Electroconvulsive Therapy for Depression: A Review of the Quality of ECT vs Sham ECT Trials and Meta-Analyses

Article


Read, J., Kirsch, I. and Mcgrath, L. 2019. Electroconvulsive Therapy for Depression: A Review of the Quality of ECT vs Sham ECT Trials and Meta-Analyses. Ethical Human Psychology and Psychiatry.
AuthorsRead, J., Kirsch, I. and Mcgrath, L.
Abstract

Background: Electroconvulsive Therapy (ECT) is still being administered to approximately a million people annually. There have been no ECT vs simulated ECT (SECT) studies since 1985. The five meta-analyses of ECT vs SECT studies all claim that ECT is more effective than SECT for its primary target, severe depression. This review assesses the quality of those meta-analyses and of the 11 studies on which they are based.
Methods: The meta-analyses were evaluated primarily in terms of whether they considered the quality of the studies they included, but also in terms of whether they addressed efficacy beyond end of treatment. The methodological rigour of the 11 studies included by one or more of the meta-analyses was assessed using a 24-point Quality scale developed for this review.
Results: The five meta-analyses include between one and seven of the 11 studies. The meta-analyses pay little or no attention to the multiple limitations of the studies they include. The 11 studies have a mean Quality score of 12.3 out of 24. Eight scored 13 or less. Only four studies describe their processes of randomisation and testing the blinding. None convincingly demonstrate that they are double-blind. Five selectively report their findings. Only four report any ratings by patients. None assess Quality of Life. The studies are small, involving an average of 37 people. Four of the 11 found ECT significantly superior to SECT at the end of treatment, five found no significant difference and two found mixed results (including one where the psychiatrists reported a difference but patients did not). Only two higher Quality
studies report follow up data, one produced a near-zero effect size (.065) in the direction of ECT, and the other a small effect size (.299) in favour of SECT.
Conclusions: The quality of most SECT-ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period. There is no evidence that ECT is effective for its target demographic – older women, or its target diagnostic group – severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or adolescents. Given the high risk of permanent memory loss and the small mortality risk, this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomised, placebo controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.

JournalEthical Human Psychology and Psychiatry
ISSN1559-4343
Year2019
PublisherSpringer Publishing Company
Accepted author manuscript
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Publication process dates
Accepted12 Nov 2019
Deposited20 Nov 2019
Copyright holder© 2019 Springer Publishing Company.
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Effects of the diagnostic label “schizophrenia”, actively used or passively accepted, on general practitioners’ views of this disorder.
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Childhood adversity and psychosis: generalised or specific effects?
Longden, Eleanor, Sampson, Maria and Read, J. 2015. Childhood adversity and psychosis: generalised or specific effects? Epidemiology and Psychiatric Sciences. 25 (4), pp. 349-359.
Improving community mental health services: The need for a paradigm shift
Longden, Eleanor, Read, J. and Dillon, Jacqui 2016. Improving community mental health services: The need for a paradigm shift. Israel Journal of Psychiatry and Related Sciences. 53 (1), pp. 22-30.
General practitioners' beliefs about people with schizophrenia and whether they should be subject to discriminatory treatment when in medical hospital: the mediating role of dangerousness perception
Magliano, Lorenza, Punzo, Rosanna, Strino, Antonella, Acone, Roberta and Read, J. 2016. General practitioners' beliefs about people with schizophrenia and whether they should be subject to discriminatory treatment when in medical hospital: the mediating role of dangerousness perception. American Journal of Orthopsychiatry. 87 (5), pp. 559-566.
Personal agency in women's recovery from depression: The impact of antidepressants and women's personal efforts
Cartwright, Claire, Gibson, Kerry and Read, J. 2018. Personal agency in women's recovery from depression: The impact of antidepressants and women's personal efforts. Clinical Psychologist. 22 (1), pp. 72-82.
Stressful events and circumstances reported by patients prior to being prescribed antidepressants
Hartdegen, Morgyn, Gibson, Kerry, Cartwright, Claire and Read, J. 2017. Stressful events and circumstances reported by patients prior to being prescribed antidepressants. New Zealand Medical Journal. 130 (1448), pp. 45-53.
Understanding the long-term effects of childhood adversities: Beyond diagnosis and abuse
Read, J. and Mayne, Rachael 2017. Understanding the long-term effects of childhood adversities: Beyond diagnosis and abuse. Journal of Child and Adolescent Trauma. 10 (3), pp. 289-297.
Is electroconvulsive therapy for depression more effective than placebo? A systematic review of studies since 2009.
Read, J. and Arnold, C. 2017. Is electroconvulsive therapy for depression more effective than placebo? A systematic review of studies since 2009. Ethical Human Psychology and Psychiatry. 19 (1), pp. 5-23.
The Opinions of Italian Psychology Students About People Diagnosed with Depression and Schizophrenia: A Comparative Study
Magliano, Lorenza, Schioppa, Giustina, Costanzo, Regina, Petrillo, Miriam and Read, J. 2017. The Opinions of Italian Psychology Students About People Diagnosed with Depression and Schizophrenia: A Comparative Study. Journal of Psychosocial Rehabilitation and Mental Health. 4 (2), pp. 147-157.
Assessing the Impact and Effectiveness of Hearing Voices Network Self-Help Groups
Longden, Eleanor, Read, J. and Dillon, Jacqui 2017. Assessing the Impact and Effectiveness of Hearing Voices Network Self-Help Groups. Community Mental Health Journal. 54 (2), pp. 184-188.
Do English mental health services know whether they followed N.I.C.E. guidelines with patients who killed themselves?
Geekie, Jim, Read, J., Renton, Julia and Harrop, Christopher 2017. Do English mental health services know whether they followed N.I.C.E. guidelines with patients who killed themselves? Psychology and Psychotherapy: Theory, Research and Practice. 90 (4), pp. 797-800.
Do adult mental health services identify child abuse and neglect? A systematic review
Read, J., Harper, D., Tucker, I. and Kennedy, Angela 2017. Do adult mental health services identify child abuse and neglect? A systematic review. International Journal of Mental Health Nursing. 27 (1), pp. 7-19.
Do GPs and psychiatrists recommend alternatives when prescribing anti-depressants?
Read, J., Gibson, Kerry and Cartwright, Claire 2016. Do GPs and psychiatrists recommend alternatives when prescribing anti-depressants? Psychiatry Research. 246 (Dec.), pp. 838-840.
Long-term antidepressant use: patient perspectives of benefits and adverse effects
Cartwright, Claire, Gibson, Kerry, Read, J., Cowan, Ondria and Dehar, Tamsin 2016. Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Preference and Adherence. 10, pp. 1401-1407.
Understanding the non-pharmacological correlates of self-reported efficacy of antidepressants
Read, J., Gibson, K., Cartwright, C., Shiels, C., Dowrick, C. and Gabbay, M. 2015. Understanding the non-pharmacological correlates of self-reported efficacy of antidepressants. Acta Psychiatrica Scandinavica. 131 (6), pp. 434-445.
Assessing and Reporting the Adverse Effects of Antipsychotic Medication: A Systematic Review of Clinical Studies, and Prospective, Retrospective, and Cross-Sectional Research
Longden, Eleanor and Read, J. 2016. Assessing and Reporting the Adverse Effects of Antipsychotic Medication: A Systematic Review of Clinical Studies, and Prospective, Retrospective, and Cross-Sectional Research. Clinical Neuropharmacology. 39 (1), pp. 29-39.
In search of an evidence-based role for psychiatry
Read, J., Runciman, Olga and Dillon, Jacqui 2016. In search of an evidence-based role for psychiatry. Future Science OA. 2 (1).
Social Adversity in the Etiology of Psychosis: A Review of the Evidence
Longden, Eleanor and Read, J. 2016. Social Adversity in the Etiology of Psychosis: A Review of the Evidence. American Journal of Psychotherapy. 70 (1), pp. 5-33.
Improving Psychology Students’ Attitudes Toward People With Schizophrenia: A Quasi- Randomized Controlled Study.
Magliano, Lorenza, Rinaldi, Angela, Costanzo, Regina, De Leo, Renata, Schioppa, Giustina, Petrillo, Miriam and Read, J. 2016. Improving Psychology Students’ Attitudes Toward People With Schizophrenia: A Quasi- Randomized Controlled Study. American Journal of Orthopsychiatry. 86 (3), pp. 253-264.
‘In my life antidepressants have been…’: a qualitative analysis of users’ diverse experiences with antidepressants
Gibson, Kerry, Cartwright, Claire and Read, J. 2016. ‘In my life antidepressants have been…’: a qualitative analysis of users’ diverse experiences with antidepressants. BMC Psychiatry. 16 (1).
The Influence of Causal Explanations and Diagnostic Labeling on Psychology Students’ Beliefs About Treatments, Prognosis, Dangerousness and Unpredictability in Schizophrenia
Magliano, Lorenza, Read, J., Rinaldi, Angela, Costanzo, Regina, De Leo, Renata, Schioppa, Giustina and Petrillo, Miriam 2015. The Influence of Causal Explanations and Diagnostic Labeling on Psychology Students’ Beliefs About Treatments, Prognosis, Dangerousness and Unpredictability in Schizophrenia. Community Mental Health Journal. 52 (3), pp. 361-369.
Are mental health services getting better at responding to abuse, assault and neglect?
Read, J., Sampson, Maria and Critchley, Christine 2016. Are mental health services getting better at responding to abuse, assault and neglect? Acta Psychiatrica Scandinavica. 134 (4), pp. 287-294.
Are older people prescribed antidepressants on the basis of fewer symptoms of depression, and for longer periods of time? A survey of 1825 New Zealanders
Read, J., Gibson, Kerry L and Cartwright, Claire 2016. Are older people prescribed antidepressants on the basis of fewer symptoms of depression, and for longer periods of time? A survey of 1825 New Zealanders. Australasian Journal on Ageing. 35 (3), pp. 193-197.
Are mental health staff getting better at asking about abuse andneglect?
Sampson, M. and Read, J. 2016. Are mental health staff getting better at asking about abuse andneglect? International Journal of Mental Health Nursing. 26 (1), pp. 95-104.
The scenes and spaces of anxiety: Embodied expressions of distress in public and private fora
McGrath, L., Reavey, P. and Brown, Steven 2008. The scenes and spaces of anxiety: Embodied expressions of distress in public and private fora. Emotion, Space and Society. 1 (1), pp. 56-64.
Embodying limb absence in the search for sexual intimacy
Batty, Richard, McGrath, L. and Reavey, P. 2014. Embodying limb absence in the search for sexual intimacy. Sexualities. 17 (5-6), pp. 686-706.
Transportations of space, time and self: The role of therapeutic reading groups in managing mental distress in the community.
Shipman, Judith and McGrath, L. 2016. Transportations of space, time and self: The role of therapeutic reading groups in managing mental distress in the community. Journal of Mental Health. 25 (5), pp. 416-421.
"Zip me up, and cool me down”: Molar narratives and molecular intensities in ‘helicopter’ mental health services.
McGrath, L. and Reavey, P. 2016. "Zip me up, and cool me down”: Molar narratives and molecular intensities in ‘helicopter’ mental health services. Health & Place. 38, pp. 61-69.
Heterotopias of mental health care: The role of space in experiences of distress, madness and mental health service use.
McGrath, L. 2012. Heterotopias of mental health care: The role of space in experiences of distress, madness and mental health service use. PhD Thesis London South Bank University Psychology
Heterotopias of control: Placing the material in experiences of mental health service use and community living.
McGrath, L. and Reavey, P. 2013. Heterotopias of control: Placing the material in experiences of mental health service use and community living. Health & Place. 22, pp. 123-131.
Exploring embodied and located experience: Memory Work as a method for drug research.
Anderson, Katie and McGrath, L. 2014. Exploring embodied and located experience: Memory Work as a method for drug research. International Journal of Drug Policy. 25 (6), pp. 1135-1138.
Seeking fluid possibility and solid ground: Space and movement in mental health service users' experiences of 'crisis'.
McGrath, L. and Reavey, P. 2015. Seeking fluid possibility and solid ground: Space and movement in mental health service users' experiences of 'crisis'. Social Science & Medicine. 128, pp. 115-125.