The use of electroconvulsive therapy (ECT) often conjures up pictures from One Flew over the Cookoo’s Nest: being strapped down and electrocuted feeling all of the pain and terror one could imagine. Yet for years now ECT has been quietly used behind the scenes for patients with depression that has been unresponsive to “standard” treatment. The procedure itself, and the side-effects, are nothing like what our imaginations conjure up. In fact, for the most part it is considered relatively safe. So why is ECT still demonized in popular culture?
Recently, the FDA classification of ECT devices has been looked at. The devises are in the highest risk class available, which limits the ability to produce and use them. Originally, they were grandfathered in to the current system of classification, but changes to the system have brought ECT devices back into the spotlight. The FDA may be requiring new clinical trials in order for ECT machines to be kept on the market.
This presents an interesting dilemma. For clinical trials to occur a company needs money. With ECT being somewhat looked down upon, will the makers of these devices – devices that have been used for years – want to put money into new research? Will the lack of these devices cause significant harm to the psychiatric community, as it is a tool they can use as a last resort? Consumer groups advocate for the clinical trials and psychiatrists advocate for lowering the classification so that more physicians can use the technology.
As with everything in the mental health world, there are advocates both for and against the use of ECT. Some groups claim its use is just a way for psychiatrists to increase their income and that research shows ECT does not work. Others argue it is a last hope for many and research shows the side-effects (mostly related to memory and cognitive functioning) are not always long-lasting.
So do we know anything factual about ECT? In looking through the evidence out there I can’t come to a conclusion, but for those who had positive experiences they state it was a life saver. When it comes to mental illness I am just as leery of taking away options as I am trying new ones that have not been tested properly.