9 June 2022

Author's reply: I thank Dr Yeomans for his letter and will answer his concerns point by point. Yeomans’ suggestion that there is no evidence to support the effectiveness of ECT is based on a review by Read et al summarising details about a handful of placebo-based studies which are now between 60 and 40 years old.^{Reference Read, Kirsch and McGrath1} As Meechan et al clearly explain, the selected studies ‘would not meet contemporary standards of evidence-based medicine’,^{Reference Meechan, Laws, Young, McLoughlin and Jauhar2} and Yeoman's letter ignores substantial recent evidence-based research, including randomised controlled trials, showing the benefits of ECT versus active comparators.^{Reference Meechan, Laws, Young, McLoughlin and Jauhar2,Reference Kirov, Jauhar, Sienaert, Kellner and McLoughlin3} In addition, there is significant research showing ECT's physical safety.^{Reference Kirov, Jauhar, Sienaert, Kellner and McLoughlin3,Reference Gergel, Howard, Lawrence and Seneviratne4}

He also suggests that I ‘generalise from personal experience’ rather than using a ‘scientific approach’. My personal experience recounted here is by no means a replacement for science, and Yeomans clearly overlooks the fact that all my key points about ECT are supported by references to the scientific literature. I chose to include my own experiences as an illustrative vignette, the authenticity of which may be harder for ECT critics to dismiss, given that I am describing my own case. As the stigma surrounding ECT makes it difficult for ECT recipients to be open about having received treatment, I aimed to offer some responses to questions often raised about experiencing this treatment.

Yeomans refers to the point that some psychiatrists have strong reservations about ECT, without providing any references or evidence for this claim. Neither Read nor any co-author of the review cited by Yeomans is a psychiatrist. In fact, in relation to his 2020 review, Read has himself written ‘I am indeed biased against ECT’.^{Reference Read5} However, even if Yeomans’ claim is true, it certainly does not invalidate the strong general support amongst psychiatrists and the international medical community for ECT. Moreover, studies have shown that clinicians’ concerns about ECT can be assuaged through experience of seeing ECT in practice.^{Reference Pranjkovic, Degmecic, Medic Flajsman, Gazdag, Ungvari and Kuzman6}

Finally, a common trope within ECT critiques suggests some global psychiatric conspiracy. What Yeomans and the other ECT critics fail to point out is that ECT is a multidisciplinary process, involving not only psychiatrists, but also anaesthetists, operating department practitioners and mental health nurses. In the UK, the National Association of Lead Nurses in ECT has an underlying philosophy that ‘ECT is one of a variety of beneficial treatments available and should be viewed as part of a holistic process’⁷ and have championed the use of nurse-led ECT. As I make clear in my article, ECT is not always successful. However, in general, those who work in ECT clinics see large numbers of patients experience dramatic recoveries from the most severe states of mental illness, which in itself convinces them of its effectiveness. Combined with a strong evidence base, Paris's claim that ECT is ‘one of the most effective treatments in all of psychiatry’ is understandable and not, as Yeomans says, ‘remarkable’ or out of place in ‘a rigorous scientific journal’.^{Reference Paris8}