Studies on Electroconvulsive Therapy

Studies

These studies have been separated into categories to make it easier to find what you're looking for.

Efficacy
Medical Issues
Patient Views
Informed Consent
Other Issues
Side Effects of ECT

Efficacy

Death of ECT
In Italy, where it began more than 62 years ago, ECT has almost been abolished. In some countries, however, ECT is still used inappropriately, particularly in elderly patients. There is no medical, moral, or legal justification for ECT, and the new requirements of modern psychiatric practice can all be achieved without it. Like prefrontal lobotomy and all previous shock treatments, ECT is non-viable. The death of ECT will help promote mental health and put the treatment where it belongs - in the archaeology of science.

Retrospective controlled study of inpatient ECT: does it prevent suicide?
Background: This study examined the use of ECT among inpatients who committed suicide at a provincial psychiatric hospital. Methods: A total of 45 psychiatric in-patients who committed suicide at a provincial psychiatric hospital were compared with a gender, age and admission diagnosis matched group of 45 hospitalized patients to examine the use of electroconvulsive therapy during the last 3 months of hospitalization. Results: No difference in the utilization of ECT was found in the two groups. Limitations: Retrospective design and small sample size. Conclusions: We failed to demonstrate that ECT had prevented suicide in hospitalized patients. Future prospective studies with large sample size are needed to further examine this question.

New study in JAMA highlights high relapse rate
Although his intention was to show that using lithium with a TCA can lower relapse rates in ECT patients, Harold Sackeim's study instead brought great attention to the fact that ECT DOES have such a high relapse rate.

Sham Statistics, the Myth of Convulsive Therapy
A major article from Journal of Mind and Behavior by Doug Cameron. This hard-hitting study exposes the myths, misinformation, and the truth about this controversial treatment. Find out why today's kinder and gentler ECT is nothing more than a public relations campaign from the ECT industry.

Does Electroconvulsive Therapy Prevent Suicide?
From Convulsive Therapy. This article examines whether or not ECT protects against suicide. The authors conclude, with some disappointment, that ECT does NOT offer any long-term protection against suicide.

Electroshock: Scientific, ethical and political issues
From Dr. Peter Breggin, this comprehensive article explains how ECT works as head trauma, and goes into the scientific, ethical and political ramifications of the controversial treatment. A Must Read!

Efficacy of ECT
Two studies on the efficacy of ECT. The first shows the need for high-dose (2.5 times the electricity needed to produce a convulsion, also known as suprathreshold) bilateral ECT; the second, the correlation between being medication resistant and the likelihood of poor results from ECT.

The effects of ECT on suicide
Do modern psychiatric treatments help prevent suicide? These provocative questions have been asked repeatedly since effective treatments for the major psychiatric illnesses were developed beginning with electroconvulsive therapy (ECT). This study concludes: "mortality did not differ between patients having a lifetime history of ECT and patients never having had ECT. We conclude from a short-term follow-up of depressives that mode of therapy received in the hospital has minimal influence on subsequent mortality, including suicide."

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Here are three abstracts on the subject of stimulus dosing. This is an important concept to understand when considering ECT. Today's ECT uses a much higher stimulus dose and longer stimulus length than ECT of the past, which is why I maintain that today's ECT is neither kinder nor gentler. It just looks better on film because the patient is anesthetized and paralyzed.

It's well established in the literature that the more benign unilateral ECT that is talked about by practitioners is not effective in treating depression. In a recent APA study, 75 percent of practicing doctors admitted they use bilateral exclusively. Yet when discussing the treatment in public, doctors continually talk about how unilateral causes less side effects. That is very true, but it also doesn't work, unless the stimulus is given for a longer period of time, and the electricity amount is very high.

The first study concludes that it isn't the total electrical dosage, but the degree that it exceeds seizure threshold, that determines effectiveness.

This study shows the following efficacy rates:

Right unilateral, low dose: 17 percent
Right unilateral, high dose: 43 percent
Bilateral, low dose: 65 percent
Bilateral, high dose: 63 percent

It also discusses that it took the bilateral high dose group much longer to recover from the post-ECT disorientation than the others. And it mentions that among those who benefited, the relapse rate was 59 percent! (This means that more than half were depressed again) The study concludes: "High electrical dosage is associated with a more rapid response, and unilateral treatment is associated with less severe cognitive side effects after treatment."

The final study contradicts most of the literature, including the studies above, saying that "The depression-relieving effect of ECT is bound to seizure activity and not, or only slightly, to other effects of electrical stimulation."

This study examines the use of ECT in schizophrenia, concluding that any impact is very temporary.

A review of the UK's Mental Health Act
This is a hard hitting critique of the way ECT is portrayed as a very effective, but benign, treatment. It also examines the role of coercion and force in ECT therapy in the UK. (and of course those implications are applicable anywhere) Needs the Adobe Acrobat Reader.

Medical Issues

Herbal Treatments for ECS-Induced Memory Deficits: A Review of Research and a Discussion on Animal Models - this article discusses the problems of memory loss during ECT and reviews the use of traditional herbal methods in combatting the deficits. From Journal Of ECT.

ECT and pregnancy
This article on the use of ECT during pregnancy examines the data of the effects of ECT, and the drugs used, on the fetus. ECT is often used during pregnancy because psychiatric medications can have disastrous effects on the fetus. If you're pregnant, and considering ECT, here's a good starting point in your research.

Cardiovascular complications of ECT
This study, from the Journal of Clinical Psychiatry, describes cardiovascular complications of ECT. CV complications are the second most frequent, after memory loss. ECT is often recommended as a first-line defense in the elderly, because antidepressants may cause cv problems. However, as this article shows, those with existing heart problems are at extremely high risk when undergoing ECT.

Electroshocking the Elderly
This alarming article by Don Weitz exposes the frequent and increasing use of ECT on the elderly, particularly elderly women. Statistics from Ontario, California and England document this trend. Studies show that the elderly patients are more vulnerable and suffer more frequent and serious medical complications, including permanent memory loss, brain damage, heart problems and death.

ECT on children
Here are some chilling excerpts from the American Journal of Psychiatry which irresponsibly sanitizes the many catastrophic and permanent effects of electroshock on children.

Dr. Max Fink, shock doc grandpa, calls for a more liberal attitude in using ECT in children. His article on pediatric ECT discusses the use of ECT in an 8-year-old child, and among 150 adolescents. Hey, kids! Don't listen to those records backwards, or you'll get a dose! Read this letter from Max about pediatric ECT. And in contrast, a British expert warns against the use of ECT in children.

EEG Monitoring in ECT
This article by Richard Abrams and Max Fink corroborates the fact that ECT is basically a crapshoot and poorly understood. The discussion of EEG monitoring is interesting enough, but in the end, the authors reiterate basic ECT advice: if what you're doing isn't working, up the electricity and do the procedure more often.

What's most explosive, however, was probably missed by the majority of psychiatrists who read the article. Click here (opens a new window) to read why, then read the full article.

Pediatric ECT
An historical review of the use of ECT in pediatrics.

Time to Abandon Electroconvulsion as a Treatment in Modern Psychiatry
From the British journal Advances in Therapy: "The history of ECT is discussed because ECT emerged with no scientific evidence, and the absence of other suitable therapy for psychiatric illness was decisive in its adoption as a treatment. Evidence for the current recommendation of ECT in psychiatry is reconsidered. We suggest that ECT is an unscientific treatment and a symbol of authority of the old psychiatry. ECT is not necessary as a treatment modality in the modern practice of psychiatry."

Food and Drug Administration Action is Required
This is a frightening article that appeared in Archives of General Psychiatry by Richard Abrams, owner of Somatics, Inc (which bills itself as the major manufacturer of ECT devices in the US). Abrams is calling on the FDA to relax FDA restrictions on ECT devices in the US. It's already well-known that you can go beyond the electrical restrictions imposed by the FDA by calling it "research." But I wonder how much of this push is financial - Abrams markets his machines worldwide. The most frightening aspect of this is that it all seems to be floating into the FDA with no expectation of research, no testing (not that these machines have ever undergone the usual FDA testing - they were grandfathered in under the Medical and Devices Act). Just up the limits because we say so. If this doesn't frighten you into action, it SHOULD! You can take action by sending the FDA a letter of concern - I've made it easy for you, just fill in your name and email address, press submit, and your letter will be sent via form to the FDA.

Patient Views

Voices from Within
This study examines patient views toward ECT, a serious flaw in previous research. Read the abstract, or the full version of this 1996 study.

Why I believe ECT is unlawful
Sarah Panton, who was herself given ECT as a patient, explains why she believes the treatment should no longer be used. This was a paper presented at the UK Advocacy Network 2000's annual conference.

The famous Freeman, Weeks and Kendell study
Patients Who Complain, a descriptive study of 26 ECT patients who felt that ECT had left them with permanent, negative effects. Authors Freeman, Weeks and Kendell recruited complaining patients via a newspaper and through hospital personnel. A group of volunteers who did not have ECT acted as the control group. Careful attention was paid to trying to factor in medications and levels of depression to account for some memory loss (a common allegation from the ECT industry is that any memory loss is from these factors, and not the ECT itself). Say the authors, "However, even when these factors and three other variables were taken into account not all the difference could be explained."

The Salford Report on ECT
From the United Kingdom, a massive report on the use of ECT across the UK, with numerous statistics on its use by gender, ethnic group, age, voluntary status, and so on. Warning: This is an enormous report. Or, just read the section dealing with ECT patient attitudes. Now available, the full study in PDF format (you need Adobe's Acrobat Reader to view this).

A new "landmark" study that shows 'the vast majority' of patients are satisfied with their treatment. Unfortunately, this study from Mayo suffers from the same research design flaws that the others do:

A small number of patients in the study, making it statistically insignificant
No long-term followups! The patients were surveyed the night before their last treatment, and again two weeks later. The author of the study admits that further research is needed, and it would be nice to survey the patients at a later date.

This begs the question: So why didn't you do that!?! How hard would it have been to send a survey to these patients six months later?
I'm afraid the answer is obvious.

Mind report on ECT
The mental health charity Mind has published a new, extensive report on the use of ECT in the UK. Among the findings: nearly 18 percent of those receiving ECT during a three-month period in 1999 did so without providing consent. One of Mind's recommendations is to eliminate the use of forced ECT.

From ECT Anonymous
This is an extensive survey of patient attitudes; a very interesting (though shocking!) read. Don't miss it!

Consumer Perspectives
A new study from the SURE Institute of Psychiatry (UK) is quite extensive and concludes that consumer dissatisfaction with ECT is much more widespread than is continuously reported. (The industry claims that this voice is no more than a vocal minority, a claim disputed by this study.) The study makes recommendations regarding the large gaps in research that exist today. (This is a PDF file, and you need the free Adobe Acrobat Reader to view.)

There are many more reports of personal accounts with ECT in the news section. And check out the message forum in the community section of this website, where people share their experiences and views.

Informed Consent

A patient consent statement from CTIP, the organization for ECT survivors.

From Dr. John Breeding
Abstract: Informed consent is a vital issue in all forms of medicine, especially in psychiatry, where patients are often in extremely vulnerable states of mind, customary practice involves high risk to patients, and the law allows for abrogation of traditional civil rights based on judgments of perceived mental incompetence. This article addresses informed consent related to the practice of electroshock. The author argues that genuine informed consent for electroshock is nonexistent because psychiatrists deny or minimize its harmful effects and, as long as the threat--overt or covert--of involuntary treatment exists, there can be no truly voluntary informed consent. The author discusses four primary ways psychiatry violates informed consent in electroshock practice and presents an outline of important information to know about electroshock. An annotated review of the research is provided to back up each of the author's assertions about medical effects and lack of efficacy of electroshock.

Informed Consent
Legal Parameters of Informed Consent Applied to Electroconvulsive Therapy. This article by John Parry discusses legal decisions regarding consent issues, competency and commitment.

The Seattle Times has published a disturbing series called "Uninformed Consent," which explores the darker side of research and the people who turn their trust and lives over to researchers, sometimes with tragic results.

Here's a great informed consent statement, with an extensive biblography. Somehow I doubt this is lying around Max Fink's office.

Informed consent is a vital issue in all forms of medicine, especially in psychiatry, where patients are often in extremely vulnerable states of mind, customary practice involves high risk to patients, and the law allows for abrogation of traditional civil rights based on judgments of perceived mental incompetence. This article addresses informed consent related to the practice of electroshock. The author argues that genuine informed consent for electroshock is nonexistent because psychiatrists deny or minimize its harmful effects and, as long as the threat--overt or covert--of involuntary treatment exists, there can be no truly voluntary informed consent. The author discusses four primary ways psychiatry violates informed consent in electroshock practice and presents an outline of important information to know about electroshock. An annotated review of the research is provided to back up each of the author's assertions about medical effects and lack of efficacy of electroshock.

A comprehensive informed consent from the state of Texas. Texas probably has the best regulation of ECT in the entire world, thanks to activists who worked hard to get it passed.

Quite a bit more on consent, including an audio file of Max Fink talking about covering your (doc) ass. Includes various consent forms, patient info, and some advice on avoiding liability from Richard Abrams. Also a model informed consent sheet that a doctor uses herself and advises for all.

Other Issues

Journal articles sometimes misleading
One of world's leading medical journals has put itself and its competitors under the microscope with research showing that published studies are sometimes misleading and frequently fail to mention weaknesses.

Separating gold from junk in medical studies
An excellent article that explains how to read between the lines in medical studies.

Sweet Words That Hurt
The Make-Believe World of User Participation, Rights and Voice by Michael McCubbin, Ph.D. Many persons exercising or seeking coercive power in the name of mental health care justify their actions by the supposed "lack of self-insight caused by mental illness". This is a circular argument because lack of self-insight is often the psychiatrist's explanation for treatment refusal, and then used to support the diagnosis of mental illness and the proposed treatment. Inability of health professionals to recognize this false logic and the catch-22 this puts people in displays quite a bit of lack of self-insight!

ECT machines
Some FASCINATING information about the voltages used in ECT machines!

The history of ECT
A look at the beginnings of using electricity as therapy, from its earliest days with electric eels, to the spread of ECT in the United States.

An attorney specializing in psychiatric malpractice writes 'Electroshock: Crimes Against Humanity!'

Peer reviews may not be good quality
This article highlights a recent study that concludes peer reviews of articles conducted by medical and scientific journals are often of questionable quality. The study was presented at a conference on biomedical peer review in Prague; other studies presented at this conference indicated (among other things) strong regionalist/nationalist biases in citation of authorities and lack of international collaboration.

Reviewing the research
Research in psychiatry clearly demonstrates that ECT is far from "safe and effective" - a phrase improperly applied as ECT, unlike a vaccine, carries no requirement that safety and efficacy is proven. Paternalistic dictum, not rational scientific basis, establishes ECT as a medical treatment; the real reason ECT is given is because doctors think it should be. ECT Anonymous has reviewed extensive literature (written by pro-ECT doctors) and shown some of the things ignored when putting together the PR materials.

The National Alliance for the Mentally Ill (NAMI) widely uses an article about ECT. The article contains FALSE (documented) information, attributing a statistic to a credible source.

Shock Doc Roster
Support Coalition International today organized the "Shock Doc Roster" to collect names of psychiatrists who use electroshock, train others to use it, or refer patients to those who do. If you would like to add a name to the ongoing roster, please read the instructions to do so. The term "shock doctor" is used in honor of Ernest Hemingway, who used it in anger while being forcibly electroshocked in 1961. He committed suicide a few days after release.
Send your listing to the Shock Doc Roster

The Side Effects of ECT

Information on the effects of ECT, including memory loss and brain damage, can be found in the Effects section of this website.

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