Over a thousand adults with severe, life-threatening depression, catatonia and other serious mental illness benefited from electroconvulsive therapy (ECT) in 2021, according to new data published by the Royal College of Psychiatrists.
Today, the College’s Electroconvulsive Therapy Accreditation Service (ECTAS) has published one of the largest and most complete ECT datasets in the world. It shows 1,835 adults received acute* ECT from 85 mental health clinics across England, Wales and Ireland between January and December 2021.
Patients ranged from 17 to 93-year-olds, and the average age was 62. Older people were more responsive to the treatment, with the remission rate increasing with age.
Two out of three of those who received ECT were women. This figure (around 66%) has remained stable over the past decade and reflects the well-documented rates of depression in females and males across the world.
For most patients ECT was administered because they had not responded to other treatments. In almost half of cases (48%), their condition was deemed to need rapid treatment. Some 84% of those who received ECT were experiencing a depressive episode. Others presented with catatonia, schizophrenia, mixed affective episode, and manic episode.
Of those who received acute ECT, 68% were found to be ‘much improved’ or ‘very much improved’ following the treatment.
Among those treated for a depressive episode, 41% went into full remission**. Memory loss is a recognised side effect of ECT; however, nine out of ten patients said their memory had improved or stayed the same following the therapy.
ECT is an evidence-based treatment approved by the National Institute for Health and Care Excellence (NICE). The therapy is usually considered when other treatment options, such as psychotherapy or medication, have been unsuccessful or when someone is extremely unwell and needs urgent treatment.
It is delivered in a clinical setting under general anaesthetic. While a patient is asleep, short electric pulses are administered to the brain to cause a brief and controlled seizure. This creates changes in the brain that enable recovery.
As with many other medical treatments, the mechanism of action of ECT is not fully understood, but many clinical research trials show it is both safe and effective. While treatment is needed twice weekly over a month or more, symptomatic benefits are typically seen much sooner than with medication.
Dr Trudi Seneviratne, Registrar of the Royal College of Psychiatrists said:
“Electroconvulsive therapy is an effective option for people with severe mental illness. We use it for patients whose symptoms are simply not responding to therapy or medication alone. It is a specialist treatment that can save lives, I have seen this with my own patients in clinic.
“ECT enables people who are very unwell to improve so they can start other kinds of treatment. Older people, females and those without mental capacity had higher rates of response or remission.
“The ECTAS report is one of the largest and most detailed datasets collected on ECT globally, and it is vitally important that we continue to gather this information. While there will always be public debate about the use of ECT, it is important these discussions are balanced and reflect the medical evidence.”
The Royal College of Psychiatrists’ Electroconvulsive Therapy Accreditation Service (ECTAS) are the authors of this report. The 2021 dataset was compiled from 2,158 data submissions from 85 mental health clinics and includes recommendations for clinics and the ECTAS network.
ECTAS was established in 2003 to improve standards of practice in electroconvulsive therapy (ECT) services in England, Northern Ireland, Wales, and the Republic of Ireland.
ECTAS does not provide regulation of ECT in the UK; this is the responsibility of the Care Quality Commission in England, the Healthcare Inspectorate Wales in Wales, Healthcare Improvement Scotland in Scotland and the Regulation and Quality Improvement Authority in Northern Ireland.
Berlinda, 53, from Manchester, suffered a severe psychotic episode at the end of 2018 and only recovered after receiving electroconvulsive therapy. She said: “It’s difficult to explain why I suffered a psychotic episode as I was in a loving marriage and was in a successful career.
“Things got bad and I made multiple attempts to end my life. My brother, a GP from London, moved in with me and my husband as a precaution. They did their best to keep an eye on me every day, but it soon became very clear that I needed to be sectioned.
“The six months I spent in hospital were extremely challenging as I was agitated, aggressive and paranoid. I was scribbling incoherent notes to my family suggesting everyone was spying on me, and it now feels as though they were written by a completely different person.
“I was given therapy and medication but for a long time nothing seemed to help with my symptoms. My situation became so dire that I told my husband not to visit anymore as I would never get better and it was only after this point that I was prepared to try ECT.
“The day after my first session, it was my husband’s birthday and for the first time in months I was able to smile and make him a cup of coffee. He still says it was the best present he has ever received.
“Almost immediately I went from being abusive and confrontational with patients, staff and visitors to getting people snacks or newspapers. After my tenth session I was able to return home and I’m now living happily with my husband and our two dogs.”
Damian, 53, from Manchester, is Berlinda’s husband. He said: “As a family, we did everything we could to support Berlinda but over time she increasingly disappeared into herself. There’s nothing worse than realising the person you love most in the world no longer wants to live in that same world with you anymore.
“I visited her in hospital every night and weekend, trying to give her all the love I possibly could, but nothing seemed to break through the darkness. Each time we tried a new medication I would desperately look for signs it was working but none of them were quite right for her.
“The suggestion of ECT was terrifying because the only stories I could find online were negative. We were fortunate our psychiatrist and mental health nurses reassured us that it was the right treatment for Berlinda and she agreed to try it.
“I’ll never forget seeing her smile for the first time in months after that initial session. She recovered incredibly quickly and while she does struggle with a bit of memory loss during the time she was in hospital, that’s better than the alternatives, and I feel so relieved to have her back.
“ECT didn’t just give us our lives back, it encouraged us to make the most of them. We’ve now got two dogs who we love to take on walks and we actively try to avoid stressful situations as much as possible.”
Aisha, 26, from Kent, was diagnosed with postpartum psychosis shortly after giving birth to her first child in July 2022. She said:
“I’m normally a very reserved and quiet person. After my pregnancy things started to spiral, my personality was changing. I started speaking without a filter, uncontrollably, and blurted things out as soon as I thought them. Although my memory of that period is hazy, I remember shouting at my mum which is something I would never normally do.
“My husband and parents quickly noticed the change and were worried about my behaviour which was getting worse. Eventually it got to the point where they couldn’t even recognise me anymore, and I needed to be admitted to hospital.
“Initially, I was prescribed medication and after a couple of months my doctor suggested it might be necessary for me to be treated with ECT as well.
“My condition had become so severe that I was incapable of agreeing to the treatment myself, so my husband had to make the decision on my behalf. I can’t imagine how difficult that choice was for him, but I’m so glad he did because I started improving after my second session.
“Looking back, I can see that my daughter noticed the change in me quickly, and we've since developed a very close bond. I’ll always regret missing out on those first few months with my daughter, but thanks to the treatment I’ll be there for her in the future.”
* - Acute ECT is a short-term, intensive treatment administered to patients 2-3 times per week.
** - Remission is defined as the absence or near absence of symptoms according to clinical rating scales.