The rate of ECT use has been falling steadily in hospitals, reports Carl O'Brien, Social Affairs Correspondent
Few other psychiatric treatments, rightly or wrongly, arouse as much fear as electroconvulsive therapy.
Depending on whom you talk to, electroconvulsive therapy (ECT) is the most effective and fast-acting treatment for severe depressive disorders; or it is a potentially dangerous procedure unsupported by research and whose side-effects include long-term memory loss.
Whether as a result of rising concern over the procedure or frightening depictions of it in popular culture - through films or novels such as One Flew Over the Cuckoo's Nest and Sylvia Plath's largely autobiographical novel The Bell Jar - the rate of ECT use has been falling steadily in psychiatric hospitals.
Clinical guidelines issued by the Royal College of Psychiatrists - and used by the Irish College of Psychiatrists - indicate that ECT is subject to strict controls and reserved for patients who have failed to respond to drugs or other therapies.
However, new figures from Irish psychiatric hospitals show the rate of use of ECT varies substantially from hospital to hospital and from region to region. Statistics show that a patient's chances of receiving the treatment can vary fourfold depending on the health board area.
The Mental Health Commission, which is drawing up new standards and protocols for the use of ECT, says it will investigate the reasons behind these variations.
The figures raise a number of questions over whether clinical guidelines are being followed; if individual psychiatrists are influencing prescribing patterns; and whether the standards of psychiatric services vary around the country.
An initial inquiry suggests regions with no modern psychiatric service are more likely to have a higher rate of ECT use. The south-east, for example, has high hospitalisation rates, high involuntary detention rates and the highest rates of ECT use.
Outside of the psychiatric profession, little is known about ECT and how it operates. The treatment consists of passing a controlled electric current across the brain for between three and five seconds. During the treatment the patient is briefly anaesthetised and also given a muscle relaxant. The electric current induces seizure activity in the brain. The whole procedure takes between five and 10 minutes.
Changes are induced in several neurotransmitter systems in the brain which are known to be disordered in major depression. ECT affects the same neurotransmitter systems as antidepressant drugs. Numerous contrasting studies have underscored either the benefits or dangers of the treatment. Disputed most, however, are the after-effects.
As well as headache, nausea and sometimes brief confusion, the main side-effect is memory impairment. Memory loss for past and current events can occur for several months.
The Royal College of Psychiatrists accepts this, but says it is important to note that depressive illness causes major impairments of memory and that the memory effects may be confused with the effects of the illness itself.
"Careful studies have shown that if ECT-treated patients are compared with equally depressed patients not treated with ECT, there are no differences in memory function six months later," the college says is an information sheet.
Britain's National Institute for Clinical Excellence, in the meantime, has recommended limiting its use, partly because of the inadequacy of research into the effects of ECT on quality of life and individual function.