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On Treatments For Depression, And The Daily Mail

Written by Ash
Note: This was originally posted on a Tumblr I used to maintain but it seems a fitting first post now that I’ve moved here. I intend to update it in the following weeks, or make a completely new post, with an updated opinion.

A Scene From One Flew Over The Cuckoos Nest.
A friend of mine recently linked me to an article, written by Bonnie Estridge of the Daily Mail[1], which argues that ‘ECT was and still is seen by many as a throwback to an age when there were no drugs available to treat depression, and when radical surgery, even lobotomies, were mistakenly believed to be the only cure.’ For once, I am pleasantly surprised by how accurate the tabloid is; it is far from perfect, although in comparison to some of their other articles[4] it is a godsend. I aim, after pointing out the inaccuracies of the article, to discuss how effective electro-convulsive therapy (ECT) is in comparison to the other mentioned method of treatment, antidepressants.




While it is undeniable that the mental health field was dominated by excessive use of lobotomies (Braslow, 1997[2]) and medical techniques were still being tailored to patients around sixty years ago, it is a wholly unacceptable argument to hold that ‘experts today are increasingly turning to electro-convulsive therapy’. It is safe to say that medicine is not fashion; ECT was not rejected upon the release of One Flew Over the Cookoo’s Nest[3], although it was seen in a different light by the public and, some would argue, aided the movement to make psychiatric treatment more ethical.

It is also put forward, throughout the body of the piece, that ECT treats depression. This is true, but it is also used to treat a whole range of mood disorders, catatonia and even schizophrenia, although current NICE guidelines advise against its use on patients suffering schizophrenia.

Another issue arises when the quote from the ‘expert’, Dr Susan Benbow, is looked at: ‘no one is ever forced to have ECT’. This is, simply put, not true; medical institutions can and have[5] given ECT without consent when patients ‘lack the capacity to refuse consent’ (Mental Health Act, 2007[6]) or ‘in case of emergency’ (Mental Health Act, 1983[7] – PDF ). Placing a number on that, roughly 2,000 people per year (The Mental Health Commission, 2005[8] – PDF) undergo involuntary ECT treatment.

Finally, more a pedantic point of history than actual incorrectness on behalf of the Daily Mail, it is stated by an expert, this time Dr Benbow, that ‘there is no big jolt’ and ‘you hardly see any movement’. It does not go onto explain, though, that in the early days of ECT there was a lot of movement leading to ‘almost always serious bruising and [cuts] on the tongue and lips… and sometimes fractures of the limbs and even the spine’ (“Early ECT Documentary”, n.d.[9]) even though it explains that in the early days of the treatment it was possible to ‘have been given higher doses than needed’.

With these issues taken note of, one can advance and look into the efficacy of ECT and antidepressants. The procedure and rigmarole associated with ECT, coupled with the possible side-effects, is perhaps why it is not utilised in all cases. Studies have shown that ECT is more effective in the treatment of depression against a placebo condition and selected anti-depressants (Pagnin et al., 2004[10]), more effective in the treatment of schizophrenic-type disorders (Taylor & Fleminger, 1980[11]) and also aids in the treatment of the catatonic syndrome (Rohland, Carroll & Jacoby, 1993[12]).

In comparison, there are ‘clinically important differences’ between the antidepressants in use today, with sertraline (brand name Zoloft) having the best balance between ‘benefits, acceptability, and acquisition cost’ (Cipriani et al., 2009[13]). However, it is also important to note that antidepressants show similar results to placebo trials (Moncrieff, Wessely & Hardy, 2004[14]) meaning that, although the study suggests further research, a lot of the work of antidepressants could by psychological as opposed to physiological.

With this in mind, in comparison to ECT, antidepressants work, but possibly the best course of action for people suffering severe depression is a combination of both treatments. One would never advise ECT for use in moderate or minor depressive disorders, but there again, it is the opinion of this author that antidepressants, too, should only be used when the case warrants it and not handed out at every possible interval.

In closing, ECT is seen by many as fearsome, old-fashioned and brash, but only because our media makes it so; the stigma associated with mental illness will never disappear when mass-publications fail to show the positive side of things and focus on the negative. There are side-effects with most treatments of any disorder, be it of the mind or body — just read the back of your paracetamol pack, now there’s a fright — but because mental health is an area still ill-perpetuated as being unknown, there seems to be an air of mystery and shame alongside getting any form of aid from your medical practitioner.

We live in an advanced time; let us do away with these fallacies and mistaken beliefs, look at the facts and ignore idiots that perpetuate seeking proper help for problems as anything but the right recourse.

[1]: http://www.dailymail.co.uk/health/article-2012924/Jack-Nicholson-did-shock-therapy-Jaws-did-sharks.html “Jack Nicholson did for shock therapy what Jaws did for sharks: An expert argues that ECT is really more effective than antidepressants”
[2]: http://books.google.co.uk/books?hl=en&lr=&id=1Rlq3jIrMSYC&oi=fnd&pg=PR3&dq=Braslow,+Joel.+T.+%281997%29&ots=FrcedCrSzH&sig=jTAJ4sKegA54_rHaGtLuiwEUusc#v=onepage&q&f=false “Braslow, Joel. T. (1997). Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. University of California Press: pp. 126–127”
[3]: http://www.youtube.com/watch?v=DCUmINGae44 “That infamous scene.”
[4]: http://www.mailwatch.co.uk/ “Pick any of these.”
[5]: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_4083142 “Electro convulsive therapy: survey covering the period from January 2002 to March 2002, Statistical Bulletin 2003/08. Department of Health.”
[6]: http://www.legislation.gov.uk/ukpga/2007/12/contents “Mental Health Act, 2007”
[7]: http://www.cqc.org.uk/_db/_documents “Mental Health Act Part 4, Section 58.”
[8]: http://www.cqc.org.uk/_db/_documents/MHAC%2011%20TEXT%20FA.pdf “The Mental Health Act Commission (2005) In Place of Fear? eleventh biennial report, 2003–2005, 236. The Stationery Office.”
[9]: http://www.youtube.com/watch?v=eXC6b0xy4ts “Early documentary clip of ECT in action.”
[10]: http://journals.lww.com/ectjournal/Abstract/2004/03000/Efficacy_of_ECT_in_Depression__A_Meta_Analytic.4.aspx “”
[11]: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2880%2992653-7/abstract “”
[12]: http://www.sciencedirect.com/science/article/pii/016503279390015C “”
[13]: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960046-5/fulltext “”
[14]: http://ukpmc.ac.uk/abstract/MED/14974002 “”

About the author

Ash

Ash is a PhD student in psychology at Northumbria University whose research focuses towards the general cognitive mechanisms of memory and attention. Most of the time he can be found writing about rubbish, or being rubbish at writing. Personal interests include philosophy, statistics and better understanding how we can convey our knowledge of science to others.

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