The recently released National Institute for Clinical Excellence (NICE) guidelines on the use of electroconvulsive therapy (ECT) discourage the use of maintenance ECT in depressive illness, the reasons being that: ‘... the longer-term benefits and risks of ECT have not been clearly established...’ (NICE, 2003).
The only result of this will be to limit the patients’ right to choose their treatment. The few patients who are considered for maintenance ECT live in the community and, therefore, are not subject to the Mental Health Act 1983. They will receive ECT because they want to and will have at any time the right to withdraw from it. These patients will have already tried, unfortunately without success, any other possible maintenance treatment and tend to respond only to ECT during their frequent acute episodes. Because of these experiences they know very well the pros and cons of ECT in their individual cases.
These are patients who, knowing their illness and the effects of ECT, have reached the conclusion that they prefer to receive ECT on a monthly basis rather than having to accept a life sentence of constant and frequent relapses of their depressive illness. If the maintenance ECT works and keeps them functioning in the community, it is my experience that they will be happy to continue with it for a long time. If it does not work, after a few attempts they will stop, encouraged by their psychiatrist.
Every patient is different and we still know very little about depression. The only result of the application of the NICE guidelines on maintenance ECT will be to deprive informed and intelligent patients of the freedom to choose a treatment that, if used appropriately, can make the difference between a life of misery and a relatively normal existence (Reference Andrade and KurinjiAndrade & Kurinji, 2002).
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