Stigma/Opinion Alert!

• There are a lot of misconceptions and misunderstndings about ECT. The portrayal of ECT as a punishment as opposed to a treatment in One Flew Over the Cuckoo’s Nest certainly did not help. There are myriad examples of unethical and paternalistic practices perpetrated by physicians. Psychiarty is certainly not immune to these atrocities. Modern ECT is an evidenced based, patient centered and shared decision making treatment option for suffering patients and their families. I would not hesitate to have ECT myself or recommend it for a child, parent, spouse, or friend who was suffering from one of the indications.

• Is ECT a cure? Of cours not. Are there risks and side effects associated with ECT? Of course there are. Just like there are risks of getting into a car and driving to work. And that risk is by some estimates orders of magnitude more risky than ECT. When there is data to support an alternative treatment that is just as safe and effective as ECT, I will happily stop ECT and adapt my psychiatric practice accordingly. That is what science and medicine are all about.

• There have been criticisms of the methodological quality of the randomized controlled trials that compare real ECT to sham ECT. Some of these criticisms are valid, however the authors of some of these critiques argue that ECT should be immediately discontinued as a treatment option due to these methodologically deficiencies. Should we discontinue exploratory laparotomies since there have been no sham controlled trials in trauma patients who are unstable? Should we discontinue craniotomies for brain bleeds since there are no sham controlled trials? What about embolization of arteries for active bleeding? Obviously these are ridiculous suggestions. The obvious answer is NO! These are life saving measures just as is ECT. For some reason there is a subpopulation of people that are against ECT for whatever reason and it appears no amount of DATA will convince them otherwise. (Please refer to flat earthers for more context of those whose beliefs supersede reproducible and verifiable DATA.

• What is the least powerful evidence in medicine? Clinical or “expert” opinion. As someone who has treated hundreds of patients with ECT and has performed thousands of ECT treatments, I can emphatically say “ECT helps the majority of patients that I see.” It’s not perfect. Not everyone gets better. It’s important to remember that ECT is not a cure.

• Depression is a lot like any other disease. It is a chronic, relapsing/remitting condition that often requires life long attention if not life long treatment for some patients.

• Despite our best efforts to stay healthy by eating right, exercising, avoiding stress, taking vitamins etc. some of us will still get sick for reasons we dont completely understand. It’s just a part of life. Just remember that if depression happens to you or someone you know, ECT may be a treatment to consider and discuss with your doctor.