Around 2,500 people in England receive electroconvulsive therapy (ECT) every year. Administered by passing an electrical current around the head of an anaesthetised person to induce a seizure, ECT is prescribed as a last resort to alleviate severe depression, long-lasting mania and catatonia in people who have failed to respond to other treatments.
But given how scientists themselves have long been divided over its use, there have been several calls to ban the treatment altogether. In 2020, a group of UK-based mental health professionals, patients and relatives wrote to the Care Quality Commission, the independent regulator of health and social care in the country, calling to immediately suspend ECT. In their letter, they claimed the treatment comes with a high risk of permanent memory loss and may even cause death. Furthermore, they wrote that research had failed to determine whether or not ECT actually works in treating depression.
Now, data from the National Health Service (NHS), reviewed by The Independent, reveals that ECT is being prescribed disproportionately to thousands of women with mental health concerns—who make up two-thirds of patients that are receiving the treatment—despite claims that it can cause irreparable brain damage.
One such patient is Sue Cunliffe, who began ECT in 2004. In an interview with the publication, Cunliffe admitted that the treatment “completely destroyed” her life despite a psychiatrist telling her there would be no long-term side effects. After undergoing two courses of the ‘treatment’, involving 21 sessions (each under general anaesthetic), she said that she had suffered “dreadful” memory loss.
“By the end of it, I couldn’t recognise relatives or friends,” she said. “I couldn’t count money out. I couldn’t do my two times table. I couldn’t navigate anywhere. I couldn’t remember what I’d done from one minute to another. I couldn’t remember the names of people. I would get through a sentence and forget the word for a house. I’d lost vocab. I couldn’t remember my kids’ birthdays. You lose all your memories from years ago.”
According to statistics obtained through Freedom of Information requests by Dr. John Read, a professor at the University of East London and leading expert on ECT, 67 per cent of 1,964 patients who received the treatment in 2019 were female. “ECT was given to women twice as often as men across 20 NHS trusts in the UK, his research found,” The Independent noted. “The trusts also said some 36 per cent of their patients in 2019 underwent ECT without providing consent.”
In the report, the NHS could only provide statistics on whether ECT was successful in 16 per cent of trusts, while just 3 per cent of trusts had mechanisms in place to monitor side effects. “The National Institute for Health and Care Excellence (NICE), which provides recommendations that guide NHS treatment decisions, said its guidelines stipulated doctors ‘should only consider ECT for acute treatment of severe depression that is life-threatening and when a rapid response is required, or when other treatments have failed’,” the publication continued.
“A spokesperson added [that] patients should be fully informed of the risks associated with ECT and the decision to deploy the treatment ‘should be made jointly with the person with depression as far as possible’.”
In his study, however, Read claimed the guidelines set by NICE are routinely ignored—highlighting how many NHS trusts admitted to giving patients ECT without first offering them counselling or cognitive behavioural therapy. The expert also argued that guidelines are “very weak” as they fail to address specific risks patients should be informed about.
“They also don’t spell out the fact [that] ECT is barely better than placebo,” he wrote. The report also went on to highlight how health professionals have warned the therapy can cause brain damage so severe that recipients are unable to recognise family and friends or do basic maths. “While some patients say the therapy profoundly helped them, leading mental charities have branded it ‘damaging’ and ‘outdated’ and called for its use to be halted pending an urgent review or banned entirely,” The Independent noted.
“We have bombarded NICE with research showing that ECT is unsafe in terms of causing brain damage and memory loss. They have just ignored our correspondence,” Read continued, adding that the most recent efficacy study was conducted in 1985—while previous research showed very little evidence of its positive impacts.
“A major adverse effect is memory loss. Studies find between 12 and 55 per cent of people get long-lasting or permanent brain damage which results in memory loss,” he explained. “We also know women and older people who are the target groups are paradoxically more likely to suffer memory loss than other people. They should be the groups who are getting it less because of the dangers.”
“Rigorous scientific research has not found any evidence of physical brain damage in patients who have had ECT,” the organisation said. “The most serious potential long-term side effect of ECT is that you might forget events from your past. A small number of patients report gaps in their memory about events in their life that happened before they had ECT. This tends to affect memories of events that occurred during, or shortly before, the depression started. Sometimes these memories return fully or partially, but sometimes these gaps can be permanent.”
The professional body concluded by adding how recent research suggests that 7 per cent of people receiving unilateral ECT only report persistent memory loss 12 months after the highly controversial treatment.
Depression has many faces, which is why people dealing with its symptoms have a myriad of different coping mechanisms. For some, it can even be too overwhelming to handle. This was the case of 38-year-old Sarah, who had been living with depression since childhood. As she shared with The New York Times, five years ago, all Sarah could think of was to end her life, “I couldn’t stop crying. The thought that consumed me the entire way on that road was just driving my car into the marshland so I can drown.”
Shortly after this incident, Sarah moved in with her parents because doctors considered it unsafe for her to live alone. No longer able to function at work, she also had to quit her health technology job. Sarah tried nearly every treatment, from different medications and months in a hospital day programme to electroconvulsive therapy and transcranial magnetic stimulation. But just like nearly a third of the more than 250 million people suffering from depression worldwide, her symptoms persisted.
That was until Sarah became the very first participant in an unusual study of an experimental therapy. In a new study published Monday 4 October in Nature Medicine, scientists at the University of California, San Francisco, detailed how their method appears to have successfully treated Sarah. And at a press conference held the week prior, she herself testified to the almost instantaneous relief she experienced after starting the treatment. So what is this near-miraculous cure?
Deep brain stimulation (DBS) is already successfully used to help manage neurological conditions including Parkinson’s disease and certain types of seizures. The concept behind DBS is to transmit electrical impulses to balance out the erratic patterns of brain activity associated with the target condition, hopefully eliminating or reducing a person’s symptoms. These impulses are sent out through electrodes implanted in the brain, which are regulated by a device typically implanted somewhere else in the body, much like how a heart pacemaker works.
When it comes to DBS for depression, it is important to note that there are noticeable differences between the brains of people diagnosed with depression and those who are not. Until now, evidence for the benefits of DBS have been inconsistent, with patients having varying responses to the treatment. That’s why, in recent years, scientists behind the newly published research have been working on ways to improve DBS—such as by finding possibly more relevant areas of the depressed brain to stimulate. Based on that earlier research, they’ve managed to develop their own unique DBS technique which they call “personalised closed-loop neurostimulation.”
The method is said to work by first finding the specific brain activity patterns associated with a patient’s depressive state and then fine-tuning the impulses needed to counteract them. After that’s done, the patient is equipped with a device that can detect when these moments of erratic brain activity show up and automatically send stimulation to the brain. This is different to typical DBS, which involves sending impulses all the time or at fixed intervals of the day.
“In Sarah’s case, the dysfunctional brain activity involved the ventral striatum, a crucial player in decision making, as well as the amygdala, an important regulator of our emotional response, particularly fear and anxiety,” further explained Gizmodo.
And so far so good for the team. “When I first received stimulation, the ‘aha’ moment occurred, I felt the most intensely joyous sensation, and my depression was a distant nightmare for a moment,” said Sarah at the press conference. “The expression made me realise that my depression was not a moral failing. It was a disorder that could be treated, and there was hope for my recovery.”
The authors do caution, however, that this is a single case and that Sarah’s experience should only be seen as a proof of concept for now. It will take more research to see if this treatment can be successfully replicated. And even if it can be, Sarah’s treatment took a lot of resources and time to calibrate—efforts that will make it hard right now for this technology to become widely used by patients with depression. Though the device itself is commercially available, the treatment would still be expensive, with the researchers estimating a cost of about $30,000, based on existing costs for DBS.
As for Sarah, her symptoms of depression did start to return in the time between the first stimulation sessions and the implanting of the permanent device. But once it was implanted and turned on, she again felt immense relief—enough to finally apply the skills she had learned in therapy earlier, she said. Now a year into the treatment, her depression remains at bay and she feels able to “rebuild a life worth living.”