Is there enough evidence for ECT?

21 March 2022

In an opinion piece in the BJPsych, Gergel¹ dismisses research that raises significant concerns about whether electroconvulsive therapy (ECT) is an effective treatment for depression. The author found net benefit from her own treatment, but the scientific approach does not generalise from personal experience. Research is a better basis for practice, and for ECT there is very little evidence.

The bare facts are that no placebo-controlled study of ECT for depression has been conducted since 1985 and according to a 2019 review by Read et al,² the 11 previous studies, which constitute the entire evidence base for ECT versus sham ECT, were mostly of poor design and together involved just 224 ECT treated patients and 187 sham ECT controls. They concluded that the combined research barely supports short-term benefit of ECT and contains no indication of long-term benefit, suicide reduction or greater effectiveness in older patients. The review also unearthed troubling mortality data in addition to frequent cognitive damage.

If ‘ECT’ in Gergel's article were replaced with ‘insulin coma therapy’, readers would be surprised at the claims for benefit and the lack of danger of treatment. With ECT, however, we are content to accept its continuing use despite the scarcity of effectiveness and safety data. Psychiatrists and researchers have a responsibility to find out how much ECT helps and harms the patients we treat rather than muddle on with so little understanding of what we are doing to people.

The BJPsych seems content to publish strong pro-ECT views despite the lack of evidence. The journal included a commentary on Gergel containing the remarkable claim that ECT is ‘one of the most effective treatments in all of psychiatry’.³ Is this the voice of a rigorous scientific journal? A call for large, well designed, placebo-controlled trials of ECT would be more appropriate.