Electro-convulsive therapy, also known as electric shock treatment, is one of the most effective treatments for psychotic depression, according to Bond University Adjunct Professor Dr Ashar Khan.
Professor Khan says that despite its bad reputation, electro-convulsive therapy (ECT) has been clinically shown to be effective in treating a variety of mental disorders, particularly depressive illness, resulting in improved quality of life in both the short and long-term.
"Studies on ECT have shown a favourable response in people suffering with psychotic depression, in that their recovery is faster and more absolute when compared to those treated with anti-depressant medications," he said.
Dr Khan said that ECT was often considered as a ‘last resort’ treatment for depressed patients who hadn’t responded to anti-depressant medications or were intolerant to the side effects.
"From my experience, ECT is often not a favoured treatment, particularly outside the immediate mental health profession.
"But research shows that in severe cases, where there are imminent risk issues to either the patient or their immediate family, ECT achieves an 80% plus success rate and is the most appropriate treatment to move the patient out of that critical phase," he said.
Dr Khan pointed to a severe post-partum psychosis as an example of when ECT would likely be the most effective treatment option.
"Depression and psychosis in a woman who’s just given birth is usually very severe, sometimes to the extent where she has suicidal tendencies. The wellbeing of both the mother and the child is in jeopardy.
"Research tells us any breakdown of early maternal bonding has ongoing consequences in the cognitive, developmental and emotional growth of the child - particularly in the first few weeks post-birth.
"In this case, the patient does not have the luxury of time to trial different anti-depressant medications that may, or may not, eventually work.
"If the treating clinician wants mother to have her quality of life back sooner and have a better impact on the child and family, then ECT ought to be considered," he said.
Dr Khan said it was crucial that ECT treatment be targeted to the right person.
"It is important that clinicians think of ECT as an art to be individually tailored to patients needs.
"The process of consultation – openly discussing the pros and cons of all options to achieve informed consent – is so important.
"The problem is that not all medical professionals – be them GPs, specialists, social workers or mental health clinicians – are up to date on the latest research when it comes to ECT.
"As clinicians, we need to have an open mind of looking at every treatment we have on offer.
"How can you have a balanced and objective approach if you’re not equipped with the latest research and guidelines?"
He says the practice of ECT has come a long way, but there is still work to be done when it comes to educating the medical profession and the public on the myths and controversies around its use.
"ECT still has a bad reputation, due in no small part to the sensationalism created by the media and entertainment industry – take for instance, Jack Nicholson in One Flew Over the Cuckoo’s Nest.
"These graphic images of people shaking and foaming at the mouth, or the idea of ECT as a behaviour control torture method, are still embedded in the community and we need to undo these stigmas.
"In the past, around 40 years ago, there was a lack of guidelines worldwide so people were being given ECT without any real clinical consensus on what was good practice.
"Now days, we have a clear set of standards and guidelines. ECT is also now the only treatment for depression that requires the involvement of multiple disciplines – an anaesthetist, theatre staff, a mental health clinician, a specialist doctor and nurses.
"The patient’s muscles are completely relaxed, they are asleep for a few minutes while ECT is administered and they don’t feel a thing.
"There are strict parameters tailored to each individual patient, with their specialist doctor working out the threshold suitable to them.
"It’s very safe. Safer than dental surgery in fact."
Dr Khan said like all treatments, ECT does have its limitations.
"A possible side effect that needs to be considered is memory loss, but generally this is only of events that occur after ECT has been administered and it is nearly always short term and reversible.
"The adherence to the strict standards and guidelines that are in place today is paramount.
"Given to the wrong person, ECT will bring about side effects and controversy. Given to the right person, it may well save a life."
Dr Ashar Khan (MBBS, MRCPsych, FRANZCP) is the Director of ECT Training for Gold Coast Integrated Mental Health, a consultant psychiatrist and an Adjunct Professor within Bond University’s Faculty of Health Sciences and Medicine.
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