Depression
Some people can lose memories from the previous 10 or 20 years . They may not be able to remember their marriage or their kids being born , he explained .
Severe depression is a very debilitating form of distress
minimising the effects of the seizure . Post-treatment , some may experience nausea , headache , or jaw or muscle pain . Almost everybody will feel confused and will have short-term memory problems .
“ They didn ’ t know who they were , they didn ’ t know where they were and , as they slowly regained contact with reality , they would ask questions like ‘ why would they do something like that to me ?’ and I couldn ’ t answer that question ,” recalled Dr Read about his experience as a nurse attendant who helped ECT patients through the process of regaining consciousness .
Almost nobody can remember the period leading up to the treatment , like sitting in the waiting room and having the therapy . “ And that often never comes back ,” he said .
Some people can lose memories from the previous 10 or 20 years . They may not be able to remember their marriage or their kids being born , he explained . In some cases , ECT patients can ’ t retain new memories , meaning they keep forgetting things they just did or talked about .
Dr Read said those who don ’ t regain their memory functions six months after the procedure are often impaired in the long term , and studies have found that this happens to 12 to 55 percent of patients , depending on the measures used for quantifying memory loss and the type of ECT they received .
Dr Oakley strongly disagrees , stressing that patients ’ memory usually returns to normal after three to four weeks .
“ There ’ s really no good evidence that there ’ s any long-term memory problem [ associated with ECT ],” he said . “ There are some individuals who say their memory has been affected in the long term , but the scientific studies don ’ t show that .”
Dr Read acknowledges there are too few ECT studies to know more precisely how many people suffer permanent memory loss , but he finds this lack of data concerning . “ It ’ s alarming that after 80 years
[ of providing ECT ] we don ’ t know how many people could suffer from permanent problems .”
These concerns seem justified considering the difficulties some ECT patients have to go through .
For example , Dr Sue Cunliffe hasn ’ t been able to work for 14 years after receiving the treatment . “ I couldn ’ t do children ’ s primary homework , couldn ’ t count money , couldn ’ t recognise faces of friends I ’ d known for years . It wrecked my memory ,” she told Sky News , noting that before ECT she was only treated with medications and wasn ’ t offered talking therapy , as recommended in the guidelines issued by the National Institute for Health and Care Excellence ( NICE ).
“ I was told I needed ECT because I had been on medication for depression and it didn ’ t seem to be working . They said it was my last hope ,” she said . But “ within two months of having talking therapy I was off the medication and stopped seeing psychiatrists .”
This is not much of a surprise to Dr Read and his colleagues , who audited ECT services in the UK and found that most did not record whether ECT patients had first been offered psychological therapy . Those that did so reported that nearly a third of patients had not been offered any psychological therapy .
NICE advises practitioners to offer ECT if other treatments , including psychological approaches , have failed , unless a rapid response is needed because of a life-threatening condition .
Though the availability of talking therapy is patchy throughout the UK , Dr Oakley stresses that most patients have some form of psychological treatment before opting for ECT . He also added that severe depression , however , could make it difficult for some individuals to engage in talking therapy .
Should we suspend ECT ? The risk of cognitive impairment and memory loss is the key reason why Dr Read advocates for the suspension of ECT until stronger evidence about its safety and long-term benefits is available .
In contrast , Dr Oakley believes the procedure is the best option we currently have for a very narrow group of patients with severe depression or depression that has failed to respond to all other treatments , and researchers should mostly focus on refining the procedures used to maximise its effectiveness and minimise any side effects .
Until science provides better answers , it ’ s paramount that patients are properly informed about the therapy so that they can decide whether its potential benefits outweigh the risks . While some will understandably find the prospect of cognitive impairment unacceptable regardless of the relief they get , others will be ready to take the risk .
“ The memories I ’ ve lost are almost all related to the time I was sick ,” MacDonald told STAT . “ If someone said to me , ‘ Kate , you ’ re [ either ] going to lose a whole bunch of memories or be depressed the way I was , I would say , ‘ Take the memories .’” n
56 NOVEMBER 2020 GlobalHealthAsiaPacific . com