Mental health staff should seek to ensure that all depressed people in their service are offered evidence-based psychological treatments before being offered E.C.T. Staff should lobby managers to ensure proper auditing of E.C.T. within their service Individuals receiving ECT should be closely monitored for adverse cognitive effects Overuse of ECT with women and older people should be avoided.

Background: In 2019, a literature review indicated that more than half of people who try to come off antidepressants experience withdrawal effects. Both the National Institute of Health and Care Excellence and the Royal College of Psychiatrists updated their positions in line with that review, and Public Health England published a 152-page report called Dependence and withdrawal associated with some prescribed medicines: an evidence review. The report made several recommendations relevant to general practice. Method: In order to facilitate implementation of these recommendations, an online survey was designed to explore United Kingdom general practitioner (GP) experiences, opinions, knowledge and needs in relation to depression, ADs and withdrawal. A total of 66 GPs had completed the survey when COVID-19 occurred. Results: In keeping with previous findings, this small sample of GPs had a predominantly psycho-social perspective on the causes of, and treatments for, depression. They broadly considered ADs effective for moderate/severe depression and ineffective for minimal/mild depression, for which they preferred psychological therapies and social prescribing. There was a marked lack of consistency in GPs’ knowledge about the incidence and duration of withdrawal effects. Only a minority (29%) felt their knowledge about withdrawal was ‘adequate’ and fewer (17%) believed this about their ‘Ability to distinguish between withdrawal effects and return of the original problem (e.g. depression)’. Two-thirds (68%) would like more training on these matters. Conclusion: It is hoped that even this small sample will be helpful when designing, and seeking funding for, GP training programmes, and when implementing the PHE recommendations for support services, based in the primary care system, for the millions of people contemplating or initiating withdrawal from ADs every year in the UK.

BackgroundThe aims of this paper were to assess the accuracy of patient information leaflets about electroconvulsive therapy (ECT) in England, and assess compliance with National Institute for Health and Care Excellence (NICE) recommendations, and the principle of informed consent.MethodsFreedom of Information Act requests were sent to 51 National Health Service Trusts for a copy of their information leaflet. These, and three Royal College of Psychiatrists (RCPsych) leaflets, were scored on a 40-item accuracy measure.ResultsThirty-six Trusts (71%) provided leaflets. The number of accurate statements, from a possible 29, ranged from four to 20, with a mean of 12.8. The most commonly omitted accurate statements included: that previous treatments, including psychological therapy, should be tried first (mentioned by 12 Trusts); cardiovascular side effects (6); lack of long-term benefits (6); patients’ right to take 24 hours to consider giving consent (1); memory loss higher in women and older people (0). The number of inaccurate statements averaged 5.8, out of 11, and ranged from two to nine. The most common inaccurate statements included: ECT corrects biological deficits (28); misleading claims of very low mortality risk (28); minimization of memory loss (23); claims that ECT saves lives (22); claims of very high improvement rates (19). The current (2020) RCPsych leaflet contained seven inaccurate statements and scored worse than two previous RCPsych leaflets.ConclusionsInformation leaflets about ECT comply neither with NICE recommendations nor the principle of informed consent. Patients are being misled about the risks they are taking and the limited nature of ECT’s benefits.

Objectives. To assess progress towards improving the administering of electroconvulsive therapy (ECT) in England since an audit covering 2011, 2013, and 2015. The same information was gathered, for 2019, on usage, demographics, consent, and adherence to national guidelines and the Mental Health Act.Design and Methods. Freedom of Information Act requests were sent to 56 National Health Service Trusts.Results. Thirty-seven trusts (66%) provided data. The gradual decline in the use of ECT in England has levelled off at about 2,500 people per year. There was a 47-fold difference between the Trusts with the highest and lowest rates per capita. Most recipients are still women (67%) and over 60 (58%). Only one Trust could report how many people received psychological therapy prior to ECT, as required by government (NICE) guidelines. More than a third of ECT (37%) is still given without consent, with 18% of Trusts non-compliant with legislation concerning second opinions. There were slight declines, compared to a previous audit, in the use of standardized depression scales, down to 30%, and standardized measures of cognitive dysfunction, down to 24%. Only six Trusts provided any data for positive outcomes and seven for adverse effects. None provided data on efficacy or adverse effects beyond the end of treatment. Twelve Trusts used identical sentences to each other, verbatim, in response to one or more questions.Conclusions. Given the apparent failure of current monitoring and accrediting of ECT clinics in England, by the Royal College of Psychiatrists' ECT Accreditation Service (ECTAS), an independent government sponsored review is urgently needed.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.