I came across an article published in 2010 and entitled ‘Electroconvulsive therapy and suicide among the mentally ill in England: A national clinical survey’ by researchers at Manchester University reporting on research that was carried out as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.
I found the following extracts from the article particularly thought provoking- I have highlighted and commented on the phrases of particular interest for me:
‘Electroconvulsive therapy (ECT) is considered an effective short-term treatment for patients with severe depressive illness (UK ECT Group, 2003). It is usually an end-stage therapy, recommended for those who have not responded to other therapies and whose severity of illness may be life-threatening (National Institute for Health and Clinical Excellence, 2003).
However, guidelines of the American Psychiatric Association task force state that ECT should not be reserved for use as a “last resort” but promotes its use as a first-line treatment when there is a need for a prompt and definitive response, when patients have responded well to previous ECT administrations, and when the treatment is preferred by the patient (Task Force on Electroconvulsive Therapy, 2001)’. (p.145)
I am wondering whether the phrase ‘recommended for those who have not responded to other therapies’ may need to read ‘recommended for those who have not responded to drug therapies’. It was suggested that I was given ECT when I was very ill back in 2009/2010 as ‘no other treatments had worked’ and my severe and enduring depression was ‘treatment-resistant’. What that really meant though is that drug treatments had not worked,as I had only been offered drug treatments.
My depression may not have been so resistant to talking therapy (psychotherapy treatment) but that was never on offer within NHS mental health services until I personally asked and insisted to be referred to a psychologist when I was discharged from hospital and I was under the care of a Community Mental Health Team…
‘In England, there has been a reduction in the use of ECT over the past few decades. In 1999, 2835 patients received ECT over a 3-month period, equating to an annual estimated total of 11,340 patients (Department of Health (DoH), 1999). By 2002, this annual figure had dropped to an estimated 9088 patients (DoH, 2003). These figures may be underestimates, however, as administration of ECT may not always be documented and there has been no formal national monitoring of ECT activity in the UK (DoH, 2003).
A more recent study in 2006 confirmed a further decline in ECT administrations overall, although reported an increase in the proportion of patients receiving ECT who had been detained under the Mental Health Act (Bickerton et al., 2009)’. (p. 145)
‘The impact of ECT on completed suicide, however, is less clear, particularly as the proportion of those who die by suicide who have received ECT is very low‘. (p.145)
‘Suicides following ECT may be an indication of treatment failure’. (p.146)
‘Estimates of suicide risk in our study were more often viewed by clinicians as moderate or high in patients who had received ECT. Clinicians were also more likely to view ECT suicides as preventable. The most common factors that clinicians suggested could have made the suicide less likely were closer patient supervision (n=34, 50%), better staff training (n=13, 19%) and improved staff communication (n=13, 19%; Fig. 1)’. (p.147)
‘Patients in out study who had received ECT and died by suicide were older than other suicide cases, the majority were suffering from affective disorder and rates of previous self-harm were high. They were proportionally more likely to be an in-patient at the time of death or die within three months of discharge. However, they were no more likely to be under enhanced observation. Clinicians more often viewed ECT cases as at high risk of suicide and as more preventable’. (p.147)
You can download the entire article here ECT and suicide (1)