Electroconvulsive therapy

Editor—Carney and Geddes highlight the conflicting advice on the use of electroconvulsive therapy by two influential bodies, the National Institute for Clinical Excellence (NICE) and the Royal College of Psychiatrists.¹ The NICE guidelines restrict the use of electroconvulsive therapy while the royal college argues for wider inclusion criteria. The NICE guidelines also emphasise that no patient should be coerced into treatment.

So what is the reason for the disagreement between NICE and the royal college? NICE deliberately wants to curb the use of electroconvulsive therapy because of unresolved concerns about side effects, particularly memory loss.² Studies into its long term effects on cognitive function are lacking, but in their systematic review Rose et al say that 29-55% of patients report persistent memory loss.³,⁴ However, the validity of this figure is questionable because of the poor methodological design of the studies included.

Faced with such a lack of convincing evidence NICE's approach has been to restrict the use of electroconvulsive therapy on the one hand while emphasising the need for fully informed consent on the other. How is the latter possible if we are still uncertain about the long term effects on memory?

Psychiatrists will now have to decide which expert opinion to accept. In the current medicolegal climate the implications of operating outside the NICE guidelines are likely to trump other considerations such as patient choice. We would advocate that the Royal College of Psychiatrists and NICE meet to resolve their differences and provide unified guidelines for patients and clinicians.