ACT patients turn to shock therapy
Dr Peter Norrie, Director of Clinical Services and Chief Psychiatrist, talks about the use of electro-shock surgery in Canberra. Photo: Katherine Griffiths
ONCE DERIDED as a form of medical cruelty forced upon the mentally ill, electro-convulsive therapy is now being increasingly accepted among Canberrans with severe depression, says the ACT chief psychiatrist.
Peter Norrie says changes to the way the electric shock is delivered have significantly lowered the risk of the patient suffering memory loss, the most well-known side effect of the treatment.
He expects the therapy to remain a treatment option in the ACT and the rest of Australia despite the development of alternative brain stimulation technology.
Twenty eight patients have received electro-convulsive therapy during the past 10 months.
Dr Norrie said many patients had returned for further courses after their initial treatment.
Most patients in the ACT undergo the treatment for severe depression but the therapy is available for those with bipolar disorder, mania, and psychotic illnesses such as schizophrenia.
''Almost always people who have had ECT, and who have had a sustained benefit from it, will actually come back to us if they are unwell again and ask us if they can have another course of ECT,'' Dr Norrie said.
''I think that's testament to the proof that it works very well.''
While people can voluntarily chose to have electro-convulsive treatment, in some circumstances people are legally unable to give consent because they are under a psychiatric treatment or Mental Health Act order.
The decision to provide the therapy then becomes an order of the Mental Health Tribunal.
An emergency course of treatment, often considered to be lifesaving, can also be delivered to a person who is not under an order but is unable to give consent.
Health Directorate figures show there were 24 patients who received 276 treatments between July 2010 and June 2011.
For July 2009 to June 2010 there were 27 patients who received 263 treatments and between July 2008 and June 2009 there were 368 treatments given to 32 patients.
ACT Mental Health Consumer Network executive officer Dalane Drexler still opposes the use of electro-convulsive therapy despite the fact that people were less often forced into undergoing the treatment.
She said some people felt coerced into having the treatment.
''ECT is not used very often … but it's certainly a big issue for those people who have used it,'' Ms Drexler said.
Dr Norrie said the shock itself had changed about two years ago and now a much shorter pulse was used.
''Rather than delivering a fairly strong electric shock it actually targets a particular area of the brain and we can monitor that,'' he said.
And the electrodes are only applied to the right side of the head, away from the left where memory function lies.
''[That] allows us to know that we're delivering a smaller pulse of electricity and that the risk of memory loss will be much significantly lowered,'' Dr Norrie said.
But in some cases where treatments were not having an effect on the depression, a bilateral shock could still be recommended, he said.
Professor Colleen Loo from the University of NSW School Of Psychiatry said the use of the ultra-brief pulse should reduce the anxiety people had about the treatment because of the lowered risk of memory loss.
The university, along with the Black Dog Institute, has trialled an alternative form of technology known as Transcranial Direct Current Stimulation, which found similar anti-depressive effects to electro-convulsive therapy. Professor Loo said this treatment provided 1/400th of the electric shock and instead of inducing a seizure in the brain, it changed the resting state of the nerve cells to make them more excitable. A trial is now being conducted to investigate whether the treatment could improve the everyday thinking of people with bipolar disorder.
Dr Norrie said while it was too early to say whether this technology would replace electro-convulsive therapy in Canberra, once it was improved it would be viewed as another treatment option.
He said it was important to look for less invasive treatments.
''This is a treatment that involves an anaesthetic, that involves a shock to the body, if we can use alternative forms of treatment that are equally safe or safer that's what we should be doing,'' Dr Norrie said.