Excerpted from CCHR’s submission to the FDA opposing its 2015 proposal to reclassify the ECT device as a Class II low risk device. CCHR’s submission was submitted in March 2016.
In May 2006, Harold Robertson and Robin Pryor writing in BJPsych, “Memory and cognitive effects of ECT: informing and assessing patients,” determined:
- “Data do not exist at this time to confirm the mechanisms by which ECT exerts its adverse effects.” Emphasis added. As such, the ECT device inflicts “adverse effects” but it’s not known why. So, “clinicians should fully inform patients of the possible permanent adverse effects of the treatment, which include amnesia, memory disability and cognitive disability, and should provide follow-up testing using relevant instruments.”[1]
- “Some of the conclusions to come out of the new work—in particular, that at least one-third of patients experience permanent amnesia” and “newer methods of ECT have not resulted in an appreciable decrease in adverse effects.”[2]
- “[T]he most common effect of ECT…is variously called amnesia, retrograde amnesia or memory loss. By these terms is generally understood the obliteration of a specific time period in a person’s life…. It has long been known that ECT can produce deficits in non-memory-related cognitive function.”[3]
- “A comprehensive battery of neuropsychological tests carried out on individuals who had had ECT between 9 months and 30 years previously revealed impairment on a range of measures, even after controlling for the effects of illness and medication (Freeman et al, 1980).”[4]
- “Despite recommendations that psychiatrists inform patients of non-memory cognitive after-effects (Calev, 1994) and warn them that ‘they are not going to function well on more tasks than they anticipate’ (Calev et al, 1995), patients are still routinely not informed about these effects; there is no mention of them in the recommended consent forms of the American Psychiatric Association (APA; 2001), the Royal College of Psychiatrists (2005: Appendix IV) or the manufacturers of ECT equipment. This may contribute to the consistent findings (Rose et al, 2003, 2005; Philpot et al, 2004) that half of people given ECT say they did not receive an adequate explanation of the treatment.”[5]
- “The current APA consent forms not only contain no warnings about adverse effects on cognition, but advise that ‘Most patients report that memory is actually improved by ECT’ (American Psychiatric Association, 2001). This statement is contradicted by all service-user research as well as the findings of SURE (2002) and NICE (2003); indeed, Scott (2005) remarked that NICE took ‘special note of the evidence from users that cognitive impairment after ECT often outweighed their perception of any benefit from it.’”[6]
- “Although terms such as memory loss are often used interchangeably by clinicians to describe the temporary effects of depression on cognition (especially attention) and the long-lasting effects of ECT on a range of cognitive functions, this confusion is unnecessary and could be avoided. The effects of ECT are quantitatively and qualitatively different from those of depression (Squire et al, 1979) and researchers have consistently distinguished between them (Cronholm & Ottoson, 1963; Squire et al, 1979; Squire & Slater, 1983; Pettinati & Rosenberg, 1984; Squire & Zouzounis, 1988).” For example, “numerous controlled studies show that individuals who are depressed but have not had ECT do not suffer amnesia.… People who have experienced the effects of both depression and ECT rarely mistake one for the other (Food and Drug Administration, 1982; Donahue, 2000): ECT’s effects are different and worse, they occur only after ECT and they persist in the absence of depression and drugs.”[7]
- “Other theories focus on ECT’s effects on brain metabolism and neurochemistry: breach of the blood-brain barrier and increased cerebral blood pressure (Bolwig et al, 1977; Taylor et al, 1985); regional increases in T2 relaxation times (Diehl et al, 1994); disturbance of the long-term potentiation mechanism (Sackeim, 2000; Rami-Gonzalez et al, 2001); excessive release of excitatory amino acids and activation of their receptors (Chamberlin & Tsai, 1998; Rami-Gonzalez et al, 2001), and decreased cholinergic transmission (Khan et al, 1993; Rami-Gonzalez et al, 2001). Even temporary alterations in any of these may have permanent effects on the brain.”[8]
- “The Royal College of Psychiatrists (2005: p. 19) and NICE (2003) advise that the potential for cognitive impairment be highlighted during the consent process. Patients should be clearly told that ECT may have serious and permanent effects on both memory ability and non-memory cognition.”[9]
- Because of “evaluation and re-evaluation of ECT’s risks and benefits by SURE, NICE and the Royal College of Psychiatrists, and the growing recognition of the extent and importance of research by and involving people who have experienced ECT, as well as increased interest in qualitative data…. In particular, prospective patients should be warned of the significant risk of permanent amnesia and the possibility of permanent memory and cognitive disability.”[10]
In addition:
- A 2003 BMJ study, Patients’ perspectives on electroconvulsive therapy: systematic review, pointed out that patients refute the Royal College of Psychiatrists’ fact sheet on ECT. This states that “in most cases this memory loss goes away within a few days or weeks although some patients continue to experience memory problems for several months. As far as we know, electroconvulsive therapy does not have any long term effects on your memory or intelligence.” However, the BMJ study says, “Some patients, however, report severe and long-lasting memory losses after electroconvulsive therapy.”[11]
- Of 35 studies on ECT, 20 considered memory loss as a consequence of electroconvulsive therapy. “The rate of reported persistent memory loss varied between 29% and 55%, but, unlike levels of perceived benefit, the rate did not seem to depend on whether studies were clinical or patient based, with relatively high levels being reported by both types of study.” [12]
- “Routine neuropsychological tests have been used in studies of electroconvulsive therapy to establish objective measures of memory loss and concluded that there was no evidence of persistent memory loss. It would seem that these are the studies on which the Royal College of Psychiatrists based its findings. The studies, however, typically measure the ability to form new memories after treatment (antero-grade memory). Reports by patients of memory loss are of the erasing of autobiographical memories or retrograde amnesia. Thus the risks reported by patients do not appear in clinical assessments.”[13]
- “At least one third of patients report significant memory loss after treatment.”
- “Routine neuropsychological tests to assess memory do not address the types of memory loss reported by patients.”
- “Reported patient satisfaction with electroconvulsive therapy depends on the methods used to elicit a response.” [14]
- MIND mental health charity, UK, in 2001 conducted a survey on ECT: Of 418 recipients to their survey, 84% said that they had experienced unwanted side effects; 40.5% reported permanent loss of past memories and 36% permanent difficulty in concentrating.[15]
References:
[1] Harold Robertson, Robin Pryor, “Memory and cognitive effects of ECT: informing and assessing patients,” Advances in Psychiatric Treatment May 2006, 12 (3) 228-237; DOI: 10.1192/apt.12.3.228, http://apt.rcpsych.org/content/12/3/228.full
[2] Ibid., Harold Robertson
[3] Ibid., Harold Robertson
[4] Ibid., Harold Robertson
[5] Ibid., Harold Robertson
[6] Ibid., Harold Robertson
[7] Ibid., Harold Robertson
[8] Ibid., Harold Robertson
[9] Ibid., Harold Robertson
[10] Ibid., Harold Robertson
[11] Diana Rose, Pete Fleischmann, Prof. Til Wykes, Morven Leese, Jonathan Bindman, “Patients’ perspectives on electroconvulsive therapy: systematic review,” BMJ, doi: http://dx.doi.org/10.1136/bmj.326.7403.1363 (Published 19 June 2003), http://www.bmj.com/content/326/7403/1363.full.pdf+html
[12] Ibid. Diana Rose
[13] Ibid. Diana Rose
[14] Ibid. Diana Rose
[15] Linda Andre, Julie Lawrence, “The contribution of ECT survivors to research on the permanent effects of ECT on memory, memory ability and cognition,” 2002, http://www.ect.org/?p=557