The National Association of Lead Nurses in ECT, (NALNECT), would like to point out that ECT has come a long way from the old media caricature. Responsibly administered by an appropriately trained team, with modern equipment, in environments fit for purpose, it has been shown to treat people with severe depression and save their lives. There is proper selection and screening of patients for ECT, in accordance with the criteria outlined in the “NICE guidelines 2003″.

 We feel strongly that ECT should not be banned, as recent research shows that 70 % of patients who received the treatment showed significant clinical benefits. It should continue to be available for selected patients suffering from depressive illness. ECT (electroconvulsive therapy) is recognised as an effective intervention by the World Health Organisation and by medical authorities and clinical experts worldwide.

 Depression is a serious illness that affects at least one in four of us at some time in our lives. It brings with it distress and suffering for the individual and their family. It takes its toll on relationships, work and achievement in life. It is associated with a significant mortality and suicide risk. Treatments for depression include counselling, psychotherapy, antidepressant medication and mood stabilisers.

However, a number of patients are not fortunate enough to respond to these treatments or combinations of them. A number of patients experience depression of such severity that risk is increased by waiting for the standard treatments to possibly work, which can be weeks to months.

There is a strong evidence base from scientific research that ECT is not only effective but also that it is life-saving in some cases. Treatment with ECT has been shown to have a profound effect in reducing suicide in the short term, and as mental health nurses with responsibility for our patients, we must never lose sight of this.

When ECT was first introduced, it was used for a wider range of mental illnesses and disorders. Clinical research and audit have allowed us to identify the patients whose clinical condition responds well to ECT. The increase in the availability and sophistication of other treatments for depression, including cognitive behaviour therapy and other forms of psychotherapy, along with greater choice of antidepressant medications, has meant that more patients recover without the need to consider ECT. Other patients, when they have ECT and respond, wonder why they have had to wait so long to be offered this treatment.

The administration of ECT has changed remarkably in recent years and bears little resemblance to the caricatured presentation sometimes seen in the media. Patients have a full medical assessment to ensure their suitability for a general anaesthetic.

All patients have a full general anaesthetic and a muscle relaxant before a short controlled seizure of about 30 seconds is induced. The patient is closely monitored throughout by specially trained staff. A consultant anaesthetist monitors their anaesthesia and recovery. The entire process is supervised by a consultant psychiatrist.

ECT in England is closely regulated by the Mental Health Act Commission, which has written rules for its prescription and a detailed code of practice. This ensures the prescription and administration of ECT is of a very high standard of practice. Many centres in England who administer ECT also participate voluntarily in an accreditation programme run by the Royal College of Psychiatrists to ensure their service is at the cutting edge.

So what is the evidence that ECT works? An audit in Scotland of all patients receiving ECT, published in 2000, showed that over 70 per cent made significant clinical improvement. Many of these patients had failed to respond to antidepressant medication and made a significant recovery after treatment with ECT. The UK review group on ECT published an article in the Lancet in 2003, concluding that ECT remained an important treatment option for the treatment of severe depressive illness.

Systematic review of patients who have had ECT shows that they have a positive view of their experience of ECT.

What about the potential side effects? There is some evidence of memory impairment after ECT, a retrograde amnesia, more associated with bilateral treatment than unilateral treatment. In 2007, a leading researcher in ECT reported that 10 per cent of patients were still experiencing some memory difficulties after six months. We expect that this number will fall significantly with contemporary ECT practice. Another area of current research showing promise concerns the mode of action of ECT. Recent work has shown growth of new nerve cells in the part of the brain regulating emotion following ECT.

ECT has a long-established proven efficacy in the treatment of depression. It is not a first-line treatment but a vitally important intervention option. Standards of administration and regulation must be kept high so that our patients and families are informed and aware of the potential benefits and possible side effects – and this of course applies to many medical interventions. This important treatment must not be evaluated on the view of individuals, but on the well-recognised and evidence-based positive outcomes experienced by patients.

NALNECT committee.