Letter: ECT: benefits vs side-effects; patients' testimony

Sir: The debate in your columns on electroconvulsive therapy suffers from simplifications on both sides. ECT is effective for some patients, although benefit may not persist without further treatments (British Journal of Psychiatry, Vol. 160, p355). It does work through changes in brain chemistry, but comparing this favourably with the current generation of pharmacologically specific drugs would be similar to the assumption that a broken television could be mended as readily with a sledgehammer as with a screwdriver: you might jog the right bit.

Yes, some patients will suffer significant memory loss; on the other hand, some will not. The only justification is pragmatic, as those patients who respond tend to have the most recalcitrant forms of depression, and many of these are grateful for its use.

As it is impossible to predict who will benefit, many patients will receive the treatment unnecessarily, especially those with conditions other than depression. How do you weigh benefit for the minority against the side effects and distress caused by this procedure? There is no simple answer.

Yours sincerely,

SIMON GREEN

Senior Lecturer in Psychology

Department of Psychology

Birkbeck College

University of London

London, WC1

15 December