ECT is one of the more controversial treatments in psychiatry. It has been vilified as barbaric and irrational, because of its (past) practice and potential side effects (Fink, 2001; Glass, 2001). However, some authors have argued that most of these are just symptoms and signs of the underlying (depressive) illness (Brodaty et al., 2001). There is good evidence that the majority of patients in experimental as well as routine clinical settings improve during a course of ECT (www.sean.org.uk/home.htm). It appears to be superior in action to placebo, that is, general anaesthesia without ECT, but for obvious reasons only limited data are available (Anonymous, 1984; Brandon et al., 1985; Buchan et al., 1992; Johnstone et al., 1980; Stuart, 1985).
Nevertheless, the frequency of the use of ECT appears to be declining in countries where its use had continued unabated since the end of the last world war (Glen & Scott, 1999). In particular, there seems to be considerable variation in its use, even between clinicians working in the same setting (Glen & Scott, 1999). This is, however, not an argument against the efficacy or rationality of prescribing ECT, as it merely confirms the influence other, non-evidence-related factors have on medical decisions. In fact, there has been a renaissance of ECT research in the USA, which appears to be associated with an upward trend in ECT prescriptions. (Sackeim et al., 2000). One of the drawbacks of ECT is its time-limited action, which tends to dissipate after a couple of weeks and requires follow-up medication. (Sackeim et al., 2001). Another is the occasionally occurring retrograde amnesia, which tends to resolve completely or, more rarely, with some residual impairment (Lisanby et al., 2000; Weiner, 2000). It would be difficult to understand why patients submit to such a worrying procedure, without the appreciation that depression is one of the most distressing and painful medical conditions. It is particularly insidious, as it undermines the ability of the sufferer to cope with functional impairment, with mental and physical pain, and with the self-destructive impulses and thoughts that accompany depression. ECT is also occasionally used for treatment-resistant psychosis and mania, where it appears to be effective in 5060% of cases (www.sean.org.uk/home.htm). Finally, ECT has been successfully employed to resolve neurological crises, such as extreme parkinsonian symptoms (on-off phenomena) (Andersen et al., 1987) and drug-induced states, such as neuroleptic malignant syndrome (Trollor & Sachdev, 1999).
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