Time to acknowledge good electroconvulsive therapy research

Gergel, Tania; Howard, Robert; Lawrence, Rebecca; Seneviratne, Trudi

doi:10.1016/s2215-0366(21)00352-7

Cited by 9 publications

(9 citation statements)

References 5 publications

(5 reference statements)

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“…Most of the criticisms Meechan et al ., make of our 2019 review have been repeatedly raised before, often in quite vitriolic terms, and have been repeatedly rebutted: Andrade ( 2021 ) – refuted by Read ( 2021 a ), Anderson ( 2021 ) – corrected by Read ( 2021 b ), Gergel et al . ( 2021 ) – rejected by Read et al . ( 2022 ), Henry ( 2021 ) – countered by Hancock et al .…”

Section: Meechan Et Al 'S General Strategies To Di...mentioning

confidence: 99%

A response to yet another defence of ECT in the absence of robust efficacy and safety evidence

Read

2022

Epidemiol Psychiatr Sci

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It is estimated that electroconvulsive therapy is still administered to approximately a million people a year. It involves passing enough electric current through the human brain, eight to twelve times, to cause convulsions, in the hope of somehow alleviating emotional suffering, primarily depression. There have only ever been 11 placebo-controlled studies (where general anaesthesia is administered but the electric shock is withheld), all of which were pre-1986, had very small sample sizes and were seriously methodologically flawed. Five of these studies found no difference between the two groups at the end of treatment, four found ECT produced better outcomes for some patients, and two produced mixed results, including one where psychiatrists' ratings produced a difference, but the ratings of nurses and patients did not. In the 80 years since the first ECT no studies have found any evidence that ECT is better than placebo beyond the end of treatment. Nevertheless, all five meta-analyses relying on these studies have somehow concluded that ECT is more effective than placebo despite the studies' multiple failings. Meanwhile, evidence of persistent or permanent memory loss in 12% to 55% of patients has accumulated. Attempts to highlight this failure of ECT proponents to provide robust evidence that their treatment is effective and safe are routinely dismissed, diminished, denied and denounced. This paper responds to one such attempt, by Drs Meechan, Laws, Young, McLoughlin and Jauhar, to discredit two systematic reviews of the eleven pre-1986 studies, in 2010 and 2019, the latter of which also reviewed five meta-analyses that had ignored the studies' failings. The criticisms and claims of the recent crtiique of the two systematic reviews are examined in detail, by the first author of both reviews, for accuracy, relevance and logic. The critique is found to include multiple errors, misrepresentations, omissions, inconsistencies and logical flaws. It is concluded that Meechan et al. fail to make a fact-based, coherent argument against suspending ECT pending a series of large, carefully designed placebo-controlled studies to establish whether ECT does have any beneficial effects against which to weigh the significant established adverse effects.

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Section: Meechan Et Al 'S General Strategies To Di...mentioning

confidence: 99%

A response to yet another defence of ECT in the absence of robust efficacy and safety evidence

Read

2022

Epidemiol Psychiatr Sci

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“…2,3 In addition, there is significant research showing ECT's physical safety. 3,4 He also suggests that I 'generalise from personal experience' rather than using a 'scientific approach'. My personal experience recounted here is by no means a replacement for science, and Yeomans clearly overlooks the fact that all my key points about ECT are supported by references to the scientific literature.…”

Section: June 2022mentioning

confidence: 99%

“…2 Indeed, only a handful of Italian centres offer the treatment, a lack of provision that has its basis entirely in politics rather than science. 3 Since ECT was first developed in Rome in 1938 3,4 and its lifesaving properties promptly recognised, it has been refined and improved to enhance its safety and effectiveness, while a large evidence base has built up to inform its ongoing use. 5 An extremely safe treatment, it is undoubtedly the most effective strategy for moderate to severe depressive illness 5 and one of the most effective treatments across the whole of psychiatry.…”

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confidence: 99%

“…5 An extremely safe treatment, it is undoubtedly the most effective strategy for moderate to severe depressive illness 5 and one of the most effective treatments across the whole of psychiatry. 4 Yet, staggeringly, Sashidharan's fellow ideological proponent of the Trieste model of care, Mezzina, has written positively of the lack of access its patients have to ECT, as though this vast gap in service provision were something of which to be proud. 2 This could not happen in any other branch of medicine: it is akin to an oncologist boasting of an inability to provide patients with chemotherapy.…”

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confidence: 99%

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Is there enough evidence for ECT?

Yeomans¹

2022

Br J Psychiatry

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“…Electroconvulsive therapy (ECT) is an effective and safe medical procedure with now more than 80 years of use for the treatment of different mental disorders [ 1 , 2 ]. In fact, about 1.4 million people are treated every year with ECT worldwide, being treatment-resistant depression its most frequent indication [ 3 ].…”

Section: Introductionmentioning

confidence: 99%