A voluntary medical organisation in India has urged the Indian Supreme Court to ban the use of electroconvulsive therapy without anaesthesia in mentally ill patients, a practice that some Indian psychiatrists say is sometimes unavoidable.
The request, which also seeks to make informed consent mandatory in all electroconvulsive therapy procedures, comes after nearly a decade of concern among doctors that electroconvulsive therapy is overused in India and often administered without anaesthesia.
“All we're asking for is that all psychiatrists should follow good practice guidelines,” said Dr Achal Bhagat, a senior consultant psychiatrist at the Apollo Hospital in New Delhi, and director of Sarthak, the organisation that has approached the court.
A nationwide survey on the practice of electroconvulsive therapy in India, conducted in the early 1990s, showed that 55% of psychiatrists who used the procedure did so without administering anaesthesia. Although new surveys have not been done, doctors say there is sufficient anecdotal evidence that electroconvulsive therapy continues to be overused and administered without anaesthesia.
“There are cases where psychiatrists appear not to have followed established guidelines of providing alternative treatment options before taking a decision to provide electroconvulsive therapy,” said Dr Bhagat.
Volunteers for Sarthak say they have encountered patients who have received minor and even severe injuries while receiving electroconvulsive therapy without anaesthesia. Advocates of electroconvulsive therapy argue that its practice in India should be viewed in the country's social and economic context.
“An overnight ban on electroconvulsive therapy without anaesthesia will not benefit patients,” says Dr B Nanjundaiah Gangadhar, professor of psychiatry at the National Institute of Mental Health and Neurosciences, Bangalore.
Practitioners are often forced to administer electroconvulsive therapy without anaesthesia because they lack anaesthesia facilities. Several mental institutions in the country are not attached to hospitals and do not have anaesthetists on call.
“When a patient needs electroconvulsive therapy in an emergency, it may sometimes be better to provide affordable treatment than to risk losing the patient,” says Dr Chitaranjan Andrade, professor of psychopharmacology at the institute.
Electroconvulsive therapy is widely accepted by patients and relatives in India, and psychiatrists have received requests from patients for the procedure. “The onset of benefits is sometimes faster, and for patients it is more economical,” says Gangadhar.
Doctors campaigning against electroconvulsive therapy without anaesthesia say the lack of infrastructure is an unacceptable excuse. “Even small towns in India today have the facilities for anaesthesia,” said Dr Bhagat.
He said studies that have established the safety of electroconvulsive therapy have been based on the use of anaesthesia and the relatively superior “brief pulse” devices. “Here we have electroconvulsive therapy procedures delivered through traditional sine wave machines and without anaesthesia.”