Science Shows Electroconvulsive Therapy Kills, Provides No Benefit to Patients

The American Psychiatric Association's claims of ECT's safety and efficacy are proven false by a new metastudy, and the FDA's plans to deregulate it are shown as pure pandering to the APA.

by Heidi Stevenson

3 January 2011

The FDA attempts to deregulate electroconvulsive therapy (ECT) and the American Psychiatric Association (APA) advocates for that deregulation while claiming that the treatment is both safe and effective. In the midst of this push for ECT, a new study carefully and thoroughly documents both its lack of efficacy and the significant risk of death and disability that it imposes on patients.

The study acts as a powerful indictment of the medical journals' peer-review system; of psychiatry, a medical practice that supports ECT; and of the FDA, which not only approves of its use, but is pushing to loosen the regulations on it. Piece by piece, it takes apart previous studies, showing that the APA is like the king parading around with no clothes.

One must ask how the APA and FDA could have gotten it so wrong, and how they've gotten away with it for so long.

The Study

The study, entitled "The effectiveness of electroconvulsive therapy: A literature review", published by the journal Epidemiologia e Psichiatria Sociale in the October-December 2010 issue (Volume 19, Number 4). The authors, John Read, Department of Psychology, University of Auckland, New Zealand, and Richard Bentall, Department of Psychology, Bangor University, Wales, United Kingdom, conclude, among other points:

Few of those exposed to the risks of memory loss, and to the slight but significant risk of death, receive any benefit even in the short-term. There is no evidence at all that the treatment has any benefit for anyone beyond the duration of treatment, or that it prevents suicide. The very short-term benefit gained by a small minority cannot justify the significant risks to which all ECT recipients are exposed.

The continued use of ECT therefore represents a failure to introduce the ideals of evidence-based medicine into psychiatry. This failure has occurred not only in the design and execution of research, but also in the translation of research findings into clinical practice. It seems there is resistance to the research data in the ECT community, and perhaps in psychiatry in general.

The authors reviewed a large number of studies on ECT. They searched MEDLINE and PsycINFO, plus all studies referenced in a recent book by Shorter & Healy, Shock Therapy: A History of ECT in Mental Illness, which concludes that it's "a safe and effective treatment". They even reviewed earlier meta-analyses.

Lack of Placebos in ECT Trials

The authors first address the issue of placebo in ECT trials. The manner in which it's now done makes it entirely possible, since patients are given general anesthetic and muscle relaxants so that the routine effects of early ECT, bruising and broken bones, don't happen. They point out that most studies claiming that ECT is effective, including the National Institute of Mental Health-funded research by the Consortium on Research in ECT, fail to include a placebo control.

They cite the typical excuses for not using a placebo. The first is that it would be "withholding a treatment assumed to be effective". This they dispose of with, "The assumption that ECT is effective is used to justify not using the method that can best determine whether it is effective."

The second excuse is that it would be "a treatment which involves repeatedly rendering a control group unconscious", and that it would be unethical as there's inherent risk in anesthesia. However, they seem to want to have their cake and eat it too, since they argue exactly the opposite, claiming that general anesthesia is safe, when justifying its use in ECT.

Does ECT Work?

The short answer to the question of whether ECT works was shown by Read and Bentall to be no, it does not. They first point out that there is a prima facie case that applying electricity to the brain is harmful. Therefore, it should be compelling to prove that there's benefit that justifies the potential harm. This, though, has clearly not been the viewpoint of most researchers.

The authors point out that weasel words (my term, not theirs) were used by many researchers. For example, they'll often refer to high "response" rates, but without defining what a "response" is. In their 382 page book, Shorter & Healy cited only four studies that claim ECT is beneficial, all of them from the 1940s when it wasn't possible to utilize placebo. Three had no control groups, vague or nonexistent definitions of "recovery", and "recovery" was assessed by either hospital staff or unidentified persons. The fourth study claimed that a control group "improved" less often than those who received ECT, but "improved" wasn't defined and who made the determinations of improvement was never specified.

Placebo-controlled Trials in Cases of Depression

Ten placebo-controlled studies have been done in patients diagnosed with depression. Five found no significant differences between actual treatment and placebo. Two of the five placebo-controlled studies that claimed benefit from ECT invalidated their own work by giving the sham ECT patients the real thing during the course of the study.

The third study was the famous Northwick Park study published in 1980. It divided patients into three groups: agitated, retarded, and delusional. They found no benefit in the agitated and retarded groups. In the delusional group, they found only short-lived moderate benefit.

The fourth study divided patients into retarded, deluded, and neurotic. It found benefit in retarded and deluded patients, but none in neurotic patients. The study did not consider whether the effects lasted beyond the treatment period.

The fifth study found that ECT patients improved significantly more than placebo patients, but did not follow them up after the treatment period.

Effects After the Treatment Period (Depression)

Six of these studies did not bother to follow up after the treatment period. Of the four that did, none found benefit in ECT, and one even reported a slight benefit in the placebo group.

ECT supporters offer rather bizarre excuses for the lack of long term benefit. The most common is that it's okay if the electroshock didn't work, since the patients can be given antidepressants following the treatment. Worse than that, though, is the argument that it only means that ECT must be continued on an ongoing basis.

Meta-analyses in Depression Trials

The authors found eight meta-analyses of placebo-controlled ECT trials of depression patients. They found that the meta-analyses either found no significant benefit from ECT or they were severely flawed. For example, one that showed significant benefit from ECT included data from a different kind of therapy! Another study found benefit, but didn't look past the treatment period.

Flaws in the meta-analyses were significant. Some didn't bother to consider whether patients were followed after treatment. One didn't include studies that had shown no benefit. One stated that the included studies had used follow-up data, when one of them didn't have any.

Trials on Schizophrenia-diagnosed Patients

The same sorts of flaws in ECT trials of depressed patients also existed in trials of schizophrenia-diagnosed patients. In this section of the report, the authors noted that, in some cases, psychiatrists were the only ones who saw benefit. At this point, the authors couldn't resist a gentle gibe:

These findings suggest that the placebo effects of expectancy and hope do seem to be operating for psychiatrists.

In follow-ups of schizophrenic patients, a limited amount of benefit continued for at most two weeks, but disappeared after that. No meta-analyses reported any long term benefits from ECT.

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(ECT causes death, memory loss, and brain damage.)

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