression: A Review of the Quality of ECT versus Sham ECT Trials
Richard P. Bentall: ECT
is a classic failure of evidence-based medicine
NICE guidance on the use of