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Scottish psychiatrists' attitudes to electroconvulsive therapy: survey analysis

  • Fiona Martin (a1) and Tim Elworthy (a1)
Abstract
Aims and method

Electroconvulsive therapy (ECT) prescription rates in Scotland are decreasing. This study aims to look for possible causes, in particular psychiatrists' attitudes. Ninety-one Scottish psychiatrists completed a survey in 2009 relating to demographics, training, current practice, National Institute for Health and Care Excellence (NICE) guidelines and attitudes.

Results

The mean number of times the psychiatrists had prescribed ECT in the past 2 years was twice. About 43% felt that their prescribing rates had decreased. Reasons for this included more effective medication, public and patient perception, and NICE guidelines. There was a significant correlation between doctors' gender and estimated prescription rates (P = 0.004), however, not with other prescription data. Almost all surveyed psychiatrists (97%) agreed that ECT has a place in current psychiatric practice.

Clinical implications

Despite generally positive attitudes to ECT shown by psychiatrists in this study, prescription rates were low and decreasing. With more effective medication the role of ECT in therapy appears to be changing.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Fiona Martin (fiona.martin5@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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Scottish psychiatrists' attitudes to electroconvulsive therapy: survey analysis

  • Fiona Martin (a1) and Tim Elworthy (a1)
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eLetters

Author response: Scottish psychiatrists’ attitudes to electroconvulsive therapy

Fiona Martin
13 October 2013

Dr Braithwaite is correct in challenging the view that antidepressants have become more effective. Our study did show that this is a dominant view within the profession that may contribute to reduced ECT prescribing rates, and articles such as those referenced may help to perpetuate this view. We concede that our use of the general media to support this assertion reflects clumsy referencing on our part. There are, however, peer-reviewed studies that support the view of increased effectiveness of some newer antidepressants over some older antidepressants (1). This may in part be related to efficacy but also better tolerability, and pharmaceutical company influence could also be a factor. However, the perceived belief that new equates to better can easily be challenged and Dr Braithwaite’s example of Reboxetine is a good one.

References:

1. Cipriani A, La Ferla T, Furukawa TA, Signoretti A, Nakagawa A, Churchill R, et al. Sertraline versus other antidepressive agents for depression. Cochrane Database of Systematic Reviews 2009, Issue 2.



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Conflict of interest: None declared

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Psychiatric medications are no more effective

Richard Braithwaite, Consultant Psychiatrist
13 October 2013

Martin and Elworthy report that the biggest reason for prescribing electroconvulsive therapy (ECT) less frequently than before is the perception amongst psychiatrists that "more effective medication" now exists (1). Unfortunately, the authors collude with this exaggerated view, claiming that "psychiatric medications have undoubtedly become more effective over recent years". Their bold statement references a 2002story in the New York Times.

Moreover, meta-analysis shows that the current first-line treatments for depressive disorder, selective serotonin reuptake inhibitors, are marginally less effective than older tricyclic antidepressants (TCAs), whilst serotonin and noradrenaline re-uptake inhibitors show no statistically significant advantage over TCAs (2). One newer drug, Reboxetine, does not work at all (3), yet is inexplicably still licensed asan antidepressant.

Lithium remains the only true mood stabiliser: it is the only drug with efficacy in treating acute manic and depressive symptoms and in prophylaxis of manic and depressive symptoms in bipolar disorder (4).

One has to conclude that the prevailing delusion that treatments across psychiatry have become more effective has been mediated by the pharmaceutical industry. Psychiatrists should take their evidence from meta-analyses in peer-reviewed journals, not from advertising representatives and certainly not from the newsstand.

References:

1.Martin F, Elworthy T. Scottish psychiatrists' attitudes to electroconvulsive therapy: survey analysis. The Psychiatrist 2013; 37, 261-266.

2.Machado M, Iskedjian M, Ruiza I, Einarson TR. Remission, dropouts,and adverse drug reaction rates in major depressive disorder: a meta-analysis of head-to-head trials. Current Medical Research and Opinion 2006; 22: 1825-1837.

3.Eyding D, Lelgemann M, Grouven U, Hrter M, Kromp M, Kaiser T, Kerekes MF, Gerken M, Wieseler B. Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. BMJ 2010; 341: c4737.

4.Bauer MS, Mitchner L. What is a "Mood Stabilizer"? An Evidence-Based Response. Am J Psychiatry 2004; 161: 3-18.

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Conflict of interest: None declared

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